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therapy with teenagers often involves intervening in dysfunctional
“games” between members. Dynamics
have become habitual and problematic.
Different teenagers present perceptual and behavioral patterns that
can be confusing or seem illogical or immoral to adults.
Games attempt to manage a hostile and disrespectful world.
An initial game with an adult, including the therapist is to
ascertain the adult’s degree of adolescent world sophistication.
Adults who fail to recognize the principles and etiology of games
end up being “played.” They are dismissed as ignorant or
“playing” the games successfully, the therapist can validate the
existential world of the teenager, thereby gaining credibility.
The therapist then introduces alternative play that is
cross-culturally competent in adult, academic, social, and economic
worlds… and in the family. Playing
“well” and then “differently” challenges and stretches dynamics.
The therapist draws upon various theories to break patterns of
problematic emotionality, cognition, and behavior.
The following parent-teenager vignette demonstrates several games,
their problematic nature, and therapeutic intervention.
Mom? Uh.... Can I go to a
concert at the Arena with Barbara, Patti, and Janet on Saturday night?
Barbara's mom said she’d driv. I have birthday money for my ticket. Everyone’s parents
already said they could go. I
need to tell Barbara tomorrow so her Mom can buy the tickets.
Can I go… please?.
It’s Thursday…isn’t it kinda late to get good seats?
No… it’s stadium seating... we can sit anywhere or even move up during
the concert. Can I go?
I don’t know. Who's
Uh... ummm... BDS...
Who’s BDS? What’s BDS stand for?
What!? Did you say BloodyDeathSex!!?
told Judy she could make choices as she got older.
She told Judy and the therapist she trusted her.
15 years old and a BloodyDeathSex concert!
Avril wanted to respect Judy’s desire to be more independent.
But, as Mom she was terrified!
If she said no (this wasn't Sesame Street Live....
it was Bloody... Death... Sex!), Avril knew Judy would feel that she didn't
Don’t you trust me?
I trust you. It’s
everybody and everything else I
You’ve been telling me I was responsible enough to make decisions.
You’re a hypocrite if you say “But. not that
had worked on being honest about her motivations, including her fears.
Her parenting philosophy felt explaining things was respectful.
Avril did not to be an authoritarian parent- setting boundaries without
sensitivity to Judy’s feelings, but authoritative- setting boundaries
with sensitivity to feelings. Her
parents had not involved
her in decision-making. Her parents dictated “the child’s life goals,
limiting the self-expression of the child, determining the child’s
choice of friends, and usually preferring actions that were most
convenient for the adult. The children were not able to express
themselves, and instead submitted and felt helpless” (Pruitt, 2007, page
72). Therapy helped Avril realize her own adolescent defiance was reactive to
her parents’ rigidity and emotional dishonesty. They had claimed to trust her but scrutinized her every
behavior. She did not want to
repeat parenting mistakes that contributed to her self-destructive
rebellion. Her willingness
to be introspective and vulnerable enable her to interact cooperatively
with Judy. “These are
characteristics, perhaps, most closely related to how well the individual
has processed and dealt with family-of-origin experiences” (Wampler et
al., 2003, page 510). She
had struggled in her personal therapy to deal with the numerous unhealthy
rules and values- schemata that she had unknowingly acquired in her family
(Dattilio, 2006). Avril’s instinct was to deny Judy without explanation just
like her parents. But she did
not want to duplicate their mistakes.
But, if she said yes,
her daughter would be at a BloodyDeathSex concert!
With three friends and 12,000 strangers!
With stadium seating! Stadium
seating is no assigned seating. Her child would be one among 12,000.
Even if Avril wanted to find her, it would be like looking for a
needle in a haystack.... a
haystack of BloodyDeathSex fans... or fanatics!).
I know you don’t intend to do anything inappropriate.
Yeah, Mom… I’m going with Barbara,
Patti, and Janet – they’re
more goodygoody than me! I
won’t… we wouldn’t do anything stupid.
knew the girls for years. Therapy
discussed the “social infection model” of adolescent behavior.
Avril had projected her own adolescent craziness onto Judy. Avril recognized that she had sought edgier kids as a teen to
rebel against her rigid family. If
anything, she had been the instigator of most risky behavior.
Judy had not been a defiant kid.
However, Avril recently found herself trying to appease Judy to no
avail. To some unreasonable
demand, Avril would suggest one option after another that Judy would
reject… often with distain. Avril felt impotent as nothing she suggested
would satisfy Judy. They both
became frustrated and angry. The therapist recognized this game as “Make
Me An Offer, so I Can Spit On It!” Individuals who learn that
power and control comes from negativity will use negativity to entice
offer after offer for them to turn down.
The other person frantically struggles to come up with another
offer the teenager for example, shoots down.
Avril had told Judy that
she wanted her to be a powerful independent young woman with accompanying
responsibility. Instinctively and now with Judy’s words, Avril felt
saying no would imply would be inconsistent her prior statements, but
letting go was difficult. Her
instinct was to suggest alternatives, but therapy had finally helped her
recognize the futility of playing “Make Judy An Offer, so She Can Spit
On It!” She desperately
wanted to be able to say yes to her daughter.
therapist briefly reviewed the difference between teenage Avril and
teenage Judy… and Avril dealing with her rigid parents and Judy having
Avril as a parent. The
therapist takes a fairly active role foregoing neutrality.
Therapeutic neutrality “refers to the attempt to
appreciate that all points of view in a family discussion are valid within
some particular context. A
neutral therapist tries to withhold judgment, and instead arouse their own
curiosity about what particular context would validated the things the
family member is saying” (Campbell, 1999, page 78).
Therapist neutrality may not always be possible and more
importantly, not therapeutic. Therapeutic neutrality may imply the therapist gives
permission for dysfunction or abuse to continue.
Using strategic principles that interrupt dysfunctional hierarchies
of behaviors, the therapist’s actions can prompt a potentially different
cycle. Interventions may
reveal secrets, remove permission, uncover passive-aggressive behavior, or
empower someone to assert him/herself.
therapist overtly stated Avril’s implicit desire.
Avril, you have been telling Judy that you trust her.
It’s clear you want to tell her “yes,” but can’t help being
a worried mother. Right?
Avril’s confirmation, therapy shifted from a fruitless game of
repetitious argument and emotional reactivity.
The yes decision moves from being the end of the process to the
beginning of another. The
story starts to change. Campbell (1999) notes that narrative therapy says
that people make autobiographical stories that include their problems or
emotional or mental illness. The
script maintains their lack of resources to handle and solve their
problems. The self-narrative
does not describe being able to function well in the system- the
family-of-origin originally and now for Avril with Judy.
Finding the story is essential to trying to change the story,
including writing ones own chapters.
“The task of the therapist is to seek out small examples of these
hidden resources and to build on them.
This can be achieved by understanding the process by which these
resources have been subjugated by various events and relationships, and
then gradually building an alternative narrative containing the new
resources… Small efforts... facilitate the process of an individual
creating a new narrative for themselves”. (Campbell, 1999, page
Avril, you want to be able to say “Yes, you can go…” and Judy,
you want to hear “Yes, you can go.”
That’s set. Now, how
do you two make it so that Mom can say “Yes?”
Just say “Yes.”
Your Mom can’t just say “Yes.”
She needs motivation to say “Yes, I will let my daughter who I
love more than anything … who I trust…is responsible… let her go to
a BloodyDeathSex concert even though that scares the hell out of me!”
Judy, make your Mom an offer she can’t refuse.
Avril, you want an offer from Judy?
Yeah. Help me out here,
Judy. I know that you really want to go.
I also trust you and your friends.
I've raised you to make good choices.
So, the answer is “Yes.” But,
Oh Mom, you don't need to worry about me.
I can’t help it.
(impatiently): That's your problem.
Just don't worry. (to
the therapist) Why do I have to make her an offer because she worries?
Well, you don’t have to.
You don’t have to go to the concert.
But your Mom is willing to let you go if you can come up with
something. If you can’t…
or won’t come up with something, then I guess you’re nott going.
often gets parents, children, and the family stuck in ambiguity.
The ambiguity creates anxiety and leaves everyone in action or
relationship purgatory. In
addition, an oppositional child often experiences the lack of a definitive
decision is often experienced as a pyrrhic victory.
When the child insists on an impossible option, the resultant
non-decision or ambiguity passive-aggressively controls the adult through
aggravation. Setting up a
default consequence or decision helps avoid or retracts oneself from this
dilemma. With a default to be
applied or exercised if some other reasonable decision is not reached,
ambiguity and passive-aggressive illusion of power and control are
removed. The therapist
removed ambiguity as an option. The
default is Judy will not get to go to the concert if she chooses not to
participate. The default
gives Judy motivation to try problem solving.
This approach draws inspiration from strategic family therapy.
Cycles of parent-child-parent-child anger, obstinate resistance,
withdrawal, and the like get broken.
There is a significant paradigm shift- a first-order change to
second-order change (Lyddon, 1990) from the parent trying to satisfy the
child to the child trying to satisfy the parent.
“First order change is change that is considered within the
values, rules, or expectations that are currently or traditionally held.
First-order change according to ‘Watzlawick, Weakland, &
Fisch (1974) …involves a variation that occurs within a given system
which itself remains unchanged.’”
Second-order change, on the other hand, “…involves a variation
whose occurrence changes the system itself… it is change of change… it
is always in the nature of a discontinuity or logical jump” (Levy, 1986,
page 9). First
order change involves small improvements and adjustments that do not alter
the fundamental core of system, while second order change alters the
fundamental structure. Avril
and Judy shifting what they argue about is first order change.
The paradigm shift eliminates Judy trying to change
Avril’s decision. Instead,
everything resets with Judy getting her desired decision, but now needing
to make it workable for Avril. The
therapist supports Avril that she is being reasonable.
She reiterates that she is willing to let Judy go pending a
Just don’t worry… Why can’t you just chill?
There’s an answer to that.
Why can’t your Mom just chill?
Because she is your MOM! That’s
what moms do… they can’t help it… they worry!
It’s part of the Mom contract… worrying about the kid!
Avril, is it possible for you NOT to be the Mom?
Not to worry?
This borrows from structural
family therapy. Structural family therapy emphasizes appropriate roles and
boundaries among family members. The
term structure refers to the “organizational characteristics of the
family at any point in time, the family subsystems, and the overt and
covert rules that are said to influence interpersonal choices and
behaviors in the family” (Vetere, 2001, page 133-34).
The therapist must be aware of taking sides, and must offer support
at times when being confrontational. This
emphasizes that the therapeutic relationship as a vehicle for therapeutic
change (page 135). Taking an
authoritative position in the family system, the therapist is reminding
them that Avril as the Mom has important role responsibilities and
experiences. The therapist does not care if Judy goes to the
BloodyDeathSex or a Sesame Street Live concert.
The therapist supports Avril asserting her healthy functional role
as the mother. Considering
children’s (including teenager’s) activities for developmental
appropriateness and safety are key responsibilities of that role.
Worrying is not just Avril’s right as a mother, but her
responsibility. The therapist
gets Judy to begrudgingly admit that Avril cannot help but be a Mom… and
she likes and needs her to a Mom… sometimes.
The therapist prompts Avril to assert her role as Mom. However, this is not just about Avril being the Mom, it is
also about Judy being a teenager- an important role that needs to be
validated. Eventually, Avril
is able to express their roles more clearly and confidently.
Even though I’m scared, I'm trying to let you be the teenager you
need to be by being willing to let you go.
But don't tell me not to be the mother that I am!
Being Mom means that I care for and love you....
And worry about you. Don't
tell me that I can't be the mother that I am, especially when I'm trying
to let you be the teenager that you are!"
was quite shocked initially. With
more processing about being a teenager, becoming independent, and the role
she wanted and needed her mother to play, she felt more understood.
After asserting the Mom role and teenager role, the therapist
points out their inter-relationship.
Judy, being allowed to be who you need to be as a teenager, also
means allowing your mother to be who she needs to be.
Asserting power and control also means giving appropriate power and
control. Reciprocal social
responsibility -- what an amazing concept!
This is what you’re experiencing going from a teenager to an
adult. So, since Mom already
agreed, you can go.... if you make her an offer, so that she feels
comfortable enough to let you go. By the way, Avril, there’s nothing
that Judy can say or do so you won’t worry.
So, the goal is to be reassured enough so that you won’t worry
too too much. Got it, Judy? Make her an offer that will reduce… not eliminate her
therapist has shifted the paradigm once again.
The impossibility of Avril as a Mom being reassured so that she
will not worry has been established.
Judy instinctively knew that if she had to eliminate her mother’s
anxiety, she was doomed. The therapist had reframed or adjusted Avril’s request to
something doable and reasonable. Despite
feeling hopeful, Judy was still perplexed.
She was used to a negativity game and getting Avril to make offers
until she was satisfied.
Now, she had to come up with an offer.
She tried to avoid this huge change in their dynamics, by baiting
Avril to resume their familiar hierarchy of interactions.
Why should I have to satisfy you?
(remembering the default) You don’t have to. If you don't want to, then the answer changes to “no.”
If you can't come up with something, you can't go.
If you can, then you can.
needed to be very clear that she was willing to let Judy go or not go.
Many parents sabotage this by protecting the child from a bad
choice and suffering a “bad” consequence.
Children learn parents can be gamed to give in by threatening to
choose to suffer. Faced with
her mother's firm stance, Judy began to make offers.
Many children and teenagers however are very experienced and expert
at being negative but had little practice offering something affirmative. Judy’s first attempts are actually negative offers.
If you let me go, I won't nag you anymore… I'll stop fighting with my
negative, intimating that she would become negative, offering to stop
being negative was a game Judy knew.
The therapist should interject that not doing something negative
was not a positive offer. Avril
asked for something that helped with her worrying, turning down Judy’s
offers to negate negativity.
(impatiently) But why not?
again tried inviting Avril into another argument that would futilely
replicate hundreds of previous arguments.
Before Avril could get drawn into the justifying game, the
therapist prompted her that she did not need to justify herself… that
her feelings (worry and anxiety) existed, or were not soothed.
Avril relaxed, realizing no need to justify her role and
responsibility as a Mom.
(calmly) No, that doesn't work for me.
Make me another offer.
really threw Judy off. Sucking
her mother into arguing she knew, negotiating and making offers was
Okay, I promise to be good... to stay in one place... not to drink or
do drugs...to stay with my friends. How's
often (adults too) promise anything to get what they want.
Also, the promise game is not a tangible offer.
Especially, as the therapist pointed out if the promise is to do
what is supposed to be done anyway. Avril
said she still would worry. Judy
then played the outraged-hurt-betrayed trust card,
You saying you don't trust me!?
accusation is a trap game. It implies that Avril not trusting her daughter was the
ultimate betrayal. And
therefore, to avoid this betrayal, Avril would have to let her go.
However, Avril had seen this trap before and had processed it in
therapy. Avril was prepared
this time and reasserted her boundaries.
I already said that I trusted you.
It is everybody and everything else that I don't trust. Besides, I asked you to make me an offer so that I don't have
to worry as much. Make an offer.
took several attempts to find something that worked for Mom. The power
dynamic had been shifted significantly.
More importantly, Judy gained power and control through an
affirmative rather than negative process.
Avril as Mom held the principles, and after quite a bit of
discussion, Judy finally came up with an offer that Avril could accept and
live with. Four prearranged
times during the concert, Judy would call to let her mother know that she
was safe. Avril was allowed
to be a worrying mother and Judy was allowed to be an independent teenage
daughter. True power and
control was obtained not through negativity but through creative mutually
respectful affirmative strategies.
vary from family to family. Some
parents feel that 15 is too young to go to a concert (especially a
BloodyDeathSex concert!) regardless.
The therapist distinguishes problem-solving situations from
important underlying principles.
Learning that power and control should be gained with
responsibility to others' needs is critical to healthy development.
Structural and strategic principles along with communications and
psychoeducation interventions are often required to break dysfunctional
patterns among parents and children, especially teenagers.
Parents, who continually restrict and restrain their children, take
away developmental experiences of power and control, leading to rebellion
and defiance. When children
are respected and given choices, they are more willing to accept
boundaries. The therapist
needs to be aware of family-of-origin dynamics as well as multi-cultural
models around power, control, roles, and responsibilities to navigate
family therapy with teenagers. There
are games that the teenagers develop with parents and other adults that
the therapist must play yet not be played.
As a new adult to the teenager and potential ally, interpreter, and
interventionist for both parents and teenagers, the therapist can reset
the games towards greater functionality.
The conceptualization of interactions and dynamics as games may be
useful in approaching child and adolescence therapy individually and in
families. The therapist should bear in mind, however that these are
very serious games with intrapsychic, interpersonal, and long-term social
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