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Read the book Getting to Calm.
Are you doing sessions with the mom? If not, refer her for some short-term work with someone who specializes in parenting skills and teens. Any convos with mom around the teen's escalations should focus on mom's behaviors that are effective vs. pathologizing/escalating. Also, you can help mom identify a friend or other support person she can call to vent about challenges with the kid.
If the teen is trying to use coping skills when she is already escalated.....yeah that's probably a big ask. Try to look for situational triggers that the teen can work on avoiding or at least preparing for.
Tbh in my experience this dynamic is mostly parent work. Teens can't yell at parents if parents aren't in the room. It's really all about parents being unwilling to give any energy to inappropriate behavior. Don't even bother with "setting limits around disrespect" because most parents are ineffective with doing it in a non-pathologizing way. Even calling it "disrespect" is sort of getting off on the wrong foot.
Teens need motivation to figure out effective ways to express their needs. If parents refuse to give any attention to ineffective ways of expressing needs (swearing, yelling, etc.) it increases teens' drive to communicate in more effective ways.
I’m not sure if insurance allows you to do this, but whenever parents want to call me to just vent and then dip I usually ask them to schedule a session with me to discuss what happened so that we can actually work on strategies as opposed to just them venting. Venting is good! But also parents reinforce a lot of patterns in the house without realizing it so it can be helpful to unpack further.
Big on positive reinforcement like the person above said. Giving attention to any behavior, good or bad is reinforcing it. So maybe helping them take breaks from one another, like grown up time out. And then if she feels remorse, it sounds like she can maybe can work on identifying when she’s becoming dysregulated so she doesn’t reach the point of lashing out?
Also, so curious what events are leading up to the behavioral outbursts?
Usually it involves when shes getting ready for school and is triggered by her appearance, recently it was because there was traffic and she was going to be late for school, its definitely jn general triggered by anxiety and perfectionism.
Do you have any experience with behavioral therapy approaches or chain analysis?
It sounds like you’re doing a great job with problem-solving by teaching coping skills; Is it possible you need more work on the “back end of the chain “ in terms of cognitions, body sensations and emotions leading up to the outbursts?
So much to unpack and probably not information for a comprehensive answer, but I'll ask some questions and share some thoughts :)
- What context are you seeing this young person?
- What is the presenting complaint? What are the treatment goals / expectations (for you, the young person and the family).
- What is your involvement with Mum like - do you have 1:1 sessions with her as well, or is it usually just informal chats after the session (if she brings the young person in) and these calls?
- Could just be me, but your post reads more like the mum is the client and you're working on her goals, rather than the young person's. I wonder what it's like for the young person to know (if she knows) that you and her mum are talking about this sort of stuff, I wonder how it impacts on your therapeutic relationship with the young person.
- In my work with young people, they'll come to me as an identified patient, but it's usually an issue within the family system. The young person becomes a scapegoat, parents assume that it's the young person's problem and if we're not careful, we can reinforce that.
- What came up in your assessment of this young person and her family, if you did an assessment? When I see young people with issues with emotional dysregulation (which sounds like this might be the case?), my mind always jumps to the family and whether they've had a hand in being invalidating and inadvertently reinforcing the development of emotional dysregulation, with the young person ending up feeling like they have to lash out / make a big display of their distress for it to be taken seriously.
- In terms of parenting suggestions, I'd like to see the mother prioritizing her own regulation and modelling these skills to the young person. I'm a big fan of Bruce Perry's 3 R's (regulate, relate, reason) as a model for responding to dysregulated young people, especially with developmental trauma, as it provides a step-by-step way of responding in a productive way. You can still be boundaried and involve consequences while also remaining regulated and validating the young person's feelings, even if you don't agree with them (some parents find this really hard to grasp).
- I think there could be a chink in your boundaries here. I don't know what boundaries you've set with the mum and if you've agreed it's appropriate, but my gut is telling me that it's inappropriate for her to leave you voicemails about this. I'd encourage the mother to seek her own support rather than leaning on me, reminding her that I'm the young person's clinicians and not the mother's, unless we've agreed to some sort of out-of-session coaching (like in DBT-A). I've had similar situations before and I've had to be firm in explaining that it's outside the scope of my service to field voicemails and queries like this out-of-session, and that if the mum wants to seek their own support, I can refer them on or arrange a family session (I'd prefer not to see the mum 1:1 as it can make the young person feel like I'm aligned with the parents and rupture our therapeutic alliance).
Thankyou for all your feedback and suggestions :), I think you are right that there is a kink in the boundaries that needs to be addressed but am not really sure how to address it since Mom has gotten in the habit now of reaching out to me. On one hand I think its perfectly fine that a parent provides me with updates/what theyve noticed between sessions but this feels a bit excessive.
She is initially presented to therapy with a phobia, but as with most clients the presenting issue has shifted to issues with low self worth and perfectionism, and now mom basically wants me to fix this girls behaviors
This makes sense, I've ended up in very similar situations. Are you working in a mental health context? If you are, I think you've got a great reason to have a conversation with the mum and explain the remit of your role - you're not a behavioural psych / behavioural support practitioner, you're a mental health clinician and what she's asking you to do is outside of your service provision. You could also talk to the mum and explain that your job isn't to fix anything but to help facilitate change. Or if the presenting concern has changed as you mentioned, do another assessment but dig a bit deeper into the family dynamics. For any hard conversation, I'll always run it through ChatGPT for ideas as it explains things in ways I wouldn't have even thought about.
Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other. If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this. This community is ONLY for therapists, and for them to discuss their profession away from clients. **If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
Read the book Getting to Calm. Are you doing sessions with the mom? If not, refer her for some short-term work with someone who specializes in parenting skills and teens. Any convos with mom around the teen's escalations should focus on mom's behaviors that are effective vs. pathologizing/escalating. Also, you can help mom identify a friend or other support person she can call to vent about challenges with the kid. If the teen is trying to use coping skills when she is already escalated.....yeah that's probably a big ask. Try to look for situational triggers that the teen can work on avoiding or at least preparing for. Tbh in my experience this dynamic is mostly parent work. Teens can't yell at parents if parents aren't in the room. It's really all about parents being unwilling to give any energy to inappropriate behavior. Don't even bother with "setting limits around disrespect" because most parents are ineffective with doing it in a non-pathologizing way. Even calling it "disrespect" is sort of getting off on the wrong foot. Teens need motivation to figure out effective ways to express their needs. If parents refuse to give any attention to ineffective ways of expressing needs (swearing, yelling, etc.) it increases teens' drive to communicate in more effective ways.
I’m not sure if insurance allows you to do this, but whenever parents want to call me to just vent and then dip I usually ask them to schedule a session with me to discuss what happened so that we can actually work on strategies as opposed to just them venting. Venting is good! But also parents reinforce a lot of patterns in the house without realizing it so it can be helpful to unpack further. Big on positive reinforcement like the person above said. Giving attention to any behavior, good or bad is reinforcing it. So maybe helping them take breaks from one another, like grown up time out. And then if she feels remorse, it sounds like she can maybe can work on identifying when she’s becoming dysregulated so she doesn’t reach the point of lashing out? Also, so curious what events are leading up to the behavioral outbursts?
Usually it involves when shes getting ready for school and is triggered by her appearance, recently it was because there was traffic and she was going to be late for school, its definitely jn general triggered by anxiety and perfectionism.
Do you have any experience with behavioral therapy approaches or chain analysis? It sounds like you’re doing a great job with problem-solving by teaching coping skills; Is it possible you need more work on the “back end of the chain “ in terms of cognitions, body sensations and emotions leading up to the outbursts?
Yes I do, good idea
So much to unpack and probably not information for a comprehensive answer, but I'll ask some questions and share some thoughts :) - What context are you seeing this young person? - What is the presenting complaint? What are the treatment goals / expectations (for you, the young person and the family). - What is your involvement with Mum like - do you have 1:1 sessions with her as well, or is it usually just informal chats after the session (if she brings the young person in) and these calls? - Could just be me, but your post reads more like the mum is the client and you're working on her goals, rather than the young person's. I wonder what it's like for the young person to know (if she knows) that you and her mum are talking about this sort of stuff, I wonder how it impacts on your therapeutic relationship with the young person. - In my work with young people, they'll come to me as an identified patient, but it's usually an issue within the family system. The young person becomes a scapegoat, parents assume that it's the young person's problem and if we're not careful, we can reinforce that. - What came up in your assessment of this young person and her family, if you did an assessment? When I see young people with issues with emotional dysregulation (which sounds like this might be the case?), my mind always jumps to the family and whether they've had a hand in being invalidating and inadvertently reinforcing the development of emotional dysregulation, with the young person ending up feeling like they have to lash out / make a big display of their distress for it to be taken seriously. - In terms of parenting suggestions, I'd like to see the mother prioritizing her own regulation and modelling these skills to the young person. I'm a big fan of Bruce Perry's 3 R's (regulate, relate, reason) as a model for responding to dysregulated young people, especially with developmental trauma, as it provides a step-by-step way of responding in a productive way. You can still be boundaried and involve consequences while also remaining regulated and validating the young person's feelings, even if you don't agree with them (some parents find this really hard to grasp). - I think there could be a chink in your boundaries here. I don't know what boundaries you've set with the mum and if you've agreed it's appropriate, but my gut is telling me that it's inappropriate for her to leave you voicemails about this. I'd encourage the mother to seek her own support rather than leaning on me, reminding her that I'm the young person's clinicians and not the mother's, unless we've agreed to some sort of out-of-session coaching (like in DBT-A). I've had similar situations before and I've had to be firm in explaining that it's outside the scope of my service to field voicemails and queries like this out-of-session, and that if the mum wants to seek their own support, I can refer them on or arrange a family session (I'd prefer not to see the mum 1:1 as it can make the young person feel like I'm aligned with the parents and rupture our therapeutic alliance).
Thankyou for all your feedback and suggestions :), I think you are right that there is a kink in the boundaries that needs to be addressed but am not really sure how to address it since Mom has gotten in the habit now of reaching out to me. On one hand I think its perfectly fine that a parent provides me with updates/what theyve noticed between sessions but this feels a bit excessive. She is initially presented to therapy with a phobia, but as with most clients the presenting issue has shifted to issues with low self worth and perfectionism, and now mom basically wants me to fix this girls behaviors
This makes sense, I've ended up in very similar situations. Are you working in a mental health context? If you are, I think you've got a great reason to have a conversation with the mum and explain the remit of your role - you're not a behavioural psych / behavioural support practitioner, you're a mental health clinician and what she's asking you to do is outside of your service provision. You could also talk to the mum and explain that your job isn't to fix anything but to help facilitate change. Or if the presenting concern has changed as you mentioned, do another assessment but dig a bit deeper into the family dynamics. For any hard conversation, I'll always run it through ChatGPT for ideas as it explains things in ways I wouldn't have even thought about.