Counseling Teens

How does it work?

Working with teens is similar to working with adults. Most of the therapy is done individually. Some teens benefit from a more practical component to their work, such as learning coping skills. While other teens get better by talking through the thoughts and feelings that have been swirling around inside and bouncing those thoughts and feelings off an adult they don't live with.

What do you share with parents?

I share assessments and related recommendations, general updates, safety concerns, and ways parents can be helpful to their child's treatment.

However, most of the things that are said in therapy I cannot share. The more your child is confident that I won't tell their parent what they say, the faster he or she can tell me what's really going on and the more effective the therapy time can be.

What if my teen doesn't want to come?

Some teens do not want to come to therapy at first, but after the first meeting, most come to appreciate having a place to talk and share what's weighing them down. In my experience, most teens know after the first meeting if I am someone they can open up to.

I've heard from several parents that their teenagers have had experiences with other therapists that didn't quite resonate with them. I work hard to make therapy a comfortable place. If you think about it from the teen's perspective, therapy can be weird (see my article below), and most therapists don't get enough training on the nuanced approach to therapy that teens need. It's been a privilege to work with these teens and it seems they have found some value in our sessions together.

Alternatively, it may make more sense to work with the adults without the teen present. Click on the links to learn more about parents looking for their own counseling, and family counseling support.

How to Talk to Your Teen About Counseling

It used to be rare for teens to request counseling, but thankfully society's views towards mental health have shifted. Stigma has been reduced, making it easier for teens to ask for help without feeling ashamed or embarrassed.

However, some teens are not going to ask for help. Instead, parents see the behavioral signs - the yelling, mood swings, isolation, drop in grades, change in friends, etc. This article will give you a few ideas about how to talk with your teen about counseling when they aren't asking for it.

What teens hear when parents suggest counseling

"We think you are crazy"

"You are a bad kid."

I've heard it over and over again with the teens I work with. Regardless of what parents have said, this is what teens think deep down that parents are really saying.

So, start by addressing this assumption head-on. "We don't think you're crazy or a super-bad kid. But we don't want to ignore the pain that we think you are in, and we don't know how to help you."

Tip 1: No surprises

Early in my practice, I had a 14 year old girl come in with her mother. Her arms were crossed, her eyes were glaring, and she was giving one word answers. When I asked her why she was coming to therapy, she said she didn't know, and that her mother had told her they were going shopping but instead they had come to therapy.

This is a set-up for failure both for the teen and for me (the counselor). How can she NOT be angry and defensive about therapy when she was lied to? In situations like these, it is difficult to move past the initial anger and betrayal and move into a time of processing the reasons for attending therapy.

Tip 2: Share your concerns

Speak honestly about some of your concerns before coming to session. Explain why you think counseling may be a good idea.

Here are some conversation starters:

"I am very upset about finding that you've been smoking. I am worried because if you've been sneaking around smoking, it makes me wonder what else you've been doing. I am going to schedule a session with a counselor, and if she is a good match for you, I am hoping you guys can talk about what is going on."

Or: "I am concerned that lately we have been fighting a lot. And I realize that I don't really know how to stop arguing with you about your grades, because you used to get A's and now you get D's. I love you and I'm worried about you. I would like us to attend counseling so that we can work on this together. I'm not sure if it would be better for us to meet together or for you to meet alone with the counselor. But we can all sort that out together."

Or: "I have noticed that you just don't seem like yourself lately. You look sad, you've stopped attending choir, and you look like you've lost joy. Have you ever thought about talking with a counselor? I think it will help. What are your thoughts?"

For some teens, it is asking too much to have them say that they want to attend therapy. For these teens, if they are going along with minimal resistance, that is their way of agreeing without losing face.

Tip 3: Use the 4-session compromise

If you’ve followed Tip 2 and found your teen adamantly does not want to attend therapy, I recommend telling them that you want them to attend 4 sessions, and then we will all discuss together if more sessions are needed. Sometimes during the first session, the teen is so angry about being "forced" to attend therapy that the first session is spent understanding that anger. If the teen were to decide if they wanted to continue therapy at that time, they would likely say no, just to get back at mom or dad for having forced them to attend.

During the 2nd through 4th sessions, we are usually able to get past this initial anger, and begin discussing the pain. It is when the teen begins to discuss their pain that their reason for attending therapy becomes less about being "forced" to attend, and more about reducing their own distress.

Here are some conversation follow-ups for teens who are not open to therapy:

"No I don't think you're crazy. I think you're creative, wonderful, and stuck in a rut. The teen years can be really difficult, and I want you to go to counseling so that you can be all that you are, and not get bogged down by peer pressure, stress, or whatever is going on. I want you to attend 4 sessions. After 4 sessions you, me and the counselor will sit down and discuss if you need to keep coming."

Or: "I know you don't think you need counseling, but I do. Your well-being is important to me. Let's make a deal. If you genuinely try counseling for 4 sessions, and then hate it, (barring any safety concerns), I won't force you to keep going. But for the agreement to stick, you have to really try counseling. Do I have your word?"

Tip 4: Unless there are safety concerns

There are exceptions to the 4-session recommendation. If there are safety concerns, such as any type of suicidal ideation, major substance use, self-mutilation, or if your teen is a danger to someone, then they are not in the position to decide if they want to continue therapy or not. Until safety concerns are resolved, they should attend therapy for their own safety.

Here are conversation starters for a teen with safety concerns:

"Yeah, I know talking with a stranger about your problems sounds weird, but I think it's really important. I'd like you to try it for a few sessions. If you don't like it after that, then we'll find a different counselor who might be a better match for you."

Or "Last night when we were fighting, you said you wish you were dead. I don't know if you were joking or if you were serious. I know you're going to say you were joking. But I care about you too much to take a chance, so I am scheduling an appointment with a counselor so we can sort this out together."

Or: "When the cops brought you home drunk, it really scared me. I don't know if it was a one time thing, or if you have an alcohol problem, but I love you and don't want to ignore something so serious. I want you to talk to a counselor. I'm happy to pick out a few therapists I think you might like and then give you the final say, or I can just schedule an appointment with the counselor I think might be best."

Tip 5: Tolerate their anger

Even if there are no safety concerns, some teens are going to rely on you insisting they attend therapy. This goes back to some teens needing to save face so much that they can't admit they are scared and sad and in over their heads. Even if you do everything “right,” your teen may still be mad at you for even suggesting they attend therapy. As they are giving you the silent treatment, remember that your actions are communicating, "I'm not ignoring your pain." It is better to do something then to do nothing.