Child and Adolescent Counseling Services, Tokyo Japan

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Approach To Treating The Adolescent

The cornerstone of treating adolescents is the Biopsychosocial Model. This means that the influence of one's social (family, school, peers, romantic relations), biological (changes in brain chemistry, family history of mental illness), and psychological (self concept, conflicts in love, dependency, control or aggression needs, etc.) needs to be evaluated in a comprehensive way in order to formulate the issues and make a treatment plan. Each area needs to be look at thoroughly both from the adolescent's perspective as well as from the point of view of the parents.


The next concept to introduce is that of the dimensional vs diagnostic based evaluation of behavior. This is a complicated-sounding statement that basically means that the evaluation should look at both a dimensional scale that measures one's level of psychologic functionig: (i.e., healty, neurotic, borderline, psychotic); as well as a diagnostic criteria-based evaluation that can provide clues to defined disorders (i.e., an illness like ADD, anxiety, or depression) that may have specific treatments or approaches.


In line with the dimensional approach is that there are certain developmental tasks of adolesence which have great importance for the therapy. Some of these tasks include, connection with and validation from the opposite sex; peer-group integration, non-conflicted separation from parents, development of adult-like competencies, identity integration, and others. The adolescent's success in these tasks will usually be closely correlated to their ability to function and to any psychologic symptoms they may have. Function is usually best seen in social and intimate relations.


Defenses are often a Focus of Psychotherapy. Defenses are behaviors that one uses to maintain psychologic stability. In particular, to keep one's self esteem and relationships functioning. These may be adaptive defenses (humor, altruism, sublimation, intellectualization, etc.) or they may be maladaptive defenses (externalization of feelings, splitting feelings about the self or others into all-good or all-bad, omnipotence and devaluation of self and others, unreasonable projection of one's feelings onto others, etc.).


In the end, an integrated treatment approach is usually the most beneficial. This generally means using a counseling approach consisting of a mix of psychodynamic, cognitive therapy, and support/role modeling approaches. Involving the family is often therapeutic, but may be countertherapeutic in certain situations depending on the level of conflict between the adolescent and their parents.


Regarding medications, in those rare situations when necessary, adolescents may require medications to help with severe depression or other problem. It is easy to conclude that kids are just having "growing pains" etc. and a professional opinion is clearly required to make this distinction. Adolescents with psychosocial problems may still have brain chemistry problems, and adolescents with brain chemistry problems still have psychosocial lives. This means that both sides of this coin should be looked at. Many kids respond just to psychotherapy so one should never be too quick to jump into medications, but on the other side, one should not unreasonably hold off too long if the child has clear symptomatology that requires medication therapy, which can sometimes even be lifesaving for a child at risk for a suicide.


Symptoms that Suggest Need for Medication include, sleep disturbance, appetite disturbance, irritability, constant crying, anhedonia (inability to enjoy things), diurnal mood variation, obsessions and/or compulsions, rapid speech, severe panic attacks, etc.


Therapists must be careful to watch their own reactions to the adolescent as the intensity of emotions can be quite powerful. Adolescents may provoke feelings of jealousy, anger, attraction, awe, or fear. In this context, the therapist should watch their behavior towards the adolescent for excessive: rescuing, scolding, patronizing, sermonizing, over-identification, tring too hard to be a "buddy", and finally boundry crossings (i.e., meetings, or chit-chat calls with the child out of the therapy hours).