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Signs Your Teenager Needs To Go To Therapy

Signs Your Teenager Needs To Go To Therapy

Signs Your Teenager Needs To Go To Therapy
Over half of my work is with teens. So I know there are a lot of parents out there doing their best, and they're concerned, really concerned. It's no great secret that teen life has morphed into something pretty unrecognisable over the last ten years. 
It's hard to tell the difference between "normal" and "normalised" now - and importantly, it's harder than ever to tell the difference between "normalised" and "healthy".
This month I thought I’d give you a guide as to what I believe is worthy of concern. That's not to say everything else should be ignored or dismissed. It's simply to say that I get a lot of inquiries asking if a tween or teen ‘needs’ therapy. And often it turns out they don't.
But I get that it can be a tough call.
I tend to steer away from words like ‘normal’ or ‘pathological.’ My belief is that we have become overly concerned with medicalisation and diagnosis. It seems that we are experiencing a surge in ADHD and a range of depressive and anxiety disorders - all requiring medication for example – but is that a surge in real incidence?
Or is it a surge in diagnosis? They can be different things. And many mental health professionals are starting to rethink our use of diagnostic manuals.
The internet is full of drama and bad science.
I know a lot of parents are on high alert for mental health issues with their kids. And I applaud this. Today's teens are lucky to have parents who are better educated and informed. Unfortunately though, this new access to information (and misinformation) can also create a lot of unnecessary stress for parents.
And for their teens - who can self-diagnose in a few clicks and send themselves into a spin of Dr Google-induced anxiety. Grief can present with OCD like behaviours, for example, sadness can look like rage, loneliness like rebellion, coeliac disease like depression.  
But if you do feel that your teen is behaving in ways unlike "normal teenaged behaviour", if you have an instinct that something's up, then professional support for you and/or for them might be useful.

Trust that gut. You are the expert when it comes to your child.
Before we start with the checklist I really want to say that it's important to know that having a child in therapy is NOT a sign of parenting failure. In fact, it's quite the opposite if you think about it. It means you have heard your child. You've witnessed the difficulty they are going through and you have acted to seek to make a supportive, safe and confidential space available. What a gift from you to them!
Sometimes the very offer is enough.
Therapy has become more mainstream now, but there can still be some stigma around it so do reassure your teen that it is normal to have difficulties and that it is courageous and mature, not cowardly or needy, to seek help. (Same goes for you!).

If they sense shame in you, they will feel the same. If they see you being at ease, they will be far more likely to feel that ease themselves.
What’s normal? (even though truly, I dislike that word immensely..)
It can be difficult to tell the difference between ‘normal’ and ‘abnormal’ behaviour with teenagers. As a quick guide to what MAY be NOT NORMAL I would suggest the following:
  • If they used to sleep well and now don’t.
  • If they suddenly start sleeping for longer.
  • If they stop eating with the family and being secretive about their food.
  • If they dump old friends and get new ones in a short period of time.
  • If they suddenly become unwilling to let you see parts of their body (like arms or legs) when this was not a problem before.
  • If they stop socialising.
  • If they engage in alarming risk-taking or self-harming behaviour.
  • If they seem constantly angry, tired and/or volatile (not just occasionally "moodiness")
  • If you find drug paraphernalia. (And if you don’t know what this is- time to learn! Google is good for that kind of info!)
  • If they are grieving and appear to be making no recovery when a year or more has passed. (Visit
  • to read a piece I co-authored while working in Barnardos as grief and trauma therapist ).
  • If there is a severe drop in schoolwork standards and interest.
  • If there is school avoidance.
  • If they are pulling out their hair, eyelashes or pinching themselves.
  • If they are consuming a lot of violent porn.
  • If they forego meals, sleep or socialising to stay online gaming.
Teens often behave in ways to flag their feelings in the hope that you will do something about it.  They might leave a trail - like leaving laptops open on certain sites, or notes or poetry for you to "find" and read. It can be difficult to ask for help straight out at any age - as you probably already know!

I knew a teen who stayed up late for weeks to make herself look tired enough for her parents to worry enough to make a referral. She wanted somewhere to talk about a grandparent's illness where her parent wouldn't hear and be upset...
Things to note before you call a therapist:

1. It is crucial that the therapist you choose has experience and training that includes work with adolescents. It is also crucial that any therapist, regardless of their age or experience is in supervision. And regardless of how long they are qualified, they may not have knowledge of or expertise in your child's issues. Are they willing to refer onwards? It's OK to ask all of these questions - you are about to trust this person with your child - and your money. If a therapist seems irritated, insistent or defensive when questioned, feel OK about moving onto the next on your list.  I wrote a more definitive piece on choosing a therapist here

2. While the space for a teenager is confidential, therapists are ethically bound to report anything that concerns them or that they consider a child protection issue. While every therapist works differently, most will be OK with you the parent calling certainly after the first session to check in to see how things went. This should be explained clearly to both parents and their teenagers for transparency purposes. In this way, therapy can feel safe for everyone, and you have a right to ask the therapist for it to happen that way.

3. Sometimes parents and teens come together for sessions. My personal experience is that more often the teenager comes by themselves. It is important to respect their privacy. They see themselves as adults so to treat them as children will feel condescending and will be a barrier to trust. Teens can misinterpret concern as control. And sometimes we adults disguise control as a concern. But that's for another day!

4. If it becomes apparent that your teenager is addicted to drugs or alcohol during the course of therapy, they may be referred to a specialised treatment centre. The evidence for traditional 12 step programmes has become mixed recently, granted, but there are newer ways of treating addiction and emerging addiction. Use Google Scholar rather than Google to inform yourself. If your teenager is at risk through disordered eating the therapist will be (should be) requesting that the family medical practitioner become involved in their therapy. A referral to a treatment centre may happen here too.

5. And finally, of course, if your child discloses sexual or physical abuse the Child Protection Services must, and will, become involved.
There are many ways to support young people now - the cost varies and the waiting times vary - and parental resilience and patience is a skill you will definitely be drawing on if you're considering this journey!
But it can be such a rewarding journey.
That's my wish for you.
Sally O’Reilly is the Family Psychology Expert here at FamilyFriendlyHQ. She's a Psychologist, Psychotherapist & Clinical Supervisor in private practice in East Cork with twenty years’ fulltime experience. She has a special interest in working with teenagers. For more info contact her through her site, via Twitter or via Facebook.