Sound Counsel: A Conversation With Lynn Ponton
If you're reading this page, it's probably because someone suggested you might be able to use some counseling, or you're thinking about getting some yourself. Maybe you've been dealing with a loss, healing from abuse, suffering from depression or anxiety or just could really use someone to talk with who you can trust and feel will listen to you.
We often suggest some of our users seek out therapy. While it's commonly assumed that we're suggesting counseling or therapy because we think something is wrong with someone, that's not usually why we're making that suggestion. Rather, counseling is something we support for young people who feel like something is wrong with them, or who have something earnestly going or feeling wrong in their lives. When we suggest a user consider counseling, it's generally because we think they could benefit from having an advocate and a sounding board in-person on a regular basis, someone who is there expressly to help that person, without asking for anything emotional back from that relationship beyond some basic respect. When we suggest counseling, it's because we know that sometimes in our lives -- probably all of our lives, and probably more than once -- we all need some good help to get through the rough spots so we can get to the good stuff.
When might counseling help?
Some situations where counseling or therapy can usually help are with:
- difficult, unhealthy or abusive relationships
- depression, anxiety or suicidal thoughts
- trouble managing hard feelings
- taking risks you don't really want to be taking
- issues with self-esteem, body image or self-confidence
- healing from sexual or other abuse or assault
- addiction or compulsive behavior
- worries about sexual orientation, sexual identity or feelings of sexual shame
- self-injury or eating disorders
- a major life transition or loss, like death, a big breakup, divorce, a serious illness or accident
- needing someone to talk to where a person is guaranteed confidence & privacy
- just feeling "stuck" in unproductive or unhealthy patterns, relationships or ways of thinking
One other reason we'll suggest counseling is because something appears to be wrong with how the other people in your life are behaving around or with you, and you could use some help managing how you cope with that, and a strong advocate in your corner whose utmost concern is for and about you, not anyone else, is probably going to make coping a whole lot easier.
Lots of people feel nervous about therapy, not just young people. Concerns about privacy and the credibility of a counselor loom large, but a lot of people are also afraid of voicing their issues out loud, not being heard, or having to look at things they really don't want to, even if looking at and talking through those things will likely make dealing with them a lot easier in time. There's also some stigma attached to therapy or seeking it, that it must mean someone is mentally ill. By all means, some people with mental illness -- people who are no more or less human or acceptable than people without -- utilize therapy, but so do a whole lot of other people without any kind or history of mental illness.
Dr. Lynn Ponton (MD) is someone I respect a lot and who I feel really works to understand young people and to care very deeply about them. Her books The Sex Lives of Teenagers and The Romance of Risk show teen realities without demonizing or chastising, and do so with a really inspiring amount of compassion and understanding. She also has great ways of thinking about and approaching problems young people are having that are earnestly about helping, not about seeking adult control or conformity. As a practicing psychiatrist and psychoanalyst with adolescents for many years, she's a great expert on knowing what young people can get out of counseling and therapy and what therapists and counselors can give back. She's currently working on a new book of fiction, Métis: Mixed Blood Stories, which portrays the lives of four adolescent members of a single family who are descents of the Métis, a mixed-blood group of Native and French originating in Canada.
I rang her up to talk with her about therapy and young people. I first asked how she thinks therapy can help young people, and she said that "therapy can provide many benefits: symptom relief, so that depression gets better or anxiety becomes less, for one. Therapy can help decrease what can feel like weird or uncomfortable thoughts or ideas, and help patients feel more normal and balanced. Therapy also usually increases self-confidence and assertiveness. Many of my patients have problems with parents and other family members, so therapy is also a good place to work out family problems."
"Therapy is a great place to talk about the meaning of life: in today's world there is not much opportunity for that. Being able to talk about those big ideas with someone who respects them can help a person be able to pursue and develop their own meaning of and for life.
Lynn thinks of therapy for young people as "a successful partnership with an adult person, where there is reciprocity back and forth in good way: you talk and listen, they talk and listen. Most teens don't have that kind of relationship with their parents or other adults." When I asked her what her patients tell her they have gotten out of therapy, she said that," so much over the years, people will say that therapy changed their life every day. Even young people I only saw a few times will tend to say they were really heard and felt listened to."
She suggests young people look at books about good therapy or movies. One of her favorites is Good Will Hunting. She says that film gives "a sense of therapy as a real partnership. Robin Williams did his own disclosing in that film as the therapist. Good therapists for young people will also disclose things themselves, not have all the disclosures only coming from the young person."
I asked whether she found that young people were usually seeking out therapy themselves, or if their parents were more often seeking it out on their behalf. Dr. Ponton said that "it's about half parents and half teens when it comes to who initiates therapy. Often, there's not a good cooperation there, where both a parent and a teen want and support therapy, unfortunately. Either the teens want it and the parents are nonsupportive or the parents are encouraging it but the teen doesn't want it."
Since a good fit with a counselor is about that person being somebody a teen can talk to, she feels it's ideal for people, including young people, to first be able to make the choice to enter therapy for themselves.
What if you can't get a parent or guardian's support in therapy you want and feel you need? How can you get a parent's support or get therapy without a parent's help?
If telling them what you feel you need isn't working, "you can try showing them positive examples of therapy in films or books. If that doesn't work, either, you can then go to public clinics to get therapy. After the age of 16 [in the United States] or once you are on your own, you don't need parents support or permission," Lynn says. She also added that lots of parents who have not worked out their own problems (which is a whole lot of people) don't want their kids in therapy because it makes them have to look at and address their own problems, and that a good therapist might consider doing additional therapy with young people with one or both parents on top of individual therapy, particularly if it was a parent who initiated therapy in the first place, or if the young person needs an advocate in working out family problems with parents or guardians.
If you're interested in therapy or counseling, and you have health insurance, public health or national health, you or your parents/guardians can find out what your plan covers. You may be able to directly go to a therapist, or you may need to see a general practitioner first to get a referral. Even without any kind of healthcare coverage (or if you have some under parents, but don't want to use it), there may still be options. Many communities -- including colleges and universities -- have mental health or counseling centers that are low-cost, use sliding-scale fees or are even no cost. Some private therapists will also take on patients at a reduced fee or for a barter. To find out if there are any free or low-cost counseling services available in your area you can check in with general community centers, your local hospital, your school college or university, church, temple or other religious meeting place or just do an Internet search with your zip code for counseling. Dr. Ponton also pointed out that school guidance counselors can also talk to you about all your problems, not just academic issues.
What's Involved in Counseling?
What's a typical adolescent first therapy session like? What should you expect? Lynn says "the very first session usually runs about 45 minutes to an hour. A patient should expect to meet with a kind person who will ask what is wrong and listen to them. If parents are involved, they may or may not be interviewed or talked to, save to address insurance and other practical issues. If someone is very nervous about therapy, a good therapist will see you for the first session with a friend there, if that's wanted.
"A first session is mostly about finding out if a patient things a therapist is a good fit for them. Good fit matters very much when it comes to therapy: if you don't like a therapist or feel like they're someone you can talk to, that's not going to work and it's best to try and find another therapist you do feel good about seeing. A good partnership and feeling of partnership is key, even more with young people than with older adults. By all means, a young person should get the feeling a therapist they are going to see likes teenagers. A good adolescent therapist is both compassionate and kind and a good listener."
We talked about the fact that just like in every other kind of work there is, not all therapists are great or even good therapists, just like not all cooks are great or even good cooks. Unfortunately, some therapists...well, really suck. Just like some doctors, teachers, lawyers or artists do. But Lynn made clear that "one bad apple does not spoil everyone. If a therapist doesn't listen, isn't treating you with care and compassion, or just doesn't seem okay to you, find another one."
"If a young person is having trouble finding a good therapist, they can always ask any friends in therapy who they see and like. Friends can also help from the onset: since so many people feel nervous about therapy, or procrastinate starting it, it can help to have a supportive friend make the call in for a first appointment."
What therapy is like if you continue after a first session depends on a host of different factors: on what your unique issues are, on how much you actively participate, on what your therapist is like and on what their clinical philosophies are and what kinds of therapy or therapies they choose to use or integrate. In a first session, you can absolutely ask about this: ask a therapist to share their philosophy, the way they like to work and to explain the kinds of therapy they generally use. Most kinds of therapy involve talking, but some can involve other ways of communicating, like via writing or artwork. In general, just like with most relationships, a relationship with a therapist and therapy itself will deepen over time: no one is expected to just walk in and dump everything out then sort through it. Sharing will tend to be gradual, and the depth of discussions and disclosures will increase over time if everyone is actively participating.
One of the biggest concerns many people have with counseling is confidentiality, a valid thing to be concerned about. It's very hard to talk deeply and honestly if we're not sure that our confidences and privacy will be respected. For young people in particular, any adult can seem like they're automatically going to share everything or anything with other adults, or ally themselves with parents instead of teens when it comes to privacy. But that's not how it goes, and you have rights to privacy in therapy and in only a few situations would what you have shared in therapy be shared with your parents or other adults.
Dr. Ponton summed that up: "What is said in therapy is confidential. Therapists will only tell parents something if a teen is doing something to harm themselves (or others), like self-injury, unhealthy drug abuse (but not limited use) or a suicide attempt." Something like sexual activity or sex under the age of consent would not be reported usually unless it is illegal or seems like bonafide harm or abuse. Remember that therapists and counselors aren't parents and don't tend to act like parents: they don't make the same judgments, don't react the same ways, and are often far more accepting of things like consensual sexual activity, some kinds of risk-taking, the spectrum of gender and sexual orientation than some parents or other adults can be.
Lynn added that if and when a therapist feels something should or has to be disclosed to a parent or guardian, "a good therapist will not disclose anything to a parent or guardian without first discussing that with their teen patient, then making a plan to disclose whatever it is to the parents together, as a team."
We also talked a bit about the prevalent and incorrect idea that it's "normal" for young people, especially teens, to be in distress. She said that "the idea that it's normal for teens to be or feel messed up and have problems, is not true. Maybe one of every ten teens have a rocky time of [adolescence]. If a young person is having a hard time, it's important for them to reach out and get help." In other words, if you feel really lost, miserable, scared, sad or freaked out, it's not because "that's how teenagers are," but most likely because you need some help dealing.
I asked her what she thought keeps young people who want or would benefit from therapy from seeking it out. She said that "some teens are afraid to talk about problems with a therapist because they have never done that with any adult. Many worry that a therapist will be critical or judgmental as is often the case with parents or other adults. Embarrassment is another common barrier: teens are often embarrassed about some of their problems, particularly GLBT youth, or those with thought disorders. Embarrassment keeps many kids out, but they have to take a risk to benefit."
Choosing to go into therapy and actively participate absolutely is a risk any of us take. It's just good to bear in mind that it's a healthy risk, and one very likely to net us positive results: it's not the same kind of risk-taking as, say, choosing to have unprotected sex or choosing to walk into the highway. Certainly, you risk being vulnerable and being seen, and you also risk finding things out about yourself that you might not know or realize, or might need to address and deal with. But the nature of therapy and counseling is that it's designed to use those risks to help people benefit from taking them. We can benefit from being vulnerable and speaking our hard truths because saying them out loud, being heard in them, and being helped to hold and work with them benefits us. We risk self-discovery, but there really are only benefits in getting more in touch with ourselves: avoidance and denial hurt us rather than helping us. We can also risk feeling uncomfortable sometimes, especially if we're delving into painful feelings, but as a group of people who are going through puberty or just coming out of it, I probably don't need to tell you that growth can be uncomfortable sometimes.
Online Counseling Vs. In-Person Counseling
Some Scarleteen readers who come to our message boards for help, will react by quickly saying they don't want or need counseling when we suggest it. But usually by the time we have suggested counseling, it's because someone has been coming to us online for exactly that for a while. In other words, most of the time, that person has already been getting a kind of counseling, and has come asking us expressly for counseling. When they've come for help talking through something, and we help out in doing that, and a user thanks us, what they are thanking us for is counseling.
Online counseling like a person can find at our boards or other online support venues is absolutely one way to get help and support, but sometimes, it either just isn't enough, or isn't as good as it could be for someone. There are some things we can do and can offer, but also some important things that we can't.
For instance, we can't give a person our complete, undivided attention for an hour each week. You can't read our body language or see our expressions and we can't read or see yours. We can't offer you the same kinds of privacy an in-person counselor can. We can't talk with you, rather than writing back and forth. We can't have the kind of health and life history for you an in-person counselor can. None of us here -- or at most other online support groups -- have the kind of education and training that in-person therapists and counselors do, and that's a pretty huge missing piece.
For sure, online counseling and support absolutely has its use, but it also has some limitations. Counseling online can be a great place to get started with talking about your issues and getting support, or to dip your toe in the water when it comes to taking a step to start talking and getting help. But online counseling can tend to make a much better starting point than an ongoing solution, particularly with very challenging, personal and ongoing issues. Chances are good that if you are finding online counseling to be useful to you, in-person, dedicated counseling will be even more beneficial.
We know that the first steps with this can be hard or scary to take: making the phone calls about it, talking to parents or guardians, walking in the door for that first visit, feeling vulnerable or weak because you need some help. But we think it's sound to be more concerned about what might happen if you don't take the risk to get the help that you need when you need it. Getting help we need is never about weakness or failure: it's about having the strength and the courage to take care of ourselves and the humility to know when we could use help doing that. When this kind of help is what you need, even just picking up the phone to make that first appointment is an action of strength and compassion, and a step towards taking better care of yourself and taking greater charge of your own life.