Natalie Frank, a Ph.D. in clinical psychology, specializes in pediatric psychology and behavioral health.
This is a fictional account of a counselor attempting to establish rapport with a sullen teen. The story provides ideas and techniques, both verbal and nonverbal (including silence), and also suggests ways to correct an attempt that’s gone in the wrong direction.
“Trust Me” is written from the viewpoint of a counselor attempting to establish rapport at the beginning of therapy with what may appear to be a difficult teenage boy. In reality, on a scale of 1 to 10, as far as building a connection is concerned, at most he is about a 5—although I'd likely push him down a bit further toward the easier side of things, around a 4. I say this because there is this idea that rapport can be established in a manner of a few minutes if you are a talented therapist, as if it's some sort of magical ability. The truth of the matter is that rapport is the beginnings of a relationship, and when you think of it this way it becomes clear that starting an actual relationship, any relationship, means establishing a bond that is strengthened from that point forward. In therapy, especially with teens, there is a push/pull process that goes on as you feel around for which strands will twist together between you, and they test the waters to see if you are worthy of their trust. I attempted to provide the feel of this process in the way the counselor and the teen interact in this story.
In the narrative, I have used some of my own approaches to working with teens, given some insights into how a psychologist or counselor might think about working with a new teen client, presented a touch of rational behind the characters comments and actions, and provided a glimpse as to how client nonverbal behavior could be interpreted in a closed off adolescent. The manner in which I describe the process of negotiating with parents to maintain a teen's confidentiality is something I would always do, unless the adolescent is court ordered or there is another prohibitive factor which prevents me from doing so. It is important to note that this is not a legal agreement and the teen is still a minor, This means that if a parent insists on knowing what was said in therapy despite the agreement, the therapist must disclose it. It is crucial to let the client know this.
Running into something in therapy that you feel needs to be shared with parents, as mentioned in the story, has negative ramifications for your relationship with you client. Should you find yourself in the position of having to break the teen's confidentiality because the parent demands information, the failure to tell a teen that the agreement is not binding ahead of time, will destroy your relationship to the point you will most likely need to refer them to a different therapist. At the same time, letting the client know you will fight for all your worth as their advocate to convince the parent that going against the agreement is a bad idea that will negate any positive progress you have made with their child will help increase the adolescent's willingness to talk with you about difficult topics.
The story also includes instances when the therapist hits hidden land mines in the adolescent's life which have meaning and implications for him which she does not know about and how she uses or doesn’t use them to further the connection. Additionally, I have attempted to provide some basic human characteristics that therapists like everyone struggle with, especially when tired, such as free association thinking (the bit about the computer), and the realization that she is spending way too much time talking to herself inside her head when she should be talking to someone outside of it. Therapists aren’t immune to basic human processes, and are at the mercy of their physiology like everyone else.
This story is not based on a real client and the counselor is a fictional character not intended to reflect myself or any other specific therapist. It is a work of fiction written in the hope of providing food for thought not just for therapists, and those currently pursuing or seeking therapy. It is meant for everyone who has an interest in relationships, as therapy, like every other human interaction is, at its foundation, only as effective as the strength of the relationship built between those in the room.
It is intended to only present the opening step of the therapy process and the struggle from the therapist’s side as to some of what she goes through to establish the quintessential trust. In reality, this isn’t truly the first step at all, really more of a precondition. Without rapport nothing else can happen. I’d appreciate any feedback and comments you have as well as knowing if this interests you enough to want to read more of this teens story which underscores other skills of the therapy session. Thanks to my readers for their help and support.
They don’t warn me they are sending down another student. I’m still exhausted from the first three, one a crisis which took four hours to locate the resources that would keep them safe and help them return to a life they could enjoy, as well as get them to the facility. God, I so hate the system sometimes. It’s not as if I’m a wolf crier, they have to know that by now. When I say a kid needs help, they need help. As in now. As in more than just an hour with a school counselor should a miracle occur and a teacher decide to let them leave class. As in somewhere safe, away from the very things and people causing their distress, where they can get intensive help in a closed environment, learn to believe in themselves again, trust again.
I catch a movement from the corner of my eye and startle. A boy’s in the doorway just standing there watching me battle my internal demons. Seemingly bored. Lord knows what he thinks I’m doing. He’d probably be surprised to know counselors have problems too. No. I take that back. Not bored. Way off the mark there. From the look on his face I’d say he’s furious and embarrassed. His body posture positively screams, “I’ll NEVER talk to you about ANYTHING and I’ll NEVER listen to what you say!”
Breaking the Ice
Internally, I sigh. Can’t I get a sweet girl once in awhile, maybe one’s who just having some mild boyfriend troubles? I wonder how long he’s been standing there. I also wonder why the hell I’m still talking to myself given he’s still standing there.
“Hi. I’m Jillian.” (I always use my first name which pisses off the administration but it helps the kids open up and so it’s non-negotiable. It’s not like I don’t know where the line is. Plus, pissing off the administration who constantly throw stumbling blocks in my way citing “budgetary issues,” is a bonus.) First name or not, the boy doesn’t budge or reply. I call for the boys info to be brought in, though I don’t have hopes it will arrive in this century. My secretary was a casualty of a previous “budgetary issue.” Computerized records? Yeah, would be nice if yet more budgetary issues weren’t keeping us in the middle ages. Oh I have a computer. One of those big scary bulky things. But a typical student record has too much data (more than about 1000 words is too much data) for the slow speed to open and so you just get error messages all day long, if you’re stupid enough to keep at it. What is it they say about the definition of insanity? That it is doing something over and over again and expecting a different result? Einstein I think. Or maybe Wile E. Coyote who just couldn’t stop himself from going over that cliff.
Insanity - Doing the Same Thing and Expecting Different Results
Try Something Different and Don't go Over the Cliff
Less Than Skillful Opening Due to Internal Monologue
The computer does make a great plant stand, though. One of the younger kids who sees me uses the keyboard to pretend she’s a rock star when she gets stressed. A peer of mine says her kids are fascinated by the fish she has in her old T.V. so I have aspirations of someday turning my monitor into an aquarium.
I try again. “I just found out you’d be coming down so I don’t have any paperwork on you. Not even a name. So how about helping me out here? Get us off to a running start.”
Nothing. Not surprised given the less than skillful opening. Okay, scratch the down to earth, direct approach. I’m so off my game today. Taking care of a suicidal teen for over four hours will do that to you.
Proximity, Attending to Positioning, Beginnings of Engagement
“Why don’t you at least sit down. Anywhere.”
I have a large office, one of the “major perks” I’d been blessed with. Did I say one? The only perk I’d been blessed with. But I’ve used the space to the max. Lot’s of bright cushiony furniture, couches, a moon chair, two huge bean bag chairs, enormous floor cushions,even an inflated yoga ball and a hammock.
He ignores all this and sits directly on the floor. Thinking I wasn't wrong on the instant initial assessment. After everything up to this point I am so not into uncomfortable today. But I won’t be able to do this looking down at him. Bean bag chair it is. Even though he looks away from me I thought the action may have earned me a quarter smile. If so it's a start. An indication he's not totally disengaged.
Either that or he’s cracking up at the old, as in 35 year old, counselor dropping gracelessly into a bean bag. I get settled into the chair without showing anything I don't want to - a major improvement over the last time I sat in this chair - and wait for the shifting pellets beneath me to quiet. I look at him calmly, take a deep breath and begin.
Poll - Formal or Informal Style
Attempt at First Connections: Responding to Non-Verbal Communication
“I don’t want to call you, You, the whole session, personal pronouns never were my thing so how about you give me something else to call you by, real, made up, initials, single initial, your favorite animal whatever you prefer.” That got me a raised eyebrow and direct eye contact for a millisecond, Ah Progress, thy name is small. He looked away again, then mumbled, “Jesse.”
“Okay, Jesse. I know you don’t like being called down here. I hate that they do it so everyone knows where you’re going. Has to be embarrassing for you and make you pretty angry. Then you’re expected to just open up to a complete stranger. I understand that. How about I get the preliminaries out of the way then let’s see if we can come to some common ground, okay?”
Nothing. Not even eye contact. I go over confidentiality and it’s limits as well as who I would have to tell if asked, legally, including his parents since he’s a minor. Finally a reaction though it’s a snort and in profile. Next step might help. If I can get his parents and they at least are somewhat reasonable.
Listen, I know that not one single teenager is ever going to trust me enough to tell me anything if they think I will have to tell it all to their parents. I have a way to deal with parents, which almost always works, so teenagers can tell me what they want with certain exceptions and not worry about me telling everything to their parents. It’s usually not so tough to get parents to go along with it.”
I can tell he is struggling with some type of internal battle. Likely at least part of it is the ‘Can I trust her or can’t I? Should I trust her or shouldn’t I?’ questions. Right now I’m sure his answers to both would be a resounding no.
He moves slightly to face me a bit more but I guess he probably doesn’t want me to notice the move so I don’t indicate I see what he’s done He turns another hairsbreadth. I turn to my desk supposedly to grab a pad and pen but remain with my back turned so that by the time I turn around he has had enough time to turn to face me directly which I purposely ignore.
“So?” I try. You can’t get much more open ended than that.
I’m rewarded with a “So what?” and a raised eyebrow. Nice open-ender of his own.
Keeping it vague to give him the greatest range to respond I say, “So, what do you think?”
“About what?” He’s trying not to give an inch yet he’s still facing me and speaking even if just in a few words that says nothing. He’s also moved from the closed up body position and is leaning back on his hands legs straight out and uncrossed, an open posture if ever I saw one. If only I could teach my counseling students that you measure progress in the little things, not the “Aha!” moments which almost never come.
“Listening to my plan.” I reply, getting use to the pace of the exchange.
I just got a shrug which suggested an answer like ,“Why not? I’m stuck her with nothing better to do.” It’s about what I expect at this point. I still have to pull out the magic wand to whip his parents into shape with from his point of view before I’ll get much more than the sullen whatever response. Still I back off a bit and let him think, get more used to the environment and me. I’ll let him signal when he’s ready to continue.
Learn About the Importance of Non-Verbal Clusters
Learn About the Importance of Non-Verbal Baselines
Thinking Outside of the Box - Going Beyond Traditional Techniques
After several minutes go by in silence, Jesse’s gaze locks on his feet, he says, “Almost always?”
Yes! Spontaneous response! But. . . Non-sequitur. Uh Oh. Brain freeze. Hold on, I know it was said and in the last 10 minutes. Just told me you were coming down, sit down, embarrassment, confidentiality . . . Eureka!
“Well, there was one time the parents wouldn’t go along, but the kid had been in jail in 8 states so it was actually pretty reasonable they’d want to know what he was saying to me in case he planned to knock over another convenience store.” I deadpan it and am rewarded with a ghost of a smile though he’s working hard to hide it. I wait.
“Is that story true?”
“Nope,” I reply. “Not one word of it. I have had a single parent who’d only been a single parent for a month or so who was very protective and felt the need to know everything about their daughter.”
“I’ll assume you’re asking about what I did. I worked within the constraints I had. Luckily the parent learned pretty quickly the importance of what I was asking them after three sessions went by and all I could report was that his daughter had sat without saying a word each time. I re- suggested my my previous deal and he took me up on it.”
“By way of parents not going along? Yep, so far that’s it.
Negotiating with Parents to Maintain Teen's Confidentiality
There’s more silence.
“Mine wouldn’t agree to me keeping secrets with you. You’d definitely have to add them to the ‘almost always.’ group,” he says with a sardonic grin.
“Think so?” I asked putting a bored tone into my voice.
“Definitely.” Defiance flashes in his eyes. I am being tested.
“Or are you maybe hoping they’ll refuse to give you an excuse not to trust me?”
His face whips upward, he gives me a startled look which is quickly replaced with an intense, resentful one. Too much confrontation too soon. I back off and let things cool for a bit.
After a few minutes I say, “I guess I pushed a bit too hard with that last one. How about I tell you what I’d like to do, but only if you’re okay with the plan,” here I get the briefest of looks but it’s something, “and you can just listen, then we’ll go from there.” There’s no response. I push ahead anyway.
"Okay, so when I work with teenagers, I recognize they aren’t going to get anything out of being here unless we can establish a relationship of mutual trust. You’ll note I said mutual. This isn’t a one way street. I don’t know anything more about you than you do about me and just like you’ll be trying to figure out if you can trust me to help you while keeping you safe, I have to be able to trust you in terms of knowing you will tell me the truth at least about the big stuff. I know there’s some stuff to get through at the beginning before you do trust me and whatever happens then is passed over, disregarded. It’s just the normal feeling each other out to see what’s what/ When we get to the meat of it though I need your trust and I need your honesty as much as you need mine. So far so good?”
At first I don’t think he will respond but I won’t go past this point until he gives me some indication at least that he’s heard and understands. Finally, he says, “Yep,” looking just to the right of and past me.
Donna picks then to bring in Jesse’s info. I don’t open the file as I don’t want to interrupt that amazing rapport that’s building oh so rapidly.
“Generally what I do with teens is speak with their parents and explain what I’ve explained to you. I say that, in this case, your son is unhappy and needs a neutral person to speak with. But you know teens. They never trust adults even with the most basic information like what did you have for lunch today?”
He mumbles something. Another spontaneous vocalization. Still on track though moving slowly. Hallelujah
“What did you say?”
“What did you do at school today? She always asks. I don’t tell her. Drives her crazy.”
I don’t address the content at that point but save it up for another time. “Right. I’ll change that around. I’ll then tell your mom that I know how much she cares about you, and wants you to be happy. I’ll point out how important it is for you to have someone you can talk to and how, let’s face it, for teens that person is almost never a parent.” I’m rewarded with a snort.
“Is that a ‘duh’ snort or an ‘I’m completely off base with what your mom will respond to’ snort?
“Fine. I’ll then strike a deal with her. I’ll tell her the only way you’ll feel that you can open up to me is if you know I won’t be discussing everything said in here with her and your father. That way you’ll know the info is confidential. I will also assure her, however, that if I think you are doing anything dangerous or are thinking of doing anything dangerous I will notify her. Do you think there are things she will insist on knowing?”
“Not an option. I’ll talk her down to reasonable. I have yet to fail.”
“We were good before the 4th session started.
Counselor as Client Advocate
“So anything you can think of your parents won’t negotiate?” I need to know because the second you have to actually tell a parent something their child disclosed in therapy you burn your bridge with them. I prefer to know ahead of time if trouble may be coming down the pike and figure out a way to avoid it, which can be tricky but so far I’ve managed it. I realize I’m holding my breath fearful if tearing apart this fragile trust.
“Do I have to worry that I might have to inform her about this at some point?”
“Nope. Unless a little pot counts.”
Did he just disclose something? Other than a grunt, snort or single word utterance? There’s a glimmer of a spark that’s just visible where ‘rapport’ stands. Now I just have to figure out how to fan it into a flame. “How little is a little?” I ask
“I’ve only done it twice, okay? I didn’t even like it much. Just made me dopey and hungry. I’m just not saying I might not do it again.”
“Between us, I don’t have an issue with a little pot, and personally don’t think it’s falls under the category of information that needs to be turned over to you mom. It is still illegal though but sometimes I have a memory problem so that shouldn’t be an issue if it were to arise.” Direct eye contact and both eyebrows in the stratosphere. “But if it were to become a thing we’d have to discuss it and I’d have to make a decision which would most likely be to inform your parents. Clear?”
“Ain’t no thang.”
Slang. Rapport is flickering heading for fully lit.
“And so you know, if I ever feel the need to say something to your parents, I will tell you first and go through exactly what I will say. I will also give you the chance to tell them first in session with me so I can act as your advocate should things become tense and we’ll go over how to tell them beforehand.”
“My advocate, right.” Revert to sarcasm. One step forward, two steps back.
“Not sure what that means.”
“It means adults stick together.”
“Look Jesse, if there’s one thing we need to have clear before we decide if we’ll work together it’s that I’m your advocate, you are my priority and that is whether your parents ever become part of this or not. You are my client not your parents and that will not change. It is your best interests that are always at the forefront of my mind not your parents, siblings, friends, or even favorite sports team.”
The slightest hint of a smile. “Yeah, well the Cubs are pretty cool. Smokin the series.”
“Yeah, well smokin or not if they ever become part of your therapy, “ hear he drops his head but not before I catch a big smile,” they will all have to be told you are my priority and if they need help they’ll just have to find their own therapist. Same goes with your parents, okay?”
We were moving forward until I mentioned his parents. Now his face is back to neutral, a doubtful look in the eyes. Well that one he’ll just have to trust me on and we’ll both hope it never comes down to it.
Using Humor to Diffuse Tension and Take it On Home
After a minute, he asks, ““How many times have you really informed on a kid?” he asks.
Informed on? Trust and rapport back to zero, do not pass go.
“Oh, only with that one kid, you know.” I flip through the his folder nonchalantly hoping he’ll pick up the punch line. A beat goes by. Then another and I realize I’m holding my breath.
“The one who knocked over convenient stores?” he finally says.
“Yep,” I say mentally putting both fists in the air.
Looking down I notice his name is actually Aaron. His older brother is named Jesse. Something else to pursue. I’ll have to use Aaron for the call but then call him Jesse until we get to a point he’s ready to go there. In the meantime the topic will be percolating since he’s aware I know his real name so hopefully he’ll be processing what’s up with using his brother’s name and be able to articulate it when the time comes.
I move ahead without mentioning it. I explain how I will handle his mother’s potential objections which I get from him. While at first he is reluctant to give me much as time goes on, he opens up more. When it seems that we’ve exhausted all the reasonable objections I encourage him to think outside the box and just throw anything at me for fun. After a couple of careful attempts he starts getting into it, even trying to imitate his mother’s voice in a pretty good falsetto.
“So what if you learn he thinks one of his friends could be a terrorist?” Jesse asks, his voice high.
I laugh, then reply,“I’d get as much information as I could but if there’s any credibility whatsoever to the claim, I’d have to call homeland security.”
“You wouldn’t call us first? I resent that.” Jesse is even starting to add facial expressions.
“I understand, Mrs. Moore, but surely you understand that sometimes kids report something they attribute to a friend when it’s actually them.”
“Are you suggesting my Jesse could be a terrorist? I’ll have your license for that.”
I can’t help but laugh at the direction in which this is going. “But Mrs. Moore, you came up with the idea. Is there something you need to tell me?
Jesse laughs. “Of course not. Even if my precious baby was somehow implicated, based on a complete mistake mind you. . . “
“Oh course” I supply.
“. . . I still don’t understand why you wouldn’t call us first.”
“Well, if it is a case where the child is hiding his leanings behind a friend, based on a complete mistake mind you, it’s possible that he learned his uh. . . Behavior Problems from his parents. So I certainly wouldn’t want to tip them off. Plus that would likely get me in trouble with Homeland Security. I really don’t think I’d make a good prisoner at GItmo.”
Jesse cracks up, then tries to get back into character. “Are you now calling my husband and I terrorists?”
“No, of course not Mrs. Moor. Again I’m just going on the scenario you gave me.”
Jesse switches back to his normal voice, and asks,”Is there something you;d like to tell me mom?”
We both lose it. When we get it back under control I ask “Jesse’s Mother” if he she has any other concerns.
“Yes, aliens. What if he tells you he’s certain his girlfriend is an alien?”
“Well, when girls and boys start dating, they often feel the opposite gender are alien.”
“No,” Jesse interjects emphatically. “I mean a real alien.”
Still pretending not to understand, I say, “My ethics code does not mandate I turn in any illegal aliens so it wouldn’t be a problem.”
“No,” Jesse, screeches in falsetto nearly rupturing my eardrums. “I mean an actual alien, you know, like ET phone home, goat slaughtering, dog food eating giant prawn-things?”
I can hardly answer I’m laughing so hard. “I think it would have to be the same answer as to the terrorist question only of course I’d call NASA. Or someone at Area 51”
“Let me guess, my son could really be the alien which means we would have to be aliens also? Oh this is just too much, Bill!” Bill is Jesse’s father’s name. “Bill! Oh there you are, I’ll have you know that Therapist person at the school seems to believe you and I are alien terrorists. Now what are you going to do about it?”
We both laughing so hard we can barely catch our breath.
“You call. . . terrorist activity. . .a behavior problem?” He barely manages to get it out.
“You weren’t . . . you then. . . you were your mom. . . I thought she would. . . take that better.” I’m just as bad.
He switches to a lower voice. “Mr. Bin Ladin, could you tell us about some of your. . . behavior problems please?
And we’re off again. Jesse is literally rolling around on the floor and I practically slip off my bean bag. I can’t help but ask, “Goat slaughtering, dog food eating giant prawn-things?”
“Districts 9. Don’t waste your money,” He replies
When we both finally do calm down we sit there for a minute just breathing.
Making the Call
I look at him and I ask, “Ready?
He shrugs and gets up.
“Hey, where are you going?” I ask.
“Teacher’s don’t let you listen in on a parent-teacher conversation.”
“I’m not a teacher, you’re the one talking to me so you are the one I have a responsibility to, so I’d never make the call behind your back. Sit back down. Though my back is killing me so could you make it a little higher up this time?” A small gin then he launches himself into the hammock. At least he’s facing me and didn’t get in backwards.
I pick up the receiver, raise my own eyebrow at him in question, receive a nod and dial.
As predicted, after addressing a few concerns (none of them terrorist or little green men from another planet related), mom went for it, and I gave Jesse the OK sign.
Also as predicted this caused ‘Jesse’ to go back into his shell. He climbed out of the hammock and went back to the floor.
This time I sat there with him side by side so he wouldn’t be threatened by me facing him directly.
We stayed silent for several minutes while I let him think and wrestle with whether to believe in me. Then I felt him shudder and heard his breath hitch. He’d decided.
I look at him over one shoulder, and softly say, “I know it’s scary. Take a couple of deep breaths and just start wherever you want. This is your show.”
He turned to look over his shoulder meeting my eyes, the pain evident in his open expression.
“Trust me,” I say.
I hear him breath in, and out a few times, then he takes a big breath and as he exhales he does just that. I am left humbled. Suddenly the floor doesn’t feel so hard.
Additional Resources of Interest
Discussion: Please Answer Any or Add a Thought in Comments
I'd love to get a discussion going based on some of the issues in this story. Please take the time to answer any of the questions below you choose or simply comment on something in the story you find relevant. Please use the comments section. Thanks.
1. How do you go about establishing rapport with a teenage client? Do you tend to have a specific style or do you vary it based on the teen?
2. For those who treat children, teens and adults, what are the differences in establishing rapport with teens compared to the other two groups.
3. How do you deal with the issue of confidentiality with teens and their parents and have you ever had to go to parents with something a teen told you that they assumed would be confidential? If so how did you handle it.
4. Do you add anything extra to your informed consent when working with teens to ensure they understand the limits not only with authorities but with their parents?
5. Please comment on any other issue you would like as it regards rapport or the ethics involved with counseling teens.
Thanks for your participation in this discussion!
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2016 Natalie Frank