How to Tell if Your Teen Should See a Therapist

by Zach Meyer

Well, it’s that time again. Labor day weekend unofficially marks the end of summer and, for families, the return to school. For many parents this transition also brings with it familiar struggles you’ve managed to avoid for a few months: academic struggles, social anxiety, conflict over curfew or friends or grades or bedtime… the list goes on and on. As a therapist, the beginning of the school year always coincides with a surge in appointments. The rigor and stress of the academic calendar have a way of making certain struggles much harder to ignore.

Incidentally, I also see a huge surge in new appointments after winter break, when students return to school in January. Invariably, parents will tell me some version of, “Well, first semester was really hard, and we don’t want to repeat that again.”

Repeat it? Why do it at all?

The teenage years are full of difficult transitions that are inevitably rocky at times, yet there are clear signs I look for that signal the need for some outside support. Don’t wait until second semester to get your teen the help she needs. It’s not worth the stress on your family. If your teen needs professional help, there’s a good chance she’s already showing you. Here’s what to look out for:

Academic Struggles

Do you have eight different job descriptions at your place of employment? Doing accounting one moment and cake decorating the next? Probably not, but that’s what’s demanded of high school students. On a daily basis, they are asked to demonstrate proficiency in several fields, including languages, science, math, history, and the arts. It’s a huge demand to place on them, and some kids are more naturally adaptable than others to the constant transitioning that kind of schedule requires.

Additionally, most of us aren’t equally skilled in all those areas, even as adults. With that in mind, realistic expectations for your teen’s grades should allow for some variability. If you know they love literature and science but have struggled in math for years, expecting “straight As" might be an unrealistic and unfair expectation. And, even in your teen’s best classes, sometimes low grades happen. Poor sleep the night before or a conflict with a friend can have a measurable effect on attention and performance. If your teen gets the occasional low grade, that’s normal.

What isn’t normal is a sudden, consistent, and general shift in academic performance. A teen who’s earned a 3.2 GPA for years but finished last quarter with a C average is not okay. Similarly, if the way your teen talks about school has consistently shifted to a negative outlook, or a desire to avoid school altogether, he is not okay. These are all signs that merit some clinical attention.

Social Struggles

Teens are still growing, especially in terms of their personality and their ability to handle their emotions. In fact, their capacity to feel bigger and more nuanced emotions develops before their capacity to adequately handle them. (Fun, right?) And while they ride out the storm of those huge feelings, they’re discerning what their likes, dislikes, fears, values, and goals are. (They’ll be doing this work well into their 20s when their brains finally stop developing.)

At any age, the best way to deal with our biggest emotions and questions is in relationship with other people. Teens generally embrace this as fact. In fact, you may have noticed they’re usually all about relationships. This is good and healthy. They’re drawn to their peers because they’re in the same boat in the same emotional storm, so to speak. They can not only commiserate, but learn from each other.

This is part of why conflict at this age can be so traumatic. Ruptures in your teen’s social fabric feel like holes in their safety net, or possibly like rejection of who they are. It’s often very hard for a teen to see a conflict with a friend as an isolated incident. It feels personal.

So, what’s normal? Healthy friends fight, but make up. They support each other and respect each other even when they know they don’t agree about everything. This communicates to your developing teen that it’s okay to hold unique opinions and that conformity is not a prerequisite to social acceptance.

What’s not normal — or healthy — is your teen feeling rejected for being a certain way or for holding a certain opinion. This can really undermine her healthy identity development and lead to social isolation, depression, and school avoidance. If you sense your teen feels alone or bullied at school, or has some friendships that seem unhealthy to you, don’t wait to intervene.

Mood Troubles

Remember those big emotions? Yeah, they wreak havoc on your teen’s mood. One moment, he’s fine, and the next, he’s furious. Or teary. Or isolating himself in his room. Unfortunately, this is generally par for the course at this age, as you likely know too well if you’ve raised a teen before or happened to be one at some point in the past. As a teen, your brain’s ability to contain it’s big feelings hasn’t caught up with it’s ability to feel them. It’s like trying to carry around a 5-gallon bucket filled to the brim. It’s gonna get messy at times.

So, generally, mood swings at this age are normal. Remind yourself that your teen isn’t trying to manipulate your or ruin your day. Their brains aren’t fully developed yet. They wouldn’t choose the angst they feel.

A healthy teen’s behavior will be marked by a couple things. First, even when his mood swings, he will be able to stabilize it in a relatively timely matter. If he seems to loose his mind at dinner, he should be back to “normal” by breakfast. Second, healthy teens generally understand these dramatic mood swings aren’t socially acceptable, and they will work hard to appear as stable as possible at school or out with friends. They will save the freak outs for when they are at home, with you. (Take this as a compliment. It means they are comfortable enough with you to not fake it. It means you’re a safe person.)

A teen whose relationship with his mood is unhealthy will have less control over it and its deviations from “normal” will last longer. He will cuss out a teacher. Storm out of the house over a disagreement at dinner. He will refuse to go to school or come out of his room. You might even perceive that his “personality” has noticeably and consistently changed.

These are all signs of what we call a mood disorder, like depression, and deserve some clinical attention. The right support and skill building can help a teen feel much better equipped to handle his emotional ups and downs.

Substance Use

I’ve had many teens explain to me in therapy that their use of alcohol or marijuana was purely recreational and had no adverse affects on their lives. In each case it eventually became clear that, to some extent, all of them were deceiving themselves and using their substance(s) of choice to self-medicate.

The reason we age-restrict certain substances isn’t necessarily because they adversely affect teens but not adults. It's because there is discernment required to use them responsibly that teens are generally not mature enough to possess. If your teen is getting drunk or getting high, I am 100% convinced she is trying to manage some kind of anxiety or depression or other stressor. Don’t wait. Get her to a counselor so she can learn some healthier coping skills.

So far I’ve covered some common areas of concern, but there are can be other signs of potential trouble. What if your teen is suddenly eating less? Sleeping less? Sleeping more? Working out all the time? Being secretive? Hanging out with a totally new group of friends? Much to their chagrin, and as much as they probably want you to believe otherwise, it’s highly likely that no one knows your teen better than you do. So trust your parental instincts. If your gut tells you that something about your kid is just “off,” trust that. 

Being a teenager is hard, and you haven’t failed as a parent if your kid needs more support than what you can provide on your own. I’ve been working with teens in a clinical context for 15 years, and I have yet to shame a parent for bringing his or her teen to therapy! Good therapists are there to support your teen and you so that you feel better equipped to support their healthy development in the future.

So trust your gut, get your teen the help he or she needs, and don’t wait until second semester to do it. Your future self and healthier future teen will thank you!