Rarely are adolescents in treatment solely under their own free will. Self-motivation does not occur readily with the adolescent patient, and counselors are often met with the challenge of facing power and control issues. Adolescents are typically experiencing numerous and heightened physical, social, and psychological transformations that often continue well into their 20s. Identity confusion, self-esteem issues, lack of social skills, feelings of invincibility, and an inordinate reliance on one’s peer group commonly accompany the psychological upheaval that one encounters during this significant life stage. Added to all this is the fact that for many adolescent substance abusers, maturation has been halted due to the use of drugs.

While providing developmentally appropriate treatment, counselors of adolescents in treatment also must avoid what most of us were likely trained in: a treatment model that may work for adults, but one that ignores the unique needs of youth and/or young adults. Fortunately, manualized research-based treatment approaches have been developed and are currently emerging as valuable resources for implementation by adolescent programs. These approaches require specialized skill development as an adjunct to the necessary ongoing training, such as the need for counselors to be kept abreast of ethical issues pertaining to adolescent treatment.

A common mistake made by counselors of adolescents is to overidentify with the adolescent patient. This can result in power struggles that can be detrimental in advancing therapeutic goals. Effective counselors can, however, successfully find a common level of communication with adolescent patients as a means of gaining trust without coming across as a friend or peer. This requires active involvement with patients while engaging them, for example, through the appropriate use of humor and a demonstration of a working knowledge of the current adolescent culture.

Since all counselors have lived through the experience of adolescence, we are often reminded of our own experiences while working with patients in this age group. Although it is essential to be aware of one’s own feelings and experiences regarding adolescence, counselors must avoid overidentification with patients and remain distant enough to avoid power struggles.

Developing a peer-like relationship with an adolescent patient not only has the potential of interfering with treatment goals, but it also becomes an ethical boundary issue. The potential to form a dual relationship can be counterproductive in counseling and harmful for the confused patient whose understanding of the counselor’s role becomes blurred. Unfortunately, the temptation to form this dual relationship stance is common.

As supervisors of adolescent counselors, we need to be vigilant as we train counselors in emerging treatment strategies and monitor their work in this highly specialized area of counseling. One way to provide these is through live supervision. This technique, well-grounded and effectively practiced in the field of family therapy, enables the supervisor to observe the counselor’s work while providing a forum for training and skill building.

Co-therapy, where both counselor and supervisor are in the room with the patient, is one form of live supervision that potentially leads to significant growth and skill development for the counselor. The supervisor has the advantage of watching the counselor work while participating when appropriate, thus modeling interventions to the counselor. This gives the supervisor valid information about the work of the counselor and gives the counselor an opportunity to learn by observing and processing the work of the supervisor.

Adolescent counseling is a specialty that is not for everyone. Counselors of adolescents must be equipped to withstand large amounts of disorder and energy that are commonly thrown at them by their patients. Included are challenges, both face-to-face and toe-to-toe, as well as constant attempts at manipulation. Good impulse control is essential — many adolescent substance abusers are masters at manipulation and are constantly looking for something to use against a counselor. As a supervisor of adolescent counselors, one must be attentive while monitoring the work of his or her counselors to ensure both their capacity to effectively meet the challenges of working with adolescents and their ability to set ethically sound boundaries in clinical relationships. It is vital that when adopting any of the newly developed manualized treatment approaches, counselors receive proper oversight and training.

It is the supervisor’s prerogative to utilize a supervisory method that best fits the needs of the patient and the counselor. Live supervision is one mode of supervision worth considering as an effective means of treating the adolescent patient while providing skill development for the counselor.

Thomas G. Durham, PhD, LADC ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) is Project Director at Danya International, where he coordinates a worldwide program of clinical supervision to alcohol and drug counselors throughout the U.S. Navy and Marine Corps.

This article is published in Counselor,The Magazine for Addiction Professionals, April 2004, v.5, n.2, pp. 81, 89.

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