It's hard to recall the number of times I've heard a therapist complain about lack of participation with teens in virtual therapy, lamenting over a lack of responsiveness and resistance to being seen on camera. Sitting on the other end while a teen states (for the eighth time) "I dunno…" can be both daunting and draining. These challenges have left therapists and parents really eager to rush back to normalcy as states ease COVID restrictions. Understandably, this reality has also led to doubt about the feasibility of hiring a therapist whose practice is 100% online (*cough cough*).
Choosing a therapist whose work is fully online makes sense for many families. Some live in more rural areas in which the nearest teen therapist is too far away for regular trips. For others, there may be a lack of transportation if the teen isn't driving. And let's face it, in the middle of a pandemic, plenty of us (myself included) simply want to protect our health for the long haul. So what makes for a good online therapy experience for angry teens?
Being comfortable with awkward silences
Many parents are surprised when I make it a point to express my comfort with awkward silence. I would argue that willingness to sit in silence is a hallmark of any decent teen therapist (among other skills of course!). However, this may be perceived as a problem when--from the parents' perspective--money is being spent for a therapist to sit with their kid in silence. I get it.
When working with kids--especially those who are prone to anger and irritability--it's essential to follow their lead. So yeah, if the teen wants to sit in silence for 20 minutes, we're sitting in silence for 20 minutes, because the likelihood that this client will eventually open up increases exponentially with each minute that I am willing to sit in silence...but please don't tell them my secret. I promise this isn't an experiment. This is tried and true. Some of my strongest therapeutic bonds (which are necessary for results) happened with kids who took weeks before talking to me. Being a therapist who is dedicated to working with teenagers who are irritable means playing the long game.
Why am I mentioning my monk-like ability to sit in silence with angry teens? Because I need parents to know that if this happens, it's part of the process…
But Dr. Stephanie, how will I know my kid hasn't left the therapy "room" if they're not talking?!...For starters, your kid shouldn't be within ear-shot (per our informed consent for minors addendum). Second, when the client ends the session before time is up, I always call the parents to let them know and we decide together how to proceed (preferably in a way that doesn't involve chastising the client).
During the intake process, we will discuss and delineate the expectations for both parents and teens. I won't give away all my juicy secrets here, but discussing expectations goes beyond the basics, like showing up on time and paying after each session. It includes making sure the teen understands that therapy is a private event, so there will be no therapy sessions in the car with friends or family.
Why am I mentioning the setting of expectations? Because setting expectations increases predictability. Predictability is like a salve for anxiety, and anxiety breeds anger. Part of treating anger includes (but is not limited to) creating a sense of predictability and consistency. Once angry teens know what to expect from therapy (e.g., Dr. Stephanie is not hanging out in the car with her friends during therapy, and neither should you), there is an increased likelihood that they will eventually buy into the process because there is a greater sense of emotional safety.
A willingness to roll with the punches is non-negotiable when working with angry teens. Sometimes, this means playing Ranger Steve while talking about the most recent episode of cussing out the teacher or eloping from virtual classes. It can also mean agreeing to let the teen put the laptop next to them on the couch while we watch Naruto for 20 minutes. I promise, every minute I've spent doing this has yielded countless minutes of deep, authentic clinical work that has helped the teen get to the root of their anger.
On the outside, these behaviors look like I'm just playing with the teen or "letting them call the shots." But as you'll learn in our work in parent sessions, this is more so about giving the teen a sense of agency. Children tend to be more explosive when there's a loss of a sense of control, and "letting" them decide how we spend our sessions (be it sitting in silence, listening to Billie Eilish, or watching their favorite show) is part of exploring what gives them a sense of agency.
Online therapy isn't for everyone, but under the current circumstances, it's all some folks have. Being patient with the process can maximize the likelihood of your family having a positive experience. And remember, the therapist-client fit is often more important than the in-person/online debate. A therapist who is qualified and experienced in treating your issues will help you decide if online therapy is right for your family. Feel free to contact me to help you decide whether this option will meet your needs!