Have you tried teaching tech. that involve the pts. instead of just the pt listening to you? For example breathing techniques. Have the pt put their fingers in a cup of ice for a few minutes then have them practice a breathing tech to get their mind off of the ice or trying to keep a feather afloat in the air while using a breathing techn or having them return demostrations or asking them what they think, how do they cope with pain or how do they learn best (seeing, doing, hearing). I find as a childbirth educator that when you can include the pt as much as possible the pt tends to relax and learn quickly even when the pt is a teen. I know this sounds simple but it works.