Recognizing and Overcoming Defensiveness and Denial in Mandatory Treatment for Troubled Adolescents with Substance Use Disorder

Abstract

Objective
This article presents an investigation of the defensiveness demonstrated by teens who are mandated to participate in treatment
as compared to their non-mandated peers.
Methods
The data for this study was collected as part of The Substance Abuse Subtle Screening Inventory (SASSI) Institute’s third itera
tion of the Adolescent SASSI-A3. A total of 164 teenagers in treatment served as the dataset for the present study. All participant
cases were provided by clinicians working in service settings throughout all U.S. Census Regions and serving in a variety of venues
including substance use treatment, criminal justice programs, community corrections, private clinical practices, behavioral health
centers, and social service organizations.
Results
We present two brief de-identified treatment case studies, aptly demonstrating defensiveness and denial from a clinical standpoint.
Additionally, we review cases demonstrating high-levels of defensiveness and denial in mandated teen clients, and ethical ways to
break through that barrier to treatment engagement.
Conclusion
Working with teens can be extremely difficult given their rapid mood changes, intensely felt experiences and shifting states of compliance, openness and defiance. When teens are mandated for treatment, they may often feel their choices have been taken away and the counselor may be viewed as more of a power authority rather than a concerned and helping figure. Contingencies placed on the teen as part of the mandated treatment experience are generally the primary focus, rather than addressing their underlying substance use disorder (SUD). As a result, the teen, as well as the counselor, require greater focus than just making sure those requirements are met.