When Teens Need Therapy

A version of this article was published in Hood Magazine in April 2019.

Adolescence is a time of change, confusion, and testing boundaries. No matter how close parents are with their children, part of growing up involves pulling away from parents and realizing who they are outside of their role within the family. If you feel that your teenager could benefit from the support of a mental health professional, what should you expect?

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If you are asking yourself, “Is my adolescent struggling enough to benefit from therapy?” you would likely benefit from consulting a mental health professional about your teenager’s needs. Although a certain amount of “teen angst” might be expected, many could benefit from additional support outside of their families. Furthermore, if your teenager asks you if they can meet with a therapist, listen to their concerns. They are asking for help and support. Teens might not feel comfortable or do not have the words to put to what they are feeling. Fighting, self-harming, or breaking rules can be nonverbal ways that your teenager is asking for help.

When talking to adolescents about therapy, the language used is important. Avoid stigmatizing language or focusing on misbehavior. For example, saying, “You seem stressed out lately, and it might help to talk to someone,” is more productive than, “You have been so rude and disrespectful lately. You’re going to talk to someone.” Therapy is a resource, not a punishment.

Research about outcomes for mental health treatment suggest that, while both adults and younger children benefit from psychotherapy, teenagers are less likely to have symptom relief. This is because the number one factor in therapy is a trusting relationship between the therapist and client. Teenagers who are naturally more guarded against authority will be slow to build trust, and parents who are impatient to see positive change are tempted to change therapists or pull their adolescent out of treatment if progress is slow.

Therapy does not always involve the client on the couch, pouring out all of their secrets. Many teens that I work with prefer to explore art therapy or music to process their feelings rather than talking. If they do choose to talk, the conversation might not focus on what the parent feels is the most important topic. If you want your teenager to benefit from therapy, you need to be prepared for them to use the space in the way that is most comfortable for them, even if it not what you picture.

Another obstacle in mental health treatment with teenagers is confidentiality. In order to have trust with the therapist, teens must have some level of privacy in their relationship with their therapist. Imagine how difficult it is to open up to someone knowing that they might call your parents and repeat what you shared! Find a therapist whom you trust to tell you what you need to know about your child’s treatment, and have an honest conversation with your teenager and therapist to outline limits and expectations for confidentiality.

Many adolescents, even when given the space and freedom to make their therapy what they need it to be, will still resist or refuse to engage with their therapist. If the teenager is self-harming, suicidal, or threatening others, they need ongoing supervision in either an inpatient or outpatient setting to maintain safety. However, teenagers who could benefit from therapy to treat mental health problems but are not in danger might insist that they do not want to participate in treatment. In these circumstances, I often recommend that we stop therapy because this teaches them that therapy is their choice, and they are more likely to seek counseling in the future when they are ready.

Mental health in teenagers is particularly challenging for both parents and therapists. With support and understanding, they can benefit from mental health services in their own way and at their own pace.

Published by Amy Marschall, Psy.D.

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. Her clinical interests are varied and include child and adolescent therapy, TF-CBT, rural psychology, telemental health, sexual and domestic violence, psychological assessment, and mental illness prevention. Dr. Marschall presently works in the Child and Adolescent Therapy Clinic at Sioux Falls Psychological Services in Sioux Falls, South Dakota, where she provides individual and family therapy and psychological assessment to children, adolescents, and college students. She also facilitates an art therapy group for adolescents and college students with anxiety and depression. Dr. Amy Marschall is certified in Trauma-Focused Cognitive Behavioral Therapy and Telemental Health.

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