Making the Decision to Begin Therapy for Your Teen
It can be difficult to distinguish typical adolescent behavior from potential mental health challenges. A helpful distinction, and one that diagnoses often hinge on, is whether emotional, behavioral, or social difficulties impair a child’s schooling, relationships, or home life.
For example, one teen might stop going to class. Another may stop seeing friends and begin to isolate. Another may start sleeping all the time or be unable to fall asleep. In these cases, it’s worth seeking therapy. Even if changes don’t appear severe, they can snowball over time, because adolescence is a critical period of development. Intervening early is key.
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“Most people bring their kids to therapy when they’re at DEFCON 1,” says psychologist Mitch Prinstein, Ph.D., chief science officer at the American Psychological Association. “It’s akin to bringing a child to the doctor with a fever of 101 as they’re coughing up blood. It’s better to go to the doctor with a sniffle and slight fever.” (Psychology Today)
What Is Teen Therapy?
In teen therapy, therapists employ a variety of different interventional strategies with teenagers; in addition to talking about their thoughts and feelings, counseling may include other creative interventions like drawing, dancing, writing, or playing games. As with adult therapy, teenagers meet with their therapists to work on specific problems or stressors that affect their daily functioning.
Teenagers may need help with issues specific to their age group, such as newly encountered peer pressure, test anxiety, teen angst, and not fitting in, or with more universally encountered issues that persist into adulthood, such as OCD, ADHD, or a mood or personality disorder.
Your teenager will meet with their therapist privately, and a high degree of confidentiality is maintained unless a specific concern needs to be relayed to the parent. However, the therapist may also recommend family therapy sessions or other parenting work to help you better support your child.
When Does a Teen Need Counseling?
There isn’t a specific rule for when a teen does or doesn’t need therapy. However, mental illness in teenagers has been on the rise for the last decade, so it is important to address these concerns as they come up. For example, your child might request therapy simply because they want to talk to someone about their feelings, which should not be overlooked as a small request. Teenagers may also need support for a specific issue like grief, anxiety, or depression.
Teens may also need counseling to cope with transitional changes. Divorce, changing schools, or a parent getting sick can all represent stressors that may impact a child’s well-being. Even if your teen hasn’t talked about feeling stressed directly, that doesn’t mean they aren’t affected. Sometimes, you may even identify your teen’s changing behaviors and approach them about therapy without them bringing it up.
Signs That Your Teen Needs Professional Help Immediately
While there may be signs that your teen is struggling, such as a depressed mood and sudden behavioral changes, there is a high probability that you may not know whether your teen needs professional help. Children may be more secretive and withdrawn from their families at this age and internalize their suffering. As a result, they might not come forward with how they feel, especially if they worry about being shamed or judged.
That said, some potential signs that your teen should see a therapist as soon as possible include:
Persistent feelings of sadness or depression
Talking or making gestures about suicide
Isolating from friends and family
Sudden feelings of grandeur and mania, associated with bipolar disorder
Evidence of self-harm (cutting, burning, hitting oneself)
Dramatic changes in appearance or weight
Concerns or evidence of substance use or addiction
Sudden behavioral changes (new friends, drop in grades, disregard for usual hobbies)
Heightened anxiety in some or many situations
Types of Teen Counseling
The type of counseling used for a specific teenager will depend on their unique circumstances and the type of provider they seek out. Different providers use different approaches and treatment plans with their clients, and it is important to remember that there isn’t a single gold standard of care for therapy. Likewise, what works well for one client may not have the same results for someone else.
Popular Options For Teen Mental Health
Some types of therapeutic interventions and methods used when treating teenagers include:
Cognitive Behavioral Therapy (CBT): This widely used first-line approach can enhance the teen’s wellbeing by focusing on identifying and modifying distorted thoughts that negatively affect their mood and behavior. In different adaptations, CBT can work well for adolescents with disruptive behavior, depression, anxiety, trauma, sleep disorders, and many other concerns.
Behavioral Therapy (BT): Behavioral therapy (BT) is a precursor to CBT with the primary focus being on behavior change. BT is often a suited therapeutic option for addressing anxiety, phobias, ADHD, or disruptive behavior disorders in teens. Using a variety of interventions, BT aims to modify/discourage troubling behaviors and reinforce positive ones, as well as build the teen’s self-confidence to cope with stressful situations and life challenges.
Mentalization Based Therapy (MBT): Stemming from a psychodynamic framework, MBT centers around increasing an understanding of one’s own and other people’s emotions. MBT can be used across different settings and can help teens who have emotional problems, poor self-control, depression, anxiety, relational difficulties, and more.
Interpersonal Psychotherapy (IPT): An evidenced-based, brief therapy, IPT targets maladaptive thoughts and behaviors but only pertaining to interpersonal relationships. IPT may be an effective intervention for adolescents struggling with depression as they learn to better relate to parents and friends, and effectively manage conflicts.
Dialectical Behavioral Therapy (DBT): DBT is an evidence-based therapy that often involves a combination of group and individual sessions. It stresses taking responsibility for one’s own setbacks and can help teens explore how they cope with intense emotions and difficult situations. It can be useful for treating older teens who exhibit suicidal thoughts, engage in self-harm, or may have borderline personality disorder.
Acceptance and Commitment Therapy (ACT): This type of treatment has a flexible framework that focuses on embracing distressful emotions, unwanted experiences, or negative thoughts, while also being able to create healthy life changes. With a therapist’s guidance, teens can use their in-depth understanding of their emotional strains to commit to moving forward in a healthy manner.
Family Therapy: Family therapy can be an effective intervention particularly for troubled teens. In general, a family therapeutic approach seeks to bring a healthy balance within the family dynamics. Thus, finding a family therapist and engaging the entire family in treatment with a difficult teen can enable them to gain the skills to better interact and communicate with one another, and learn ways to support the teen and manage their behavioral problems.
Mindfulness: Among the many benefits of mindfulness several studies have shown that mindfulness-based interventions can help regulate intense emotions. This can be particularly useful for a teen’s mental wellness during a period in which their emotions tend to be high. Practicing mindfulness can increase their self-awareness and improve the teen’s ability to identify situations when they can tone down their reactions. (Choosingtherapy.com)
Factors to Consider When Choosing a Therapist
There are many elements to consider when selecting a therapist—and it takes time and work to do it. Parents should aim to be smart consumers: Make sure that the therapist is credentialed and licensed, and ask about their training and experience.
Some specific questions to ask might include, “What is your approach to therapy?” “What orientations are you trained in?” “What would a potential treatment plan look like?” “How will progress be measured?” “What has been the outcome for other teenager's you’ve treated for this condition?”
Parents should also establish clear expectations about confidentiality, says clinical psychologist Sharon Saline, Psy.D. A parent might ask, “What are your boundaries around confidentiality?” “Will you consult with us at all and if so how?” “What role will family play in the therapy?” Incorporating the family’s perspective can be valuable in addressing dynamics that influence mental health. “The teen is not growing up in a petri dish,” Saline says.
Above all else, the provider should be trained in approaches that are proven to reduce a child’s distress. The Society of Clinical Child & Adolescent Psychology’s EffectiveChildTherapy.org lists disorders and their corresponding evidence-based treatments.
In addition to clinical expertise, ask your teenager if they have preferences about the therapist's gender, age, and race. It can be helpful to select a few candidates and then allow the adolescent to choose who they feel most comfortable with. (Psychology Today)
Talking to Your Teen About the Decision to Start Therapy
Many parents feel nervous or unprepared to talk to their teen about therapy. However, modeling openness can help your child feel more comfortable talking about their own feelings. If you seem angry, uneasy, or disconnected about your teen needing help, they will likely shut down as a result.
Here are four tips for talking to your teen about starting therapy:
1. State Your Observations
You may acknowledge the symptoms you have noticed, but aim to be objective without shaming. For example, you might say, “I’ve noticed that you are in your room most of the day and aren’t doing well in school. You no longer spend time with your best friend. What’s going on?”
With that, it’s also appropriate to then follow up with your own personal feelings. You might say, “In seeing all this, I can’t help but feel worried. I love you and am concerned about your well-being.”
2. Anticipate Defensiveness
Your teen might deny any problems or get upset at you for highlighting their struggles. This often comes from a place of fear or shame. Try not to combat their defensiveness. Instead, remain calm. Let them know that you are here to listen and you want what’s best for them.
3. Provide Options
Options can be helpful if your teenager exhibits resistance to therapy. For example, if they’re against seeing a counselor on their own, you might ask if they’re open to family therapy or group therapy. You can also try to get them involved in the search process, or ask what it would take for them to feel excited about therapy.
4. Respect Their Privacy
Some teens balk at the idea of therapy because they worry their parents will become overly involved in their treatment. Therefore, it’s a good idea to establish ground rules with your teenager and encourage them to do their own research about confidentiality in teen counseling. It may also be helpful for the therapist to overview what will and will not be discussed. Do your best to respect that your teen needs a safe space away from you to talk about their feelings.
How Much Does Teenage Therapy Cost?
The cost of therapy varies, and the fee depends on a provider’s level of experience, professional background, insurance coverage, and location. You should expect to pay significantly more for treatment in metropolitan areas than in more rural locations.
Your mental health insurance may cover some or all of the treatment. Check with your insurance carrier to determine your deductible, copay, and the types of services covered. An in-network therapist will bill your insurance to pay for sessions. Out-of-network therapists may offer sliding scales or provide you with a superbill, which you can submit to your insurance for potential reimbursement.
Preparing for the First Session
Some therapists will provide paperwork for teens and their parents to complete before the first session. If this is the case, aim to complete the assignment ahead of time. You should also arrive early for the first session to account for traffic or technical difficulties. You might consider asking your teen to write down anything specific they want to address.
Remind them that it’s normal to be nervous! Over time, therapy should feel more comfortable.
How to Determine If This Is the Best Therapist for Your Teen
Each therapeutic relationship is unique. Likewise, good relationships can take time to develop. Ideally, you should let your teen inform you if treatment is going well. It is important to verbally check in and ask your teenager how therapy is going, what they do and do not like, etc. If your child likes their therapist, they will likely be more compliant and motivated for growth.
Signs You Should Find a Different Therapist
Some signs you should look for a new therapist for your teen include:
Your teen repeatedly makes negative comments about their therapist
You don’t feel like the therapist considers your needs or concerns
Your teens’ negative behavior persists or worsens after therapy
You don’t have any clarification on what’s being addressed in therapy
Your teen vocalizes wanting to work with someone else.
How Long Can I Expect My Teen to Be in Therapy?
Treatment lengths vary based on individual goals and progress. Therapy typically ends when a client has successfully completed their goals, but it is important to highlight to your teenager that therapy can be used whenever needed in the future. On average, 50% of people complete therapy within about 15-20 sessions. Many clients, however, prefer longer periods of treatment (six months or more) to maintain progress and continue receiving support. Chronic or severe issues may require more care.
How Can I Help My Teen Get the Most Out of Therapy?
As a parent, you play an important role in supporting your teen’s well-being. Even if you may feel discouraged, you can take proactive steps to promote their treatment compliance.
Here are a few things you can do to help your teen maximize their time in therapy:
Ask Questions Without Being Nosy
Let your teen know that you are available and interested in hearing about their therapy. If they discuss what they’re working on, ask thoughtful questions and avoid jumping to assumptions. With that, don’t bombard them with too many questions about the specifics–they have a right to their own confidentiality. Focus on how the overall approach is working, as opposed to the details being discussed.
Take Their Suggestions
Try to be open to the changes your teen wants to make. For example, if they come up to you and tell you that they discussed quitting soccer with their therapist, listen to their points and try to support them as best you can. If their therapist suggests that certain changes be made in the home environment, such as allowing your kid to sleep in on the weekends, try to consider their benefits for your teen. You want to respect that they can make healthy, autonomous decisions as young adults.
Acknowledge Progress
Make sure to praise your teen when you notice positive changes. Compliments (as long as they aren’t overdone or seem insincere) can go a long way in reinforcing good habits and instilling a sense of confidence.
Look After Your Own Mental Health
Model taking care of yourself by practicing self-care, asserting healthy boundaries, and working on your mental health. Helping somebody through difficult times can be taxing on you as well, and it is important that you model healthy behaviors during times of hardship and conflict. (Choosingtherapy.com)