Most parents who bring an adolescent to family counseling want the therapist to fix their kid.
That expectation is often the first thing the therapist has to work on, but not because parents are wrong to be afraid. This is because a household coming in with one declared issue person is likely to create an adolescent who shuts down in week one.
And there's one figure to know before you start. In Functional Family Therapy – one of the most studied teenage family models – the biggest benefit over routine services is not in a symptom score. It is that fewer families drop out of treatment. Most of the battle for teenage treatment is just remaining in the room.
This article will assist you to understand what adolescent family counseling looks like, what the research shows, how confidentiality really works with a teen and how to find someone.
What Is Adolescent Family Counseling?
Adolescent family counseling is treatment in which the family comes together, with the teen's problem as the reason for coming.
The teen is not the clinical target. It's the pattern surrounding them. How conflict builds, who escalates, who withdraws, what's avoided, what attempted remedies have become part of the problem.
A session will usually involve the teen and one or more parents or caregivers. Sometimes brothers and sisters join. The clinician may also have individual time with the teenager in addition to family sessions.
It is provided by a licensed clinician, usually an LMFT, LCSW, LPC or psychologist.
Why Do Parents Take the Whole Family When It's the Teenager Who's Struggling?
Because a teenager is not an isolated individual. Because much of the change must occur in the household.
A 16 year old can gain flawless communication skills in a therapy room, but still go home to a house where the same conflict starts at 6pm. Family work gets at the loop not one person's half of it.
It is not about blame. Good therapists make it clear that nobody is being accused of causing this. Parents usually arrive braced for exactly that, and it is worth saying at the first session if the therapist doesn't bring it up initially.
Does Family Counseling for Teens Really Work?
The evidence here is stronger than most people would think.
Functional Family Therapy has been studied in dozens of clinical trials. A systematic review of 27 trials found it to be better than routine services on a number of fronts: fewer families dropping out of treatment, fewer conduct problems, less substance misuse, fewer foster placements and less recidivism. Follow-up periods ranged up to five years and results were consistent across different ethnic groups.
Broader assessments of family-based treatment for adolescent behavioral problems find it beneficial in reducing re-offending and promising for antisocial behavior, substance use, psychological functioning and school performance.
It's worth mentioning the honest caveats. Another well-known paradigm, Brief Strategic Family Therapy, demonstrates strong strength in engaging and maintaining families but more mixed findings on teenage substance use outcomes particularly. And you'll see pages with extremely specific percentages of recidivism reduction for different methods. Frequently these numbers are attributed to sources which cannot be checked. You'll often see suspicious exact numbers on therapy marketing pages — take them with a grain of salt.
What Can Teen Family Counseling Help With?
Most families come for one of these:
- Constant fighting that restarts every few days.
- A teen who has stopped talking, or stopped leaving their room.
- School refusal, decrease in grades or sudden decrease in engagement
- Substance use
- Self-harm, or a scare that frightened everyone
- Defiance, rule breaking or police trouble
- Anxiety or depression that the household is organizing itself around
- A blended family that has not settled
- Divorce or separation or a parent moving out
- Grief, and the fact that teenagers typically mourn laterally, not obviously
It also helps if there is no crisis to start with. Families that work but have stopped talking honestly. Parents who disagree on the rules and have been arguing through the teen rather than with one another.
How Is This Different Than Individual Adolescent Therapy?
Individual adolescent therapy is working on the teenager's own routines, their thinking, their coping, their anxiety or low mood. It's their room.
What happens between people is the focus of adolescent family counseling. Different goal, different room.
Neither one is superior. They are answering different questions:
- Individual work works well when the challenge is primarily internal, or when an adolescent wants a space that is really his or hers.
- Family work helps when interactions are problematic, when parents and teens get trapped in a repetitive pattern, or when home is the place where change has to take root.
Both together are common. The family meets with the same clinician, or two who coordinate, and the teen has solo sessions.
If you're unsure which you need, that's a reasonable issue to bring up on a first call, rather than determine for yourself.
What Happens in Family Therapy for Teenagers?
The first session is assessment and includes primarily questions.
The therapist will probably question each person separately, in front of the others, about what he or she thinks is going on. The youngster gets asked properly, not as a last consideration. Parents report what they see. No one is asked to agree.
And thus sessions do tend to get stopped. Your therapist will cut a fight off in the middle of it and ask what happened. That's deliberate. The idea is to slow down a cycle so that the shape is visible to all.
Between sessions, there will often be items to try out at home. Not quite homework, but talks to handle differently or a certain adjustment to how a reoccurring moment is managed.
It's usual to have a teenager who says almost nothing for the first three sessions. This is not a sign that this is failing.
What Will The Therapist Say To My Parents?
This is the biggest cause of trouble down the road and one that most families never get clear about right away.
Generally with teenage work parents are given attendance, general progress and anything impacting safety. The teenager keeps session content.
The exceptions are the same for all of the practices: substantial risk of self-harm or suicide; a credible threat to someone else; suspected abuse or neglect. Disclosure can also be forced by court order.
What are the good practices around it:
- Make the agreement at intake, in writing, with both parent and teen present so everyone hears the same thing at the same time.
- Some practices ask parents to sign a statement promising not to ask what happened in a session, in exchange for occasional reports on progress and immediate notice of anything dangerous.
- Revisit it. A thirteen year old and a seventeen year old need different set ups.
If a therapist can't explain their confidentiality policy on a first call, that's good information.
Also, if the parents are separated, one more thing. Establish in writing which parent has legal authority to consent to treatment and access records under your custody agreement. Getting that sorted out before session one prevents a lot of trouble later.
Does My Teenager Have to Consent?
In North Carolina, state law permits a youngster to consent on their own to therapy by a physician for emotional disturbance. A non-physician provider, which includes most therapists, usually requires parental or guardian agreement.
Rules vary by state, so check if sessions will be online with a family member elsewhere.
Legally needed consent and actual willingness are not necessarily the same thing. A teen dragged to a first session can be engaged by session four. A good clinician anticipates reluctance and plans for it, rather than viewing it as a barrier.
What Methods Are Employed in Counseling for Adolescents?
Fit is more important than approach, although it's worth knowing what's on offer.
- Functional Family Therapy. Structured, phase based, greatest evidence foundation for teenage behavior issues, and most generally referenced model for minimizing dropout.
- Multisystemic Therapy. Intensive, works in family, school and community, all at once. Generally used for serious behavior and offending issues.
- Brief Strategic Family Therapy. Short and targeted, particularly good at engaging families who wouldn't otherwise attend.
- Structural family therapy. Takes into account hierarchy, boundaries and alliances. Who has power, who is too close, who is left out.
- Attachment-based family therapy. Focuses on the bond itself and is typically employed when there is depression or suicidality.
Most clinicians mix these. The key factor is not the school they belong to, but whether they can tell you in straightforward English what they would actually do with your family.
How to Find an Adolescent Family Counselor
1. Verify the license on the state board's website
Not on their own site. LMFTs in North Carolina are verifiable through the state's Marriage and Family Therapy Licensure Board.
2. Ask how much of their caseload is teenage family work
This is a particular skill. Someone who sees adults all week and takes a family now and again is not the same as a clinician who does these sessions routinely.
3. Check their confidentiality policy before you book
It's a positive indicator when they can tell you what parents do and don't get. Vagueness here causes problems in month two.
4. Find out what happens if your teen refuses to go
Experienced clinicians have an answer. Usually it's working with the parents first.
5. Look for the fit for the youngster, not just for you
Many practices will give a quick consultation. Let your teen have some input with the selection. They are more inclined to open up to a therapist they had an involvement in choosing.
How long does adolescent family counseling last?
Weekly at first for most, then every other week as things settle.
A specific, limited difficulty can require eight to twelve sessions. Longer for more entrenched patterns of substance use or offending scenarios. Structured models such as Functional Family Therapy are designed to run for a fixed length, rather than continuing indefinitely.
Don't expect to see anything in the first few sessions. This is the hardest stretch for parents. Your therapist should offer you a rough estimate after assessment, and change that estimate out loud as treatment progresses.
Why Opt for Fresh Breath Therapy for Adolescent Family Counseling?
Fresh Breath Therapy provides family therapy and adolescent counseling in person and online throughout North Carolina, with locations including Cary, Raleigh, Greensboro, Winston-Salem, Charlotte, Fayetteville and Wilmington.
Family work sits alongside individual therapy, couples counseling, EMDR and co-parenting assistance, which is important as very frequently a teenager's problem is tied in with something else in the household rather than being something apart from it.
If you aren't sure whether family sessions, individual work for your teen or both is the best way to start, that's a good thing to bring up in a first call.
Are you ready to go forward? Reach out to Fresh Breath Therapy to talk through what is happening at home.
Frequently Asked Questions
What is adolescent family counseling?
Adolescent family counseling is family therapy attended by the family together, spurred by adolescent trouble. The focus is on the pattern among the family members, not the teen as the problem to be corrected.
Is family counseling for teens any better than individual therapy?
They're asking various questions. Family-based methods provide good evidence for adolescent behavior problems, especially in terms of maintaining the families in treatment, not allowing them to drop out. Individual adolescent therapy is good for largely internal problems. Many families do both.
Will the therapist tell us what our teen says?
Normally no. Parents usually receive information on attendance, general progress and any safety issues, but session content is the teen's own. There are exceptions such as substantial risk of harm, suspected abuse and court directives. Agree this in writing at intake.
Does my teen have to consent to come?
Your state and the provider's licensing will dictate the consent requirements. In North Carolina, parental approval is often necessary for non-physician services. Reluctance at the start is common and most clinicians make allowances for it.
What if my teen doesn't want to go at all?
Begin with the parents. Often changes in the way parents respond are enough to change the household routine so that the teenager joins in later, when it doesn't seem like an ambush.
How long does teen family counseling last?
Usually eight to twelve sessions for a limited difficulty, longer for long-standing behaviors or circumstances involving substance use. Don't expect an estimate before assessment, expect it after.
Final Thoughts
The evidence for working with teenagers on a family basis is good. The greatest strength of family-based care is unglamorous: families continue in treatment.
The choice you face is more narrow than "does counseling help?" It is who, and if you can get in without the frame that one person requires mending.
Check the license. Ask what percentage of their practice is with adolescent family counseling. Ask how they handle confidentiality with a teen and listen for a detailed or ambiguous answer. Involve your teen in the selection.
If there is self-harm or any talk of suicide, don't wait for an appointment. Call or text 988.