Working effectively with teens (with Marie Vakakis)

[00:00:00] Bronwyn: Hey, mental workers, you're listening to the Mental Work Podcast, your companion to early career psychology. I'm your host, Dr. Bronwyn Milkins. And today we are talking about working therapeutically with teenagers and here to help us unpack it and deep dive into the topic is guest Marie Vakakis.

Hi Marie.

[00:00:23] Marie: Hello, thanks for having me back.

[00:00:25] Bronwyn: It's such a pleasure to have you back. Marie, could you just remind listeners who you are?

[00:00:30] Marie: Absolutely. So I'm an accredited mental health social worker and family therapist. And one of the areas I work with is with adolescents. So after finishing my master's of social work degree, I went and studied a graduate diploma in youth and adolescent mental health, and I became a youth mental health first aid instructor.

And worked with young people in schools and realised, oh my goodness, they come with parents. I don't, I don't know what to do with parents. And so I went back and did my Masters of Family Therapy. So, young people is where my career sort of really, all the paths sort of led to working with that age group.

[00:01:06] Bronwyn: No, wonderful. So it sounds like you've worked quite extensively with young people then.

[00:01:12] Marie: Yeah, so I worked as a school counselor and wellbeing coordinator. So across a whole sort of cohort of young people. And now in private practice, a large bulk of the young people, uh, or the referrals I get are for, for young people as well as family and couple therapy.

[00:01:27] Bronwyn: I'd love to talk with you today about some general questions to do with working with adolescents, but also some of the common things that adolescents bring to therapy as concerns.

[00:01:39] Marie: Yeah. And I think it'll be interesting because we were having a chat before we started recording of how to actually structure this because the concerns adults have are not what the kids often come to therapy for.

[00:01:50] Bronwyn: Yeah. Yeah. I was like, we're going to talk about phone use and you're like, that's not what teens bring to therapy. So maybe we'll start there in that the topics that I had thought that we would talk on would be like, oh, let's talk about teenagers, phone use, their vaping, their self harm, their alcohol use, when parents think that their friends are a bad influence on the teen.

But tell me, are those the things that teenagers come to therapy with?

[00:02:17] Marie: No.

I've never had, especially in private practice, in a school setting, it's different because the referral pathways might be a teacher or might be a parent that says, my child has been caught vaping. They need to speak to wellbeing. But in terms of self referral or encouraging, like young people saying to their parents, I need to see a therapist, it's never for those things.

What it could be is those are things to look out for that might be symptoms or indications that something's not quite right. So parents might notice those things, but maybe what gets them into the door is they're so tired of the conflict. And so they might come in saying, I'm sick of fighting with my child, or they might notice substance use and then think, Oh my goodness, what's happening?

Often the first reaction, not always, is punishment or scolding, and then for some families they realise that that might be just a one off, or it might require some further investigation. It could be a symptom of anxiety or depression, or they're coping with difficult emotions or difficult experiences in a way that's seen as unhelpful, and then that's where they'll come into.

into therapy. So it's often for anxiety or depression. And a lot of what you've described could be symptoms that parents notice or a school notices.

[00:03:38] Bronwyn: And in your experience, do teens understand what a therapist does when they come to therapy? Like are their expectations lining up with what we can offer them?

[00:03:50] Marie: Probably more so than some of the parents.

[00:03:53] Bronwyn: Oh, really?

[00:03:53] Marie: Yeah, but the, the experience is mixed. And I think some of the trouble with school age young people is if they've been seeing someone at school, we don't have a universal, I guess, position description of what a school is. I'm a mentor, I'm a counsellor, I'm a wellbeing coordinator.

So, you might have someone in a school who's a teacher, and the young person might go see them and just get a couple of like headspace flyers and leave that session thinking, I'm never going to see a therapist again. Not realizing that wasn't a therapist. Or they might have someone who, their job is to do school wide implement school wide health promotion activities and triage. So there could be some misinformation about who they're seeing and what they do. And then, depending on how the person comes to therapy, if they've gotten to the point where they've self referred, they often kind of, they have a sense of what it could look like.

[00:04:48] Bronwyn: Okay. And I'm wondering, have you found that That might be influenced by what they see on social media, like their expectations about therapy, or are you finding that teens, they just don't really know much about it at all?

[00:05:06] Marie: The expectations, not so much. We don't talk that much about it, but often videos that they see, TikToks, other social media things might plant a seed of, Oh, that gives me the language to describe an experience I had, or that resonated with me. So we can use that as a starting point for deeper exploration.

[00:05:25] Bronwyn: Okay, sure. I know you mentioned earlier that anxiety or depression might bring a teen into therapy, but are they coming to you saying, Hi, Marie, I'm here because of my anxiety and depression, or are they saying other things when they come through the door?

[00:05:41] Marie: They won't say it like that. Often, the way I work is always to include parents in the room, because I've yet to have someone who can afford to come and see me without their parent permission. So the point of contact has always been the parent. So the parent brings me in, the parent put their credit card details on file.

So it's different in the context that I work in and often I'll have them both in I'll go through my confidentiality spiel and make sure they both really understand that. I might ask for the parent's thoughts on who made the appointment, whose idea was it, that can help kind of get together, get some of that, gather some of that information and then I might send the parent out and then I ask the young person, you know, why now? Or If they didn't want to really be there, it's like, why did mum or dad or your carer think that you needed to speak to someone?

So we can be really open and transparent. Or if I have a little bit of information from the initial referral or point of contact, I might say, look, I've got this referral from your GP. And I'll go through what it mentions. Where can we start? You know, so I'll go through and really try and understand what that is for them.

[00:06:47] Bronwyn: I really love how you ask who made the appointment because then without directly being like, are you here by choice... brings up a lot of information about who made the appointment and why, who wants to be in the room and maybe who doesn't.

[00:07:03] Marie: Yeah, and why now?

[00:07:05] Bronwyn: is a really important question. And so, Marie, what if a teen doesn't want to be in therapy at all? Maybe it is the parent who is like, we just keep on fighting over the phone use. They're using it at 12 at night. I've told them not to use it. And the teen is like, I'm just here because they told me to be here.

[00:07:26] Marie: That happens often.

[00:07:28] Bronwyn: Oh, does it?

[00:07:29] Marie: Yeah. Um, I would focus probably then on the parents. And I might look at the parents relationship with their young person. That might be, the conflict might be created through an issue in the relationship between them or a dynamic and Just saying, Oh, can we both agree that you're going to put the phone down at 10 o'clock? Yep. Is that okay? No, I want at nine 30. If you just tried to come up with a strategy, it's not going to work. And especially if the young person has started to relate to the parents and that be the, the stance is combative.

It doesn't matter how reasonable the request is. If neither feels heard, if neither feels understood, it's not going to work.

[00:08:13] Bronwyn: In that case, then, might it turn into the family is the client rather than the teen is the client?

[00:08:21] Marie: Potentially I, I always think it's, it's impossible not to have family included in working with young people, especially if it's creating that conflict. There's the, it's the parents who need to shift how they relate to their young person, not the other way around.

[00:08:39] Bronwyn: Yeah, because, I mean, just thinking about the phone use, for example, I can really see both perspectives. So, from the teen, they're like, look, this is how everyone interacts. It is embarrassing to not be on social media. It is embarrassing that I have to have a curfew for my phone use. And then from the parents perspective, they're like, well, you have to get up at seven to go to school and if you're on your phone until 12, that compromises your ability to get up on time.

So it's a really tricky dilemma. And I think like this dynamic shows up in a lot of ways for young people, like you would have a similar dynamic with say alcohol use or when they can drive and when they have to be home, that kind of thing, right?

[00:09:27] Marie: Yeah, but the, the thing that catches my attention about that is... the relationship with the parents and then trying to, I would not focus so much on the phone use and I would focus on the pattern of communicating. Is it critical? Is it shaming? Is it taking perspective? Is it offering compromise? Do they have a good attachment?

Because it doesn't matter how good the advice is, how right they are. They won't listen if they don't have that buy in. And so parents sometimes lose that connection from that transition to child to adolescence and they need to romance their kid back. They need to almost rebuild that relationship. You know, if you've got a 17 year old and you're still giving curfews of phone use, it's like maybe in a year they're at uni. This might not be an effective teaching method.

So it's really stripping that back to how are you communicating? Are you getting hurt? You're feeling hurt because you're feeling rejected or insignificant. And if, and that's where, that's where I would be going. I'd be looking at what's happening here and, Oh, I just want them to listen to me. Well, that's not going to work. You've moved from that manager to consultant role. And so the conversations need to be had as adults. And then sometimes it's leading by example. Is your phone in another room charging? You know, like we have to role model some of those things.

[00:10:50] Bronwyn: Do you find that that's difficult sometimes for parents to concede? I'm just picking up on the speaking to each other as adults. I can imagine a parent would be like, but they are a child still. I'm wondering, is that something that you come across in, in the therapy setting?

[00:11:07] Marie: I do. And that takes a little bit of understanding for everybody to think they will always be your child. I mean, I'm in my late thirties and my mom will still tell me, don't forget to take a jacket out.

But what, what we can talk about is it's hard to be what you can't see. So if you're patronizing, if you're talking down to them, if you're not taking accountability when you make a mistake, they don't then learn how to do that. They don't learn how to transition their language across to treating you in that way. So it's an opportunity to start mentoring and role modeling and allowing dignity of risk. Allow there to be some consequences. You know, if they're always running late to work, maybe you have to let that go. And you think you're late, you get in trouble, you lose your job.

You can't then afford the things you want. So it's trying to find a way to not, To still guide and still keep them safe, but the window of how much you allow changes every year with either more responsibility or they prove themselves in whatever ways you feel necessary. So it's really around adjusting that expectation and getting them ready to not need you.

[00:12:23] Bronwyn: Gosh, it's so hard for parents as you're speaking. I'm like, gosh, what a challenge, you know, every year they're, they're growing and they're changing and you have to adjust it. It sounds like a real challenge for parents to constantly manage.

[00:12:36] Marie: And I would overt that because that's part of the empathy for parents instead of blaming them and saying this is hard adjustment and you've done everything you can to get them here to keep them safe. You're probably terrified and so they might need a space to have that empathized with and understood.

[00:12:55] Bronwyn: Yeah, totally. Yeah. I imagine they would, many parents would need that space and that they are trying so hard to just protect the young person and bring them up in a way that's healthy and that's challenging. I wanted to ask you about the converse situation where let's say that the parent is modeling beautifully, um, their communication and they show a lot of respect and they're willing to let the young person have natural consequences. Um, but let's just say the young person just isn't having a bar of it. And they're just like, I don't care what they say. I'm going to use my phone to 2am. Like I can handle it. Um, they're just trying to ruin my life. They don't understand me.

[00:13:40] Marie: That could then be a starting point to understand the family dynamic. I think it's tricky because I'm still grappling with how to navigate those more complex families and I have an extensive like training in family therapy, so it might be that that's something that It might be out of some people's scope.

It might not be a very simple solution, but it could be, well, what are you doing? What are the benefits? Maybe like you would use some of the things you use for any other sort of addictive or compulsive behavior. What purpose is it serving? What do you get out of it? Does that seem fair and reasonable? Who's paying for it?

Like there might be a lot of curiosity. and try to get through that defensiveness because that's showing me there's something there. They're either feeling minimized or attacked or criticized or maybe they're feeling left out like actually trying to understand the why of the behavior and then also the what the perceived consequences are.

So if a parent's issue is that they're tired, that's one thing. If it's that you never spend time with us anymore, that's a different thing. If it's like, so, It can be quite complex and again I wouldn't focus so much on the phone use, I'd be looking at the system and the process.

[00:14:55] Bronwyn: It's a, it's a really good point. And I mean, just to get a sense, so don't scare listeners as well. Do you frequently have young people who are that combative in sessions or is that kind of a rarity?

[00:15:09] Marie: It's a rarity because if they're that combative, they probably didn't get through the door.

[00:15:14] Bronwyn: Yeah, it's so true.

[00:15:16] Marie: But then I offer parents the session for themselves. If they're really struggling, then that might be a flag that the family or the system is struggling. So I might say to the parent, look, if your kid won't come to therapy, that's fine. How about you come and we can talk about how you're coping, how you're handling it, because one person shift in their behavior can have a ripple effect.

So the parents can still learn how to support their young person to manage their anxiety or... how they're actually coming across because I've, you know, I've had some parents who are like, but I've told my young person what to do. And I said to do this and do this. And I've been really supportive. And then you speak to the young person and they're, they'll say, mom keeps trying to fix it. And I just want her to listen.

[00:16:02] Bronwyn: Yeah.

[00:16:03] Marie: And so they've missed each other completely.

[00:16:06] Bronwyn: When you say like you're focusing on the systems rather than the phone use as an example, is that a similar approach that you use for other problems? I'm thinking like teens who are missing schools because they are really into playing online games. Like, is that another example where you might focus on the system rather than I guess the, what they're telling you, the the problem is?

[00:16:31] Marie: That would be a more complex one and something, if it's moved into a bit of a gaming addiction, I would be referring that out because that's not something I work (with)

[00:16:39] Bronwyn: okay.

[00:16:40] Marie: Because just like when, you know, I work with adolescents, but I don't work with every single presentation because that's impossible. So just like someone who says I work with adults, but then they might not work with eating disorders or they might not work with BPD or they have a real specialty in OCD within that age group, I still have things that I, I am not equipped to work with. So a gaming addiction, I would be out of my depth and I would provide the family some support around. Maybe normalizing the challenges, but I would be referring personally, I would be referring that on. So I'm not the best person to ask!

[00:17:17] Bronwyn: Same. That's really good to hear that because I don't work with young people anymore. I used to, but, I didn't work much with them and it's really reassuring for me to hear and hopefully for listeners that if you say you work with adolescents, you still don't have to see every adolescent. There's still presentations that might be out of your scope of knowledge or competence.

[00:17:37] Marie: Yeah, absolutely. Because I can want like, they're not a homogenous group just because they have the same age. Like I work with some who have complex trauma, uh, victims of assault, sexual assault, single incident trauma, like car accidents. That might be something someone else can't work with. So it's the age group doesn't necessarily mean you then can take everything that that age group has, because that's the whole human experience.

[00:18:06] Bronwyn: No, absolutely. I'm just thinking, when you work with teenagers on maybe sensitive topics like trauma, is there any way that you might discuss sensitive areas with young people a little bit differently than adults?

[00:18:25] Marie: I would adjust the language and not make assumptions of what they understand or not. I think it's, I mean, they're like the humans, right? They have a good bullshit detector. And one of the, I guess, the key bits and probably why we talked about this topic about working therapeutically with teens. It's, in my experience, I think we need to overt some of those really obvious things first, and that's where the difference might be because there is a different power dynamic.

If I have a 14 year old come to see me who has teachers that tell them off, parents that tell them off, not that they're, I'm not saying naughty kid, but often it's disciplinary. You're late, where is your stuff? Have you got your locker? Why have you forgotten these? Don't forget this... and then they come here, they might be used to that dynamic. They might not have had a single adult in their life have space that's just for them and show them unconditional positive regard.

So we might need to avert that saying you probably get to all this, get taught off here, there, blah, blah, blah. This is how I work. These are the questions you can ask me. You don't have to worry about swearing. You don't have to call me Mrs Vakakis or it's letting them know cause that might be a foreign experience for them.

So a lot of it is, is owning that power dynamic that's there just by the, you're the professional, the parents have the power to pull them out of the sessions if they disagree with you or, you know, for whatever reason, they're in a very vulnerable position. So we have to revert that and work with that and talk about how do we manage that. I think that's probably the key difference.

And then maybe having, you know, board games and colouring pencils and being a bit more, you know, whimsical. Beanbags to sit on or sit on the floor. Like they don't want to see someone in a pantsuit. Um, that's just like, like, uh, no, who's this person.

[00:20:23] Bronwyn: Yeah, totally. I mean, that would, that could reflect somebody else with authority in their life and maybe they want to see that differently in the therapy space.

[00:20:33] Marie: Yeah. But even the language, like sort of saying authority figure, they might be like, what's like someone who tells you what to do or someone who's very, um, bossy. So it's adapting the language and you start to get into a rhythm. You can start to hear how they talk and you can adjust accordingly.

[00:20:49] Bronwyn: Do you ever try to use the cool words with the young people?

[00:20:52] Marie: No!

[00:20:56] Bronwyn: Good to know. Good to know. Would you recommend that listeners try and use the cool words with the young people?

[00:21:02] Marie: I don't think you need to be inauthentic. If you hear it and don't understand it, I don't think we need to be scared. Just being like, what does that mean? Oh my goodness, I can't keep up. You know, it's using humor and authenticity. And I think that generation values that. They see a lot more of that. So that's really important.

[00:21:23] Bronwyn: Yeah, I usually find with young people, they love telling me what things are anyway. So it's, and just like, I feel like Australians, we're quite good at self deprecating humour as well. So I'm very happy to be like, I have no idea what rizz means. Tell me what rizz is. Use it in a sentence. Yeah.

You were speaking about systems earlier and how it's integral to work with the parents. I wonder how that extends to the school. Like, I know you're in private practice. Is that a system that you consider as well?

[00:21:56] Marie: I do, I'm limited in how much support I can provide and it's, it's trying to find a balance because sometimes I think family therapy is the most important thing, but the young person then feels like I'm aligning with the parents or the parents might feel like I just need to fix the young person. So it can be really tricky to navigate that with a school.

I don't have a lot of communication with the school. That's something I might equip the young person to do or help them and their parents advocate on their behalf. So it's really setting them up to be able to do that on their own. I could provide a support letter and that's probably about it in, in my context. I don't offer case management. I don't do that kind of work. So if we're talking about therapy, it's very different to other kinds of maybe work that is mental health related, but not. Based on therapy and counseling.

[00:22:52] Bronwyn: And so, what might you say to a young person, like, you've been seeing them for a few sessions and there wasn't any reason to involve the school and then they're saying, uh, you know, with my ADHD diagnosis, I'm hoping that we can get some accommodations through exams. Is that something that you might support a young person with, with a letter or are you saying something else?

[00:23:20] Marie: Yeah, I could write a letter. I would, and I would, I don't go out of my scope. I'll say so and so has received a diagnosis by this, maybe this practitioner dated this time. We've discussed the following accommodations would be helpful. So I would still stick within my lane and be very honest. If I'd only seen a person twice, all I can say is thank you for the referral of jane Smith, I've seen them for two sessions so far. I've read the report created by their clinical psychologist. They've expressed that they would like some accommodations made based on the work we've done I think these could be beneficial.

So I might have to just be really honest. I'm not going to lie or get, um, triangled into something. I'll say I can provide information on what I've seen and observed. And that's, and that's it.

[00:24:14] Bronwyn: Yeah. Once again, I think it's really good to be open and clear about what you can and cannot do for the young person. It does seem that authenticity and transparency goes a long way with young people.

[00:24:26] Marie: With everybody, really, I think it's really helpful. I just, we need to keep in mind that young people are more vulnerable, and then children even more so in terms of having someone advocate for them and support them. So, there is a different power dynamic when you've got an age group like that.

[00:24:44] Bronwyn: Speaking of that, and let me know if this is not a presentation that you see as well, but what if the young person is experiencing a lot of difficulty at home and the parents don't want to be involved in therapy? Maybe the young person is in a chaotic environment and the family doesn't want to come into therapy to assist. How do you assist the client or advocate for them in that circumstance?

[00:25:18] Marie: It really depends on what they need. Like the family might have some level of chaos. What would I, what, what's still the presenting concern? If it's the family dynamic, then that might require a referral to case management. But if they're coming explicitly for counselling and they've gone to the GP, they've got a mental health care plan, or they're paying for it privately, it's a very different presentation. And so it's just like we can see an adult whose life's in total chaos, but they want help dealing with anxiety.

[00:25:52] Bronwyn: Yeah.

[00:25:53] Marie: So we need to keep checking in about the scope of the work, how we work, what kind of modality we use, where the referrals are coming from. Like we can't get caught into case management stuff.

[00:26:09] Bronwyn: So being really clear about your scope of practice and assessing why the client is here, why now, what they want help with and how you can help.

[00:26:18] Marie: Um, yeah.

[00:26:19] Bronwyn: Yeah. So. I've got kind of maybe one or two more general type questions. I'm going to ask the one that is like nagging at me, but it's just a random question first, which is, have you noticed the young people bring a lot of like TikTok diagnoses to you? If so, what do you think?

[00:26:42] Marie: I have, but there's something that's made them look that up. The algorithm would be giving them content based on something that they've clicked that captured their attention. So if they're getting lots of things around, um, and I don't want to use an actual diagnosis here, but let's say they'll, it was something around plants. They must have seen something that they clicked on that showed an interest in that and so I can still use that information I'm not going to go straight into saying well recent research has shown that about 90 percent of it is misleading or false and 10 percent is incredibly harmful or whatever the research was.

I might say what interested you about that? And then I might provide some claim like, well that's not a real thing, that's not an actual diagnosis, but this is what it really does mean. And so we can talk about that if we have that rapport.

[00:27:33] Bronwyn: I really like your kind approach because I think one of the reasons I asked that is because online I've seen a lot of therapists express some frustration or just kind of mean views of people who bring in these diagnoses to therapy, and they're just like, Oh my gosh, like people being Dr Google and being so annoying.

But then on the other side, I think similarly, and I'm like, well, something must have grabbed their attention and they must be curious or resonate. And I'm wondering what resonates with them about that, even if it's not quite the right, in air quotes, experience. Overall, there must be some difficulty or concern or just experience that's drawing them to the content.

[00:28:18] Marie: Yeah. And we can, we, we can fight it, but it's here to stay, uh, until it gets replaced by something that hasn't been created yet. And we have to think what would it be like in reverse? What's an equivalent situation that we might find ourselves in? You know, if you're going to, if you're like, I need a new car and you start Googling stuff, you're going to have to start somewhere to narrow down your search. And then you might read some reviews. So we all kind of do it to some extent. And I think we have to accept that that's part of how some people try to digest information or make sense of their experience and run with that.

We can provide counter resources, like I love reading books, but a young person who might like a 15 second video won't read a whole book. So I can try and think, well, what's the psycho ed bit? that I think is really missing here. How can I bridge that gap? What can I provide? How can we talk about it? Why is that important? So being curious will elicit more information.

[00:29:20] Bronwyn: Another aspect of this discussion is when young people might latch on to a particular diagnosis, let's say it's plant loving disorder, and they really want to have plant loving disorder and it becomes part of their identity to have that.

How do you feel internally if that happens? And is that a reason to bring it up with a young person as a concern? It's like, well, you don't really have plant loving disorder. Um, I just wondering how you approach that?

[00:29:55] Marie: I would never say it probably like that. I would be curious as to why? What is it that some people like to have? The diagnosis provides some relief of, oh, there's finally a reason that explains my fondness for indoor plants. I need to know why I am surrounded by ferns and ficuses. So maybe that is why they want to know, they want to know. And so that could be helpful.

And sometimes it can be saying, look, I can see some traits and not. all of them. So let me go through, maybe you go through the criteria of this is why it would be considered that, but maybe it's not a full blown plant loving disorder and it's, you have a fondness for plants or there are some traits of, or you might talk about your differential diagnosis and you could say this might require a bit of exploration. So again, I would still be coming at it with empathy and curiosity.

And if there are some. presentations that the diagnosis doesn't actually change the treatment, then I could even say the same. Look, if that feels good for you, let's hold that in mind. And let's look at the specifics of how that impacts you day to day, because you might not need the formal diagnosis if the tools and strategies can be customized or adjusted for that person's preferences.

[00:31:19] Bronwyn: Mmm. No, I think that's really lovely. You have such a, a really lovely empathetic approach, Marie. It's so refreshing.

[00:31:26] Marie: You should see me when I get stuck in traffic. There's no empathy.

[00:31:32] Bronwyn: I'm wondering, because you've worked so much with young people, you know, like some therapists, like myself, they have, they tend to avoid working with young people. I think the main reason I do it is because it's, I find it difficult to navigate the ethical complexities and set up the procedures that come along with working with young people.

Um, maybe what advice would you give to someone like me, who's, who's avoiding working with young people because they're worried about working with like separated parents, or if the young person says something concerning about the parents, how can we navigate these ethical concerns?

[00:32:12] Marie: You could have Um, an intake session. So you could actually have a bit of a process where you just say, look, any new client I have an intake session with, maybe it's a half session and you get a bit more of that information, but again, it's the age group is so varied that you don't have to take on everybody. So if you're thinking this person's high risk. They have child protection involved, they've got separated parents. I don't have the support as a solo practitioner or in a small practice to navigate that. I'm going to decline this referral.

If they need, if there may be an eating disorders client. Uh, I don't see them in particular, and I don't have good strong connections with a psychiatrist and a dietitian and a GP. I might say the level of complexities outside my scope.

So I wouldn't just limit it to the age. It might be narrowing down the presentations and then you can take it one step at a time. Like you document your work, you do the proper consent forms, you have legal support through your insurance or, you know, there's consults. It's, it's just staying within your scope. And if something arises that is outside of that, you might say, look, this is now a conflict of interest, or I'm no longer able to work with your young person. Here are the recommendations.

So you don't have to get frazzled. You can take it one step at a time and chat with your senior clinicians or your supervisor, or have an intake session, like put in places, the different strategies to, to get, you know, a bit more support around those things.

[00:33:50] Bronwyn: No, that's really helpful to hear because I think reflecting on what you are saying, I reckon, This comes from, for me at least, being an early career psych in your first jobs and not being able to decline referrals. So getting allocated cases and then not feeling able to, or, or being told by the workplace that you cannot *not* take on this client and then that continuing on in later professional practice. But it's really important to hear that we do have autonomy about who we see and who we don't see.

[00:34:23] Marie: Yeah. And it might be a conversation as well with wherever you're working of saying, if I'm not like, you might have a stretch bit of your scope, but then asking for what you need so you can provide the appropriate care is if it's your own anxiety, is there checklists that you might need? Do you want to practice recording, you know, yourself doing your consent... informed consent spiel.

Um, and I just ran a training, which is up on the website now on demand, but around how do we set up those first few sessions so that you can go through paperwork. You can talk about the admin stuff. You can say what I do and don't do and have those different kinds of check in points. So there's still, even if you don't have a lot of choice, you still have choice in how you handle those scenarios.

[00:35:11] Bronwyn: Oh, fantastic.

[00:35:13] Marie: I think you can even say to someone, look, this is not my area of specialty, or, you know, think about an EAP program. You only get three sessions. So you might have to say, look, I can see there's a lot going on for you. We only have three sessions and your work agreement with us is that it's work related.

So these are the things I can talk to you about. Anything outside of that, while I'd love to help you, we're limited to these bits. Is that okay? Or knowing that, what do you want to do?

[00:35:45] Bronwyn: No, wonderful. No, that's so helpful. I'll ask you for the link to that training in a moment, and I'll make sure that it's in the show notes. It sounds incredibly valuable just to have that. It's almost like a kickstart. It's like, how do I set this up and make sure that I've got all the good components from the get go?

[00:36:03] Marie: Yeah, absolutely. And it's, it's, it's transdiagnostic and transdiscipline because it's not about, you have to do it this way. It's being clear on what you do, how you do it, and how do you explain that?

[00:36:16] Bronwyn: Yes. Which I think is so important, you know, even in, um, anecdotally, like talking to Uh, people in the public, like when I go, cause they always ask what you do, and then you tell them that you're a psychotherapist. Um, and then you hear stories, and sometimes you hear stories from people who are like, I went to go see XYZ professional, and I didn't understand what they were doing, and I didn't understand the scope. I felt like, They weren't explaining stuff to me and I've heard this more than once anecdotally and so it does seem to be important and what people are looking for is that clear explanation of what you can do, what you can't do, how you want to help.

[00:36:56] Marie: Yeah, absolutely. And think about it. If it was physical health, you know, we all have grievances with particular professionals when they haven't been clear to us. So that clarity of, you know, you might go to your GP and you've got a stomachache. And if they just give you a script and say, go out, go and do this. You're like, what the? But if they really explain, look... my exam sort of showed some tenderness. It could be a number of different things. I want to start with the least invasive and most likely based on your, you know, your age and gender or, you know, whatever parameters they have. So I need you to go get an internal ultrasound and then get a blood test. Remember, it needs to be a fasting blood test. Get all of that stuff done. I should have the results within two weeks of the blood test, then come back and see me.

Like, it's the clarity of this is what I need you to do next. Becuase Imagine just going to the pathologist and being like, I need some blood tests. What do you want? Oh, whatever you feel like, like we don't, we don't want that.

[00:37:53] Bronwyn: No, it's yeah. It sounds ridiculous when you say it like that. And it's like, I think we all appreciate clarity. And I say that to clients, even when I'm talking about assertiveness, I'm like, do you prefer clear communication? And I've always had clients be like, yes, I love clear communication. And it's like, how can we do that for other people? They'll really like to receive it.

[00:38:11] Marie: Yeah. And that's, you know, I was talking to someone earlier today and we'll talk about schema therapy and sort of saying that it's really important to, to practice or at least participate in a lot of the treatment modalities that you offer. And, you know, we were talking about how a lot of therapists have, self sacrificing sort of schemers. And so there's some really common, the commonality there of that might be something you struggle with. You're trying so hard to, to please or not rock the boat or not be assertive or not be, um, you know, take up too much space that you might be doing them a disservice by not being clear.

[00:38:46] Bronwyn: Mmm.

[00:38:47] Marie: And so that might be, you know, That might be some of your work that might be for supervision or it might then be a little bit more personal where you figure out does this belong in supervision or in therapy, but that's part of our ongoing learning for ourselves.

[00:39:02] Bronwyn: Yeah. No. And I love talking about therapists in therapy and working on our own stuff because it is so important. It's like, what are the barriers to helping our clients that might be our own barriers that we could work on?

[00:39:15] Marie: Yeah, absolutely.

[00:39:17] Bronwyn: I am thinking with young people as well, like I tend to avoid them. I'll be less avoided now after hearing your wonderful explanations. Um, but I'm wondering if there are any memorable or particularly good things about working with young people that you find keeps on drawing you back to working with this population?

[00:39:38] Marie: Yeah, for me, it's the prevention of things getting worse. So I, I've talked about briefly in, um, I think, I don't know if we spoke about my start of my career, but I worked in aged care and homelessness. And so I kept sort of working my way younger thinking, where can I have more of an impact?

And I settled with adolescent. I still work sometimes with kids, but I find adolescents a little bit more enjoyable is hopefully I get to prevent things getting worse. If I can bridge some of that communication gap with parents, that might be amazing. If I can support them to reduce self harm that might keep them safe. You know, it's, it's, it's really setting them up on a different path to maybe not need me in the future or to be okay with getting help and be able to recover from an episode of maybe anxiety or depression or know that if they have a particularly stressful in a worldwide pandemic or other life event that they don't feel they have to suck it up on their own, that we can normalize that help seeking. So for me, that keeps me going.

And then also seeing the progress, like I've got some people I've worked with for three, four years, and I've seen them struggle at parts of school, maybe with bullying or particular negative life experiences. And now I've seen them graduate or start jobs or, uh, build, New friendships and so you get to see that stuff when you work with some people long term and that's pretty awesome.

[00:41:10] Bronwyn: That is really awesome, I love both of those things, I love the preventative um, It's so cool that you could have a positive change in a young person to change their trajectory and really help them to feel more confident or heard or understood. And then that has a really good impact on them. And I love that you get to see the positive life experiences they have after going through some difficult times as well. That must be really rewarding.

[00:41:36] Marie: It is and some of them I just want to beat them at the board games we play because they...

[00:41:40] Bronwyn: yeah.

[00:41:41] Marie: I'm not getting any better so I've just, I play to win and I, I want to win.

[00:41:48] Bronwyn: Yeah, I do that with the young people as well, but I, I try and be like, I definitely have played board games with young people and I'm like, I'll let them have this. Have you ever done that?

[00:42:01] Marie: so I um, I'd like to use it as a teaching moment strategically.

[00:42:07] Bronwyn: Mm. is important to learn how to, uh, lose, lose well. It is a good skill actually. Mm.

[00:42:16] Marie: I think so.

[00:42:17] Bronwyn: Yeah. Well, Marie, is there anything else that we haven't covered about working with young people that you'd really love listeners to know?

[00:42:28] Marie: I think some of the work that I've personally done, and again, I started off in a very medical model so that, you know, the graduate diploma was very medical. It was, you know, pharmacotherapy, risk diagnoses, differential diagnoses, and that was helpful then. And the more I move away from that, I realized the interpersonal communication, and I try and focus on that with young people.

So kind of thinking, I also get to role model stuff for them that I can role model how to contain their parents. I can role model owning mistakes. I can demonstrate some of that myself. So there's still, you know, kind of like a dress rehearsal.

So don't feel like it's going to go to waste, the work you do, even if it's just a handful of sessions because you might still be one person who's showed care or concern or compassion or even, you know, had a laugh or, you know, bet them in UNO or whatever. So, try not to be scared by the age difference really.

[00:43:32] Bronwyn: No, thank you. And I think that rings true. I saw my first when I was 16 and I still remember her name, Michelle. Lovely person. And it really is like, it's kind of like remembering your early teachers. I feel like it holds a similar place for me, like my first counsellor. And it's just, it was just really powerful. So, you know, I think it can be that way for a lot of young people and they come and see us and they get that really good experience.

[00:44:02] Marie: Hopefully.

[00:44:03] Bronwyn: Yeah, I hope so.

Well, Marie, you did mention that you've got a course. Could you just let listeners know where they can find you and where they can find this course that you have on setting up therapy?

[00:44:16] Marie: Yeah, so, uh, everything's on the marievacacis.com.au website. So every month this year, I'm running a webinar, so it'll be run live and then digitized to on demand. So the first one that's already up is enhancing clinical outcomes. Uh, next month, we've got actually the same topic working therapeutically with teens, and then there'll be a few scheduled throughout the year.

So they are available, they'll be available to purchase to attend live. And if you come live, you get to ask questions. Uh, if it's on demand, I edit it a little bit and just make it a bit more concise and that'll be there for purchase as well.

So there's a few different ways to connect. If someone's local to Melbourne. I run the local youth mental health professionals network for Footscray. Um, and then I have my, my podcast, This Complex Life, which is probably more suited to the parents, but there's some episodes there on parenting and adolescence and, um, this idea of moving from manager to consultant as well.

[00:45:14] Bronwyn: Awesome. I'll pop all those links in the show and I'd really recommend listeners. Get onto it.

So thank you so Marie, for coming on. As always, it's been a pleasure and thank you listeners for listening. And listeners, if you're loving the show, I would love it if you could leave us a rating and review. It really does help new people find the podcast.

And if you have someone, a mate or a colleague who would enjoy this episode, do share it with them. That also helps. That's a wrap then. Have a good one and catch you next time.