Dealing with the Adolescent Client

Communication plays a vital role in everybody’s life. Communication is a process through which we convey our thoughts and feelings to other people. One of the major components of communication is to listen and to understand others’ points of view and feelings. Communication is more effective if it is two-way rather than one-way. It is important to understand the realities and the mindset of the adolescent client to foster better communication and responsiveness to their needs.

Communication and Counselling

Communication is the art of expressing and exchanging ideas, feelings and thoughts through gestures,speech or writing.

Verbal/Non-verbal Communication

Health care providers need to explore the many different nonverbal and verbal behaviours they use when communicating with adolescents. Sometimes, without realizing it, providers communicate one message verbally, while communicating the opposite message non-verbally. Non-verbal communication is a complex and often unconscious mixture of actions, behaviours, and feelings, which reveal the way we really feel about something. Non-verbal communication is especially important because it communicates to clients the level of interest, attention, warmth, and understanding we feel towards them.

Positive non-verbal cues include:

• Leaning toward the client.
• Smiling without showing tension.
• Facial expressions which show interest and concern.
• Maintaining eye contact with the client.
• Encouraging supportive gestures such as nodding one’s head.

Negative nonverbal cues include:

• Not making or maintaining eye contact.
• Glancing at one’s watch obviously and more than once.
• Flipping through papers or documents.
• Frowning.
• Fidgeting.
• Sitting with the arms crossed.
• Leaning away from the client.

What is Counselling?

It is face to face communication between two or more people in which one person helps the other to make a decision and then act upon it:

• It is two way communication and the counsellor listens patiently to the clients’ thoughts / fears / misconceptions / problems without being judgmental.
• Takes into account psycho-social, emotional and spiritual needs of the client
• Is strictly confidential
• Information given to the client is full and accurate
• Helps the client to make decisions for himself or herself

The purpose of counselling the adolescent on Sexual and Reproductive Health issues are to help the adolescent to:

• Exercise control over her/his life.
• Make decisions using a rational model for decision-making.
• Cope with her/his existing situation.

Achieving control over behaviour, understanding oneself, anticipating consequences of actions, and making long-term plans are characteristics of maturity-one of the goals of adolescent counselling.

Feelings of the Adolescent

Understanding the realities and mind-set of the adolescent client will foster better communication and responsiveness to her/his needs.

When an adolescent is face-to-face with a provider (or an adult staff member) s/he may feel:

• Shy about being in a clinic (especially for Reproductive Health (RH)) and about needing to discuss personal matters.
• Embarrassed that s/he is seeking RH care.
• Worried that someone s/he knows might see her/him and tell the parents.
• Inadequate to describe what is concerning her/him and ill-informed about RH matters in general.
• Anxious that s/he has a serious condition that has significant consequences(e.g. Sexually transmitted infections (STIs), pregnancy).
• Intimidated by the medical facility and/or the many “authority figures” in the facility.
• Defensive about being the subject of the discussion or because s/he was referred against her/his will.
• Resistant to receiving help because of overall rebelliousness or other reasons fostering discomfort or fear.

Establishing Trust with Adolescent Client

The adolescent is going through dramatic biological and psychological changes in general. Seeking health care may be challenging and difficult for her/him.Each staff person who may interact with adolescents must understand these circumstances and feelings and must be prepared to assist in a helpful, nonjudgmental way.

Winning an adolescent’s trust and establishing rapport with the adolescent client will facilitate discussion and enhance the likelihood that needs will be revealed and addressed.

The following are tips for good communication:

• Allow sufficient time for the adolescent client to become comfortable enough to ask questions and express concerns.
• Express non-judgmental views about the client’s needs and concerns.
• Show an understanding of and empathy with the client’s situation and concerns.
• Exhibit confidence and professional competence in addressing Adolescent reproductive health (ARH) issues
• Be genuinely open to an adolescent’s question or need for information (ranging from “where is the toilet?” to “Should I use birth control?”)
• Do not be judgmental in words or in body language that suggest disapproval of her/him being at the clinic, of her/his behavior, or of her/his questions or needs.
• Understand that the young person has various feelings of discomfort and uncertainty.
• Be reassuring in responding to the adolescent, making him or her feel more comfortable and confident.
• If sensitive issues are being discussed, help ensure that conversations are not overheard.

How to deal with difficult situations when communicating with the Adolescent Client

The following are some situations that require appropriate handling:

• If the adolescent is silent: Silence can be a sign of shyness or may signify anger or anxiety.
• If it occurs at the beginning of a session, the provider can say, “I realize it’s hard for you to talk. This often happens to people who come for the first time.”
• If s/he seems angry, the counsellor can say, “Sometimes when someone comes to see me against her/his will and doesn’t want to be here, it is difficult to speak. Is that what is going on?"
• If the client is shy, the provider can legitimize the feeling by saying, “I’d feel the same way in your place. I understand that it’s not easy to talk to a person you’ve just met.”
• If the adolescent has difficulty expressing her/his feelings or ideas, the counsellor can use some brochures or posters to encourage discussion or refer to a story or anecdote so the adolescent can talk about others rather than her/himself.
• If the adolescent cannot or will not talk, the counsellor should propose another meeting.
• Crying: The counsellor should try to evaluate what provoked the tears and assess if it makes sense in the given situation. If the client is crying to relieve tension, the counsellor can give the adolescent permission to express her/his feelings by saying, “It’s okay to cry since it’s the normal thing to do when you’re sad.” If the client is using crying as manipulation, the counsellor can say, “Although I’m sorry you feel sad, it’s good to express your feelings.” If the crying is consistent with the situation, the counsellor should allow her/him to freely express emotions and not try to stop the feeling or belittle its importance.
• Threat of suicide: All suicide threats or attempts must be taken seriously. It is essential to determine if attempts were made in the past, if s/he is really considering suicide, and the reasons for doing so-or it it’s something said without thinking. It is best to refer the adolescent to a psychiatrist or psychologist and accompany her/him to the appointment.
• Refusal of help: The counsellor should discreetly try to find out why the adolescent feels this way. If the client has been sent against her/his will, the counsellor can say, “I understand how you feel. I’m not sure I can help you, but maybe we could talk for a minute and see what happens.”
• Need to talk: Challenges in counselling may also include a situation where the client is very vocal and wants an outlet to express other concerns that may not be directly related to the immediate counselling need as perceived by the service provider.
• Give the client the opportunity to express her/his needs and concerns. If you cannot help the client, show that you are listening to the concerns that s/he is trying to express. When possible, direct the client to someone who can help with the problem. The counsellor may say, “I can see that you are very concerned about this problem. I wish that I could do something to help you. Have you discussed this with . . .”
• If you cannot help the client or direct her/him to someone who can provide assistance, then demonstrate care and concern about the client’s problem.

Tips for Effective Communication with the Adolescents

Several techniques help assure good communication with adolescents:

Create a good, friendly first impression

• Start on time; don’t make the client wait.
• Smile and warmly greet the adolescent client.
• Introduce yourself and what you do.
• Ask her/his name and what s/he likes to be called.

Establish rapport during the first session

• Face the adolescent, sitting in similar chairs.
• Use the adolescent’s name during the session.
• Demonstrate a frank and honest willingness to understand and help.
• Begin the session by allowing the adolescent to talk freely before asking directive questions.
• Congratulate the adolescent for seeking help.

Eliminate barriers to good communication

• Avoid judgmental responses of body or spoken language.
• Respond with impartiality, respecting the adolescent’s beliefs, opinions, and diversity or expression regarding her/his sexuality.
• Use “active listening” with the client
• Show your sincere interest and understanding and give your full attention to the client.
• Sit comfortably; avoid movements that might distract the adolescent.
• Put yourself in the place of the adolescent while s/he speaks.
• Assist the client to be more aware of the problem without being intrusive or taking away her/his control over the issue.
• Observe the tone of voice, words used, and body language expressed and reflect verbally to underscore and confirm observed feelings.
• Give the adolescent some time to think, ask questions, and speak. Be silent when necessary and follow the rhythm of the conversation.
• Periodically repeat what you’ve heard, confirming that both you and the adolescent have understood.
• Clarify terms that are not clear or need more interpretation.
• Summarize the most relevant information communicated by the adolescent, usually at the end of a topic.

Provide information simply

• Use an appropriate tone of voice.
• Speak in an understandable way, avoiding technical terms or difficult words.
• Understand and use where appropriate the terms/expressions adolescents use to talk about their bodies, dating, and sex.
• Use short sentences.
• Do not overload the adolescent with information
• Provide information based on what the adolescent knows or has heard.
• Gently correct misconceptions.
• Use audiovisual materials to help the adolescent understand the information and to demonstrate information in more concrete terms.

Sources :

1. Rashtriya Kishor Swasthya Karyakram - Resource Book by Ministry of Health and Family Welfare
2. Rashtriya Kishor Swasthya Karyakram - Facilitator Guide by Ministry of Health and Family Welfare