Working with a fourteen year old like Jack who is struggling with a circumscribed problem - in this case, sleep disturbance - can be gratifying work, as a good outcome is highly likely. For situations such as these I often engage the adolescent in relaxation training, deep breathing techniques, and good "sleep hygiene" (such as minimizing caffeine, waking up at the same time each morning to develop a proper sleep schedule, etc.).
After our misunderstanding regarding his classmate and potential stepmother Angie, our relationship had suffered a rift. Thus, the goal of the next session was to "re-establish the therapeutic alliance." In other words, I had to get the extremely bright and interpersonally sensitive Jack to like me again and have confidence that I can help him. Research shows that a strong therapeutic alliance is the best predictor of a positive outcome in treatment.
"Jack, how about we talk about what happened last time?"
"I'd like that very much. But we should converse as adults," Jack says, sitting with perfect posture on the therapy couch.
"That would be...lovely," I say, realizing that if I had Jack's posture as a teenager, I probably wouldn't have my current back problems. "Shall I speak first?"
"Actually," Jack says, "Mom explained your malady to me and I looked up SI Joint on Web MD. How do you intend to mitigate your ailment?"
"Mitigate?"
"Yes," Jack says. "The SAT's are coming up in 3 years, and there are some fascinating words related to back injuries. Your pain is my gain!"
"Well good. Let's not worry about my back, let's talk about you and I. Do you understand now that I don't dislike Angie?"
"Yes, I am able to descry that."
I briefly consider that Jack might actually be the spawn of Miriam and Webster.
"Robert," Jack adds, a bit anxiously, "there's something that my mom told me to speak to you about."
"Great. Do you want to play some UNO while we talk?"
"No, please. Adult dialogue today."
"Alright then," I say, somewhat relieved that I don't have to get down on the floor again. "Go ahead."
"Well, all of my non-Dungeon and Dragon friends are really interested in girls and sex. I think I like girls but I might like guys too. I find both sexes kind of sexually appealing."
All "Conversion Counselors" and those suffering from homophobia should stop reading now. You'll probably enjoy this link much more.
Afraid to move a muscle, lest I let out a scream of back pain that can be re-misinterpreted as judgment, I speak. "So you're not quite sure of your sexuality yet? Am I getting that right?"
"Yes," and Jack starts to stare at the floor.
Therapist Rule: Before helping a client work out a problem, help him to understand what the exact nature of the problem is.
"You know Jack, I don't think that's anything to be ashamed of, but it looks as though you do."
"Normally I wouldn't care, it's just that everyone else seems so sure."
"Do you get a lot of peer pressure to like girls, Jack?"
"I wouldn't say a lot, more like a modicum."
"Okay, a 'modicum' of peer pressure then?"
"Shouldn't I just know what I am?"
"Actually, I don't think you should have to know for sure, Jack. It's okay to be curious. Maybe if we talked about it during our sessions, you might develop a sense of your sexual preference, but I don't think you should pressure yourself to know right at this moment. And whatever you do decide about your sexual preference is okay, you need to know that."
"What should I do when my friends ask me about girls and stuff?"
"Well, that sounds like the more pressing issue to discuss, because dealing with peers can be one of the toughest things for guys around your age."
"It is. Some of them aren't virgins and want me to have sexual relations as well."
"Are you considering becoming sexually active?"
Therapist Rule: Because there is no magical age when a person should start having sex, it is important to convey a calm tone of acceptance, indicating that whatever the answer is, the client will not be judged.
"No, I'm not really considering it. Should I be?"
"Do you think you're ready for that?" Although I have an opinion, it's generally a good idea to let the client think things through and process his own opinion before hearing mine.
"Um, not really. I don't know much about sex, actually, other than seeing Knocked Up four times and a few dirty magazines that my friend has."
"I think you answered your own question then. I know some people your age are active, but that doesn't mean that you should if you don't feel ready. Personally, I think 14 is a little young for sex, but that's not for me to decide, only you can know when the time is right. I can help you figure it out, but you'll ultimately make the decision."
"So, instead of playing Uno, are you saying we can talk about s-e-x?"
"If that's what is on your mind, I don't see why not."
"Great! Mom will be so happy. Ever since she and Dad broke up she's been afraid that she's going to have to be the one to teach me everything. Now you can do it for her. Robert, you are a sagacious man."
With the therapeutic alliance restored, I have been promoted from therapist to teaching a 14 year-old boy everything there is to know about sex.
I think I miss UNO already.
Posted by Rob Dobrenski at 4:15 PM