Enhancing resilience in youth at risk: implications for psychotherapists.
Subject: Psychotherapy (Methods)
Psychotherapy (Health aspects)
Child psychopathology (Care and treatment)
Psychotherapists (Practice)
Authors: Schwartz, Robert C.
Thompkins, Sonya M.
Pub Date: 12/22/2009
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2009 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Winter, 2009 Source Volume: 12 Source Issue: 4
Topic: Event Code: 200 Management dynamics
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 216961285
Full Text: Many child and adolescent psychotherapy patients can be classified as youth at risk due to the psychosocial stressors they are confronted with and the resulting negative consequences for their lives. This article highlights some features of youth at risk as well as the construct of personal resilience, a factor that can help at-risk youth cope with life difficulties. Implications for psychotherapists are presented in order to illuminate alternatives that mental health professionals can use to promote resilience among clients in this vulnerable population.

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Introduction to At-Risk Youth

Recent evidence suggests that personal resilience can have positive therapeutic implications for guiding youth at risk toward improved coping skills and enhanced functional outcomes. Various clinical issues presented by child and adolescent clients are particularly challenging for psychotherapists. It is not uncommon for psychotherapists to feel helplessness, frustration and confusion regarding the issues that children and adolescents manifest in therapy. For example, numerous adolescents are prone to engage in risky behaviors, accompanied by cynical attitudes, developmental difficulties, and possibly aggressive or violent tendencies (Hanna & Hunt, 1999).

Psychotherapists must possess the fortitude and patience needed to understand this client population, especially those identified as youth at risk. That is, youth at risk display many of the same life issues as children and adolescents in general; however, research has shown that these individuals are more in danger of future negative outcomes in the absence of intervention (McWhirter, McWhirter, McWhirter, & McWhirter, 2007). Current data suggests that valid therapeutic implications exist for youth who utilize the elements of resiliency because these elements tap into inner strengths/resources to improve coping skills and problem-solving abilities (Baruth & Carroll, 2002).

Recent evidence presented in a national Forum on Child and Family Statistics (Federal Interagency Forum on Child and Family Statistics, 2008) shows that underage cigarette smoking (leading to tobacco-related illnesses), adolescent alcohol use (associated with crime, accidents, injuries and deaths), and early sexual activity (resulting in emotional and physical health risks) often lead to increased rates of juveniles being at-risk in American society. And incident rates of some of these risk factors are on the rise. The following are examples of statistics specifically regarding at-risk youth that have been reported by Capuzzi and Gross (2008) and the Centers for Disease Control and Prevention (2000):

* 3,800, 000 juveniles drop out of high school each year

* 500,000 juveniles give birth each year

* 27,000, 000 juveniles live in poverty

* 14,000,000 juveniles are raised by a single parent

* 1,500,000 juveniles are referred for some form of abuse each year

* 3,000,000 juveniles and teachers are victims of crime each year

* 665,000 juveniles belong to gangs

* 500,000 juveniles are homeless

* 4,000 juvenile suicides are reported each year

Although federal, state, and local governments are aware of the circumstances cited above, there has been difficulty correcting these societal problems (Federal Interagency Forum on Child and Family Statistics, 2005). As reported by McWhirter et al. (2007), the result is sociological problems that further reinforce hardships for at-risk youth--hardships that make it more difficult for these vulnerable individuals to maintain psychosocial health:

* The number of children who live with persistently unemployed parents has increased 25% since the year 2000

* More than 92,000 juveniles are arrested for violent crimes (e.g., murder, robbery) each year

* Approximately 14% of juveniles report being in a physical fight on school property each year

* In the last 10 years there have been 39 school shootings

* Approximately 25% of all juveniles will be infected with a sexually transmitted disease before they graduate from high school

* Approximately 77% of juveniles have used alcohol by the eighth grade

The National Center for Education Statistics (NCES, 2005) also reported extensively on various at-risk behaviors carried out by youth. In their "Youth Risk Behavior Survey" the following risky behaviors and related consequences were identified among American youth: unintentional injuries and violence, tobacco use, alcohol and other drug use, risky sexual behaviors, dietary behaviors that result in poor nutrition, and lack of physical activity resulting in poor health. NCES findings revealed a total of 17% of high school students reported carrying a weapon (e.g., gun, knife, or club) in 2003. A total of 12% reportedly drove after drinking alcohol, while 30% admitted riding with a driver who had been drinking alcohol. Over 30% of students engaged in a physical fight and 3% reported being injured in a physical fight that required medical attention. In addition, 34% of high school students reported being sexually active, a statistic that may lead to higher rates of unwanted pregnancies and sexually transmitted diseases.

The personal and societal difficulties described above have direct implications for the mental health of individuals and communities. Through both direct clinical service and client advocacy, psychotherapists can play a unique role in helping to alleviate some of the risk factors impacting youth. If youth at risk could be quickly and effectively identified, psychotherapists could intervene in more efficient and professionally impactful ways.

Defining and Identifying Youth at Risk

Ultimately, one of the most important aspects of helping youth improve their psychosocial well-being is the identification of who is at risk. In this regard, defining "youth at risk" is a challenge in itself. A thorough literature review has shown that various authorities distinguish youth at risk status using different definitions and parameters. According to Capuzzi and Gross (2008), tracing the original conception of the phrase "at risk" is nearly impossible, however, the term has appeared in the American educational system for over 35 years. The term "at risk" appears to have originated in and continues to linger in educational literature, reports composed by the federal government and education-related legislation. One report noted that by 1988 three out of four states had established or were prepared to accept a formal definition for at-risk youth. It is now known that nearly every state has instituted an official classification for this populace, although specific criteria vary widely (Minga, 1998).

Capuzzi and Gross (2008) pose the question, "How can we realistically identify youth who, based solely on their behaviors or circumstances, are more at risk that others?" The literature suggests that there are more opinions than facts in this regard. It appears that one of the primary issues creating confusion is the ever-changing definition of "at-risk youth." As shown in the statistics reported above, at-risk youth are often defined by their academic deficits (e.g., tardiness, truancy, poor grades, low math and reading scores, failing in school), drug and alcohol use, physically and sexually risky behaviors, and other risk factors (Dynarski & Gleason, 2002; Hermann, 2004; Walker & Sprague, 1999). In the broadest sense, at-risk youth could include all juveniles who may vacillate in and out of "at-riskness" depending on negative personal, social, educational, and family dynamics (Capuzzi & Gross, 2008).

These inclusive criteria have both benefits and limitations. In one regard they foster early mental health intervention aimed broadly at all at-risk youth. However, because the criteria for at-riskness are so broad, they may limit the validity and reliability of identifying existing problems and may inadvertently reinforce stigma among already susceptible persons. For the purpose of this article, we define at-risk youth as juveniles who have recently been exposed to adverse psychosocial life events which, based on prior psychotherapeutic theory or research, lead to a significant future risk of negative mental health consequences. Because "youth" can be broadly interpreted, with various meanings that depend on the culture and age of the person perceiving the client, the term "juveniles" is used to more clearly denote that we are speaking about persons under the age of legal consent. To be at risk for adjustment difficulties, the adverse event should have occurred recently. Although "recent" has a different meaning for each patient (and depends on the patient's personal vulnerability, social support, culture, and life history), evidence does suggest that in most cases, adjustment difficulties and associated symptoms lessen over time (American Psychiatric Association, 2000).

Finally, because at-riskness implies future potential for negative consequences, the psychosocial problems associated with the event may not have occurred yet. However, an evaluation of how at risk a client may be should be based on clinical theory or research rather than solely on the psychotherapist's personal or intuitive perceptions. If clinical interventions following an assessment of at-riskness are not based on professional evidence, psychotherapists may have difficulty justifying their interventions (a requirement by most state licensure boards and professional ethical codes). Professionals are also at heightened risk themselves for countertransference, bias, and other non-therapeutic factors to enter the clinical decision-making process. Therefore, psychotherapists should become familiar with the youth-at-risk literature when working with this vulnerable population. The statistics reported earlier are offered only as a cursory overview.

As described, a plethora of risky behaviors exists among youth. The aforementioned statistics and descriptions of youth at risk demonstrate that many younger psychotherapy clients will be identified as at-risk. Therefore, the need for psychotherapeutic intervention strategies for this populace is vital. If psycho therapists acquire the knowledge about such issues and reduce the psychosocial risks, their chances of helping juvenile clients would be greatly improved. It is important to ask, "How do individuals in this vulnerable population recover or bounce back from such precarious situations?" and, "Is it possible that specific factors or constructs provide the necessary strength and power to tenaciously assist youth with strong coping skills amid stressful and disruptive psychosocial problems?" Perhaps personal resilience is one such construct that can help serve as a valuable resource for youth at risk.

Resilience and Youth at Risk

Resilience is a complex phenomenon that refers to the process of constructive human growth and development emerging from successful adaptability and healthy coping skills. It is one's ability to overcome stressors, misfortune, or unforeseen circumstances. It is the internal process of coping with stressors, adversity, or change in a manner that results in the fortification and enrichment of protective factors (Richardson, 2002). According to Ahern, Kiehl, Sole, and Byers (2006), researchers argue that the construct of resilience is defined by a set of traits (Jacelon, 1997), a result (Olsson, Bond, Burns, Vella-Brodrick, & Sawyer, 2003; Vinson, 2002), or a developmental process (Olsson et al., 2003).

Richardson (2002) describes resiliency as a multidimensional concept and identifies three waves of resiliency literature based on a resiliency model (Richardson, Neiger, Jensen, & Kumpfer, 1990). The first wave asks the question, "What personal traits distinguish individuals who will successfully thrive in the face of adversity as opposed to those who submit to destructive behaviors?" The first wave of literature on resiliency essentially placed the focus on the core intrapersonal and external qualities that allow an individual to recover from major setbacks or adversities. The second wave was the search to identify the process of attaining the known resilient qualities and how such characteristics were acquired. Later, many unanswered questions birthed the third wave of resiliency inquiry and asked the question, "What and where is the energy source or motivation (that permits one) to reintegrate resiliently?" Richardson (2002, p. 313) states that "a succinct statement of resilience theory is that there is a force within everyone that drives them to seek self-actualization, altruism, wisdom, and harmony with a spiritual source of strength. This force is resilience, and it has a variety of names depending upon the discipline."

When considering the survival strategies and psychological needs of individuals, resilience is a powerful phenomenon. The life-preserving element of resilience has numerous benefits, especially within the at-risk youth population. As Ahern et al. (2006) explains, resilience is a personal characteristic that restrains the negative effects of stress and promotes healthy adaptation. Enhanced resiliency produces more positive outcomes in the face of adversity. A comprehensive understanding of the processes that build resilient qualities in youth at risk will enable psychotherapists to encourage such behaviors during life transitions and periods of adversity.

We define resilience as "a construct that refers to personal qualities and characteristics that enable one to adapt or thrive when exposed to adversity, personal life challenges, or stressors." Resiliency typically determines an individual's response to exposure to stress or trauma. Youth at risk are more susceptible to adverse or negative responses due to their fragile psyches and underdeveloped personalities. Resilience is a significant factor which promotes positive outcomes. Resilience generates self-esteem, self-mastery, self-confidence, and improved quality of life (Ahem et al., 2006). Resilient youth present with intrinsic strength and resources that permit them to overcome feelings of hopelessness, despair, and depression. In addition, resilience is a protective process that furnishes at-risk youth with a sense of empowerment and often reduces the need for them to resort to negative and self-destructive behaviors.

Research suggests that resilience improves social problem-solving skills, reduces the effects of stress, and increases self-esteem and self-confidence (Capuzzi & Gross, 2008). According to Kobasa (1979) some of the positive characteristics of resilient people include viewing change or stress as an opportunity, being more committed to facing a challenge, and recognizing limits to environmental control (perhaps related to an internal locus of control). Rutter (1985) proposed that more resilient individuals seek the support of others, have closer and more secure attachment to others, have greater self-efficacy, demonstrate a proactive approach to dealing with life issues, and display a more pronounced sense of humor. It appears that, psychotherapeutically, all of these factors, if strengthened, could enhance the lives of youth at risk. Lyons (1991) asserted that patience and tolerance of negative affects are inherent in resilient individuals. Finally, Connor and Davidson (2003) added that optimism and faith are characteristics of resilient persons. It is therefore important that psychotherapists consider these attributes as part of what can help at-risk youth become more resilient and less vulnerable to psychosocial adversity.

Implications for Psychotherapists

Because youth at risk are by definition exposed to behavioral, familial, educational, and societal adversity, these individuals often present in psychotherapy as unmotivated, defiant, oppositional, and possibly hostile. The potentially explosive combination of prior trauma, current maladaptive coping styles, and reduced personal resilience can make it difficult to develop a therapeutic relationship which does not elicit anger, resentment of authority, or rebellion. As Hanna and Hunt (1999) stated, "Adolescents [especially youth at risk] are among the most difficult of all the various populations that present themselves in therapy. Within a very short time frame, adolescents can be insulting, spiteful, charming, lovable, conniving, compelling, and deceitful" (p. 56). This sentiment is echoed by Hanna, Hanna, and Keys (1999), who noted that youth at risk are often extremely difficult to engage fully in therapy, even for the most well-trained and skilled psychotherapists. These challenges implore the question, "How can psychotherapists connect with and motivate (at-risk) youth in order to build resilience during the psychotherapeutic process?" Clinical wisdom must be developed and implemented in order to successfully work through client opposition, competing negative environmental influences. Often precarious behavior patterns can potentially make or break effective treatment (Hanna & Hunt, 1999).

General Interventions for Psychotherapists

Due to the numerous issues faced by youth at risk, it is often difficult to know, in reliable terms, which treatment approaches best fit each at-risk behavior. This validates the need for general interventions to be available to psychotherapists to use with all youth at risk. The following general interventions cut across all professional orientations, demographics, client characteristics and clinical diagnoses.

Establishing the Therapeutic Relationship

Hanna et al. (1999) share general strategies for working effectively with youth at-risk and provide legitimate ways to help psychotherapists relate to oppositional/defiant and at-risk youth. When working with this population, the first priority must be the development of a strong therapeutic relationship, as it is the single most important factor. According to Hanna and Hunt (1999), a strong therapeutic rapport may be even more important with juveniles than with adults. In the process of developing the relationship, psychotherapists will discover youth are more candid and sincere when viewed as competent and independent individuals. Having respect for them will take a therapist a long way. One sure way to respect the adolescent client is to never take the position of "expert" until you are sure that you have a very strong and stable relationship. Psychotherapists who are perceived as know-it-alls will appear to the adolescent as another adult authority figure who should be lied to, deceived, or placated. The following are some practical general techniques/strategies to use with at-risk youth.

Reaching At-Risk Youth

* Use a non-traditional introduction and approach. Whenever possible and appropriate, get out of the office. Typically, at-risk youth offer more self-disclosure outside of the traditional setting. This also permits the psychotherapist to be more open, genuine, and natural.

* Avoid desks, which are symbols of authority and are clinical labels. This will make the youth more at ease.

* Offer a snack. This simple tactic implies nurturance and is a good icebreaker.

* Avoiding stereotypical attire and routines can help alleviate the youth's perception of the psychotherapist as being intimidating and/or controlling.

* Assist the youth with understanding the counseling process. This will empower the client to know what is in it for him/her. Explain how counseling may make them happier, more productive and admired individuals--with dedication and effort. Be concrete, as most youth are unexpectedly pleased to discover that they encompass the skills and abilities to change.

* Cultivate positive personality traits. This proves to be more successful with at-risk youth. For example, acceptance is vital when working with this population, and it is important to communicate this in every way possible. When a psychotherapist is unable to accept the adolescent youth for whom he/she is, it can lead to a power struggle that the psychotherapist almost never wins. Patience and empathy are the keys to this challenging process.

* Circumvent demands for personal respect. Regardless of how offensive the language of an adolescent may become, it is imperative that the psychotherapist avoid reacting negatively, as this similar reaction will come across as a double standard. Most youth will naturally respect the psychotherapist over time if he/she is proficient. Respect must be earned.

Accepting and Relating to At-Risk Youth

* Accept anger and resentment as a reality for most at-risk youth. Set clear boundaries of acceptable behaviors. It is rare that an adolescent will resort to violence or threats. However, it may be necessary to inform the youth from the beginning that if this boundary is violated legal action will ensue. Structuring the boundaries for acceptable behavior and making it very clear that violence or verbal threats are never permissible reduces the odds of such occurrences.

* Use humor and the ability to laugh at oneself. This will engage the client and score the psychotherapist even more brownie points. Adolescents tend to respond more positively and trustingly toward adults who don't take everything too seriously.

* Avoid lectures and make statements that are short, simple, and to the point. Most adolescents lack patience and tend to drift, risking that the therapeutic message may be lost. When making valid points or exploring issues with adolescents, the briefer the statement, the better. It may sometimes seem too basic or simplistic, but this can lead to productive conversation.

* Admit lack of knowledge about a particular topic. Ignorance with regard to youths' ever-changing customs is inevitable. Asking for clarification is not only acceptable but respected by the youth.

* Adolescents easily identify with other adolescents. It may be very beneficial to offer examples of other troubled teens, or to provide stories of similar situations of at-risk youths who have successfully overcome the odds.

* Adolescents resist inflexible or rigid adults. Youth tend to gravitate toward those who have a passion for life and delight in its pleasures. Make it a primary goal to keep in touch with your inner-child when working with this population.

* Do not allow your empathy to interfere with the therapeutic process. Such an obstruction can cloud the psychotherapist's ability to empathically view the world from the client's point of view.

* If a youth is seeking attention, simply give it to them. Many experts have suggested ignoring attention-seeking behaviors. However, this can lead to certain acting out behaviors or negative attention. Hanna et al. (1999) report that by allowing the youth an opportunity to be heard and validated, the youth will feel more empowered. For example, state, "You have my attention, what are you are going to do with it?" We agree with this response and also add that you should teach the youth to seek attention at appropriate times and in the correct manner by asking, "Do you need my attention? If so, I'm more than willing to offer it to you."

One of the most difficult tasks of working with youth at risk is motivating them to participate in therapy. Many aren't convinced that the psychotherapy process is conducive to maintaining their freedom, autonomy, and self-determination (Hanna & Hunt, 1999). This thought process often changes once the youth realizes that he or she feels better and has a better awareness and understanding of the benefits of effective therapy. Hanna and Hunt (1999) identify some motivation strategies that afford youth the opportunity to gain successful results from therapy. For example, when working with youth at risk, apathy must be dealt with. Used by youth as a defense mechanism, apathy must first be acknowledged. For example, the therapists may ask, "I understand that you don't want to discuss your sadness, but isn't there a small part of you that worries if things will get better for you?" Next, the therapist may challenge the youth's lack of freedom. Many adolescents tend to blame others for their negative behaviors and attitudes. By refraining the blame that allows others to take control over one's life, the youth may be less inclined to give away their freedom.

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Cultural and Sociocultural Considerations with At-Risk Youth

Psychotherapists must always be conscientious of the fact that a client's worldview, social environment, and culture impact his or her ability to develop resilience and cope with stressors. In addition to the many adversities faced by youth, ethnic minorities, especially urban children and those from lower socioeconomic backgrounds, encounter further dilemmas due to discrimination, poor education, and lack of social advancement opportunities. This creates an even greater need for enhanced resiliency. Multicultural counseling skills are essential for youth at risk in every ethnic minority group.

Prior authors have asserted that youth at risk who experience a low socioeconomic status, urban residence, and ethnic differences may be at increased risk of more severe psychosocial stressors. According to Mosley and Lex (1991), most of the research suggests that psychotherapists could better serve their clientele if these factors were taken into account during the treatment process. Several studies have pointed out that trauma and stress are higher among at-risk youth who have lower socioeconomic statuses, as these clients experience more stressful events than suburban children of higher socioeconomic status (Chandler, Million, & Shermis, 1985; Gad & Johnson, 1980; Newcomb, Huba, & Bentler, 1981; PryorBrown, Cowen, Hightower, & Lotyczewski, 1986). McGrath and Burkhart (1983) concluded that one's level of education and income are also significant predictors of one's resilience and capacity to cope with stressors. According tO Sue (1997), "Without the appropriate training, work with ethnically diverse populations could be considered unethical...." Additionally, Sue cautions that "western culture" counseling interventions may not easily translate for all ethnic minority groups.

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In addition to general interventions, there are some specific therapeutic frameworks that can help to enhance the resilience of a young client. Below are a few specific frameworks that can be used with the aforementioned general techniques to compliment psychotherapy with at-risk youth.

Specific Interventions for At-Risk Behaviors

There have been many articles and chapters devoted to promoting specific treatment approaches to combat at-risk youth issues. For example, school dropout, teen pregnancy, anti-social behavior, and substance abuse are among the major problems that affect the at-risk adolescent population. These four ills certainly do not reflect all of the crises faced by youth at risk, but they are highly represented in the at-risk adolescent population. Current research shows that there are specific interventions that can effectively address each predicament. McWhirter et al. (2007) for example, demonstrate how each of the above-mentioned dilemmas can be addressed using specific therapeutic models.

The solution-focused model is considered appropriate for addressing those at-risk youth who may be struggling with poor grades, performance issues, or a self-defeating attitude about school. Solution-focused counseling is goal-oriented and client-generated. No attempts are made to either identify or describe the pathology, or gain in-depth insight into the problem. Solution-focused counseling's primary focus is on change through solutions rather than the theories (hypotheses) about where the problems originated. The focus is on what people do right and their strengths, not what they are doing wrong.

Alfred Adler's concepts of social interest, mistaken goals, and purposive behaviors are believed to be some of the most effective models for understanding and dealing with a wide range of adolescent problems and issues. McWhirter et al. (2007) use Adlerian therapy to address teenage pregnancy and risky sexual behaviors (Adler, 1930, 1964; Ferguson, 2001; Hoffman, 1994). Adler believed individuals are in search of discovering their place or position within a group. Young people possess the need to belong or contribute to a social group. Youth first find their sense of belonging within their primary environments or their families and then go on to build onto their feelings of self-worth in their secondary environment or within the school setting. At-risk youth tend to engage in less desirable activities, such as risky sexual behavior, and they may act out to gain a sense of fulfillment or acceptance into a certain social group.

Next, the seven principles of Reality Therapy, developed by William Glasser (1998, 2001), can effectively attend to antisocial behavior, delinquency, and gangs. reality therapy focuses on involvement, current behavior, evaluating behavior, planning responsible behavior, commitment, and accepting no excuses. A strong involvement and empathic relationship between the at-risk youth and psychotherapist is ideal in order to effectively build a therapeutic relationship based on mutual respect and trust. The client must be made aware of his or her present behavior, and the consequences of such behavior. The psychotherapist also helps the youth make accurate judgments about what is deterring him or her from succeeding. The psychotherapist then helps the youth recognize and construct a plan for altering the identified behavior.

Miller and Rollnick (2002) assert that motivational interviewing (MI) is a well-documented and researched model for drug and alcohol problems. Using Prochaska and DiClemente's (1986) "Stages of Change," MI is based on the metatheory that people go through a process of preparing to make a change before actually making the change. These stages include pre-contemplation, contemplation, preparation, action, and maintenance. MI is designed to motivate people to aspire toward and plan for making a life-long change. MI is based on a client-centered approach that assists clients with exploration of the resistance behind behavior changes. MI assumes that a part of the client has the desire or inspiration to change. In this way, MI highlights the notion of perceived choice. The psychotherapist's job is not to generate or produce motivation for a client; rather, it is a way to "dance with" the client to enhance his or her motivation for change.

Conclusion

Today's youth face many crises simultaneously, which is why the youth-at-risk population is so important for psychotherapists to understand. Psychotherapists will be better prepared to work with at-risk youth if they understand who constitutes the group. The aforementioned general interventions can be utilized in psychotherapy with at-risk youth to cultivate and promote resiliency--a construct that can significantly help promote mental health. What makes these techniques so special is that they cut across all theoretical frameworks, counseling approaches, and modalities. However, the client's sociocultural characteristics should be assessed before interventions are initiated in order to better adapt clinical approaches to the lifestyle and world view of the client (Sue, 1997). The specific treatment perspectives outlined above can add to these general approaches. As psychotherapists, we must recognize the complexity of the issues faced by youth at risk, including how to show respect for their experiences and needs, empathy for their suffering, and motivation to help them achieve heightened resilience in life.

This article is approved by the following for continuing education credit:

The American Psychotherapy Association provides this continuing education credit for Diplomates and certified members, whom we recommend obtain 15 CEs per year to maintain their status.

The American College of Forensic Examiners International is an approved provider of the California Board of Behavioral Sciences, approved PCE 1896. Course meets the qualifications for I hour of continuing education credit for MFTs and/or LCSWs a required y the California Board of Behavioral Sciences.

This organization, The American College of Forensic Examiners International Approval Number 1052, is approved as a provider for continuing education by the Association of Social Work Boards 400 South Ridge Parkway Suite B, Culpeper, VA 22701. www.aswb.org.ASWB Approval Period: 8/20/2007 to 812012010. Social workers should contact their regulatory board to determine course approval. Social workers will receive I continuing education clock hour in participating in this course.

After studying this article, participants should be better able to do the following:

1. Understand the definition and scope of youth at risk,

2. Gain knowledge about struggles faced by at-risk youth.

3. Learn general psychotherapy strategies that increase resilience in youth at risk.

4. Understand specific interventions for at-risk behaviors.

KEY WORDS: Youth at risk, resilience, empowerment, interventions

TARGET AUDIENCE: Mental health professionals, social workers, marriage and family therapists

PROGRAM LEVEL: Basic

DISCLOSURE: The author has nothing to disclose.

PREREQUISITES: None

POST CE TEST QUESTIONS

1. Which of the following correctly describes resilience?

a. Social skills in more than one environment

b. Self-awareness of one's strengths and limitations related to life struggles

c. Personal qualities and characteristics that enable one to adapt or thrive when exposed to adversity, personal life challenges, or stressors.

d. None of the above

2. Which of the following is true regarding youth at risk?

a. The definition of youth at risk is often nebulous and in need of further refinement

b. At-risk behaviors among children and adolescents has significantly declined over the pat 15 years

c. The description of at-risk behaviors is usually reserved for life-threatening circumstances such as violent crime, destruction of property, or self-harm

d. None of the above

3. Which of the following general psychotherapy strategies have been shown to help youth at risk?

a. Being more informal and not using desks

b. Being confrontational with behaviors that may cause the client problems

c. Being passive and non-directive throughout the therapy process

d. None of the above

4. Which of the following will not help a psychotherapist better relate to at-risk youth?

a. Use of humor and avoiding lectures

b. Self-disclosure and giving the client the attention if he or she needs it

c. Not admitting when something is not known or understood from an adolescent culture perspective in order to show expertise

d. None of the above

5. Which of the following are interventions shown to help at-risk youth cope with specific life problems?

a. Motivational interviewing with substance abusing at-risk youth

b. Person-centered counseling with violent at-risk youth

c. Gestalt therapy with at-risk sex offenders

d. None of the above

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Robert C. Schwartz, PhD, graduated from the University of Florida with a doctorate in counselor education. He is currently a professor in the Department of Counseling and director of the Clinic for Individual and Family Counseling at the University of Akron. He is a licensed professional clinical counselor, and his research interests include depressive and personality disorders, schizophrema, and spirituality.

Sonya M. Thompkins has a master of science degree in counseling from Youngstown State University. She is currently a doctoral candidate at the University of Akron. She is an licensed professional counselor in Ohio and works for Valley Counseling Services. Her research and clinical interests include adolescent mental health issues and spiritual approaches.
Looking for solutions to youth violence
Researchers and psychiatrists are trying to understand why some
children are more violent than others and to craft solutions to
the problem.

Problem     Children tend to         Some youths do
            be impulsive             not have social
                                     skills to settle
                                     disputes

Cause       Parts brain              Some
            of the                   children
            that govern              lack role
            judgment                 models,
            and impulse control      especially male,
            aren't fully developed   to teach effective life
            until the 20s            skills

Possible    Close monitoring         Support families
solutions   and guidance by          and provide positive
            adults                   role models

Problem     Some children feel          Youths in high-risk
            disconnected from           neighborhoods are
            their communities           traumatized

Cause       Some                        Many
            neighbor-                   have
            hoods                       witnessed
            suffer                      violence
            from high crime, few        or been victims of it
            jobs and rundown
            housing

Possible    Create jobs and             Increase the
solutions   better schools and          availability of mental
            eliminate gun               health services for
            violence                    low-income families
Graphic: Chicago Tribune

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