EMDR and Teenagers: Part 1

EMDR and Teenagers: Part 1

August is Teenager Mental Health Awareness Month. As I (Amber) think about what to write to you I think of several different topics I could cover.

First, I think of a statement I heard from Dave Ramsey (yes, the financial guru) that when talking to a teenager sometimes you are talking to a four-year-old and sometimes a thirty-four-year-old and you have to figure out which one you are communicating with. This is especially true when working with teens and their mental health concerns. The book The Teenage Brain by Frances E. Jensen talks of how the neurology of the teenager is more like a toddler than it is to an adult. There is an extreme time of neural growth during puberty with neural pruning taking place through the early twenties. This results in these young humans literally feeling differently than we do as adults. Their anger is more angry, their depression is more depressed, their anxiety is more anxious, and it is simply the way their brain is managing all of the new neural connections. This is a time of enhanced learning, experimenting, and rebelling. I have often told parents that their teenager’s job is to find out who they are and to become independent and the job as the parent is to keep the child alive as they get there… and sometimes these goals are mutually exclusive.

When seeing teenagers in the therapy setting we have the privilege of working with this person through a difficult time in their life as they are sorting out who they are and who they are becoming. To add to this, we are also interacting with the parents who may or may not be engaged with their teens. I have interacted with parents who were overinvolved in their teen’s life and did not allow the right places for them to fail with structure and other parents who seemed disengaged in their and held expectations for this young person to be an adult in all respects.

As therapists, this can be a difficult line to walk. I am of the opinion that supportive caregivers need to be included in therapy sessions. My goal is to help engage the teen with their supportive caregiver so they can have a healthy place to go between sessions and once therapy is over to bounce off ideas, talk about challenges, and be challenged on their own (possibly dangerous) ideas.

So, what does this have to do with EMDR? I am glad you asked!

When working with teenagers using EMDR therapy, you will be working with someone who is still very much learning about themselves during their time in therapy. Their brain is going to process differently than a child or an adult. They may need more time to connect with their resources before working on their target memories. And sometimes what is most important to them may not be what their parents think needs to be addressed. Here are some ways I have found to adjust the 8 phases with teens.

Phase 1: History Taking and treatment planning. I will obtain a history from both a parent or parents and the teen. I want to know any concerns that may have started earlier in childhood. Any difficulties through the pregnancy or delivery. If there was time spent in the hospital or early childhood surgeries. Were there any significant losses such as grandparents, pets, or even moves away from family or important figures? I want to know about any changes that happened around cognitive growth stages, especially around ages 7 and 12. I want to know what age they started puberty and how this was managed in the family. I also want to know what the parent sees as the best things about their child. Many times, parents come into session with a “fix the puppy program” mindset and are focusing on the things their teen is doing wrong, rather than what they are doing well. I also want to know from the adult, what they see as the greatest concern for their teen and what, in their perspective, the root is of this problem. Often the concerns reported by a caregiver are the symptoms rather than the root of the concern. From the AIP lens, we are looking for where these maladaptive thoughts and patterns developed- this means we are hunting for the root. Finally, I want to know what the parents’ goals are for their child. How will they know that we are “done with therapy”, if they want their child to be perfect and there to be no conflict at all in the home then we will have conversations on expectations. I also will recommend the parent attend their own counseling as their child is in counseling, in my opinion, it takes working with two generations of a family to break maladaptive generational patterns.

For the teenager, I want to know what their thoughts are about therapy. I want to know how they feel about coming, if it is voluntary, forced, or bribed. We will discuss what they see as their greatest challenge to having the life they want; I also want to know what their goals are and the challenges they have to reaching these goals. We will discuss limits to confidentiality and discuss how we will go about talking to their adult if something comes up that I think they need their adult to know. Through this, I will be catching any negative beliefs, maladaptive thoughts, and behaviors that are the symptoms of the problem. I also want to know what the teenager’s favorite things are about themselves. I want to have an idea of how they view their greatest strengths- these will later become resources we build in.

With the teen, we will create a list of the top 10 events they remember which keep them stuck. I want to know what they see as this top 10 list and will compare it to what their caregiver views as the most significant events. I won’t dive into these memories yet, just a quick label for each one will work. Finally, I will have the teen complete a dissociation scale either the Adolescent Dissociative Experiences Scale (A-DES) or Dissociative Experiences Scale II (DES II) depending on the age of the teen. I want a starting point of where they are with being mentally in the room with me. This provides a quick checkpoint to determine what may need to happen next and how long to stay in Phase 2 with them.

By starting with a clear history taking, treatment planning, and understanding the level of dissociation we know where we are starting with the teenager and what is expected from both them and the caregivers in their life. Sometimes this part of the process takes more than one session as we are building the therapeutic relationship and getting to know their style a bit more. While teens can be a challenge and many try to put on a front, they are also amazing humans with grand ideas. It can be exciting and challenging to work with teens with EMDR.

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Dr. Amber Quaranta-Leech, LPC-S

Amber holds a PhD in Counselor Education and Supervision from Regent University. She is a Licensed Professional Counselor in both Texas and Oklahoma and holds Supervisor credential for Texas. Amber is an EMDRIA consultant and trainer. She has over a decade of experience in the trauma field in work with uniformed services, domestic violence, childhood trauma and abuse, and recent mass trauma events. Amber provides consultation for EMDRIA certification, for consultants-in-training, and supervision for LPC-Associates. Amber continues to research the benefits of EMDR therapy with a variety of populations. Her goal is to help build strong clinicians who are well versed in trauma interventions to better support their clients. Amber sees a limited number of clients with a focus on trauma work, she is also a Certified Career Counselor and Certified through EAGALA to provide equine-assisted therapy. 

Dr. Jose Carbajal, LCSW

Dr. Jose Carbajal, a U.S. Army veteran, earned his bachelor’s and master’s degrees in social work and a master’s in theological studies from Baylor University, and a Ph.D. in Social Work from the University of Texas at Arlington. With over 15 years of clinical experience and extensive teaching experience, Jose specializes in trauma, sexual abuse recovery, domestic violence, and substance abuse. His research focuses on trauma interventions, neuroscience, and faith. He is EMDR Certified, an Approved Consultant, and an EMDRIA Approved Trainer, with numerous publications and professional presentations to his name.

Dr. Amanda Martin, LMFT-S, LPC, BCN

Amanda Martin holds a PhD in Family Therapy and is a Licensed Professional Counselor, Licensed Marriage and Family Therapist Supervisor, and EMDRIA Approved Consultant. With over 14 years of experience, she specializes in trauma therapy for individuals and families in residential and outpatient settings. Amanda also provides supervision for EMDR certification, EMDR consultants-in-training, and LMFT-Associates. Her mission is to help people find a healthy, joyful, and fulfilling path in life. Her warm, supportive, and interactive counseling style incorporates Symbolic Experiential Therapy, Trauma-Focused Cognitive Behavioral Therapy, EMDR, HeartMath, Animal-Assisted Therapy, Neurofeedback, and Collaborative Problem Solving.

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