PRACTICAL PROBLEMS AND IMPROVEMENT STRATEGIES OF ENGLISH VOCABULARY TEACHING FROM THE PERSPECTIVE OF EDUCATIONAL PSYCHOLOGY
Jia Zhou

SUMMARY
Background: Mental health problems start early in life. However, the majority of adolescents fulfilling the criteria for mental health disorders do not receive treatment, and half of those who do get treatment drop out. This begs the question of what differentiates helpful from unhelpful treatment processes from the perspective of young clients.
Subjects and methods: In this study, we interviewed 12 young people who entered mental health care reluctantly at the initiative of others before the age of 18. Their journeys through mental health care varied significantly despite sharing the same starting point.
Results: Our analyses resulted in a model of three trajectories. We describe relational and structural facilitators and obstacles within each trajectory and have formulated narratives highlighting core experiences differentiating them. Trajectory 1 (I never saw the point – Being met as a case) was characterized by a rapid loss of hope, leading the adolescents to conclude that mental health care was not worth the investment. Trajectory 2 (I gave it a go, but nothing came of it – Being met by a therapist representing a rigid and unhelpful system) was characterized by a lingering hope that never materialized into a constructive therapeutic process despite prevailing efforts by both therapists and adolescents. Trajectory 3 (Something good came of it – Being met by a therapist who cares and wants to help) was characterized by genuine meetings, allowing the therapist to transform from an unsafe stranger into a safe, competent, and benevolent adult.
Conclusions: These findings point to the key role played by the therapist as a person and adolescents’ positive meetings with a safe, genuine, and flexible therapist who could make their treatment useful despite a less-than-optimal starting point. The results have important clinical implications, including the extent to which service organizations allow sufficient flexibility for therapists to ensure individualized treatment that meets the needs of adolescent clients. The findings also shed light on how adolescents are active participants in therapy, feel responsible for making the therapeutic relationship work, and often remain in therapy for a longer period without experiencing benefits even when they have entered therapy at the initiative of others.
Key words: adolescent - mental health – helpful – unhelpful – therapy - treatment
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SUBJECTS AND METHODS
Study setting
The study was conducted in the context of a welfare system, in which children and adolescents receive free medical, dental, and mental health care until they are 18 years old. The idea for the current study was conceived while the first author was working as a psychologist in an outpatient clinic for children and adolescents. Meeting adolescents weekly that were referred because the school put pressure on the parents to seek help on behalf of the adolescent or because child protective services thought the adolescent needed help or because the parents pushed them to go, she wanted to learn more about how adolescents experienced coming to mental health care at others’ initiative, how therapy could become helpful with that starting point, and how therapists understood and related to this phenomenon. Some years later, when working as an associate professor at the university, she, therefore, initiated a multisite qualitative study involving practitioner-researchers and colleagues at the university to explore this phenomenon from the perspectives of the therapists and the adolescents (Sherchanetal 2017).

Design
To explore how adolescents experience therapy when the starting point for therapy is difficult, we chose to recruit adolescents who had experienced adult-initiated referrals to mental health care. Given this starting point, we expected challenges related to recruitment as the inclusion criteria meant adolescents had to trust that we, as adult researchers, were interested in their experiences and perspectives despite their previous experiences with adults overriding their perspective and pressuring them into contact with mental health care services. We, therefore, put a lot of thought into study design and cooperated closely with a youth user organization (Forandringsfabrikken) in all phases of planning and designing the study, including recruitment strategies and materials and the formulation of interview questions.
To access the adolescents’ perspective, we chose a design whereby participants were invited to two individual semistructured interviews with the same researcher. This would enable the participants to get to know the interviewer slightly, allowing them to provide the information they were comfortable with in the first interview while also knowing they had a second opportunity to share and expand on their perspective. We also wanted to provide the adolescents control over the information they shared and enable them to utilize the ways of sharing with which they were most comfortable. We recognize that interview as a format keeps so much control in the hands of the interviewer and is on the adult’s premise. As the interview occurs at one specific point in time, the data generated consist of the experiences available to the interviewee at that time. Although we invited participants to two interviews, we wanted to include more flexibility in the design. The adolescents, therefore, had the opportunity to write down or record relevant experiences, reflections, or thoughts they wanted us to include in the data material. Each participant received a pin code–protected digital recorder at the first interview in addition to instructions on how they could password-protect word documents to ensure confidentiality.
Participants were asked to give their consent to participate in the study and, if this was given, they were given the Arabic version of the NTBSQ, with both quantitative and qualitative questions, to com-plete. Participants’ identity was anonymized to ensure the confidentiality of the study. Statistical methods used in this study included bivariate analysis and chi-square (for categorical data) or t-tests (for continuous data) using the Statistical Package for the Social Sciences (SPSS). Through the analysis of variance, there are significant differences between the three groups, and the specific data analysis is shown in Table 1.

Table 1. Anxiety levels of different sports frequencies for non-physical students.
The frequency of motion	Do not exercise	Once a week	Twice a week	
Anxiety level	42.58±6.84	41.97±6.43	36.57±7.94	

CONCLUSIONS
In this study, we investigated the experiences of 12 adolescents who had attended mental health care at the initiative of others. We found that the participants’ journeys through mental health care differed significantly as illustrated by three different trajectories. Some participants experienced a rapid loss of hope (Trajectory 1), others had lingering hope and stayed in treatment without experiencing any benefits (Trajectory 2), and the last group experienced some benefits from treatment (Trajectory 3). These findings point to the key role played by the therapist as a person and adolescents’ positive meetings with a safe, genuine, and flexible therapist who could make their treatment useful despite a less-than-optimal starting point. The results have important clinical implications, including the extent to which service organizations allow sufficient flexibility for therapists to ensure individualized treatment that meets the needs of adolescent clients. The findings also shed light on how adolescents are active participants in therapy, feel responsible for making the therapeutic relationship work, and often remain in therapy for a longer period without experiencing benefits even when they have entered therapy at the initiative of others. These findings also emphasize the importance of assessing adolescents’ experiences in therapy and adjusting treatment to facilitate helpful therapeutic processes.

Acknowledgements: We want to thank the participants for sharing their experiences with us, making this research possible. We also want to thank Forandringsfabrikken for invaluable input on design, recruitment strategies, and interview guides. Finnmark Hospital Trust gave Tonje Barca an internal grant to release her from clinical tasks for 6 weeks to take part in the research process. The University of Bergen payed for the Open Access fee.
Conflict of interest: None to declare.

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