Teenagers in Trouble: A Family Therapy Perspective

The first weeks of January mark the half year point in the school calendar. They become for some parents times of increasing apprehension triggered by their teenagers’ school performance.
Observations at home, reports from school and impressions about friends may lead to tense discussions between parents and loud arguments with teens ending in frustration, resentments, or relational withdrawal.

Joe struggled during most of his middle school years, yet he got through. But now, two weeks into the New Year the “bad news” messages began to pile up on the computer screens of his parents who are divorced. “Joe did not complete any homework this week. When asked about it, he gave evasive answers.” Or: “Joe appears often disorganized and chaotic in his work and behavior.” Or: “During Math, Joe came late and put his head on his desk. Often, I cannot reach him.”

Another teen, Mary, had been a grade A student during elementary and middle school. She was known for her diligence regarding homework. Now, after the first two quarters of 9th grade her parents noticed that earlier changes in her moods and behaviors increased in frequency. Sheer limitless high energy days seemed to flip without cause into periods of lethargy and excessive need for sleep. Mary withdrew into her room while only a week earlier she had contacted everybody on her face book list to organize a county wide meeting for breast cancer awareness week. Here are some guidelines for parents who face the challenge of teenagers who suddenly appear much more in trouble than previously imagined.

1. Understanding Your Teenager

During adolescence troublesome signs that cause serious parental concerns become visible mainly in three contexts, within the family, at school, and among the peer group. It is, therefore, most useful for parents to direct their attempts at understanding their teenager first to these contexts. Instead of risking conjectures as to the inner state of mind of an adolescent, parents will be on much more solid ground if they rely on observations of their daughter’s or son’s interactions, communications, and experiences within important relationship networks, i.e. within family, school, and friends.


Parents should examine the family’s history, relational dynamic, and style of living. As an integral part of the family parents face, of course, the challenge of including themselves in the examination of the biologically, psychologically, emotionally, and culturally profoundly interconnected family system. It is essential to grasp the interactions between parents, between parents and kids, especially the adolescent, between siblings, or with members of the extended family.

Preferably with the assistance of a consultant‐therapist, family conversations aimed at understanding the current process would inquire about recent family stresses, significant conflicts, and any traumatic past events affecting the life of the teenager. What are the characteristic relationships and strengths of the family, rooted in the family’s culture, gender role definitions, and their religious beliefs and practices? What life style factors stand out, such as father’s daily commute or the teenager’s excessive use of TV, typical recreational activities, level of alcohol and drug consumption, rules regarding family meals, curfew, household chores, or holidays?


The second context to be examined is the teen’s school context and educational history, especially when disorders such as “attention deficit disorder” are assumed rather than professionally explored. Much can be learned from teachers, guidance counselors, coaches or from educational tests. But what about the classroom atmosphere, the student’s popularity with her/his classmates, possible marginalization due to bullying, exclusionary cliques, or some students’ racist or sexist attitudes? A difficult and discouraging educational history may have led to the adolescent’s self image as a below average student, even when she/he possesses a keen intellect or talents that may lie outside of what is valued at a particular school or grade level.

Social Network

Some parents know too little about the world of their son’s or daughter’s personal relationships and the closest friends with whom their kids are in constant exchange, personally or over internet based social networks. It may not be easy to get an accurate picture about this ever more complex youth context, but stressful or frightening experiences with friends can become destructive forces in the lives of teens.

Individual Consultation

After an adolescent’s place in the various contexts has been examined it is, of course, essential for a proper assessment to explore her or his state of mind. A teenager’s experiences within a personal context and his or her inner mental state and mood reinforce each other in a circular process. A structured interview of the adolescent by a psychotherapist may reveal significant information, more than superficial and easily biased checklists or tests. Traumatic experiences, struggles around biological and sexual maturation and identification, or socially or culturally unacceptable behaviors acquire a different meaning when understood in their proper context.

Medical Examination

Finally, a thorough physical checkup should be part of any overall evaluation of a teenager. The presence of any medical illness as a possible cause of sudden behavioral or mood changes should be excluded.

2. Helping Your Teenager

Understanding your teenager in various contexts, deciding on a course of action, and implementing a strategy of change and healing may require a therapist. A context sensitive professional provides a view from outside the family and can help to integrate the disparate suggestions and sometimes competing truths from different disciplines. Yet, the parents need to remain in charge of the treatment process in collaboration with the therapist.

A combination of family meetings, individual therapy, school conferences, and, sometimes, the activation of the adolescent’s social network may be needed to get the healing process underway. The focus should not be exclusively on the individual teen; otherwise crucial facts may be missed. The burden of making adults understand and of providing the energy for change should not be solely on the adolescent.

“Mental Illness”

Parents with a high school student who is thought of suffering from a psychiatric illness such as “bi‐polar disorder”, schizophrenia, or major depression are confronted with a level of pain, worry, and confusion that is hard to appreciate by outsiders. For them the high school years may turn out to become the beginning of a bewildering and nightmarish search for an effective treatment. To become an educated consumer to guide a teenager’s journey toward sanity is a daunting challenge.

Even in these difficult situations, the process described above contains all the essential components of an assessment that is complex enough to chart the teenager’s vulnerability, specific thought patterns, emotional experiences, and residual strengths. The parents, additional supportive adults, teachers, a context sensitive therapist and other professionals should form a care team to provide guidance, monitor individual and family therapy, and find access to group support and social skills education as needed. The frequent calls for “psychiatric medications” to control a child’s or teenager’s behaviors, to dampen excessive mood swings, or to clear up disturbing thought patterns should be critically evaluated by the care team in light of the adolescent’s relational contexts and inner experiences.

Overcoming the fragmentation of the “mental health system” and forming a collaborative team of professionals with the parents in charge will provide the best assurance of hope and support for parents of teenagers at any level of trouble.

Dr. Norbert A. Wetzel is a NJ licensed psychologist and Director of Princeton Family Institute. He can be contacted at www.princetonfamily.com or by calling 609‐921‐2551.

The text was first published by the Princeton Packet.

teens, family