Ages 11–14 | Child Health + Development | Ages 15–18

Trusted Counsel: Does Your Tween Need Therapy?

A guide to when and how to find a therapist or counselor for your tween or teen

Lucy* was 10 years old when lightning struck. Her father’s secret gambling addiction — and the resulting financial devastation — came to light, and her parents’ marriage was ending. Suddenly, Lucy was not only enduring the tremendous emotional upheaval of divorce, but also facing the loss of her Bellevue childhood home. 

Though Lucy’s sadness never seemed out of proportion with the situation, her mother worried about her own emotional bandwidth to ensure that Lucy was OK. She wanted to be sure her daughter had someone to talk to, as well as a safe place to feel angry while sorting through some serious emotions. She asked her pediatrician to recommend a therapist.

“Lucy has a real caretaker personality,” her mother says, “and I didn’t want her trying to nurse me — let alone her little brother — through this mess. It was important for her to have a place to go where she could worry only about her own emotions.” Therapy helped Lucy ride out the storm; now 17, she returns to it from time to time when issues arise.

Signs and struggles

Big events such as family traumas can be clear indicators for therapy, but sometimes kids struggle in ongoing, less obvious ways. It’s not always easy to know when it’s time to seek help for your child, but chances are if you’re asking yourself the question, it’s worth exploring.

“Most parents will have noticed their child struggling with intense emotions, difficult thoughts or behaviors, or problems in their relationships for several months or longer when they begin to contemplate finding their child a therapist,” says Katie McLaughlin, Ph.D., a licensed child clinical psychologist and assistant professor of psychology at the University of Washington.

If you’re wondering about therapy for your child, McLaughlin suggests you consider the following:

  • Are the emotional and behavioral patterns in question developmentally appropriate? Most children experience challenging emotions and behaviors at certain points in development. Talk to teachers, child-care professionals and fellow parents about whether your child’s behaviors seem consistent with those of other kids the same age.
  • Are the patterns consistent and stable? Most kids feel distressing emotions, such as fear, sadness and anger, or have problems regulating their behavior in certain situations, with certain people or for short periods of time (especially during important transitions — a new school, a new sibling, etc.). These transient or context-specific patterns are probably not significant enough to warrant therapy. But if the patterns stay relatively stable over time and appear in multiple contexts, therapy may be important to consider.
  • Are the patterns causing your child significant distress? Are they interfering with important domains of life, such as school or relationships with friends and family? If the answer is yes, then finding your child a therapist might be the right step.

Margaret remembers the moment  she knew she needed to look for help. Her 11-year-old son Theo’s behavior had slowly become stranger and more disruptive over the course of several years. “I knew something was going on, because he’d get really stressed out over little things, and then he’d get into trouble at school,” says the Seattle mom. “He was so anxious and having a harder and harder time doing simple things.”

One day, Margaret noticed Theo blowing on his fingers repeatedly. She mentioned it to a friend, who thought the behavior sounded like obsessive-compulsive disorder (OCD), an anxiety disorder often accompanied by repetitive movements. “It sounded right,” Margaret says, so she did some online research and found Theo a psychologist at a clinic that specializes in treating anxiety disorders in kids.

Theo was indeed diagnosed with OCD, and he went to therapy several times a week for about six months. Now 17, he still gets the occasional checkup, Margaret says. “He thinks therapy is exhausting — he never feels like going — but it helps him a lot.”

The perfect provider

It can take work to find the right therapist for your child, but it’s well worth the effort, says McLaughlin. “Many parents can feel overwhelmed by the numerous options available, or [they] feel unsure about how to start the search process,” she says. “Therapists vary widely in the types of training they have received, the strategies they use to treat emotional and behavioral problems in children, and their interpersonal style.”

An important first step, McLaughlin notes, is to determine what kinds of treatment have been found effective (are “evidence-based”) for the types of problems your child is experiencing. Speak to your pediatrician or consult reputable online resources.

Once you have a basic idea of what type of treatment your child needs, search for providers covered by your health insurance who offer that treatment. Most insurance plans have provider directories on their websites.

The final step is determining whether a therapist is a good fit for your child. Request a brief consultation or phone interview (not all therapists have time to do this, and many charge a fee). You may need to speak to a few providers before settling on one both you and your child like. “Try not to be discouraged if the first therapist you meet does not seem to be a good fit, and do not be afraid to shop around,” McLaughlin says. “You know your child best.”

The effort can really pay off, she explains. “The right therapist can have an enormously positive impact on your child’s development.”

Theo’s mom, Margaret, agrees: “When you find the right therapist, it makes all the difference in the world.”

*Names have been changed to protect privacy.

Counselor credentials

Psychiatrists (M.D. or D.O.) are medical doctors with advanced training and experience in psychotherapy and pharmacology. They can prescribe medications.

Clinical psychologists (Ph.D., Psy.D. or Ed.D.) are therapists with a doctorate that includes advanced training in the practice of psychology, and many specialize in treating children and teens and their families. Psychologists may help clients manage medications, but they do not prescribe them.

Licensed clinical social workers (LCSW) have a master’s degree, specialize in clinical social work and are licensed by the state.

Source: The Nemours Foundation/KidsHealth

Types of therapy

Cognitive behavioral therapy (CBT): Focuses on the ways that a person’s cognitions (thoughts), emotions and behaviors are connected. Hinges on teaching children specific skills.

Psychoanalytic therapy: Usually used with tweens and teens who may benefit from more in-depth analysis of their problems. Does not focus on short-term problem solving in the same way as CBT.

Group therapy: Kids meet in groups of six to 12 to solve problems and learn new skills, such as social skills or anger management.

Family therapy: Counseling sessions with some or all family members to help improve communication with each other.

Dialectical behavior therapy (DBT): A form of psychotherapy developed by University of Washington researcher Marsha Linehan that combines cognitive-behavioral techniques with the concept of mindful awareness. Especially effective for self-harm behaviors, depression and eating disorders.

Sources: American Psychological Association, The Nemours Foundation/KidsHealth, The Linehan Institute



Read Next