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The Importance of Congruence, Empathy, and Positive Regard in Therapy with Adolescents

By: Lauren Ford, MMFT; Executive Board Member


Adolescents are remarkable. They are charged with navigating enormous internal and external changes, all the while balancing academics, family obligations, sports, school clubs, leadership activities, community service, and active social lives. In western, post-industrial cultures, adolescents are learning what it means to have more responsibility, they are learning how to cope with labile emotions, and they are continuously trying on different identities or personal labels in an attempt to define themselves as individuals within a social context. Does this sound exhausting? Well, it is.  Being an adolescent is hard work (It should also be mentioned that it is just as hard to be the caregiver of an adolescent – but this a subject for a different article).

Yet, despite the years of hard work that go into simply being a human between age 12 and age 18, adolescents get quite a bad reputation. Here’s an example: When you think of the word teenager, what words come to mind? While you might not want to admit it, I bet most of you thought of words such as “drama,” “over-emotional,” “peer-focused,” “moody,” “sex-crazed,” “self-centered,” and/or “impulsive.” In order for me to connect with clients who, as a group, engender these associations, it is critical that I contextualize this reputation within what I know about human development and meso-/exo-/marco-level systems. In this pursuit, I have found Carl Rogers’ three attributes for therapists – genuineness, unconditional positive regard (UPR), and accurate empathy – to be critical. Without these factors, a strong working alliance cannot be developed; and without a strong working alliance, no other treatment strategy is going to be effective.

Genuineness/Congruence: Adolescence is a time of enormous social growth. Teens spend a great deal of time socializing with peers, relying on them for support and advice, and placing a considerable emphasis on the values and perceptions of their peers. As such, they are keenly aware what it’s like to interact with someone who is portraying a facade, or who is pretending to be something that they are not. With teens it is especially important to bring yourself into the therapy room. This is an opportunity for you, as a therapist, to model authenticity. While you are building a relationship, you are also teaching your adolescent client what respectful, honest, human-to-human social interactions look like. Moreover, in striving to be authentic, you are also, in effect, sayin421ea6fcfae30ce8b6d9ea57b92a00c4g that you respect your client enough to be real with them. This demonstration of respect goes a long way in helping a teenager to trust you.

Unconditional Positive Regard: Adolescence is a developmental period in which conditions of worth tend to be at the forefront. When you think back to your own adolescence, can you pinpoint how conditions of worth manifested? For many, academic achievement, appearance, and emotionality represent major areas in which conditions of worth are established. Rogers believed that we need to be regarded positively by others; we need to feel valued, respected, treated with affection and loved. Yet, many teenagers do not feel they are regarded positively, let alone regarded positively and unconditionally. Despite the fact that they may have caregivers who do love them unconditionally – caregivers’ reactions to individuation can mimic conditions of worth (e.g. teenagers often interpret strong caregiver reactions as a message that they can’t beboth an independent person and still regarded as an important, valued, and loved member of the family). Therefore, showing your adolescent client that you are in their corner – that you value them, accept them as they are (even when they cry or scream or fail a test or come to session in sweatpants), and will still care for them even if they make a mistake or have poor judgment – is critical.

Accurate Empathetic Understanding: I can’t tell you how often I hear the phrases “I don’t know” or “I want you to know, but I don’t want to tell you” when talking about feelings.  Sometimes the above phrases are signs of resistance – but more often than not, they are accurate portrayals of how an adolescent is actually feeling. They feel in bold colors, but have no idea how to communicate what that’s like for them or what mix of feelings they are even experiencing. The part of the brain that allows them to reflect on their own experience and relate it to others is still developing, which sometimes renders them unable to use their words to express themselves. In that moment, being able to reflect the emotion, with accurate intensity, from an empathetic (not sympathetic) place can help to contain and center adolescents who may feel confused by their internal experience.

How do you embody these three characteristics in your work with adolescents? Do you find these characteristics essential, as Rogers did?

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