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Passing notes: the use of therapeutic letter writing in counseling adolescents.

Uses and advantages to using letter-writing techniques within a therapeutic context of counseling adolescents are examined. A theoretical framework for letter writing is discussed, along with specific guidelines to follow when using letter-writing interventions. An overview and examples of ways to apply letter writing when counseling adolescents is presented. Finally, purposes and benefits to using different types of letters are discussed.

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Letter writing or note writing has a long and secure place within the everyday world of adolescent communication. It is difficult to walk down a high school corridor and not see adolescents passing notes to each other. Study halls and even class time are often spent writing to friends seeking and sharing advice, support, and gossip--serving as a means of keeping in touch and as a way of documenting countless events. Adolescent note writing functions as an outlet for adolescents to test out new ideas and behaviors while receiving peer feedback. Note writing also provides a place for adolescents to implement their emerging self-concept, and connect with peers as they develop autonomy and move away from adult control, important adolescent developmental tasks (Erikson, 1968).

With a few exceptions, letters have not become an integral part of therapeutic interactions. Rather, verbal dialogue between counselors and adolescent clients is used as the primary means of resolving counseling-related issues. Letter writing, by adding the written word to traditional talk therapy, can allow for self-exploration and change. While spoken words often fade over time leaving behind only fragmented ideas, written words provide more permanence and therefore, a concrete means for adolescent reflection over a greater time span (Goldberg, 2000; Madigan, 1997). The use of letters in counseling can serve the following purposes: correspondence between counselor and client, elaboration of important elements of discussions that occurred during the sessions, client empowerment through altered personal narratives, and identification of client strengths (Wojcik & Iverson, 1989).

Additionally, the growth of minority families in the United States has contributed to the emergence of clients who often have different communication styles--verbal expression, eye contact, and assertiveness when compared to their white middle class American counterparts--and therefore have special counseling needs (Ho, 1992; Ridley, Li, & Hill, 1998). For example, adolescents from African-American, Asian-American, and Latino-American cultures are more likely to value nonverbal expressions, collaborative behavior, and indirect communication (Sue, Ivey, & Pederson, 1996), behaviors which seemingly lend themselves well to letter-writing interventions.

With regard to the literature, narrative theory has been applied to work with adolescents (e.g., Biever, McKenzie, Wales-North, & Gonzalez, 1995; Goldberg, 2000; Smith & Nylund, 1997), but there has been no discussion of the applications of letter writing per se as an intervention in individual counseling with adolescents. In this article, uses of letter-writing techniques within a therapeutic context of counseling adolescents is examined. A theoretical framework for letter writing is discussed, along with specific guidelines to follow when using these interventions. An overview and examples of ways to apply letter writing when counseling adolescents is presented. Finally, the purposes and benefits to using each of the types of letters are discussed.

THEORETICAL BASIS FOR THE USE OF LETTER WRITING

There are several important links between theory and the use of letter writing in the counseling process. France, Cadieax, and Allen (1995) described the theoretical link between Morita Therapy and letter writing. They conceptualize letter writing as an opportunity for counseling to take place without disruption of the individual's everyday life through traditionally scheduled counseling sessions. Although much can be said about the beneficial qualities of direct proximity during counseling sessions, letter writing can provide an avenue for communication when face-to-face therapy is not feasible or convenient (France et al., 1995; Rasmussen & Tomm, 1992). Many practitioners have noted that their adolescent clients are often more open in counseling when they are partially engaged in another activity (e.g., a board game or art activity), or when they are not sitting directly facing the counselor. The use of letters provides an even more indirect form of communication that may be less threatening to traditionally self-conscious adolescent clients than a traditional face-to-face therapy dialogue.

The strongest link between theory and letter-writing practice is narrative therapy. The theoretical tenants of narrative therapy allow both the counselor and adolescent client to benefit from letter-writing techniques. Narrative theorists (Freedman & Combs, 1996; White & Epston, 1990) have explicitly discussed the use of letter writing with clients and suggest that as individuals interact with their social environment, they create stories to encompass their beliefs and experiences into one compact reality. The construction of such a personal reality leads individuals to form dominant stories which focus on experiences and beliefs perceived as having the greatest impact (White & Epston, 1990). Often, the dominant story is one of personal struggle and negative experience within the social environment, and little if any focus is given to positive experiences and personal attributes and strengths. The primary goal of narrative therapy is to help clients re-author these dominant stories to incorporate those positive and empowering lost aspects (Biever et al., 1995; White & Epston, 1990). Letter writing, therapeutic documents and certificates, and stories are the primary means by which clients begin to re-write their life narratives.

Through narrative therapy, adolescents can realize that a problem is not an inherent part of his or her identity, as often suggested by other members of their peer and family social groups, and the medical model of mental health (Johnson, 1994; Tomm, 1989; White & Epston, 1990). As White and Epston (1990) suggest, it is through this revelation that clients can then separate or externalize the problem from themselves, and transcend the label(s) which may have been placed on them--the adolescents realize that they aren't the problem, but that the problem is the problem (Biever et al., 1995; Johnson, 1994; Tomm, 1989; White & Epston, 1990). After externalizing the problem, clients are encouraged to explore their past and find times when the expected event associated with the problem did not occur. By re-evaluating their pasts, clients are able to find these unique outcomes, which can serve as contradictions to their dominant stories and as a means to recognize successful behaviors and attitudes when coping with the problem (Draucker, 1998; Etchison & Kleist, 2000; White & Epston, 1990).

Narrative therapy's potential effectiveness with adolescents stems from the encouragement of clients to take control of the therapeutic process, and from an often newfound sense of empowerment achieved by self-exploration of potential solutions. The very nature of narrative therapy stimulates clients to become aware of their decision-making abilities and of the fact that the choices they subsequently make determine the course of their own lives (Biever et al., 1995; Tomm, 1989; Wetchler, 1999). Nowhere are these lessons more important than in the context of adolescent development.

Within the narrative therapy framework, letter writing can allow a physical way for the problem to be externalized, named, and then confronted (Zimmerman & Shepherd, 1993). In addition, because the content of such letters is directed in most part by the client, the client determines pacing, what, when, and whether to disclose (Rassmusen & Tomm, 1992). Thus, letter writing proves to be a beneficial technique to implement in counseling because it provides a means for an individual to trace his or her story through time at a self-guided pace, thereby embodying changes and avenues for potential change for which clients are searching (White & Epston, 1990). This inherently empowering approach is based on the idea that adolescents are competent to navigate the course of their counseling (Hall & Jugovic, 1997). These issues are especially important for adolescents who are trying to develop their identity and autonomy in a world where one or more adults is imposing authority and definitions of the world onto them (Biever et al., 1995). The adolescents' ability to pace the level and content of exposure could, theoretically, reduce the resistance that so many counselors report when working with adolescent clients.

Another advantage of using letter-writing interventions with adolescents relates to the concrete and tangible nature of the letter. Just as with adolescent note writing to peers, therapeutic letters can be re-read and the story can be reconsidered with a concrete means for evaluation both during the session and well after the session has ended (Dolan, 1991; Furman & Ahola, 1992; Goldberg, 2000; Madigan, 1997; White & Epston, 1990). These therapeutic letters then provide clients with a supportive resource to which they can refer back for encouragement or reminders, similar to what adolescents often do with the notes they pass to each other (Chen, Noosbond, & Bruce, 1998).

GUIDELINES FOR USING LETTER-WRITING INTERVENTIONS WITH ADOLESCENTS

In utilizing letter-writing interventions with adolescents, it is important to consider the guidelines or intentions behind the counselors' letters and the counselor-generated, letter-writing assignments. The following paragraphs will describe general postmodern guidelines to facilitate the counselors' letter-writing interventions with clients. These guidelines can be useful in letter-writing interventions as well as general counseling practices with adolescents (see Biever et al., 1995).

First, look for exceptions to the problem and unique outcomes. O'Hanlon and Weiner-Davis (1989) have suggested that large and meaningful differences can come from small changes. Be mindful of these small changes and accentuate them in the letter-writing interventions. Exceptions to the problems can be facilitated through presuppositional questioning (i.e., open-ended versus yes-no responses) which lends itself well to an open letter format.

Additionally, framing questions asked in the letter from a position of curiosity, or a not knowing stance (Anderson & Goolishian, 1991) can facilitate the adolescents' reflective thinking and encourage their ability to identify unique outcomes (Anderson, 1992). For example, "I'm wondering how you were able to get along so well with your brother last weekend."

Also, assume that the adolescent has strengths and resources. Asking about exceptions to the problems and identifying the client's strengths are ways to accentuate these positives (de Shazer, 1988; O'Hanlon & Weiner-Davis, 1989).

Finally, externalizing problems through the use of language honors the adolescents' everyday actions of resistance to the problem and emphasizes the clients' abilities to fight the problems (Etchison & Kleist, 2000; White & Epston, 1990). Giving the problem a name and talking about the problem external from the person are the primary modes of externalizing (see Fristad, Gavazzi, & Soldano, 1999).
 Externalizing is an approach to theory that encourages persons to objectify
 and, at times, to personify the problems that they experience as
 oppressive. In this process, the problem becomes a separate entity and thus
 external to the person or relationship that was ascribed to the problem.
 The problems that are considered to be inherent, as well as those
 relatively fixed qualities that are attributed to persons and
 relationships, are rendered less fixed and less restricting. (White &
 Epston, 1990, p. 38)


There are differing types of therapeutic letters with varying intentions and emphases. The following sections describe the various uses of letter writing with adolescents according to the following taxonomy: letters between counselors and clients, letters from counselors to clients, and letters from clients to themselves. Additionally, examples specific to counseling with adolescents are provided.

TYPES OF THERAPEUTIC LETTERS

Letters Between Counselors and Clients

As mentioned within the context of Morita therapy (France et al., 1995), letters between counselor and client have the potential to become an integral, continual part of the counseling process. Letters between adolescent clients and counselors provide a convenient way for a check-in when the physical meeting option is not possible or convenient, due to factors such as distance, time restraints, or missed sessions (Rasmussen & Tomm, 1992). Additionally, as previously stated, some adolescents may not be comfortable discussing certain topics in sessions but may feel more flee to discuss challenging issues in letters.

Letters From Counselors to Clients

Wojick and Iverson (1989) have identified several purposes for the use of letters as therapeutic intervention on behalf of counselors. They state that a counselor can write letters not only to provide support and encouragement for clients, but also "for the purposes of emphasis, ambiguity, provocation, appeasement, communication with absent members, and termination" (p. 77). For example, a counselor's letters can emphasize content or salient points of sessions to provide clients the opportunity to further examine these ideas. Additionally, such letters might perpetuate a sense of ambiguity or provocation to encourage clients into clarifying the vagueness or foster change when they have become too comfortable with the status quo.

Letters of invitation. Letters of invitation are designed to encourage client involvement (White & Epston, 1990). Such letters are particularly useful when individual clients or members of a family in treatment are reluctant to attend. The content of such letters can range from encouragement to simple understanding as to why a person may be reluctant or anxious to attend sessions. The intent of the letters is to provide a supportive voice when the person has chosen not to be there to hear it. Consider the following example:
 Fifteen-year-old Rob refused to attend family therapy, stating he thinks it
 is stupid and that he wouldn't be heard anyway since no one ever listens to
 him at home. The counselor chose to write a letter of invitation to Rob,
 which addressed his concerns. Such a letter indicates a desire to hear his
 opinions and points of view. By suggesting to Rob that no one else in his
 family would fully be able to represent his interests during the sessions,
 he found the necessary incentive to attend sessions.


Redundancy letters. In many cases, adolescent clients find themselves in multiple roles which may at times conflict. Examples include adolescents who find themselves in the role of caretaker for their family members. Clinicians could use letters to explore these assumed roles in an attempt to assist clients in relinquishing these roles to the appropriate source (White & Epston, 1990). The following is an example of a situation that would lend itself to a redundancy letter:
 Acacia, age 16, is the oldest of three children. She attended to the needs
 of her two younger brothers for the past few years while her parents were
 at work. Recently, her brother John, age 12, has started being delinquent
 from school, often skipping classes. He had fallen in with the "bad crowd."
 Last week, the police escorted John home after he was caught throwing rocks
 at a new construction site. Acacia is distraught and is blaming herself for
 not making sure that he was at home instead of out getting in trouble with
 his friends. A brief letter was sent to Acacia inviting her to allow her
 parents to handle the situation and to extricate herself from this role in
 order to reduce her personal distress over this matter.


Letters of special occasions. Often clients may find themselves faced with difficult or special events that cause them anxiety or stress. Such events may include the anniversary of a death, a trial, seeing a perpetrator of abuse, holidays, a play at school, etc. Clinicians can validate an individual's feelings regarding the event through letters related to these special occasions (White & Epston, 1990). If this validation takes the form of a letter, it becomes a means of continued support throughout the special occasion as the individual can reflect on its content whenever he or she feels it necessary. An example this writer used with a client is as follows:
 Isabel, age 16, presented for counseling very anxious about an upcoming
 talent show in her residential school. She reported severe anxiety around
 performing and a fear that she would "freeze" while on stage. A letter
 normalizing her experiences of anxiety, addressing her strengths in
 performing and managing the anxiety that is trying to influence her was
 helpful in getting her through the event. Isabel reported that she read the
 letter before performing and she found it comforting. She reported that she
 wanted to use the letter in other similar situations.


Letters of reference. When the client is aware of progress made, but is unsure of whether those around him or her may notice the changes, a clinician may write a letter of reference to help proclaim the news. Similar to a letter of reference made for those seeking employment, this type of therapeutic letter documents the changes made since treatment began and provides highlights of the accomplishments of the client (White & Epston, 1990). The client may then show the letter of reference to those she or he feels may need to see written proof of changes that might not be evidenced otherwise.
 Before attending counseling sessions, Lee felt he was considered the bad
 seed in his small community. Although he had been involved in several
 counts of minor property damage, his neighbors had begun to blame him for
 any incident that occurred. Lee felt that no one would believe that he had
 turned over a new leaf after participating in counseling. Lee and his
 counselor composed a letter that contained examples of how his attitude and
 related behaviors had changed since counseling initially began. This letter
 highlighted changes in regards to respecting others and their property, as
 well as Lee's understanding of the implications should he not follow
 through with general societal expectations. The counselor noted that Lee
 had made great changes over the course of the previous 2 months and that
 all his efforts to make changes in his life were genuine. With this letter
 in hand, Lee had a means to demonstrate to others, and to himself that he
 had made progress.


Counterreferral letters. At times the client may need evidence to remind him or herself of the reality of progress and accomplishment. Letters that refer the individual to someone else such as a previous doctor or an imaginary group with such accomplishments incorporated often fulfill the client's requirements for this type of evidence (White & Epston, 1990). An example follows:
 Dina had been battling a negative body image due to the teasing and
 ridicule to which she was subjected by a group of three girls at her
 school. These girls called her a range of negative names and told her on a
 daily basis that she was fat and ugly among many other criticisms.
 Throughout counseling, Dina had been able to develop a healthier
 self-image. When her counseling was drawing near an end, Dina once again
 doubted the progress made during her sessions. Dina was asked to think
 about her situation and create an imaginary group to which she wanted to
 belong. With a smile, Dina indicated that she wanted to belong to the
 "Inner Beauty Association." Although at that point, Dina felt comfortable
 about her appearance, she stated that she had always been beautiful on the
 inside. The counselor then wrote a letter to inform the Inner Beauty
 Association that throughout her ordeal with the bullies in school she had
 proven herself worthy of membership by refusing to resort to violence or
 similar degradation of others. Further, the letter stated that Dina should
 be congratulated for overcoming anxiety caused by peer ridicule and for
 learning to be happy with who she is regardless of what others think of
 her.


Letters of prediction. Letters of prediction are useful in giving clients a sense of hope for the future. A clinician may choose to write a letter of prediction for the client with a specific framework of time in mind (White & Epston, 1990). For instance, a counselor may chose to write a letter to a client that encompasses the idea that he or she will have obtained a desired goal such as gainful employment or renewed relationships with previously estranged family members. An example follows:
 Mark, a high school senior, was suffering from adjustment issues due to
 parental divorce. His grades subsequently dropped, and Mark was anxious
 about how his future would be negatively impacted if this pattern were to
 continue. While working with Mark on accepting the new familial
 environment, Mark's counselor decided to write a letter of prediction to
 provide Mark with the necessary hope that things would improve over time.
 The letter the counselor chose to write to Mark placed him as a
 well-adjusted freshman at a nearby university, where his grades were even
 slightly above average, and he was actively involved in intramural sports,
 one of his favorite past-times.


Letters From Clients to Themselves

Letter writing provides an avenue for locating support not just from external sources but also from internal sources. Rather than sending letters of disclosure to others for a response, an often painful or threatening suggestion to those who experienced traumatic events such as sexual molestation, a client responds to the letter with a realistic response and with what he or she feels would be the most beneficial response, thus providing self-support (Madigan, 1997).

Letters to one's self from the present. One option is to write a letter to one's self in terms of experiences he or she is currently having. Again, this provides clients an opportunity to separate themselves from the problem and to view their situation from a different frame. For instance, when having a positive day, clients may be asked to write a rainy day letter, for the days when they aren't feeling so good, and in the letter discuss strengths and positives about themselves and their situations (Dolan, 1991, 1994). This letter then can provide a sense of hope or encouragement when the adolescent feels hopeless or anxious regarding his or her situation. For example:
 Dianne, age 14, often felt as though she didn't "fit in" with other kids
 after she moved to a new school 3 months ago. She felt as though she would
 never fit in and people would never want to be friends with her. When
 having a positive day when she felt better about herself and her situation,
 she wrote a letter that she could use on days she felt down. She identified
 her strengths and told herself that things would be getting better soon.


Letters to one's self from the future. An alternative is for clients to write to themselves from the future (White & Epston, 1990; Zimmerman & Dickerson, 1996) or from a more positive state, such as when they are older and wiser (Dolan, 1991, 1994). The letters from the future encourage clients to reflect and think of solutions other than those they've already tried, while assuming that positive change will occur. This activity allows clients to notice possibilities. Using the above example with Dianne, she could be asked to write herself a letter as an older, wiser woman. She could identify how she was able to make the necessary changes to become older and wiser. Dianne could give herself feedback and address the strategies she used to get to this place in her life.

CONCLUSION

The use of letter-writing interventions is an excellent counseling intervention for adolescents as it accounts for issues associated with adolescent developmental levels, utilizes a strength-based orientation, and is culturally sensitive. It can be helpful with cooperative adolescents as well as adolescents who are more resistant to the counseling process. The technique provides the counselor with an outlet to work with the client to create a more positive strength-based perspective of the client's situation. The letter-writing process is inherently collaborative and enables the adolescent to work at his or her own pace while also facilitating client empowerment. The open ended, flexible nature of this approach allows the counselor to consider cultural issues and identify client supports and strengths

Letter-writing interventions may not be appropriate for every adolescent, and therefore, several contraindications should be mentioned. Adolescents who have extreme language difficulties, or writing or reading learning disabilities may experience difficulties or feel uncomfortable writing or reading letters. Additionally, severely resistant clients may not follow through on between-session invitations to write to the counselor. In these cases, counselor generated letters may initially be the most helpful and may contribute to the building of the counseling alliance.

Additionally, letter writing can cut into the counselors' non-billable time. However, generally, letter writing can be rather brief and take anywhere from about 5 to 10 minutes depending on the counselors experience in writing letters, the intentions and length of the letter, and the amount of thought and planning put into the letter.

In writing letters to clients, we recommend that a supervisor or a colleague read the letter before it is sent. It is better to not send a letter than to send a letter that is not well contemplated and could do harm (Wojcik & Iverson, 1989). In sum, letter-writing techniques are one potentially useful intervention mental health counselors can use when counseling adolescent clients.

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Fristad, M. A., Gavazzi, S. M., & Soldano, K. W. (1999). Naming the enemy: Learning to differentiate mood disorder "symptoms" from the "self" that experiences them. Journal of Family Psychotherapy, 10, 81-88.

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O'Hanlon, W. H., & Weiner-Davis, M. (1989). In search of solutions: New directions on psychotherapy. New York: Norton.

Rasmussen, P.T., & Tomm, K. (1992). Guided letter writing: A long brief therapy method whereby clients carry out their own treatment. Journal of Strategic and Systemic Therapies, 11, 1-18.

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Wetchler, J. L. (1999). Narrative treatment of a woman with panic disorder. Journal of Family Psychotherapy, 10(2), 17-30.

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Wojcik, J. V., & Iverson, E. R. (1989). Therapeutic letters: The power of the printed word. Journal of Strategic and Systemic Therapies, 8, 77-81.

Zimmerman, T. S., & Shepherd, S. D. (1993). Externalizing the problem of bulimia: Conversation, drawing, and letter writing in group therapy. Journal of Systemic Therapies, 12, 22-31.

Zimmerman, T. S., & Dickerson, V. C. (1996). If problems talked: Narrative therapy in action. New York: Guilford.

Victoria E. White, Ph.D., is a professor, Department of Counseling, Youngstown State University, Youngstown, OH. Email vewhite@cc.ysu.edu Melissa A. Murray is a graduate student in the Department of Counseling and Educational Development, University of North Carolina at Greensboro.
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Title Annotation:Counseling Adolescents
Author:Murray, Melissa A.
Publication:Journal of Mental Health Counseling
Geographic Code:1USA
Date:Apr 1, 2002
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