Why We Publish the Counseling Approaches Used in Our Adolescent Substance Use Disorder Treatment Program

Most treatment programs list the names of the therapies they use and leave it there. We would rather explain what each one actually involves, because a parent or a county worker deciding where to place a fifteen-year-old deserves more than a row of acronyms.

The approaches below are not competing schools that a counselor must choose between. They are different lenses, and in practice a single session may move through several of them. A resident who arrives angry and defensive may need the Rogerian conditions established before anything else can happen; the same resident three weeks later may be ready for the sort of direct cognitive work that would have gone nowhere on day one. Knowing which lens the moment calls for is most of the skill.

Two things stay constant regardless of approach. The work is anchored to the resident’s Individual Treatment Plan, and it is delivered by licensed counseling staff within a program licensed by the Minnesota Department of Human Services.

Client Centered Rogerian Counseling: Creating a Growth Promoting Climate for Adolescents in Residential Treatment

In Client Centered, or Rogerian, counseling, the counselor provides the growth promoting climate and the client is then free and able to discover and grow as the client wants and needs to. The prevailing characteristics of the session are active listening, empathy, acceptance — unconditional positive regard — and genuineness.

This is the foundation the rest of the work sits on, and with adolescents it is rarely optional. A great many young men arriving at a residential program have spent years being talked at by adults with an agenda: a school, a court, a parent at the end of their patience. The experience of being listened to by an adult who is not immediately trying to correct them is genuinely unfamiliar, and it is often what makes the next several months possible.

The Holistic Health Biopsychosocial Model: Treating the Whole Young Person Rather Than the Substance Use Alone

Holistic Health, the biopsychosocial model, asserts that we have physical, intellectual, social, emotional, vocational and spiritual needs, the neglect of which reduces a person’s ability to withstand the effects of stress. It also recognizes that we live in socio-economic conditions that can enhance or demean long-term well-being.

That second sentence is the part most programs quietly skip. The circumstances a young man returns to — household income, housing stability, whether there is work in his town, what his school is like — are not background detail. They shape what recovery is going to cost him, and pretending otherwise sets a family up to blame the young man for an outcome that was partly structural.

Strength Based Counseling: Building on Past and Present Successes to Address Current and Future Challenges

Strength Based counseling focuses on what is going right in a person’s life. The counselor and client work together to find past and present successes, and use these to address current and future challenges.

Young men entering treatment usually arrive with a thoroughly documented list of their failures. Assessments, court records, school reports and family conversations have all cataloged what went wrong. Very often nobody has written down what he is good at, what he has already survived, or the occasions when he did the right thing at some cost to himself.

Locating those things is not flattery and it is not about making a resident feel better in the short term. It is a search for working material. A young man who stayed clean for four months last year already has evidence that it is possible, and the practical question becomes what was different then and how much of it can be rebuilt.

Positive Thinking and Learned Optimism: Teaching Residents to Focus on What Can Go Right

Positive Thinking, or Learning Optimism, is about learning a positive perspective — focusing on what can go right.

The distinction worth drawing here is between optimism and pretending. This is not a technique for talking a young man out of a real problem or encouraging him to describe a difficult home situation as fine. It is about the habit of explanation. Adolescents in the middle of a substance use disorder tend to explain setbacks as permanent, universal and their own fault, which is a reliable route back to using. Learning to hold a setback as specific, temporary and workable is a skill, and it can be taught and practiced like any other.

Cognitive Behavioral Therapy and the ABC Method: As I Think, So I Feel and So I Act

Cognitive Behavioral Therapy, worked through the ABC Method, could be described as “as I think, so I feel and do.” In any given situation there are three elements.

The value of the ABC framework with adolescents is that it is concrete enough to use outside a counseling room. A resident can be walked through a specific incident from that same afternoon — a comment from a peer, a difficult call home — and shown that the event did not produce the feeling on its own. Something happened in between, and that something can be examined and changed.

Once a young man has genuinely grasped that his belief about an event is a separate step from the event itself, he has been handed a piece of leverage over his own reactions that nobody can take away from him at discharge.

Solution Focused Therapy: Asking Where a Resident Wants to Be Rather Than Dwelling on the Problem

Solution Focused Therapy asks, in effect, where do I want to be. It focuses on what clients want to achieve through therapy rather than on the problems that made them seek help. The approach does not focus on the past but on the present and the future, and the client is asked to envision how the future will be different when the problem is no longer present.

This approach earns its place in adolescent treatment partly because of what it avoids. A teenager who has already been asked to recount his worst year to an assessor, a probation officer, a social worker and an intake counselor may be thoroughly exhausted by the subject of the problem before treatment has even begun. Asking a different question can restart a conversation that had stalled.

The forward-looking framing also fits the developmental stage. A fifteen-year-old has limited interest in analyzing the origins of his behavior and a great deal of interest in what his life looks like at nineteen. Working from that picture backward is often more productive than working from the past forward.

The Existential Approach and Meaning Therapy: Helping Young Men Answer Why Am I Here

The Existential approach, which asks why am I here, is also known as Meaning Therapy. Viktor Frankl expressed its central idea by observing that a person who understands the reason for his existence can endure almost any circumstance. Therapy in this tradition is concerned with creating one’s identity and establishing meaningful relationships with others.

Identity is not a peripheral concern for this age group; it is the developmental task they are in the middle of. A young man whose sense of himself has been organized around using, around a particular crowd, or around being the one who does not care, has to build a replacement. Abstinence with nothing put in its place is a vacancy, and vacancies get filled.

This is also where the spiritual component of the program and the Twelve Step work connect to the counseling. The question of meaning is not treated as an abstraction here. It shows up in practical form as what a resident is for, what he wants to be known for, and who he is willing to be accountable to.

How These Counseling Approaches Compare and When Each One Tends to Be Most Useful

How Counseling Approaches Are Selected and Applied Within Each Resident’s Individual Treatment Plan

Selection is not arbitrary and it is not a matter of a counselor’s favorite method. A resident’s Individual Treatment Plan sets out the specific issues to be addressed, and the approach follows from that.

In practice the sequencing tends to run in a recognizable direction. The Rogerian conditions come first, because nothing else functions without them. Strength based and solution focused work often follows, since both give a young man somewhere to stand before harder material is opened. Cognitive behavioral work becomes genuinely useful once he can observe his own thinking without immediately defending it. Existential questions tend to belong to the later part of a stay, when abstinence has held long enough for the question of what to do with a life to become real rather than theoretical.

That said, residents do not move through stages on a schedule, and neither does the counseling. A young man three months in can have a week that requires going straight back to being listened to and nothing more.

What Counseling at a Residential Program Can and Cannot Be Expected to Achieve

Being clear about limits is part of describing a clinical program honestly. Counseling here is delivered inside a residential treatment setting for adolescent males. It is not psychiatric treatment, it is not a substitute for medical care, and where a resident is prescribed psychiatric medication by an outside provider, that treatment continues in coordination with the prescriber rather than being managed here.

Nor is any approach on this page a guarantee. These are well-established techniques used widely across the field, applied by trained staff to individual young men whose circumstances differ enormously. What a program can commit to is that the work is planned, documented, delivered by qualified people and reviewed as a resident progresses. What no program can honestly promise is a particular outcome for a particular teenager.