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Posted: Jul 21, 2005 16:38


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Shy And Withdrawn Teens
A Parent Guide
Part Three: Treatment Options
By: Marc D. Skelton, Ph.D., Psy.D., ABPP

[Dr. Marc Skelton is a licensed adult and adolescent clinical psychologist as well as a marriage and family therapist. He also earned board certification as a Diplomate in clinical psychology from the American Board of Professional Psychology (ABPP).]

In the third and final part of his essay on shy/withdrawn teens, Dr. Skelton describes the treatment options parents can access to help the family and teen.

The Office Therapy Process—Individual

  1. Psychotherapy or Counseling—Basic Operations:

      a.) Symptom Reduction—example: Decreasing depression

      b.) Conflict Resolution—example: Setting a reasonable curfew

      c.) Skill Building—example: Teaching direct communication

  2. Psychotherapy or Counseling—Basic Goals:

      a.) Insight into the nature of problems addressed

      b.) Decreased distress (addresses symptom reduction)

      c.) Modifying irrational cognitions, beliefs, and dysfunctional habits

      d.) Environmental restructuring to change behavior

The Office Therapy Process—Family

At some point, parents always become part of the treatment plan with their son or daughter. There comes a point in the therapy when an adolescent can directly negotiate and/or compromise with parents in a family session.

  1. Family sessions focus on a blend of the above individual therapy efforts, along with interpersonal components. Major strategies to deal effectively with your teen in the family context include:
    a.) Seek Partial Compliance: If an adolescent is to be home at 9 or 10 p.m. during the school week and comes in one night at 11 p.m. and the next at 10:30 p.m., you see the attempt at compliance in the 10:30 p.m. arrival and positively comment on the progress. b.) Choose your battles: Responding to all infractions will only serve to wear parents out and provide adolescents with recharged will.
    c.) The blame game does not help either arguing party. Power struggles and control issues are inevitable. Given an adolescentís increased cognitive ability they are without question now able to argue and use logic (at times). Parents do not have inexhaustible energy and resources at their disposal, therefore choosing the right “battle” is important with an adolescent. Always maintain at least some communication.
    d.) Behavioral contracts can also be productive. The contracts are useful because they require establishing a plan with rules and consequences (positive & negative) ahead of time. A good contract is one that both parties can live by. With shy/withdrawn teens, the contract may focus on talking more with others as a goal, which is in contrast to an already outgoing teen that needs limits on telephone time.

The Residential Therapy Process—Individual and Family

Interventions for out-of-home or residential therapy process mirror those offered in the office therapy process for individuals and families with one important added component: Intensive program structure and staff/peer support.

Virtually all residential programs can use the power of groups. In addition, using socializing agents (such as parents or teachers) or peer mediated approaches, is ideal.

Adolescents who are excessively withdrawn may benefit more, at least initially, in individual psychotherapy versus group therapy. In time, group therapy can be utilized and is often helpful in improving social skills using positive peer influence. At the same time, shy/withdrawn teens are oftentimes capable of skillful insights, and writing assignments about their own motivations can be helpful. Thus, an autobiography can be written, with the teen reflecting meaningfully about his/her past then shared with the group.

Highly structured programs can contain serious acting out or detached behaviors in teens, while providing support to learn more adaptive coping. Behavioral contracts can be used to focus attention on learning, then maintaining positive thoughts, feelings and actions. For example, a teen can be rewarded for accomplishing a specific contract item that reads, “Pt. will remain abstinent from all drugs, while attending entire treatment program.”

In the continuum of care from outpatient to residential or even inpatient treatment—degree of structure, consistency, limit-setting and positive peer interaction are all increased. Social skills are easier to learn in a structured setting with other teens present and there is an opportunity for the adolescent to internalize self-regulation and enhanced self-image. The structure of residential/inpatient treatment allows control of the adolescent’s lifestyle to the extent that alcohol and drugs will, of course, be eliminated. How to turn around adversity is the main question with adolescents.

Because problems occur in a context it is important to treat parents along with their adolescent at appropriate junctures in outpatient, or if needed, more intensive residential settings. Whether parents take on the assignment to help their shy/withdrawn teen informally, or turn to outpatient or residential/inpatient treatment options the assessment and treatment guidelines detailed can be followed to create life changing enhancement in their shy/withdrawn teen.

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