The teenage years are wonderful! So much growth and opportunity; the fantastic metamorphosis from child to adult; the shifts in decision-making that hallmark the onset of grown-up thinking; the first ability to assert one’s own beliefs and values; the giddying prospect of finding true love and experiencing a deep, meaningful sexual relationship; the endless possibilities that lie ahead for forging a fascinating, fulfilling career; the thrill of finally feeling as though one is being heard and respected as a peer by adults (including family members) – yes, it is a wonderful time indeed, and parents of teenagers should think themselves very lucky to be able to witness the seamless transformation of their baby into a rational, caring, responsible, well-adjusted adult. How close you will feel! What wonderful moments you will share! Does this sound like your experience of parenting a teen? No? If not, and the above vignette seems as likely as a herd of flying pigs landing in your garden, read on……………..
The teenage years are DIFFICULT – teenagers can often seem to BE “difficult”. Plenty of parents of teenagers come to see me because they are struggling with the new relationship they find they are having with their child, and they wonder whether they are doing something wrong, or whether there might even “be something wrong” with their teenager. If you are the parent of a teenager, you are likely old enough that you will have been an adult for a lot longer than you were a child, so those transition years may seem like a bit of a dim and distant – if fond? – memory. To understand what your teen is experiencing, it’s worth considering the various different factors which are all at play in the teenage years, and how they exert their influences on a teenager’s development and behaviour. Let’s call these factors the “Tasks of Adolescence” – these are the things that teenagers have to manage, or deal with, before the transition to adulthood can be fully completed.
Firstly, teenagers experience enormous physical change. They are at the absolute mercy of the hormones which shove them, ready or not, from childhood into sexual maturity. Hair might grow, the voice might change, skin might erupt, strange odours might appear, not to mention the necessity to get to grips with unfamiliar items such as sanitary towels and razors. All these changes are happening on the background of unprecedented growth in height and weight, and together this uses a massive amount of energy. Little surprise that teenagers are often to be found sleeping for huge lengths of time, waking in bodies they don’t recognise, didn’t ask for and don’t know how to “work”. How very disconcerting! No matter how well-intentioned parental or school preparation might be for the physical changes of adolescence, certain “first times” (the first menstrual bleed, or first wet dream) are not just disconcerting but downright terrifying!
This brings us onto the second daunting task – that of exploring sexuality and seeking out sexual partners. This can be a source of huge anxiety and upset, as well as excitement. Teenagers may worry that their new interest in sex is abnormal; may fear that they will lack sufficient know-how or experience to be able to enjoy sex; they may believe that their bodies or faces are not sufficiently attractive to potential partners (having perhaps compared themselves to images of celebrities or porn stars); they may find themselves obsessing about an individual to the exclusion of other activities; they may question why they don’t feel as sexually motivated as some of their peers; they may feel pressurised into sexual activity before they are ready, or at the mercy of “sexting”. This is all quite without the considerations of sexually transmitted infections, contraception and same-sex attraction. No wonder teenagers might seem irritable at times – the glittering temptations of the grown-up world are spoiled by accompanying trials and tribulations.
The third task of adolescence is that of finding, and being accepted, by a peer group. This is often one of the most powerful drivers of all, for teenagers. Peer relationships are extremely important to them, and can inform teenage decision-making in a way that older adults may find completely inexplicable. Likewise, fallings-out amongst peers, or friends moving away, can lead to a devastating sense of loss which might appear disproportionate to parents. The desire to be liked, respected, and considered “cool” by peers can lead to lifestyle/appearance choices that might not be popular with the grown-ups in a teenager’s life. Which parents of teens have listened with incredulity as their teenager declares that the choice of university will be made based upon the plans of friends (rather than fees structure, success record, and so on)? Trust me, telling your teenager that she probably won’t even be in touch with these friends in ten years’ time will not go down well – for her, right now, these friends are the most important influencing force she knows.
This links in with the fourth task of adolescence – achieving full independence from parents. This varies in its timing, but in the UK at the moment tends to correlate with the time at which youngsters attain a level of financial freedom which allows them to “move out” – this is getting later and later, as it is harder and harder to get a foothold on the housing ladder. This, in turn, can lead to conflict, as a young person longs for the independence of “having their own place” at the same time as recognising (and possibly resenting) their need to rely on their parents for support and therefore, on some level, being required to sing to their tune. This need for independence can be manifest as secrecy, withdrawing from family life, insisting on locked doors or password protected devices, and other behaviours which can be challenging to live with, but are a normal and natural part of the transition to adulthood.
At the same time as coming to terms with living separately from their families, and making their own way in the world, teenagers’ fifth task is being asked to perform in (probably) the most important, highest-stakes examinations of their lives – the ones which will determine their university entry. The cute “what do you want to be when you grow up?” question so beloved of adults when talking to small children, takes on a brooding and sinister significance when contemplated by a teenager. Think about it – in the midst of the maelstrom of all the changes discussed above, we expect our young people to be choosing life paths, studying hard, and remaining resilient in the face of increasing performance pressure from school and home. I have often believed that these life choices are simply too important to be made during adolescence – however, that’s the way our world currently works. Poor teenagers!
When working through all these five tasks, young people will be establishing their identity, and learning what sort of adults they want to become. What do they stand for? What do they believe in? What are their priorities? How will they choose to live? They have to learn the answers to these questions by experimenting and experiencing, and – crucially – by making mistakes. The adolescent mind does not respond well to “being told what to do” and constantly seeks to challenge accepted rules, test boundaries, take risks, and generally behave in a way which can appear rebellious - but is in fact a necessary step in discovering where safety and danger lie, and developing confidence in decision-making. The impulsivity of teenagers that can be so infuriating to parents should, in fact, be embraced as a safety feature – teenagers are testing the waters in the relative security of the family home in readiness for being along in the world.
As we can see, being a teenager is no picnic. It often coincides, sadly, with other issues within the home – for example, a parental divorce or illness – which can make life seem even more difficult. Mothers of teenagers are often facing the challenge of their own menopauses, and can find it harder than they would like to be effective parents. But what about if the teenager has health issues as well as all of the above? Parents of teenagers often worry about their children’s health, but many report that it is extremely difficult to persuade them to engage with health care professionals. However, illness – physical and psychological – in teenagers is common enough that doctors need to develop a strategy which enables them to connect with young people, talk to them and listen to them in the right way, and forge a long-lasting relationship of trust and mutual respect. Given that teenagers are often reluctant to talk to adults they don’t know about their personal issues, as well as having highly developed bullshit sensors, it can often feel to doctors that they have their work cut out when consulting with teens.
According to the Young People’s UK Youth Parliament, 38% of young people polled said that they would not consult a GP about: sexual health/contraception, sexually transmitted infections, pregnancy, “personal or private parts”, “adolescent concerns”, mental health, self-harm, eating disorders or weight. Young people may not be aware of their rights as consumers of health care – they may not be sure how to make an appointment, or whether their confidentiality will be respected – key factors that “put off” teenagers from attending the GP, in one focus group, were “unfriendly receptionists”, “waiting ages in the waiting room”, “not enough time with the doctor”, “not the same doctor every time”, “the doctor not understanding”, “the doctor talking down to me”, “the doctor making me feel stupid” and “the doctor not treating me as an adult”. How badly we are letting down our young people, just when they may need us the most!
At Winchester GP, we know that treating teenagers is not the same as treating adults, and needs a different approach and set of skills. Nevertheless, it is important that teenagers understand that we make them the same service commitments as we do to every single one of our patients regardless of their age:
- We will demonstrate authentic concern and interest in you as a person
- We will treat you as an autonomous individual, respecting your opinions and hearing your views
- We will give you sufficient time to discuss your issues (20 minutes is a standard appointment)
- We will explain carefully, so that you understand fully what is going on and what your options are
- We will make sure that you see the GP you want to see, and that you are able to form an ongoing therapeutic relationship
- We will see you alone, with your parents, with friends, with a chaperone or any combination of the above – whatever suits you
- We will treat you in complete confidence - we are here to listen, not to tell - (unless your health and/or safety depend upon doing otherwise) - it’s up to you who is involved in your healthcare decisions
- We will see you at a time and place that suits you, in person, or on the telephone
- We will make sure that you are treated with respect and courtesy by all of our staff, and that you are seen promptly
And to close, we give the last word to the psychologist, Gretchen L. Schmelzer and the lines of her 'The Letter Your Teenager Can't Write You'
This is the letter that I wish I could write.
This fight we are in right now. I need it. I need this fight. I can’t tell you this because I don’t have the language for it and it wouldn’t make sense anyway. But I need this fight. Badly. I need to hate you right now and I need you to survive it. I need you to survive my hating you and you hating me. I need this fight even though I hate it too. It doesn’t matter what this fight is even about: curfew, homework, laundry, my messy room, going out, staying in, leaving, not leaving, boyfriend, girlfriend, no friends, bad friends. It doesn’t matter. I need to fight you on it and I need you to fight me back.
I desperately need you to hold the other end of the rope. To hang on tightly while I thrash on the other end—while I find the handholds and footholds in this new world I feel like I am in. I used to know who I was, who you were, who we were. But right now I don’t. Right now I am looking for my edges and I can sometimes only find them when I am pulling on you. When I push everything I used to know to its edge. Then I feel like I exist and for a minute I can breathe. I know you long for the sweeter kid that I was. I know this because I long for that kid too, and some of that longing is what is so painful for me right now.
I need this fight and I need to see that no matter how bad or big my feelings are—they won’t destroy you or me. I need you to love me even at my worst, even when it looks like I don’t love you. I need you to love yourself and me for the both of us right now. I know it sucks to be disliked and labeled the bad guy. I feel the same way on the inside, but I need you to tolerate it and get other grownups to help you. Because I can’t right now. If you want to get all of your grown up friends together and have a ‘surviving-your-teenager-support-group-rage-fest’ that’s fine with me. Or talk about me behind my back--I don’t care. Just don’t give up on me. Don’t give up on this fight. I need it.
This is the fight that will teach me that my shadow is not bigger than my light. This is the fight that will teach me that bad feelings don’t mean the end of a relationship. This is the fight that will teach me how to listen to myself, even when it might disappoint others.
And this particular fight will end. Like any storm, it will blow over. And I will forget and you will forget. And then it will come back. And I will need you to hang on to the rope again. I will need this over and over for years.
I know there is nothing inherently satisfying in this job for you. I know I will likely never thank you for it or even acknowledge your side of it. In fact I will probably criticize you for all this hard work. It will seem like nothing you do will be enough. And yet, I am relying entirely on your ability to stay in this fight. No matter how much I argue. No matter how much I sulk. No matter how silent I get.
Please hang on to the other end of the rope. And know that you are doing the most important job that anyone could possibly be doing for me right now.
Love, Your Teenager
If you have enjoyed this post on teenager health and wellbeing, please consider liking and sharing on social media using the buttons below. Wishing you well! Winchester GP :-)