In my zeal to discuss treatment implications for mandated clients, culturally diverse clients, women, the dually diagnosed, and other special populations, I might have overlooked the one target population that seems to need us most: adolescent males.

Boys are five times more likely to commit suicide and more than twice as likely to drop out of school.1 Substance abuse is more likely to lead to depression in boys, and often results in an early entry into the criminal justice system. Males make up 92% of the juvenile justice system's population.2

Adolescent boys also are scarier for many in the helping professions to address. They are seen as more violent than adolescent girls, and often are viewed as perpetrators rather than victims. So it is possible that a smaller group of professionals is willing to deal with boys.

In some ways boys are the same as your other clients. But in a few important ways they are different. All clients tend to perceive the therapeutic relationship differently from their counselors,3 but this discrepancy is probably more pronounced when your client is an adolescent male. The counselor and client will attribute change to different factors, and research indicates that it is the client's perception that counts.3 So it is important to attend to the adolescent male's perception of how things are going and to agree on what is helpful and what is needed.

It is also important not to challenge immediately the male adolescent's preferred views. These are the strongly held beliefs and perceptions about himself that he is not willing to negotiate at present. Identifying and accommodating the boy's preferred view helps him change inaccurate perceptions more quickly than directly challenging them.

The importance of listening—really listening—cannot be overstated. Many boys believe they have no say in their own lives, and the problems that bring them to therapy often stem from a misguided attempt to assert their right of self-determination. For many boys you meet in treatment, you have the opportunity to become the first person who really listens and takes seriously what they have to say.

Don't rush to the defense of people about whom your adolescent male client complains. Parents, parole officers, teachers, principals, bosses, and others might have valid grievances, but pointing this out to your client is likely to get in the way of establishing a solid therapeutic relationship. You run the risk that the client will see you as a representative of whatever authority pressured him to see you.

Rather than take the client's complaining at face value, consider what treatment goals might be beneath the complaints. Rather than try to help your client find the truth in his parents' grievances, for example, focus on a specific goal that might be of interest to him: a later curfew, more respectful treatment at home, a greater level of trust from parents.

Once your client accepts such a goal, you can work with him as a partner. A discussion of how to gain a later curfew, for example, would naturally turn to things the client might do to inspire more trust in his parents.

Address use comprehensively

Do not hesitate to address in your discussions the perceived benefits of using drugs. This might seem counter-intuitive, but there is no better way to understand the needs being met or goals being sought through your client's drug use. An adolescent boy's use likely will continue until he finds and experiences better ways to meet these needs.

If feeling like part of the group, or getting relief from stress, or numbing the pain of a “meaningless” life is identified as the motivation to use, we can work with the client on social skills, stress management skills, or spiritual development, respectively.

Once your client has exhausted the list of reasons for using, it is usually safe to ask about the things he doesn't like so much about using. With their drug buddies, clients talk mostly about the fun of using. With teachers, parents, and others in authority, they expect to hear about only the bad things. If you provide a neutral place to process the decision to use drugs, where access to information both for and against the choice is allowable, many boys eventually will come to the decision that the risks outweigh the rewards.

Exhibit trust

On many occasions boys will have made positive changes even before they show up for a session. This is true whether they have been formally mandated to treatment, are responding to pressure from others, or decided to enter treatment on their own. Even if it's a formal mandate, don't express doubt that your client is serious about changing. Discuss the decision to come to treatment in the context of other good decisions he currently is making.

Discussing problems over session after session is very discouraging to most boys, so focus on any areas of improvement instead. Rather than ask the client to track or focus on problems he is having, ask him to keep track of all the things he views as positive. This will result in a list that includes personal strengths, supportive relationships, and external resources that can be drawn upon to achieve treatment goals.

In short, don't be turned off by angry, obnoxious, intimidating boys. They're the ones who need us most.

Nicholas A. Roes, PhD, author of Solutions for the `Treatment-Resistant' Addicted Client (Haworth Press, 2002; reviewed in the January 2003 issue of Addiction Professional), is Executive Director of the New Hope Manor residential treatment facility in upstate New York. His e-mail address is NickARoes@aol.com and his Web site is https://www.nickroes.com.