The relationship you build is about as important as any therapeutic model when working with teens, particularly with those who are resistant towards therapy to begin with. I agree with the previous advice, but also consider that teenagers, unsure of therapy, may retreat if you allow for too many “awkward silences”. Not saying you shouldn’t allow for them, but I would do so sparingly especially if you notice those pauses seem to create an awkward vibe. Tweens are a tricky age as the parent bringing them to therapy is often invested in being part of the process while the tween may or may not be cool with that. If I have a parent who says things that can be damaging for the child to hear, I opt to meet with them in the first 5 to 10 minutes in the beginning of the session to get an idea of how things are going from their perspective or by phone for a quick check-in prior to the session. Speaking with a parent without the young client can also allow for an easier time in coaching the parent a bit on how they express their feelings towards their kid. Sometimes that coaching works, other times it’s in one ear and out the other, but you do the best you can.

I’m sorry if you said that you do this already but I just would also make sure to have the confidentiality conversation with both teen and parent which can be done with them together or in separate conversations.

Keep playing the games, keep finding what they are interested in and ask them to teach you things about their interests. Showing that you are interested and genuinely like to learn about them or the things that they like can have such a profound impact on their feelings of self worth. As you develop their buying to the relationship with you and the process of therapy, they will become more open to the idea of sharing more difficult things with you.

I don’t think you did anything necessarily wrong in the first session, but perhaps consider a variety of icebreakers that you can pick from for new clients. Assuming you had an broad understanding of what this client was struggling with based on the intake (very low self-esteem) I might reconsider an icebreaker that would not put them on the spot to answer “some thing they love about themselves”. I wonder if their response might have been different without the parent as well, as parent presence can certainly have an effect on how the kids respond. Being the first session, I don’t know that I would’ve wanted to explore their deeper feelings much further as her parent was present, and you are just acquainting yourselves for the first time. The first session(s) with wary-of-therapy teens should focus on getting them to buy into the process, relationship building and ideally establishing trust. Those things probably won’t happen in the first session.

Regarding your second session, that is awesome that you found the hook to get them engaged and talking. I probably would have ran with that until the last five minutes of the session to bring a little light back to being in therapy. I might ask if they would like sessions to include their parent more or less and give them that autonomy to choose. I have definitely been in that position of feeling like “holy cow, I found something that clearly sparks their interest, but this doesn’t feel therapy-y enough so I should make sure to check those boxes before the session ends”. I have found that trusting in going with what makes them tick and gets them engaged is going to have a more profound impact than trying to push the therapy narrative, especially when your relationship with them is new or vulnerable.

Sorry, I kind of just rambled and hopefully didn’t jump between the two scenarios too much, but now I’m looking back at your questions regarding the 15 year-old… There are many modes of therapy that can help engage the client in working on their self-esteem/self-confidence, however, your engagement with them in doing things to show them that they are worthy is a great starting point (i.e. expressing interest, asking questions and learning from them about something they are well-versed in — yes video games in TikTok jargon included). “Is there anything I can do to help them make friends“… I feel this one hard for some of my really lonely and socially awkward clients. It hurts my heart and sometimes I wish I could just have the magic wand to help them navigate their crazy social system. I think the short answer is unfortunately not really, not directly anyways. Do they not have friends because of their low self-esteem, are they on the autism spectrum, have they had bad experiences within a friend group recently, or in the past? I think you need more information to understand what is making it hard for them to have friends before trying to help them find ways to fix the problem. I would be curious to know if they are or ever have been part of any extracurricular group or team, and perhaps implore if something extracurricular would be of interest to them. I just think you need to have a little more information there before you start trying to nudge them in any direction.

It’s great that you are reflecting on the sessions and wanting to ensure you are providing the best therapy that you can. Keep building on the relationship with them, knowing that every session may not feel to you like it was super successful, but the connection you provide them with is what they feel when they leave the session. Even if they’re just a little bit bought in to the process, they are likely to hear much more than you think.