Reconfiguring adolescent–parent psychotherapy

In this chapter, a recalibration of our understanding of working with parents and adolescents is presented. Traditionally, this has been marginalised, both in the clinical setting and in the Child and Adolescent Psychotherapy literature and research. The marginalisation of parents in the therapeutic process leads to poorer therapeutic outcomes for the adolescent. Instead, when the therapist incorporates the parent–adolescent relationship as one that, by its nature, is deeply intertwined, powerful unconscious dynamics become part of the therapeutic process, both in the service of adolescent health and growth and as well as in working through negative experiences and identifications. The chapter describes five essential components that give rise to the necessity for the reconfiguration of adolescent–parent psychotherapy. The first is attention to the developmental task of adolescence; the second is reframing the adolescent’s presenting problem as an opportunity with dynamic meaning in parental relationship terms; the third involves widening the therapeutic frame, paying attention to the adolescent’s experience within the school, the community, and culture; the fourth component, time-limited psychotherapy, challenges the assumption that long-term therapy is the required therapy for troubled adolescents; and finally, the fifth component takes a values-based approach, emphasising the need for parental duty of care in supporting adolescents at a time of major social and technological change. Several clinical vignettes are included in the chapter that illustrate how these five components enable the therapist to engage in an assessment and treatment process that substitutes a linear individual pathology-based focus with one that promotes relational meaning and empowers parents to support their adolescent in the longer term. In this way, confidence is instilled in a therapeutic process that affirms and empowers both adolescents and their parents to trust in their own capacity to bring about positive change. This therapeutic method has implications for the way in which ‘risk’ is understood and managed, since the adolescent–parent therapeutic approach provides the essential scaffold as a holding and containing framework. As such, in Winnicottian terms, a facilitating therapeutic environment is generated for the developmental priorities of the adolescent and young person.