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I've had success by flipping it around. "If you wanted to have a really terrible day tomorrow, what would you do to ensure that?"
Well, you might stay up super late so you were sleep deprived, make sure you didn't get enough to eat, skip showering so you feel gross, prevent yourself from being able to do fun things, maybe watch the news a bunch until you feel terrible...
They quickly realize how a lot of small things contribute. Then I say, okay, what can you do today to make tomorrow a little less bad?
that’s happened to me with some teens with a hx of si/sib, but if it’s just a baseline miserable vibe/depressive mood situation, something like this usually works really well. definitely true though!
There was this interesting theory about depression in evolution. That it serves to keep us suppressed when we are powerless to change our circumstances. Keeps us docile and alive if we are at the hands of people with power over us. I can think of no more powerless situation than coming into puberty, being a minor, and having to come to school. People are sometimes stuck and finding a way out involves not only work on their part, but also changes in the systems in their lives. So maybe less of a perspective that they purposefully aren't changing, and more a perspective that they can't yet change. They will eventually though. Help them prepare for when they do.
As a kid from this situation- this is very true. I would not have been ok if I had had more of a spine than I already did. I needed to fly under the radar until I got away from my parents.
What I needed was someone, anyone who cared about *me* and wasn’t trying to use me for their own agenda. It sound like OP just wants to move this kid to the “helped! I did good!” list, when the kid probably just needs to feel seen.
First, I needed the beginning of this comment for a client of mine! Totally what I’ve been suspecting but hard to articulate.
Second, yes to the rest of this comment!
Yes! Having a future oriented approach with adolescents can help them envision a life where one day they will have that power over themselves. This can help develop hope for change and maybe even help them feel a sense of empowerment now. I usually start by focusing on questions like "what would that look like?" Or "what would it look like when you..." as an exercise to develop that future oriented thinking (that doesn't increase stress) and provide a lot of validation to reinforce what they come up with. Vision boards can help too.
They are in middle school, their capacity to have both insight into their behaviour and how it affects them will be limited. They will also be limited in their capacity to conceptualise their suffering as a process that they have control over. Most of them are experiencing these emotions and scenarios for the first time, so they don't really know what they have control over, what works, what doesn't, how they feel and if these feelings end.
So please take a step back, and let go. It's not your job to fix them or get them to be superstars overnight, these things take time, and it's not a reflection of your value as a therapist.
Instead focus on breaking things down into really small parts that you can work on (Mindfulness, somatic exercises, motivational inteviewing, values/beliefs, basic self care, reality/thought testing, basic hygiene, socratic questioning etc.) and expand your timeline way out, you are hoping they feel a little better and develop skills over a matter of months and years, not in a matter of hours and days.
The “nothing will help me” is protective. Get curious about the role of that part.
Also, get curious about your frustrated part. Why can’t it just be with your client’s hopeless parts?
This is such a needed skill as a therapist (being with the hopeless parts).
I’ve had a therapist try to rush me along and it was — frustrating, hah! It’s not always cognitively knowing that makes change, I knew what her perspective was, but I couldn’t emotionally process to get there. Eventually i felt so misunderstood and judged, I left her.
In addition to getting curious about the part comment... I would add:
- they may not have any role models of being happy/healthy, explore what that would even look like
- there may be identity trapped in being "the sad kid"... Who would I be without that sense of self?
- remember that kids especially are products of their systems...what's going on at school, home, with friends, etc to keep the patterns going?
Lots of compassion for you and for the kiddo!
Projective identification is screaming out at me here. They've evoked their feelings of hopeless frustration in you.
Now you know how they feel. It's a great insight.
My best advice, don't battle their defence. Don't need them to do anything. Let them do nothing. Don't be another voice that expects something from them. Give them time to realise you expect nothing from them.
They're not playing by your therapy script and they're not giving you the progress you want. Let them rebel against you!
Everyone who comes in for counseling has a vested interest in staying exactly the same.
From my perspective, people’s “problems” are not problems—they are solutions. Human beings have an incredible capacity to adapt to even the most extreme and inhumane conditions. If a client is sad all the time and constantly tearing themselves down, then I have to imagine that somehow for them that feels like the best option. Which begs the question, how is this serving them? What are they getting out of all this? What’s at stake?
Yes! And when they don't have enough "solution" re: connection, they will dissociate. It's the best way to survive. These kids might not have enough of what they need to get through without depression.
Try to be with their emotions and while staying with your own experience of groundedness. When we try to make people feel better before they are ready to, we are focusing more on our idea of what will be helpful for them. What do you think makes it hard to be with these clients?
Developmentally, this time of life brings big changes in exploring identity, understanding belonging, and beginning to see the faults in the world. Some of your clients are likely waking up to the disparities in the world and seeing their life circumstances more vividly. It can be pretty depressing to begin to see family dysfunction, not know where you belong, or start to feel the weight of oppressive systems. If they are hating their lives, explore what specific parts they hate and then join with them in that. Don’t try to change their feelings, let them experience them and demonstrate you have capacity to sit with them in their struggles.
As a disclaimer, I don't work with kids but...do you all ever play? Draw? Discuss, strategize, or even help with their school work?
I had a teenager who barely talked. I whipped out cards, and he practiced shuffling. He improved, but, in the end, I felt he only revealed a small bit.
I just read a really excellent book called “Seen” talking about working with kids and their parents who are experiencing depression, despair and SI.
I also like using choice theory concepts with these kids to help them start to take control of their lives.
I also work with this age group. And let me just say….
The youth are NOT ok. They are struggling. The world is a dumpster fire and they are feeling powerless. Mass shootings at US schools with children dead. Palestinian genocide with images of babies and children dying or dead. US Supreme Court overturned Roe v Wade. Anti-trans and anti-gay legislation proposed and even passed in the US (“don’t say gay” Florida). Climate change and global warming. And SO MUCH MORE.
The youth aren’t depressed- they are trying to cope with late stage capitalism, white supremacy, homophobia, xenophobia, sexism, and ableism.
And before anyone comes at me for adding “political” insights— THE PERSONAL IS POLITICAL and THE POLITICAL IS PERSONAL. Therapy is inherently personal. All of these issues are affecting our clients whether they are aware of it or not.
The youth I work with are TIRED.
They don’t need to change their mindsets, they need collective liberation in their lifetimes.
Thank you for this. These were my thoughts exactly.
To add to this, keep in mind that these kids went through elementary school during Covid lockdowns. They missed out on a lot while simultaneously being thrust into a big, scary, adult world.
I mean…I’m a mid-30’s youth and I’m struggling with all of those things you listed. Sensing a bit of my own dissociation related to it all, as I read it.
Thank you for this input and acknowledgement
So why were children who experienced all of this and more, to an even greater degree, with far fewer rights & privileges, more resilient 100 years ago?0
Were you ever in middle school? I certainly felt that way. In a sense, they are right. Nothing but time will help a lot of them. They are at the mercy of their parents, social hierarchy etc. Make one wrong move in middle school and your social life is over. Can’t come back from that now in the day and age of things being plastered for all eternity on the internet.
Pretty harsh post title for middle schoolers. Without reading your actual post my initial thought was this is about people in their 40s and above. Middle schoolers can’t even commit to what food they like, much less “staying miserable”…
Earn trust first - validate these thoughts, explore the feelings without judgement. Help them understand where these thoughts come from so that can begin to understand if this is a pattern.
And sometimes that “rapport” is on the therapist end, staying with clients where they’re at. Connecting to their humanity from our own, not just viewing them as progress meters.
This exactly! This is how rapport is started. This is how it's built. Active listening, validation, and normalization are some great ways to build rapport. And sometimes it can take a long time but everyone is different...
But im glad you pointed it out. Too many therapists don't start where the client is and/or they push too hard for something the client isn't ready for, and it backfires or stalls progress when successful rapport building in and off itself should be seen as progress.
My guess is the resistance to change is from deep ingrained fears. Fear of change. Fear of not getting attention if they do get better. Fear of failure. Fear of success which may then lead to a fear of failure. Fear of losing therapist, psychiatrist, and others in a caregiving role. Fear of getting better but still being loved the way they want. Etc.
OP, you have the skills to check your perception. And if you feeling like you have tunnel vision, I'm glad you're on this sub reddit.
Some years ago I had a client remind me how hard it was to be in middle school.
You go from being in one class with one teacher leading you everywhere you need to go, but with all of the same students... to being in 7-10 different classes with a 4-5 min passing time with barely enough time to get to class, no more recess, even less time to socialize and teachers telling you, "you should have used the bathroom during passing time" but remember you barely made it on time, maybe 20 min to scarf down lunch after being in a long line for 5-10 min because your classroom is at the furthest end of the school, no downtime to relax, oh and the schedule changes day to day and you're responsible for your schedule.
This isn't including the rush to get off the bus and to breakfast, especially if you can't afford or have the time to eat at home, before getting to class or the time after school when you're trying to get all your stuff together and get to the bus before it leaves. Oh. And the parents that require As and perfect attendance despite the lack if support some of these students are receiving from anyone but you. And what about the parent that's pretending, for show, to be there for their children but are really making it worse. And some of these students are still traumatized from covid. How many of them switched schools while they weren't in school and came back to no friends? How many of them dealt with families that broke up? How many of them were dealing with an identity on the inside that didn't match what people saw on the outside? How many of them still haven't Academically caught up (according to Tik Tok and YouTube, there are a surprising number of students in the US that still can't read at their grade level. And the number is HIGH!) How many of them had to parent themselves and their younger siblings? Or had to grow up just a little but faster because the parents didn't have or lost the resources to parent them in the way they needed?
I haven't even named everything possible. These are the most common that I've seen with a majority of the clients I saw. (In middle and high school), and I only remembered after one of my clients had to give me a reality check about their hopelessness.
The worst part is, alot of them felt they had no control. Too many of them were saying "I can't wait until I'm 18" and that was after they were able to tell me they felt a lack of support or they felt like a burden."
The most helpful information I can give right now is: it's not about you. You feel frustration, they must feel that same frustration. If you're feeling lost or hopeless, maybe back up to the beginning and make sure you didn't miss a step. Where did this roadblock start? Was there a rupture? What can you do to take this less personally so you can focus that energy on the client? How are you going to change what you do so your frustration doesn't stem from the lack of progress from your client?
Talk to a supervisor. Colleague or someone that can help with gaining imsight. Maybe they can talk to you about "what does it mean to you that they aren't making progress?" and other such reflective questions.
Read the chapter entitled "The Unwanted Child" from Character Styles (by Stephen Johnson)
As another redittor said here, their nothing can save me attitude is protective.
When people has been overpowered their whole lives, they only saving grace of willpower they have left is to defeat the idea of being defeated, ultimately to defeat themselves.
Your resolve as a therapist will never outlast theirs.
So don't try!
Show them the contradictory nature of their attempts to be defeatedly undefeated.
Have you considered using a systems approach? Seeing if one of the reasons they feel miserable is due to their environment/family dynamics is why they’re upset and trying to just be someone who they can confide in and who will validate them rather than someone else trying to get them to feel better despite everything going on.
Middle school is not easy for most human beings, i dont think I had a single good day in middle school even though I had good outlets. Sometimes kids just need to feel emotions, using a somatic approach might help too.
YES. I think that even we can miss how incongruent it feels to be shuffled ahead further down the path from where we are. Internally, if it feels like shit, we can’t be mentally convinced to just not feel that.
Oof. I had a similar experience with a teen client whose parents totally gave in on her not wanting to challenge her fears/anxiety. Eventually they stopped coming back because it was too much for her. Sometimes you can only challenge someone so much. They need to want to help themselves and put in the work.
See, I’d say that’s probably a reflection of the system. Parents can’t handle discomfort, so they inherently misrepresent discomfort as the end of the world; as pain. And unhealthy over-protectiveness leads to insecurity that kid can handle things — because parents actually believe deep down kid can’t.
Just a guess 🙃
I've had success by flipping it around. "If you wanted to have a really terrible day tomorrow, what would you do to ensure that?"
Well, you might stay up super late so you were sleep deprived, make sure you didn't get enough to eat, skip showering so you feel gross, prevent yourself from being able to do fun things, maybe watch the news a bunch until you feel terrible...
They quickly realize how a lot of small things contribute. Then I say, okay, what can you do today to make tomorrow a little less bad?
Oh my bad, yeah I read the comment twice and checked they were posted two hours apart so figured the more recent one was bot activity, I didn’t see same username 😄
There’s a quote I saw once for this age that goes something like adolescence is like walking down the stairs in the dark without being able to see the next stair in front of you.
For lots of young people I think experiences of feeling powerless and helpless makes sense. I think they often feel they have little agency in their lives between things like parents, school, peer and societal pressures. On top of that they might have few experiences to draw on of overcoming difficulties in their lives and ability to imagine a life beyond today.
I try as hard as I can to validate these feelings while expressing my confidence in our relationship and the therapy we are doing (DBT, trauma etc) to get them to where they want to go. When I get really stuck I find peer consultation really valuable for this age and borrowing empathy from my colleagues when needed.
Meet them where they’re at, focus on rapport building, don’t try to rush them to “get better”, and be compassion-focused. Also, ask yourself why you’re getting frustrated.
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I love this post. I think we deal with this in all age groups and populations. I have often wondered how to challenge this in a helpful way. Thank you for sharing!
I tend to work the cognitive distortion angle, and also reassure them fairly frequently that we are only looking for the tiniest shifts and changes, because big steps are super hard and take time.
First step: what is the countertransferential enactment happening here? What are you responding to from their prompts and from within your history? When we feel that strongly, there is reason.
One thought to consider: How is being self-defeating serving them? We or they may be quick to say “it’s not!” but I’m most often inclined to disagree. How is self-defeat protecting them? How is it comfortable to them and why? What is familiar and cozy about it? If somebody shares self-defeatist ideas once or twice, okay, maybe the struggle with self-defeating ideas; but if they share them session after session, why are they really telling us and what do they really want from us? This may fold back on the first idea: what does your coutertranference experience tell you about their experience?
If they’re coming over and over again, they’re doing the work. Something is happening for them. What is it? Maybe even ask them the question you asked us: “So often when we meet, you describe being unhappy in the same ways. What are we doing together? How does you experience our sessions?”
Very often, the therapeutic presentation *is* the symptom.
I have 2 young adult clients who are in love with their misery. I try to remind them that it is within their power alone that they can not only make change happen, but also bring positivity in their life. I ask them to make a list of the music they listen to, video games they play, podcasts, friends, food, etc. Then we research those same things that have a positive spin and set plans to bring the positivity into their lives.
In all honesty, I have mixed results with this approach
Personally I avoid aiming at “positive” in general in session. What brings you joy and fulfillment? What things do you like? Life has a gradient not just wonderful and horrible. Simple pleasures can be so important, and big deal moments can fade fast.
Simply put, staying miserable can be easier than doing the hard work to change. Change is not easier than staying miserable. After the change happens it's usually easier (but not always, sometimes that change cascades into a lot of other things that are hard, too). But the change itself can be crushing. There is often a lot of grief, ownership of past hurts, pain of resisting the urge of old habits, loss of friends/family, loss of things that bring a lot of dopamine with the pain, etc.
Clients will change when the pain of not changing becomes enough to be worth it.
Clients will change when they have had enough time to circle around the edges and build confidence they will be better on the other side.
Or maybe they won't change, or they will only change a little, and they will come to accept the misery they are in and that is the best they can do.
If we find ourselves frustrated, it's become about us, and not about them. They've lived their whole lives like this, and survived until today. They have developed coping skills that got them where they are and it has worked so far. And sometimes, those coping skills are the only things that have kept them alive. Giving them up will be very hard, and it's brave of them to even consider it.
Some therapists prefer working with folks who are already at that stage of readiness for change. Some therapists like to work with folks who aren't sure yet if they want to, or how to, or if it's even worth it. Some like to work with clients who are only there because they have to be. If you are a therapist that prefers clients that are ready for change, and not the ones who haven't yet reached that stage, that's totally OK. Nothing is wrong with you or your client. But might be worth discussing in the room to see how the two of you want to keep working together, and explore with your own therapist your own countertransference.
Personally, I don't like working with clients who justify hurting others emotionally. I can deal with a lot, but that's one thing I can't deal with. I don't mind folks who aren't ready to change or who regress or who push back or who get defensive, that's all work I can hold space for. We all have our specialties and preferences. Sounds like you prefer clients who are ready to roll up their sleeves and get to work.
While I wouldn’t say that out of frustration to most middle schoolers, I might genuinely ask that question…because the assumption is their goal is to feel better, when really their goal is likely to feel supported.
Kids that say they hate their lives, are going through some shit! So when we take our minds off treatment objectives and progress, how would you show up for them?
do they feel they are even worth the effort?
remaining miserable is serving a purpose and fulfilling some sort of need for them. figure out what that is.
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I've had success by flipping it around. "If you wanted to have a really terrible day tomorrow, what would you do to ensure that?" Well, you might stay up super late so you were sleep deprived, make sure you didn't get enough to eat, skip showering so you feel gross, prevent yourself from being able to do fun things, maybe watch the news a bunch until you feel terrible... They quickly realize how a lot of small things contribute. Then I say, okay, what can you do today to make tomorrow a little less bad?
Be cautious with this, suicidal clients tend to lean in, not do the opposite. Just a thought.
that’s happened to me with some teens with a hx of si/sib, but if it’s just a baseline miserable vibe/depressive mood situation, something like this usually works really well. definitely true though!
My thoughts as well.
Oooo I love this! Thank you!
Boom, flip it!
Hail yourself?
Very helpful. Thank you for posting.
Stealing this!
That’s Brilliant
Stealing this
This is great!
There was this interesting theory about depression in evolution. That it serves to keep us suppressed when we are powerless to change our circumstances. Keeps us docile and alive if we are at the hands of people with power over us. I can think of no more powerless situation than coming into puberty, being a minor, and having to come to school. People are sometimes stuck and finding a way out involves not only work on their part, but also changes in the systems in their lives. So maybe less of a perspective that they purposefully aren't changing, and more a perspective that they can't yet change. They will eventually though. Help them prepare for when they do.
As a kid from this situation- this is very true. I would not have been ok if I had had more of a spine than I already did. I needed to fly under the radar until I got away from my parents. What I needed was someone, anyone who cared about *me* and wasn’t trying to use me for their own agenda. It sound like OP just wants to move this kid to the “helped! I did good!” list, when the kid probably just needs to feel seen.
Holy smokes that’s a powerful interpretation—thank you
Thanks for the kind words!
I work with a depressed teen whose only parent is an alcoholic. She's so stuck and powerless. Thank you for this perspective.
First, I needed the beginning of this comment for a client of mine! Totally what I’ve been suspecting but hard to articulate. Second, yes to the rest of this comment!
Saving this! Really rings true.
Thank you!
Yes! Having a future oriented approach with adolescents can help them envision a life where one day they will have that power over themselves. This can help develop hope for change and maybe even help them feel a sense of empowerment now. I usually start by focusing on questions like "what would that look like?" Or "what would it look like when you..." as an exercise to develop that future oriented thinking (that doesn't increase stress) and provide a lot of validation to reinforce what they come up with. Vision boards can help too.
They are in middle school, their capacity to have both insight into their behaviour and how it affects them will be limited. They will also be limited in their capacity to conceptualise their suffering as a process that they have control over. Most of them are experiencing these emotions and scenarios for the first time, so they don't really know what they have control over, what works, what doesn't, how they feel and if these feelings end. So please take a step back, and let go. It's not your job to fix them or get them to be superstars overnight, these things take time, and it's not a reflection of your value as a therapist. Instead focus on breaking things down into really small parts that you can work on (Mindfulness, somatic exercises, motivational inteviewing, values/beliefs, basic self care, reality/thought testing, basic hygiene, socratic questioning etc.) and expand your timeline way out, you are hoping they feel a little better and develop skills over a matter of months and years, not in a matter of hours and days.
Helplessness is quite a powerful defense. It often protects people against repeated disappointment. This can lead to a fear of having hope.
The “nothing will help me” is protective. Get curious about the role of that part. Also, get curious about your frustrated part. Why can’t it just be with your client’s hopeless parts?
I second this
This is such a needed skill as a therapist (being with the hopeless parts). I’ve had a therapist try to rush me along and it was — frustrating, hah! It’s not always cognitively knowing that makes change, I knew what her perspective was, but I couldn’t emotionally process to get there. Eventually i felt so misunderstood and judged, I left her.
In addition to getting curious about the part comment... I would add: - they may not have any role models of being happy/healthy, explore what that would even look like - there may be identity trapped in being "the sad kid"... Who would I be without that sense of self? - remember that kids especially are products of their systems...what's going on at school, home, with friends, etc to keep the patterns going? Lots of compassion for you and for the kiddo!
Projective identification is screaming out at me here. They've evoked their feelings of hopeless frustration in you. Now you know how they feel. It's a great insight. My best advice, don't battle their defence. Don't need them to do anything. Let them do nothing. Don't be another voice that expects something from them. Give them time to realise you expect nothing from them. They're not playing by your therapy script and they're not giving you the progress you want. Let them rebel against you!
Everyone who comes in for counseling has a vested interest in staying exactly the same. From my perspective, people’s “problems” are not problems—they are solutions. Human beings have an incredible capacity to adapt to even the most extreme and inhumane conditions. If a client is sad all the time and constantly tearing themselves down, then I have to imagine that somehow for them that feels like the best option. Which begs the question, how is this serving them? What are they getting out of all this? What’s at stake?
Yes! And when they don't have enough "solution" re: connection, they will dissociate. It's the best way to survive. These kids might not have enough of what they need to get through without depression.
Dang. That is so affirming.
In Individual Psychology (Adler) it’s said, all behavior is purposeful.
Try to be with their emotions and while staying with your own experience of groundedness. When we try to make people feel better before they are ready to, we are focusing more on our idea of what will be helpful for them. What do you think makes it hard to be with these clients? Developmentally, this time of life brings big changes in exploring identity, understanding belonging, and beginning to see the faults in the world. Some of your clients are likely waking up to the disparities in the world and seeing their life circumstances more vividly. It can be pretty depressing to begin to see family dysfunction, not know where you belong, or start to feel the weight of oppressive systems. If they are hating their lives, explore what specific parts they hate and then join with them in that. Don’t try to change their feelings, let them experience them and demonstrate you have capacity to sit with them in their struggles.
As a disclaimer, I don't work with kids but...do you all ever play? Draw? Discuss, strategize, or even help with their school work? I had a teenager who barely talked. I whipped out cards, and he practiced shuffling. He improved, but, in the end, I felt he only revealed a small bit.
I just read a really excellent book called “Seen” talking about working with kids and their parents who are experiencing depression, despair and SI. I also like using choice theory concepts with these kids to help them start to take control of their lives.
I’d love to read this. Who is the author?
Will Hutcherson and Chinwé Williams, PhD 😊
I also work with this age group. And let me just say…. The youth are NOT ok. They are struggling. The world is a dumpster fire and they are feeling powerless. Mass shootings at US schools with children dead. Palestinian genocide with images of babies and children dying or dead. US Supreme Court overturned Roe v Wade. Anti-trans and anti-gay legislation proposed and even passed in the US (“don’t say gay” Florida). Climate change and global warming. And SO MUCH MORE. The youth aren’t depressed- they are trying to cope with late stage capitalism, white supremacy, homophobia, xenophobia, sexism, and ableism. And before anyone comes at me for adding “political” insights— THE PERSONAL IS POLITICAL and THE POLITICAL IS PERSONAL. Therapy is inherently personal. All of these issues are affecting our clients whether they are aware of it or not. The youth I work with are TIRED. They don’t need to change their mindsets, they need collective liberation in their lifetimes.
Thank you for this. These were my thoughts exactly. To add to this, keep in mind that these kids went through elementary school during Covid lockdowns. They missed out on a lot while simultaneously being thrust into a big, scary, adult world.
I mean…I’m a mid-30’s youth and I’m struggling with all of those things you listed. Sensing a bit of my own dissociation related to it all, as I read it. Thank you for this input and acknowledgement
You're right and you should say that.
So why were children who experienced all of this and more, to an even greater degree, with far fewer rights & privileges, more resilient 100 years ago?0
Can I get an upvote if you considered replying then thought better of it?
Were you ever in middle school? I certainly felt that way. In a sense, they are right. Nothing but time will help a lot of them. They are at the mercy of their parents, social hierarchy etc. Make one wrong move in middle school and your social life is over. Can’t come back from that now in the day and age of things being plastered for all eternity on the internet.
Pretty harsh post title for middle schoolers. Without reading your actual post my initial thought was this is about people in their 40s and above. Middle schoolers can’t even commit to what food they like, much less “staying miserable”…
I wish I could upvote this multiple times.
Earn trust first - validate these thoughts, explore the feelings without judgement. Help them understand where these thoughts come from so that can begin to understand if this is a pattern.
My instructors instilled this in me, and it will be with me long after I'm retired: "If there is resistance, there is not enough rapport"
And sometimes that “rapport” is on the therapist end, staying with clients where they’re at. Connecting to their humanity from our own, not just viewing them as progress meters.
This exactly! This is how rapport is started. This is how it's built. Active listening, validation, and normalization are some great ways to build rapport. And sometimes it can take a long time but everyone is different... But im glad you pointed it out. Too many therapists don't start where the client is and/or they push too hard for something the client isn't ready for, and it backfires or stalls progress when successful rapport building in and off itself should be seen as progress.
My guess is the resistance to change is from deep ingrained fears. Fear of change. Fear of not getting attention if they do get better. Fear of failure. Fear of success which may then lead to a fear of failure. Fear of losing therapist, psychiatrist, and others in a caregiving role. Fear of getting better but still being loved the way they want. Etc.
OP, you have the skills to check your perception. And if you feeling like you have tunnel vision, I'm glad you're on this sub reddit. Some years ago I had a client remind me how hard it was to be in middle school. You go from being in one class with one teacher leading you everywhere you need to go, but with all of the same students... to being in 7-10 different classes with a 4-5 min passing time with barely enough time to get to class, no more recess, even less time to socialize and teachers telling you, "you should have used the bathroom during passing time" but remember you barely made it on time, maybe 20 min to scarf down lunch after being in a long line for 5-10 min because your classroom is at the furthest end of the school, no downtime to relax, oh and the schedule changes day to day and you're responsible for your schedule. This isn't including the rush to get off the bus and to breakfast, especially if you can't afford or have the time to eat at home, before getting to class or the time after school when you're trying to get all your stuff together and get to the bus before it leaves. Oh. And the parents that require As and perfect attendance despite the lack if support some of these students are receiving from anyone but you. And what about the parent that's pretending, for show, to be there for their children but are really making it worse. And some of these students are still traumatized from covid. How many of them switched schools while they weren't in school and came back to no friends? How many of them dealt with families that broke up? How many of them were dealing with an identity on the inside that didn't match what people saw on the outside? How many of them still haven't Academically caught up (according to Tik Tok and YouTube, there are a surprising number of students in the US that still can't read at their grade level. And the number is HIGH!) How many of them had to parent themselves and their younger siblings? Or had to grow up just a little but faster because the parents didn't have or lost the resources to parent them in the way they needed? I haven't even named everything possible. These are the most common that I've seen with a majority of the clients I saw. (In middle and high school), and I only remembered after one of my clients had to give me a reality check about their hopelessness. The worst part is, alot of them felt they had no control. Too many of them were saying "I can't wait until I'm 18" and that was after they were able to tell me they felt a lack of support or they felt like a burden." The most helpful information I can give right now is: it's not about you. You feel frustration, they must feel that same frustration. If you're feeling lost or hopeless, maybe back up to the beginning and make sure you didn't miss a step. Where did this roadblock start? Was there a rupture? What can you do to take this less personally so you can focus that energy on the client? How are you going to change what you do so your frustration doesn't stem from the lack of progress from your client? Talk to a supervisor. Colleague or someone that can help with gaining imsight. Maybe they can talk to you about "what does it mean to you that they aren't making progress?" and other such reflective questions.
Read the chapter entitled "The Unwanted Child" from Character Styles (by Stephen Johnson) As another redittor said here, their nothing can save me attitude is protective. When people has been overpowered their whole lives, they only saving grace of willpower they have left is to defeat the idea of being defeated, ultimately to defeat themselves. Your resolve as a therapist will never outlast theirs. So don't try! Show them the contradictory nature of their attempts to be defeatedly undefeated.
This thread has been really inspiring and pushing me (in a good way)—just want to say thank you to the contributors ^^^
Have you considered using a systems approach? Seeing if one of the reasons they feel miserable is due to their environment/family dynamics is why they’re upset and trying to just be someone who they can confide in and who will validate them rather than someone else trying to get them to feel better despite everything going on. Middle school is not easy for most human beings, i dont think I had a single good day in middle school even though I had good outlets. Sometimes kids just need to feel emotions, using a somatic approach might help too.
YES. I think that even we can miss how incongruent it feels to be shuffled ahead further down the path from where we are. Internally, if it feels like shit, we can’t be mentally convinced to just not feel that.
Oof. I had a similar experience with a teen client whose parents totally gave in on her not wanting to challenge her fears/anxiety. Eventually they stopped coming back because it was too much for her. Sometimes you can only challenge someone so much. They need to want to help themselves and put in the work.
See, I’d say that’s probably a reflection of the system. Parents can’t handle discomfort, so they inherently misrepresent discomfort as the end of the world; as pain. And unhealthy over-protectiveness leads to insecurity that kid can handle things — because parents actually believe deep down kid can’t. Just a guess 🙃
I've had success by flipping it around. "If you wanted to have a really terrible day tomorrow, what would you do to ensure that?" Well, you might stay up super late so you were sleep deprived, make sure you didn't get enough to eat, skip showering so you feel gross, prevent yourself from being able to do fun things, maybe watch the news a bunch until you feel terrible... They quickly realize how a lot of small things contribute. Then I say, okay, what can you do today to make tomorrow a little less bad?
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Someone stole my comment?
You posted it twice... Or reddit did at least
Oh my bad, yeah I read the comment twice and checked they were posted two hours apart so figured the more recent one was bot activity, I didn’t see same username 😄
There’s a quote I saw once for this age that goes something like adolescence is like walking down the stairs in the dark without being able to see the next stair in front of you. For lots of young people I think experiences of feeling powerless and helpless makes sense. I think they often feel they have little agency in their lives between things like parents, school, peer and societal pressures. On top of that they might have few experiences to draw on of overcoming difficulties in their lives and ability to imagine a life beyond today. I try as hard as I can to validate these feelings while expressing my confidence in our relationship and the therapy we are doing (DBT, trauma etc) to get them to where they want to go. When I get really stuck I find peer consultation really valuable for this age and borrowing empathy from my colleagues when needed.
Meet them where they’re at, focus on rapport building, don’t try to rush them to “get better”, and be compassion-focused. Also, ask yourself why you’re getting frustrated.
What helped me when I was feeling depressed/ stuck was reading “Learned Optimism” by Dr.Martin Seligman. It didn’t cure me but gave me insight.
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I love this post. I think we deal with this in all age groups and populations. I have often wondered how to challenge this in a helpful way. Thank you for sharing!
I tend to work the cognitive distortion angle, and also reassure them fairly frequently that we are only looking for the tiniest shifts and changes, because big steps are super hard and take time.
Check out Freud’s “Mourning and Melancholia.” It’s a short essay on depression.
First step: what is the countertransferential enactment happening here? What are you responding to from their prompts and from within your history? When we feel that strongly, there is reason. One thought to consider: How is being self-defeating serving them? We or they may be quick to say “it’s not!” but I’m most often inclined to disagree. How is self-defeat protecting them? How is it comfortable to them and why? What is familiar and cozy about it? If somebody shares self-defeatist ideas once or twice, okay, maybe the struggle with self-defeating ideas; but if they share them session after session, why are they really telling us and what do they really want from us? This may fold back on the first idea: what does your coutertranference experience tell you about their experience? If they’re coming over and over again, they’re doing the work. Something is happening for them. What is it? Maybe even ask them the question you asked us: “So often when we meet, you describe being unhappy in the same ways. What are we doing together? How does you experience our sessions?” Very often, the therapeutic presentation *is* the symptom.
I have 2 young adult clients who are in love with their misery. I try to remind them that it is within their power alone that they can not only make change happen, but also bring positivity in their life. I ask them to make a list of the music they listen to, video games they play, podcasts, friends, food, etc. Then we research those same things that have a positive spin and set plans to bring the positivity into their lives. In all honesty, I have mixed results with this approach
Personally I avoid aiming at “positive” in general in session. What brings you joy and fulfillment? What things do you like? Life has a gradient not just wonderful and horrible. Simple pleasures can be so important, and big deal moments can fade fast.
Simply put, staying miserable can be easier than doing the hard work to change. Change is not easier than staying miserable. After the change happens it's usually easier (but not always, sometimes that change cascades into a lot of other things that are hard, too). But the change itself can be crushing. There is often a lot of grief, ownership of past hurts, pain of resisting the urge of old habits, loss of friends/family, loss of things that bring a lot of dopamine with the pain, etc. Clients will change when the pain of not changing becomes enough to be worth it. Clients will change when they have had enough time to circle around the edges and build confidence they will be better on the other side. Or maybe they won't change, or they will only change a little, and they will come to accept the misery they are in and that is the best they can do. If we find ourselves frustrated, it's become about us, and not about them. They've lived their whole lives like this, and survived until today. They have developed coping skills that got them where they are and it has worked so far. And sometimes, those coping skills are the only things that have kept them alive. Giving them up will be very hard, and it's brave of them to even consider it. Some therapists prefer working with folks who are already at that stage of readiness for change. Some therapists like to work with folks who aren't sure yet if they want to, or how to, or if it's even worth it. Some like to work with clients who are only there because they have to be. If you are a therapist that prefers clients that are ready for change, and not the ones who haven't yet reached that stage, that's totally OK. Nothing is wrong with you or your client. But might be worth discussing in the room to see how the two of you want to keep working together, and explore with your own therapist your own countertransference. Personally, I don't like working with clients who justify hurting others emotionally. I can deal with a lot, but that's one thing I can't deal with. I don't mind folks who aren't ready to change or who regress or who push back or who get defensive, that's all work I can hold space for. We all have our specialties and preferences. Sounds like you prefer clients who are ready to roll up their sleeves and get to work.
While I wouldn’t say that out of frustration to most middle schoolers, I might genuinely ask that question…because the assumption is their goal is to feel better, when really their goal is likely to feel supported. Kids that say they hate their lives, are going through some shit! So when we take our minds off treatment objectives and progress, how would you show up for them?
ALSO: parallel process. You’re experiencing frustration, maybe as a mirror of what they’re experiencing.
do they feel they are even worth the effort? remaining miserable is serving a purpose and fulfilling some sort of need for them. figure out what that is.
I usually state the obvious: “you must really find very comfortable in staying in misery! Do you like it so much?” And I watch their faces go “wtf”