Brain growth and change are key factors in adolescent development and influence cognitions, emotions, and behavior. Much of the research on the adolescent brain is fairly recent, and mental health practitioners working with adolescents must have knowledge about these changes to more effectively engage their young clients in therapy. The therapeutic relationship is paramount in counseling with all ages and is particularly important with adolescent populations. Use of innovative and creative strategies such as sand tray and art therapy are suggested as means to establish the therapeutic alliance with teens in processes that engage their developing brains effectively.