I like to think that all therapists have a population which, when considered, brings on sweaty palms and feelings of anxiety. For me, that population is adolescents -- I've had some good experiences working with them, but it does NOT come naturally to me. In some ways, they're like giant toddlers -- and I love working with toddlers -- but with adolescents, their natural inclination toward defiance, independence, and challenging authority just makes me nervous (as do the potential consequences of their behavior!). On the test, dealing with adolescents can come up in a few different ways.
A social worker begins treatment with a 14 year-old girl and her parents; the family has been referred by a school social worker due to truancy issues. The parents report that although her grades are still good, their daughter's behavior is "getting out of control" and ask the social worker to reason with her. The girl tells the social worker that she has been skipping school to spend time with her friends because her parents won't allow her to see them outside of school or speak to them over the phone. "You guys still think of me as a little kid -- it's so annoying!" she tells her parents. What should the social worker do NEXT?
A. Teach the family members effective communication skills and engage in role-playing exercises
B. Explain typical adolescent development to the parents and encourage leniency around socialization
C. Assist the daughter in understanding her parents' perspective and help the family find a topic that encourages consensus
D. Acknowledge family members' differing perspectives and offer psychoeducation around typical adolescent development
There are two points I'd like to make about adolescent development. First, as was stated above, adolescents go through a period of development that is very similar to the development of toddlers, but on a grander scale. There's a push for individuation, separation from the family, and independent (at times seemingly questionable) decision-making. When you are looking at questions on the test, have these developmental tasks in mind, but don't assume that all behavior attributed to the adolescent can be explained by them. Second, remember that the adolescent brain is still developing -- those frontal lobes aren't completely connected to the rest of the brain until the mid-twenties, so mood swings, impulsive behavior, poor decision making, and lack of insight are all par for the course. Helping families understand what's going on in their teen's brain may be a good place to start.
D is the best answer because it acknowledges both the parents and the daughter, while providing the parents with information that may help them understand their daughter's behavior and make a different decision about how to set age appropriate limits with her. A is not the best answer because it bypasses the developmental information and assumes that there is a communication issue. B starts out well enough, but encouraging the parents to be more lenient may alienate them and damage the therapeutic alliance. Likewise, C starts off okay, but moving onto a less controversial topic will not do anything to help the family with their current conflict. Have you been studying for hours today? Put the book, pen, CD, etc., down!
Coming up next week: Work Issues
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