Adolescence is a traumatic time. Young people are faced with mounting piles of schoolwork, decisions about their life paths and hormonal changes as they go through puberty. Add in decisions about their identity, sexual orientation and their standpoint in friendship groups and you have the recipe for a perfect storm.

Parents or carers may feel confused and frustrated in their interactions with their teenagers. Previous habits and interests may disappear, behaviours may change and teens are likely to push back in unexpected ways as they work out where their boundaries lie. Parents may disagree and argue about what should be done, losing credibility with their teens in the process.  Sometimes parents may feel the need to seek help from mental health professionals – for their teens, for the whole family or for themselves.

Schools and specific teachers may try to help, but that help is not always recognised, useful or appreciated. Some schools or teachers may blame the student for emerging troubles, adding work, detentions or negative comments in the process. These students don’t always respond the way that authoritarian adults expect. They may choose to drop out if they feel school is boring, overly constrictive or humiliating for them.  Some teens may only go to school to be with groups who understand them. These same groups may include people introducing disillusioned teenagers to risk taking behaviours involving recreational drugs, alcohol, cars and more.

Many health care and education models today do not adequately address the unique needs of teenagers in crisis.  A diagnosis is often made based on a few interviews and a general impression. Thorough evaluations are not always completed. Family, teachers, friends and siblings may not always be interviewed in an open and cooperative manner. The underlying cause for the crisis may not be understood or addressed, because the real issue often requires more effort than providing “symptom relief.”

It can take a great deal of time for a mental health professional to earn a teenager’s trust, especially if the teenager is not initially willing to consider counselling or psychotherapy. After a few sessions, many teenagers do not want to go back to the “therapy” as it “isn’t helping”. They may simply refuse to stop engaging in their risk-taking or self-destructive behaviours. Sometimes the worrying symptoms may disappear when a teen first starts working with a counsellor. Psychotherapy may be effective, but it is not a quick fix. The same symptoms that worried a family may resurface at any time. These symptoms might include failing school, missing classes, staying out late, sleeping all day, running away, school expulsion, self-harm or other risky behaviours.

Teenagers are learning to hide their behaviour and symptoms to manipulate doctors, counsellors, teachers and their parents. They may seek advice and support from other teenagers. However, teenagers may lack the experience to support another adequately and may simply give ways on how to avoid the consequences of their actions and manipulate others. 

While a teen in crisis may feel anxious and sad when faced with trouble, they might also feel invulnerable and willing to defy law enforcement and their parents.  Not everyone is willing to learn from their mistakes. Some may prefer to avoid and escape the consequences of their actions.  This can sometimes lead to a downward spiral into victimisation or abuse. Without understanding the long term repercussions of their actions, some teens can end up abused, assaulted, threatened or worse. 


Causes of Teenage Crises
A crisis will usually take some time to become critical or life threatening. A pattern of escalating issues usually take place before a crisis becomes dangerous.  At some point, a counsellor should be able to trace one or more factors that have led to the current crisis. Identifying the factors can help the counsellor or mental health professional to characterise the evolution of the crisis, which in turn helps them to find the appropriate response and duration of any required intervention.  
 
Potential crises may include:

• Drugs
• Alcohol
• Peer and social pressure
• Parental alcoholism, drug abuse or an untreated mental health issue 
• Failure by the parents to provide consistent rules, discipline and a bonded relationship.
• Family conflict and discord
• A traumatic experience
• A fragile emotional state
• Parental separation or divorce

Interventions
There are a range of potential interventions to be used in times of crisis. These interventions should be tailored to the unique needs of the individual. Interventions may include:

• Education and training for parents
• Education and training for teenagers
• Self help
• Group counselling/therapy
• Individual counselling/therapy
• Family counselling/therapy
• Change schools
• Outdoor adventure programmes
• Wilderness therapy programmes
• Increased parental supervision and involvement
• Move to a new area
• Move in with other family members
• Foster care
• Private school
• Boarding school
• Day treatment programme
• Therapeutic boarding school
• Residential treatment programme 
• Psychiatric hospitalisation
• Police or law enforcement response
  
  

The duration and choice of intervention and the competence of the professionals involved are crucial to the intervention’s success. The intervention must also be appropriate to the type of risk-taking the teen is practising. The level of risk needs to be determined and the likelihood of the problem escalating or continuing considered. 

The Adolescent Clinical Screening Questionnaire is one of the most systematic and reliable methods for assessing risk with teenagers.  When a crisis first occurs, it is important to stabilise the teenager and provide any symptom relief. Once the teen is stable and has some relief from their presenting symptoms,  there must be sufficient structure and follow-up to prevent further crises or a relapse. Parents and family members must keep it in mind that an inappropriate intervention can make matters worse and can undermine their relationship with their child, potentially creating another crisis.
 
An inadequate response can prolong a problem and reduce the likelihood of future interventions succeeding.  There is often a cycle to the crisis that teenagers experience. The crisis tends to grow, escalate, subside and resurface in a pattern of increasing emotional, psychological and behavioural problems.  Typically teenagers may experience brief periods of normalcy between crises. At those times, the teenager may be cautious, reflective and remorseful.  Whether a crisis represents a turning point or not will depend on whether an appropriate intervention is designed and implemented. 

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