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Break the ice with wary adolescents

Discussing Sports Illustrated articles and popular films can help establish rapport with teenage patients

Thomas Demark, MD; Jahi Anderson, MD; Thomas Newmark, MD
A teenager who doesn’t trust you can become resistant, leave the room, clam up, or become verbally hostile during a psychiatric interview.1 Our group has identified techniques that may help you develop rapport with teen athletes or other adolescents.

Be a Good Sport

The department of psychiatry at Cooper University Hospital in Camden, NJ, established a program at an urban high school to evaluate student athletes for stress, anxiety, depression, trauma, and substance abuse. The assessment takes place in the high school’s athletic department after an initial screening. Because the assessment program and psychiatrists were new to the school, many of the boys and girls were not forthcoming when talking with clinicians.

Our resident psychiatrists and medical students used Sports Illustrated covers and popular films to break the ice with these teenagers. This approach—which we used during group and individual psychotherapy— often puts teens at ease.

For example, the psychiatrist would bring to the session an issue of Sports Illustrated featuring a well-known athlete with a psychiatric disorder—such as substance abuse, depression, or steroid abuse. The teens quickly became more relaxed and talkative. They seemed interested in giving opinions about the athlete on the magazine cover and his or her issues.

The teens also responded to discussion of the popular sports movie Friday Night Lights, which portrays a small town’s obsession with winning another state football championship. Many of the film’s characters exhibit psychopathology, including the running back’s narcissistic traits, the fullback’s substance abuse, and the quarterback’s lingering effects of having a mentally ill mother. The plot raises questions about the stress and pressure of football; does it exacerbate the development of psychopathology, adequately prepare athletes for life’s uncertainties, or encourage an unrealistic view of society?

Psychiatrists with a sports background often could relate well to the students’ experiences. A therapist with a good understanding of the sport the teen plays can talk about shared experiences, such as dealing with winning or losing. This shared knowledge allows you and the athlete to speak the same language and helps the teen identify with you.

Dress the part

By wearing neat casual attire, you can put a student athlete at ease. A modest polo shirt with the school’s or hospital’s logo—rather than a suit—is appropriate for male and female psychiatrists when interviewing an adolescent athlete at high school. In our experience, teens begin to view psychiatrists as down-to-earth people to whom they can relate, as opposed to overly formal physicians who ask difficult questions.

References
Sadock V, Sadock B. Kaplan and Sadock’s synopsis of psychiatry. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:1312.
Dr. Demark is a fourth-year psychiatry resident and Dr. Anderson is a first-year psychiatry resident, Cooper University Hospital, Camden, NJ. Dr. Newmark is chief of psychiatry at Cooper University Hospital, professor of psychiatry at Robert Wood Johnson Medical School, Camden, and secretary of the International Society of Sports Psychiatry.

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