Beyond Talk Therapy: Alternative Therapies for Teens

Working with teens in the counselling space can be incredibly rich and rewarding – and it also holds its own considerations. Beyond basics like whether they’ve come to therapy of their own accord or have been sent by a caregiver, there are other factors to be aware of when working with this population. Simply put, teens are their own animal. Their brains are developing in different ways than younger children or adults. This invites counsellors to view them through a broader lens, and also offers the potential for deep discovery and insight in therapy.

Dr. Daniel J. Siegel, psychiatrist and founding co-director of the Mindful Awareness Research Center at UCLA, explains the twofold task of the adolescent brain as it remodels itself. Its first task is to prune itself. Whereas in younger childhood the brain is absorbing any and all information, during adolescence the brain begins to differentiate. This is where teens begin to specialize and find their passion.

The second task of the adolescent brain is myelination. Myelin is the healthy sheath that allows connected neurons to communicate with each other in a faster, more efficient, and coordinated way. Teens can use this focused attention to become more aware of themselves, others, their environments, thoughts and activities. The potential this offers in the counselling space is vast, as so much of our work with adolescent clients involves supporting them to expand self-awareness; build interpersonal skills; and connect to their meaning and passion.

This myelination – or linkage, as Siegel calls it – can reinforce parts of the brain that a person wishes to hold onto. Between the differentiation provided by pruning, and the linkage from myelination, the brain becomes more integrated. And integration, according to Siegel, is what allows “more intricate functions to emerge – such as insight, empathy, intuition, and morality. A result of this integration is kindness, resilience, and health” (reference #1, see below).

In his work, Dr. Siegel puts forth what he calls the ESSENCE of adolescence – an acronym that stands for Emotional Spark, Social Engagement, Novelty-seeking, and Creative Exploration. Emotional spark refers to the way that “emotion generated from sub-cortical areas washes over the cortical circuits of reasoning” (reference #2, see below). When we talk about teens and emotions, we often hear stories about attitude. Viewed from a more empowering lens, however, emotional spark points toward their passion and idealism.

Social engagement refers to the importance of relationships in our lives. During adolescence, this can look like turning away from parents and more toward peers. It also highlights how central relationships are in influencing and shaping who we become. Social engagement is an important aspect of our sense of connection to the world around us.

Novelty-seeking can certainly be problematic for teens: though their bodies are strong, they can be at greater risk for injury and harm. It’s one of the reasons why getting a driver’s licence is such an arduous process, and why insurance rates are higher for new drivers. On the other hand, novelty-seeking is what allows teens to move beyond the safe and familiar and into the great unknown – an important task in becoming their own people. And finally, creative exploration is a feature of the idealism that we often see from youth – that ability to see beyond (and challenge!) the status quo, in order to imagine what could be.

Why spend so long setting the stage simply to discuss alternative therapies for teens? It’s important to appreciate who we are working with so that we can understand better ways to serve them. What follows are some of my favoured approaches to working with teens – and there are many more, as well.

Art Therapy

Art therapy is a great go-to with teens. At this age, straight-on talk therapy can feel too direct. For some, language isn’t a great resource, and talk therapy can be quite demanding in this respect. Others are in counselling because their caregivers want them to be. In those cases, buy-in is not even a guarantee. Finding common ground and ways to establish therapeutic rapport are paramount.

Many adolescents also prefer a more casual approach, finding a clinical setting to be too formal for them to relax and feel safe in. Pulling out art supplies can help teens feel at ease. It invites imagination, creativity, and play. And though play sounds like a simple concept, its effects can be profound.

One of the things we can work with in art therapy is implicit rather than explicit processes – the emotional more than the cognitive. Allan Schore (2009) discusses the dominance of the right hemisphere of the brain in “the recognition of emotions, the expression of spontaneous and intense emotions, and the nonverbal communication of emotions” (p. 114). When we sit down to play with our adolescent clients, we come alongside and communicate indirectly with their emotions.

The results are often surprising. One teenage client I worked with had been coming for weeks, quite unwillingly. As a general rule I tend to decline working with clients who do not wish to be there. I made an exception in this case because the severity and immediacy of the trauma warranted intervention. We plodded along, week after week – I, trying to build therapeutic rapport and they, steadfastly withdrawn. One week we did some drawing to explore the trauma. What they drew was nuanced and expressive, the emotional communication as clear as a bell. While they had been drawing I also drew – a unicorn wearing high heels. For the first time I saw this client laugh, marking the beginning of our therapeutic bond.

Through the lens of Daniel Siegel’s work, what came alive in this interaction was the client’s emotional spark, as they shared their passion for art with me; their social engagement as we connected relationally for the first time; and of course, their creative exploration. They wordlessly taught me what they needed from therapy: an approach that fit their passions, and a language through which they could express themselves.

Somatic Therapy

Somatic therapy is a body-based approach to working with clients (soma means body in Latin). In this therapeutic technique, the body is seen as a holder of information – if you’ve ever heard the term “your issues are in your tissues” it fits here. It’s particularly useful when working with trauma. There are certain situations when cognitive approaches fall short: simply put, one cannot think their way out of trauma. When trauma is alive in the body, it must be resolved in the body.

In situations of dissociation or disconnect, somatic therapy is a means by which counsellors can help the client re-enter their bodies in a safe way. A guiding principle is that we cannot change what happened in the past, but we can change the way it’s held in the present. And the way we do this is twofold: with present-time awareness and relational support.

Generally speaking, the present moment is safer than the traumatic memories from the past. As counsellors we can help clients anchor themselves in the present moment so that they can recognize and distinguish this from the past. It must be a ‘felt sense’: their body must take in the information of the now, and allow it to update residual fear and trauma still being held in the body.

Another other key piece of somatic therapy is the relational nature of trauma. Oftentimes there was not enough (or any) support for the individual when the trauma occurred. A phrase that lends well to the experience is “No map, no help, no exit”. Our role as counsellors is to help repair that rupture, as we support the client in the present. We do this through attunement, validation, and mirroring the client’s words and gestures.

Somatic therapy lends well to themes that can arise for teens, such as bodily awareness and boundary support. Growing up, it’s fairly standard for children to be given a lot of direction. As they enter adolescence, they begin to see the world more through their own eyes. This fits well with Dr. Siegel’s’ pruning concept: rather than taking in any and all information, teens begin to specialize and find their own passions and interests. What helps any of us know what matters to us, what rings true and what does not? Bodily awareness is essential to this – the ability to check in sense of what fits, what feels safe, and what inspires us. Some people call this gut instinct.

As teens move beyond their families and into broader social connections, understanding boundaries takes on new meaning. There are a couple of activities that I like to use with them to help them gain a greater sense of their own personal space. In the first activity, they stand still and I gradually approach them. This goes very slowly so that they can continually check in with their bodies and see how they feel: Is the person too close? Do I want them to come closer? Would I like them to be more to the left or right of me? I encourage teens to get really fussy about their needs – oftentimes a new permission for them. The goal is for them to get a felt sense in their bodies of what feels ‘just right’.

Another way to explore boundaries is with props. I offer them rope and encourage them to create a circle around themselves, however large or small they feel it needs to be. Then using other props as well (pillows, furniture), I encourage them to make the boundary as strong or as permeable as feels right to them. And then again, we explore how close or near feels okay for them to have someone approach. During adolescence, teens often begin to explore intimate relationships for the first time. Whether for this reason or to simply practice assertiveness, boundary work can be a means for learning about embodiment, autonomy, and empowerment.

A Final Word

An academic supervisor for my counselling degree once said to me, “You should be experimenting in therapy.” This surprised me: at the time I really thought we had to do things by the book. As open as teens are to novelty seeking and creative exploration, they are among the most up for experimentation in therapy. Our adolescent clients are wonderful teachers.

In the end, it comes down to safety and rapport. When clients feel safe with you, they are more likely to trust the therapeutic process. The more that we, as clinicians, can abandon our own agendas and show up for what happens in the present moment, the more our teens clients will feel seen and respected. And I might add: it’s better for us, as well. Curiosity, exploration, and play don’t stop in adolescence. These qualities help us keep the passion for our work both generative and alive.

Resources

1) Dr. Daniel Siegel’s work, including articles, videos, and books: www.drdansiegel.com

2) Art therapy content and ideas:
expressiveartworkshops.com
arttherapyblog.com
thirstyforart.com

3) Somatic resources:
Opening to Grace Somatic Studies ~ openingtograce.com
*this is where I received my certification in relational somatic therapy

Lisa Mortimore ~ lisamortimore.com/workshops-training/
*Dr. Mortimore has contributed to Insights magazine in the past, and also offers trainings in somatic attachment

Trauma Geek: Trauma and Neurodiversity Education ~ facebook.com/TraumaGeek/
*this creator generates incredibly comprehensive and educational posts on, among other things, somatic therapy tools

References Within the Article

1) https://www.drdansiegel.com/about/interpersonal_neurobiology/

2) https://www.drdansiegel.com/blog/2014/02/07/the-essence-of-adolescence/

3) Right-Brain Affect Regulation: An Essential Mechanism of Development, Trauma, Dissociation, and Psychotherapy, Allan N. Schore, The Healing Power of Emotion (pp. 112-144).