Conversation Examples
Here are examples of better and worse ways to engage with teenagers about mental health. These examples are excerpts from a sample conversation with Justin, an adolescent who is new to your practice.
Justin came in today complaining of headaches, and you have not yet been able to determine a physical cause for them. Before you send him for neurological testing, you want to find out more about his state of mind, since stress is often a cause of headaches, especially in this age group. You know he recently moved to town, and you wonder if these headaches may be related to the move.
Bringing up mental health
Good option
Provider: You know, I see a lot of teens with headaches or stomachaches. Sometimes it’s a physical issue, but other times it’s stress, or their mood, or when they’re going through a hard time.
Justin: Like, they get sick when they’re stressed?
Provider: Exactly.
Justin’s inner thought: Maybe she’s right… I’ve been having a lot of bad days the last few weeks.
- Advice: Normalizing stress and discussing the connection between mental and physical health is a good way to get Justin engaged in the conversation.
Bad option
Provider: Have you felt anxious or depressed recently?
Justin: (shrugs) Maybe. A little.
Justin’s inner thought: Great, now she thinks I’m depressed or crazy or something.
- Advice: This was a closed-ended question, and Justin gave a short answer that didn’t provide that much information. As well, “anxious” and “depressed” are loaded terms which he might not identify with.
Discussing issues in the teen’s life
Good options
Provider: So, you’re at a new school now. That’s a big change; how’s that going?
Justin: (frustrated with himself) It’s not even that new anymore, I’ve been there for months already, but… I don’t know; it’s weird. Everyone here takes school so seriously. It’s like, (cruel imitation) “What grade did you get, who’s going to be valedictorian?” (snorts) Who cares? Like… my old school was just… chill, you know? People were laid back.
- Advice: This open-ended question encouraged Justin to open up about his feelings.
Provider: You feel frustrated that it’s been so long and it doesn’t seem to be getting better.
Justin: I really hate it. I don’t know anyone, I don’t fit in, and… I just hate going there every morning.
- Advice: This reflection really connected with Justin. Saying that he “hates going there every morning” is a pretty severe statement, and it’s good that you’re helping him explore these feelings.
Bad options
Provider: Have you made any friends?
Justin: No. Not really.
- Advice: This was a closed-ended yes-or-no question, and Justin hardly gave you more than a no. If you want to build rapport and find out more about his situation, reflections and open-ended questions are more effective.
Provider: I’m sure being new at the school is stressful; but, I promise, it gets better.
Justin: You sound like my dad.
Provider: What does he say?
Justin: (blowing her off) Oh, the same stuff.
Justin’s inner thought: (imitating Dad) “Son, you can get through this. Toughen up. Take out the trash.”
- Advice: It’s hard for adolescents to think long-term, and this kind of appeal to a better future probably won’t get through to Justin.