Teens in Therapy: Making It Their Own

Clearly written, down to Earth and at times humorous, this book is a practical guide to working with teens and adolescents. It is bursting with real life examples of characters who howl, swear, make up fantastic stories and fall asleep throughout their sessions — but whom Bromfield portrays with respect and usually with affection.

Rating: 4.5

Teens in Therapy: Making It Their Own

By , 2005. ISBN 0393704645. W.W. Norton. 224 pages.

This is a clearly written, down to Earth and at times humorous book written by an experienced psychologist and therapist who obviously still finds his work challenging, fulfilling and enjoyable.

The book is a practical guide to the terrain, bursting with adolescent characters who howl, swear, make up fantastic stories and fall asleep throughout their sessions, but are always portrayed with respect and usually with affection. No theoretical points are made without support from a real story.

Bromfield’s angle is that adolescents have to take responsibility for their therapy and themselves, thereby distinguishing it from visits to a kindly expert, analytical psychologist or parental figure who gives advice. The therapist here is seen primarily as someone who enables the adolescent to take control of their life, by respecting and valuing them with all their vulnerability and the challenging forms it may take, setting limits, and meeting the young people exactly where they are, empathising and speaking their language.

Bromfield also covers some of the ways he has been creative in the therapeutic relationship (“Thinking Outside the Couch”) and in the other kinds of contacts which often arise with teenagers, such as working with parents, and advocating for clients in a variety of settings. His approach, showing that you mean it rather than theorising about it, seems particularly suited to this client group. It is thrown into particularly sharp relief in the section on crises, taking the form of suicidal intent or suicide attempts, self harm, drug problems or problems with the law. Bromfield’s direct, open and flexible approach and resistance to ‘handing over’ the client to emergency services which are not individually responsive to the suffering person is brave and, I’m sure, effective.

Therapists working with teenagers have to be extremely resilient, both flexible and firm with boundaries, both able to challenge and to be extremely gentle with emerging thoughts and feelings, and able to sit comfortably with any amount of grief and anger in all the forms they can take, which tend to be weird and wonderful during adolescence. Above all they cannot be phoney or fake, as a young person can smell this a mile off. Trust must be earned by the therapist’s being real and demonstrating that they are willing to get right into where the client is but that they will not be destroyed by the strength of their emotions, that they will be willing to go the extra mile, but not compromise on their boundaries. In short, they have to do some concentrated good parenting.

The obvious impossibility of performing this task perfectly leads us to one of the most engaging chapters — “Failures, Missteps and Lost Causes” — in which Bromfield shares his occasional tendency to ask too many questions, “All that was missing in my interrogation of Gideon was the lone, unshaded light bulb hanging over his head” (p. 178). He also shares times when, as a young therapist, he was simply taken aback, such as when a client’s father turned up in a truck with a console, screen and joysticks, in order for the client to play video games during the session. Musing on how he might react to a similar situation today, he writes “there’s a good reason why my office doesn’t have a string of grounded outlets and a 48 inch screen…” (p. 182).

Joking aside, this book will be very helpful to therapists starting out with this client group, and an insightful companion on the journey for those who already do this fascinating, demanding, important work.

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