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What tough topics do teens talk about in therapy?

The toughest part of my job is to create an environment where kids trust me enough to say what they really feel.

This isn’t easy, particularly with teens who are suspicious that a therapist will tell parents about their conversations. In some instances, psychologists are legally and ethically required to disclose personal information, such as when a youngster tells a counselor about being sexually abused.

When that trust is developed, teens finally let go of their defenses and deal with some issues that are really bothering them. Here are three topics that teens have the most difficult time talking about in therapy.

1. Sexuality. This is a complicated subject for many teens, most of whom are the victims of being bombarded with media messages and images that are very different than their parents’ generations. The internet has changed everything about sexuality. Teens tell me stuff they’ve seen or read that leaves them bewildered about what’s normal or abnormal, and what’s morally right and wrong.

Sexual feelings scare teens. What makes sexual experiences acceptable outside of a committed relationship? Is an occasional attraction to your best friend, an adult teacher or younger kids a normal feeling or a reflection of some pathology? This is tough stuff to figure out on your own.

2. Parents. While it’s normal for teens to have some tension with their moms and dads, some kids just don’t like their parents and haven’t for many years. They can’t tolerate their parents’ lifestyle, bad marriages, drinking problems or excessive materialism. In other cases, there is just not a fit between a child’s personality and those of his parents. Other kids feel guilty about liking one parent more than another.

3. Being real. The gap between acting one way but feeling differently in your private world is tricky for teens to reconcile. Most youngsters are good kids who want to please their parents and meet the expectations of others.

However, it’s hard to appear happy on the outside while feeling depressed within your own world. There are times when kids, like the rest of us, get tired of pretending and want to go through just one day where they say what they truly think and feel.

This is really scary for teens, many of whom are fearful that love and acceptance from others is dependent upon acting a certain way. It is far better to be phony and loved rather than be real and rejected.

There is a tremendous sense of relief when kids can finally voice their real concerns. It truly is the rewarding part of being a therapist to be a part of that process.

Next Week: How to listen so your kids will talk

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