Working with Young People in Therapy – Nine Takeaways

Now more than ever young people need our support to navigate the world they’re living in. From navigating the pandemic to immersion in online life, there are challenges that will take a lot of processing – alongside the already potentially turbulent time of being in a changing body while developing a sense of identity – and whatever else is going on in life. On Saturday 12th June we’re lucky to have esteemed children’s and young people’s writer, therapist and trainer Rebecca Kirkbride presenting a day on working integratively in therapy with children and young people. In this article we share some key ideas around working with this age group.

Working with Young People in Therapy – Nine Takeaways

The following points share a sense of what it can be like to work with young people and to be their counsellor, providing a safe space for exploration, acceptance and validation.

Image of an adolescent boy on a road, from behind, wearing a backpack with his hand on his head. Therapy can help young people offload emotional problems.

Young people have a lot to carry and as therapists we can help lighten their load by being ready to meet them where they’re at.

1. The importance of Vygotsky

You’ve probably heard of Jean Piaget whose work on child development has influenced many aspects of how children are educated today. Many believe that Lev Vygotsky may well have become a far greater contributor to our understanding of child development and education had the Russian Marxist psychologist not died of tuberculosis at the age of just 37 in 1934.

One of his central ideas is that of the ‘Zone of Proximal Development’ which, put simply, means that a young person will learn and develop much better if they have someone to help them with their learning. Think of it like this. You’re trying to learn to play the guitar, so you buy a book and lock yourself away to study and practice. You will probably learn a lot. But you will learn more, and more deeply, and more enjoyably if you get support and guidance from someone who has already mastered the guitar.

Carol Garhart Mooney in her book “Theories of Childhood” (2000) explains Vygotsky’s craft of ‘scaffolding’ like this: “[He] believed that a child on the edge of learning a new concept can benefit from the interaction with a teacher or classmate.” Therapists working with young people can provide vital ‘scaffolding’ for young people through the therapeutic process, helping them to helpfully navigate their emotional world and their relationships, and to make sense of their experiences.

2. Wittering

In an unpublished paper titled ‘On the importance of wittering and imaginary conversations’ (1999), Dr Mic Burton of the University of Sussex Psychology Department, asserts that one thing that marks out therapy with young people is the idea that “they require that you should go to them rather than that they should come to you”.

This is not, as it sounds, a plea for home visiting, but an acknowledgement that we must make the therapeutic space relevant to young people, and where necessary adapt our practice to make ourselves young people friendly, rather than expecting young people to fit in with our usual ways of ‘being’ that we employ when we’re working with adult clients.

Therapists need to understand that missing a counselling session to play for the school netball team can often be far more important to a young person’s healthy emotional and psychological development than sitting in a room with us, their therapist.

3. It Doesn’t Really Matter What You Talk About

This is an extension of the ‘wittering’ idea. In essence it doesn’t really matter what you and your young person client are talking about. Whatever the topic you will be able to learn a great deal about their inner world, as well as demonstrating your willingness to meet the young person in their world and on their terms. This can be so helpful for young people who feel too frightened or not ready to talk about difficult topics.

This is brilliantly demonstrated by Robert Hobson in his book “Forms of Feeling: The Heart of Psychotherapy” where he talks about his work with 14 year old Sam who “sat rigidly in his chair and glowered at me. All he gave me was a surly frown and the very occasional favour of a short, grudging answer”.

The breakthrough in this work came when Hobson was listening to cricket on the radio shortly before a session with Sam. “I was full of it when Sam came in. For some minutes I spontaneously and unreservedly poured out my opinions and feelings about the state of the game – an irresponsible piece of behaviour. Then I asked him what he thought about the state of play…. Sam smiled. For the first time….”. Hobson’s therapy with Sam, revolving initially around talk of cricket, led to a deep and caring therapy relationship where Sam was able to explore his feelings about his absent father.

Image of someone playing on a Nintendo Switch. Therapy with young people can involve talking about their interests.

Therapy with young people needn’t focus solely on emotional issues. There is value in them having a voice and sharing their interests with an adult who is interested and invested.

4. Navigating silence in therapy with young people

When working with adults we know how important silence can be. There are always silences in therapy. For thinking. For reflection. For breathing. For, just being silent. Some therapists may utilise careful use of silence to encourage their clients to speak about what is uppermost in their minds or leave silences to allow their clients to fill the space rather than themselves.

Silences deserve special attention when working with young people, because very long pauses can (and do) raise the anxiety levels of most people. Young people are not generally well equipped for managing anxiety, so long silences can provoke overwhelming anxiety and become very frightening. The mindful therapist working with a young person will check in with their client about how pauses and silences are being experienced and intervene to shorten a silence that might be too uncomfortable.

5. Splitting

The term ‘splitting’ comes originally from the work of Melanie Klein who described the dilemma of the infant in relation to their Mother, who was all at the same time the giver of so much pleasure and nourishment through feeding and comforting, at the same time as taking all this goodness away by not being always present for the child. The child is left trying to assimilate both the ‘good’ breast, or pleasurable parts of the Mother experience, and the unpleasurable ‘bad’ breast parts of their experience of being Mothered.

All of us will recognise the experience of believing that another person, or an experience, is ‘all good’ or ‘all bad’, and when we are in the depths of truly experiencing another person’s dreadful behaviour we can be completely blinded to any positive attributes that person may have. The world can seem simpler in black and white, and so it often is with young people.

As the therapist of a young person you may often encounter conversations where your young person client speaks glowingly of their Mother (for example), yet their Father appears to be the Devil personified. We know, of course, that it is rarely so clear cut. Quite often our role is to gently stir the pot of ‘good’ and ‘bad’ and help our young person to uncover the nuances and the grey and shaded place between good and bad and start to grow the belief that everyone is a mixture of the two.

Image of a young woman with mascara streaked on face, holding a piece of paper with a smile in front of her face. Therapy is a place teenagers can have their feelings accepted.

Therapy is a place where teenagers and young people don’t need to filter or put on a front – their feelings, and how they are, can be accepted and explored.

6. Be Pleased to See Them

We are not a very young person friendly society. We expect teenagers to be at school at 8.30am when their brains are not actually awake until 10am. A number of studies have shown that teenagers would get better school grades and have better mental health if we gave them more time in bed in the mornings and started the school day later (Hannah Richardson reporting in The Guardian, 9th October 2014). Yet we still drag them out of bed at 7am.

Young people get told off a lot. Really a lot. By parents, teachers, even the bus driver on the way to school. Apparently, many more times per day than they are praised or told they’re great. Imagine if there were 3 or 4 people who you spent time with every day of your life, and 70% of your interactions with them involved you being told ‘no’ or reprimanded in some way. Yeah, ouch! And we wonder why teenagers can get fed up, depressed, act out, or have low self-esteem.

A 2019 US study by Dr Paul Caldarella found when teachers increased the amount of praise they gave children in class that both their behaviour and their attainment improved. By as much as 30%! So, when your young person client walks through the door it’s important to be one of those adults in their life that gives them a smile and a warm welcome. Let them know that you genuinely value being with them. Just be pleased to see them.

7. Externalise the problem

(This point contains a brief reference to sexual assault in childhood – if this would be triggering for you to read you can skip to the next point by clicking here)

This idea is borrowed from the field of Narrative Therapy and in particular the work of Australian therapists Michael White and David Epston who remind us that “The person is not the problem; the problem is the problem.”

Externalising the problem is particularly relevant for work with children and young people because it is much harder for a child or young person to separate themselves from their experiences. Developmentally they are not yet in the place that allows them to understand that if someone in their household is in a bad mood, it does not mean it’s all their fault and their responsibility.

Young people will often believe they are the problem if something goes wrong and take the whole world on their shoulders. Consider the amazing American poet and novelist Maya Angelou. She tells the story of how she was raped by a man when she was 8 years old. The man was jailed for just one day, and then murdered upon his release from prison. As a child she believed that he died because she spoke the man’s name, so in fear of murdering anyone else she became mute for 5 years. In therapy we can help young people to distinguish between having a problem and feeling like a problem. For some children and young people it can be helpful to speak about, write about or draw ‘the problem’ and then talk about how ‘the problem’ affects them.

8. Make Them the Expert

If you get the chance let your young person client take the opportunity to show you that they are an expert. Let them excel and speak with confidence about any topic with you, so they can experience an adult taking an interest in their views and opinions.

Be an adult who takes them seriously and engages them in something that is of interest to them. Let them be the expert on the rules of football, the importance of drum and bass, the implausible plot lines in Harry Potter, or the real reason why Game of Thrones is brilliant (or not…). Young people love to show that they know more than adults. So let them. Let them shine.

Image of young woman laughing with trees in background. Laughter should be embraced in therapy with young people.

Laughter can be a great way to connect with clients, and young people especially may find relief in shared laughter in their therapy sessions.

9. Don’t Forget to Laugh Sometimes

Laughter can be super helpful in therapy. It can help us to bond, it is a wonderful way to share a moment, and it can be a great way to introduce or talk about difficult topics sometimes.

Talking directly about a painful life event can be overwhelming for some young people. They are unlikely to have the resilience, the language, or the capacity to manage their anxiety like adults. We can help them. We can explain the process of therapy, we can help them to understand what to expect, and we can try not to take ourselves so darn seriously. We can help young people with wisely used humour.

Above all when working with young people, just remember that one of the most important things you can do is give them a good enough experience of being in counselling. So that in many years’ time they will remember their time with you and will feel positive about seeking out help again should they need it.

Guidance on working with young people in therapy

We hope you’ve found this blogpost on working with young people in therapy helpful. If you’d like to learn more about working with this client group, you can join us for an online CPD day with children’s and young people’s therapist, author and trainer Rebecca Kirkbride: ‘Root down to reach up’: An Integrative Approach to Therapeutic Work with Children & Young People (Saturday 12th June via Zoom, with catch-up). To get a glimpse of what to expect, and our host’s background, you can read our Interview with Rebecca Kirkbride.

Here’s Rebecca introducing the day:

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