Psychotherapy with Twenty-Somethings??


In starting this article, I could imagine the comedian Jerry Seinfeld saying “WHAT’S THE DEAL WITH TWENTY-SOMETHINGS???!!!”.   Recently, many parents, bosses, teachers, and even peers, wonder about people in their 20s, with the invention of new phrases such as “Failure to Launch”, “boomerang kids”, millenials (said with some contempt), etc.  There seems to be growing concerns about Twenty-Somethings being selfish, out of touch, lost, confused, mixed up, or “not going to make it”.   Currently, about a third of my caseload is individuals in their 20s, and while researching for this article, I got more insight into their challenges and discovered ways to help them more effectively.  I’ve learned a lot, including the following trends:


  • One third of people in their 20s move to a new residence every year.
  • 40% move back home with their parents at least once.
  • Most young Americans change jobs and average of 7 times from age 20-29.
  • Two thirds spend some time living with a romantic partner without being married.
  • In 1960, the median marriage age was 20 for women, and 22 for men. Today it's 27 for women, and 29 for men.
  • The birthrate has declined from 3.5 children per woman in 1960 to 2.0 in 2010.
  • In 1960, 33% of young people attended college, most were men.  Today, 70% of high school graduates enter college, most are women.


There are a number of key factors connected to these changes.  Our economy has changed dramatically from predominately manufacturing to information, technology, and services.  In addition, the reverberating effects of the recession of 2008 have impacted the availability of jobs to college graduates and others across many vocations. 


Other changes can be labeled as Cultural/Social changes include:    the Sexual Revolution, the Women's Movement, and the Youth Movement. 


In terms of the Sexual Revolution, 50 years ago or so, pre-marital sex used to be scandalous, and risky because of pregnancy fears. Today, the sexual revolution has created freedom through contraception, legal abortion and perspective.  Pre-marital sex is widely considered a normal part of a relationship, and cohabitation used to be “living in sin”; now it's considered normal, and an important precautionary step before marriage.


Women’s Movement.  Broadly speaking, women's possibilities for adult life used to be limited to wife and mother.  Often career choices 50 years ago would have been nurse, teacher, or secretary as main options.   Now, gender is not seen as a career obstacle, and reliance on a man for financial support has dramatically changed.  Pursuing career and waiting for marriage and motherhood is normative.


Youth Movement.  The meaning of adulthood has shifted.   Again, years ago, many people couldn’t wait to become an adult, typically a few years after high school.  The standard goals would be to pursue a job, new marriage, new baby, starter house, a lawn, a car, etc.   More recently, the value of youth has risen, and the desirability of adulthood has dropped.


This dynamic may be more likely connected to reactions to parental divorce, financial responsibility and stress in parents, job loss, and the perception of “stability as stagnation”. With these changes, has come a new stage of development, according to Jeffrey Arnett, Ph.D.   Labeled: Emerging Adulthood.  Parents ask questions: What is going on with our young adults? How should we respond?  What can we do to help them navigate this stage?  What options do we have if we see our children floundering?


Arnett describes Five Features of Emerging Adulthood:

1.      Identity explorations:  where emerging adults ask questions such as who am I?  What do I want?  What’s important to me?

2.      Instability:  Where emerging adults experience the depth of many things including changing their majors, falling in love, falling out of love, falling in love again, a new job, another job, etc.  

3.      Self-focus:  This occurs when young adults aren’t selfish, but instead become self-concerned.  They ask what do I want.  What do I want to experience?  What makes me happy? 

4.      Feeling In-between:   This occurs with the young adult having mixed feelings about adulthood.  They don’t want to be stagnant, and don’t always perceive stability as the answer.  They don’t quit feel like an adult, but not a teen.

5.      Sense of possibilities.  This is a phase of high hopes, a sense of excitement about goals and possibilities, options, and the pursuit of dreams.


Three Phases of Emerging Adulthood:


1. Launching: age 18-22, which is an age of connection and reliance to parents, but trying new things.  This appears to be more experimenting with options and ideas, but maintenance of connections with parents when necessary.


2. Exploring: age 22-26, seems to be a phase of greater independence and branching out on their own.  First jobs, moving out, periodic co-habitation, travel, graduate school, etc.  This reflects much more distance from parents, and may feel more rejecting or cold towards parents.  It can be a phase of many and frequent changes.


3. Landing: age 26-29.  It seems that 30 is a hallmark age, where mates are chosen, careers more solidified, and traditionally perceived stability begins to settle in.


Treatment with Twenty-Somethings.  I really enjoy working with young adults in their 20s because of their high energy, sense of options and hopes, pursuing dreams, and overall optimism.  I think it often helps that I’m the parent of four Twenty-Somethings.   As with any new patient, the first step in psychotherapy with this age group is a careful and thorough assessment.  Clearly I want to determine why they are in my office?  What is the problem?  What they want to get out psychotherapy?  All these questions help me gather information and get a better understanding of my patients, but my experience and collaboration with my peers has trained me to also be on alert for what I call “Hidden Diagnoses”.  Hidden Diagnoses are disorders that aren’t always obvious.   Many of the Twenty-Somethings I see experience crippling anxiety, and often reveal intense social anxiety that isn’t readily apparent. They can seem socially facile, but often reveal extreme social insecurity and paralysis.


ADHD can often be undetected or marginal in high school, but can derail college performance.  Often the determination of this diagnosis is a relief, and can be managed via behavioral intervention and possibly a referral for medication to manage symptoms.  Failures connected to ADHD can impact self-esteem and confidence. Understanding the diagnosis and learning management skills can alleviate this pain.

Unfortunately, I have often met young adults who have “partied their way out of college”, and struggled with self-control and moderation away from home. They have had trouble managing substance excesses surrounding college life.   Developing greater frustration tolerance and broadening coping skills can often diminish over-reliance on substances for these individuals.


The 20s are an age where Bi-Polar Disorder can break through with severe symptoms in the face of being away from home and the stress of academic pressures.   Major Depression can often occur in reaction to the challenges of college without having one’s typical social support network.  Family history is often important to explore to help understand the contribution of depression on parenting, biological trends, and even parents responses to medications and/or treatment.  Periodic sadness and mood shifts are normal for Twenty-Somethings, but emotional paralysis, extreme apathy and withdrawal, and consuming dark thoughts or suicidal ideation necessitate committing to psychotherapy.


I am fortunate to have 4 children in their 20s, which has aided my understanding of the young adult world.  I would advise clinicians and parents alike to try to broaden their understanding of Twenty-Something’s music, TV preferences and shows, language and jokes, past-times (including video games or role playing games),  substance use and connected beliefs about substances, sexuality and gender identity, social media use, apps on their phones, their friends, and their philosophies.   If you don’t know, ask.  If you’re unfamiliar, ask.  If you disagree, try to learn.   You won’t learn or agree with everything, but if you are open-minded and curious about the Twenty-Something’s interests, you will learn a ton about them including their values, joys, struggles, goals, and successes.


I believe that it’s important to treat Twenty-Somethings with an attitude of acceptance, understanding, and reframing.  I particularly liked Arnett’s perspective of Emerging Adulthood as an “age of possibilities”, in a more optimistic sense.  I am paraphrasing, but he thought that many young adults saw their 20s along the lines of:  “why wait until my mid-life crisis to figure things out”.  This really helped my acceptance of the flux and apparent instability of Emerging Adulthood.   Maybe society, timing, economics and circumstances have contributed to this new age of exploration, and that the delay in “settling down” may be very normal.  Even the Twenty-Somethings may be fearful of their own uncertainty, and may feel more at ease with a reframing of these dynamics.


A lot of my work with Twenty-Somethings includes working with their parents.  I often have 2 main goals with parents including managing parental fears and helping parents sort through their projections onto their children.  It’s important to respect parent’s fears about their children and pay careful attention to their concerns.  No one knows their children better.  I find that some education about Emerging Adulthood as a stage is informative and soothing, hopefully allaying anxiety.   Often, family therapy with parents of young adults centers about improving communication, creating boundaries and limits, developing expectations and goals, increasing understanding and empathy, and creating support for all parties.  Many parents get labeled as “Helicopter” parents, and therapy often helps shift this dynamic from over-management of the young adult, to empowerment and the encouragement and development of broader coping skills.


Lastly, depending on the young adult’s symptoms, family history, and course of treatment, part of my job includes directing them to further assessments.  These other assessments may include a psychiatric evaluation for medication to help manage Depression, Bi-Polar Disorder, Anxiety, ADHD, etc.  Sometimes young adults can benefit from psychological testing, genetic testing, and substance abuse evaluations to help clarify their diagnosis, treatment, and interventions.

 

Steve Wodka, Psy.D.  847-413-9700, ext. 313                       stevewodka@gmail.com

References:

When Will My Grown-Up Kid Grow Up, J. Arnett, Ph.D., and E. Fishel, 2013

What Is It About 20-Somethings?   Robin Marantz Henig, August, 2010, The New York Times