By Dahlia Rimmon
Medically reviewed by Michael Tang, MD
Key takeaways
Several types of therapy work well for teens, including CBT, DBT, family therapy, art therapy, and more. The right fit depends on their specific challenges and goals, as well as the relationship and level of trust they have with their provider.
It’s important to look beyond a teen’s behavior to understand which type of therapy can be helpful. Symptoms often overlap, so a qualified provider can help assess which type is the best fit.
If your teen is struggling with therapy, there could be several reasons why: The provider may not be the right match for your teen, the therapy type may not be working, or your teen may need two different types of therapy. Your teen’s provider can help guide you and make adjustments when necessary.
If your pediatrician or school counselor has suggested therapy for your teen, or you’ve noticed they could use some extra support, where do you even begin? With so many different types of therapy out there—from CBT, DBT, ACT, and IPT to family, group, and trauma-focused therapy—figuring out which approach may be a good fit can feel confusing and overwhelming. Is one better for anxiety? What about a teen who struggles to manage their emotions? Or has a tough time opening up?
The uncertainty is completely normal. Choosing a therapy method for your teen isn't necessarily as straightforward as matching a symptom with a specific therapy approach. Your teen’s individual needs, personality, and relationship with their provider all play a role. In this guide, we’ll walk through some of the most common therapy approaches used with teens, how they can help, and what you and your teen can expect during therapy sessions so you have a better idea of what teenage therapy looks like.
Major therapy approaches for teens
There are several types of therapy for teenagers that help them work through their emotions and behaviors. The best fit depends on what your teen is going through, what they need support with, and what you're hoping to address in therapy. Here are the most common therapy approaches used with teens.
Cognitive Behavioral Therapy (CBT)
According to the American Psychological Association, CBT is a behavioral therapy for teenagers that helps teens better understand their emotions and how to manage them. They learn skills to regulate their emotions, healthy coping strategies, and how to challenge negative thought patterns. CBT can be helpful when teens have emotions that feel intense to manage on their own, such as with depression or anxiety disorders, or when teens are struggling with harmful behaviors, such as with alcohol or substance use or an eating disorder.
Dialectical Behavior Therapy (DBT)
DBT is a variation of CBT and is often used when teens have trouble managing intense emotions or experience relationship conflicts, as well as complex mental health issues, such as suicidal thoughts, self-harm behaviors, and borderline personality disorder (BPD). With the help of a clinician, teens learn how to regulate their emotions, mindfulness skills, and build distress tolerance.
Family Therapy
Rather than working one-on-one with a clinician, this form of psychotherapy for teens involves the entire family unit, which may include parents, siblings, or grandparents. Family therapy can be helpful when there are issues with home communication or family dynamics, or if family conflict is affecting a teen’s mental health. Some sessions may only include the teen and others only with the parents. Ultimately, the clinician works with the whole family to improve communication, strengthen relationships, and create a stronger support system for the teen.
Acceptance and Commitment Therapy (ACT)
ACT is a type of CBT that helps teens acknowledge and accept difficult emotions while building their psychological flexibility, per the Journal of Affective Disorders. This includes their ability to be mindful and present with their emotions and experiences without judgement, while still behaving according to their values. In sessions, clinicians use mindfulness-based exercises to help teens become more aware of how they’re feeling. ACT may be particularly helpful for teens struggling with anxiety, avoidance, or perfectionism.
Interpersonal Psychotherapy (IPT)
A popular teen peer issues therapy, IPT is a time-limited treatment (12 to 16 weeks) for teens who experience mood disorders (such as depression) or have social difficulties or relationship problems. Examples include conflicts with parents, feeling isolated from peers, or major changes in relationships such as divorce. To help, clinicians guide teens through their challenges often using role play. Teens also learn communication skills and healthy ways to manage interpersonal and emotional concerns.
Trauma-focused Therapies
Trauma-focused therapy can help teens process and cope with traumatic memories or experiences, such as violence, abandonment, abuse, or sudden death. Clinicians who specialize in trauma utilize different trauma therapies, such as Eye Movement Desensitization and Reprocessing (EMDR), which involves focusing a traumatic memory while using eye movements or other forms of bilateral rhythmic stimulations. Trauma-focused therapy can also be helpful for teens dealing with post-traumatic stress disorder (PTSD) and other stress disorders.
Creative or Art-based Therapy
Creative therapies give teens a way to express or process difficult emotions when talk therapy feels too overwhelming. It can also help when teens have trouble putting words to their feelings. Creative or art-based therapy may involve drawing, painting, sculpting with clay, or working with other creative mediums.
What’s really driving your teen’s struggle?
Teenagers can be a mixed bag of chaotic emotions. They may seem hot and cold, stop talking to you completely, constantly worry about what their friends think or about fitting in, or suddenly act completely out of character.
But what you see on the surface doesn’t always tell you what’s truly going on. What looks like defiance may actually be anxiety. What seems like laziness could be depression. Understanding why a teen is struggling matters just as much as the behavior you’re seeing.
So, why do teens struggle? It’s not always clear. Hormones, developmental changes, and everyday pressures can all overlap and influence one another. Some common factors include:
Anxiety or depression: Mental health challenges can show up in unexpected ways, such as avoiding school, shying away from social situations, or worrying about failure or being judged. Depression may also look like laziness or a lack of motivation. “Changes in patterns related to sleep hygiene, eating, and academic performance are often noticeable,” adds Brandi Schweizer, a licensed clinical social worker and Behavioral Health Department Manager at Blackbird Health.
Executive functioning challenges: A teen may seem disorganized or dysregulated, even when expectations are clearly established. They may struggle with getting started with a task, managing their time, or following through. What looks like not caring may actually be a struggle with the executive functioning skills needed to plan and prioritize tasks.
Trauma, grief, or major life changes: Experiences such as bullying, loss, change in family dynamics, abuse, or a change in schools can affect how a teen acts or behaves. Some teens can become more reactive and angry, while others will withdraw and become avoidant.
Social pressure: Peer relationships, fitting in, or fear of being judged or rejected are common stressors in a teen’s life.
Academic stress: Academic expectations and pressure, especially planning for college or life after high school, can impact how a teen behaves.
Once you know what’s driving a teen’s behavior, you can better understand which type of support they need. “With understanding of the root cause, a therapist can determine what is occurring or has occurred, why behaviors are happening, and what the teen needs to overcome the struggles they are experiencing,” says Schweizer.
Below, we’ll cover common scenarios and therapy approaches that may help.
What situations often bring families to each type of therapy
You know your teen needs therapy, but figuring out which kind feels like a whole other challenge. Below are some common situations that might point you in the right direction.
Keep in mind that this is just a starting point, and not a tool for self-diagnosis or choosing a therapy on your own. Teen challenges are usually complex and issues often overlap, so it’s important to speak with a qualified mental health provider to help you find the right fit.
| Common teen struggle | What it might look like | Therapy types that may help | Questions worth asking your provider |
|---|---|---|---|
| Trouble putting feelings into words | They may respond with, “I’m fine” or “I don’t know,” withdraw, become angry, or cry. |
CBT DBT ACT Creative therapies |
|
| Anxiety, avoidance, or perfectionism |
|
CBT ACT |
|
| Friendship or social struggles | Frequent changes of social groups, fighting with peers, isolation, bullying or cyberbullying, people-pleasing, misunderstanding social cues, or feeling left out. | DBT IPT |
|
| A traumatic experience | Poor sleep, impaired school performance, difficulty with relationships, anxiety, avoidance, irritability, withdrawal, and distrust. | CBT DBT Trauma-focused therapies |
|
| Family conflict or communication breakdown |
|
CBT IPT Family therapy |
|
| Big, hard-to-manage emotions | Crying, shutting down, acting impulsively, self-harm, difficulty calming down, anger, and emotional outbursts. | CBT DBT ACT Creative therapies |
|
How the relationship with the provider matters as much as the approach
Therapy for teens only works if your teen feels comfortable enough to open up and engage. The relationship they have with their therapist, called a therapeutic alliance, is just as important as the therapy type. Your teen needs to feel like they can trust their provider, feel understood, and be themselves in the room.
Several factors can influence whether a teen clicks with a provider, including personality, communication style, age, gender, and more. As a parent, you may think you know exactly who your teen will feel comfortable with, only to find out that they have a completely different preference.
A provider who seems like a perfect match on paper may not be the right fit once your teen meets them—and that’s perfectly okay. Finding the right fit can take time, and the first one you try doesn’t have to be the one you stick with. It’s also important for you and your teen to stay open-minded when selecting a provider, and try not to pre-judge. You both might be surprised by who your teen ends up connecting with. Trying a therapist for a few sessions is the best way to assess this.
Here are some tips for finding a therapist your teen connects with:
When possible, include the teen in the process of finding a provider to give them a voice and some control in the decision.
Ask the therapist if they have experience working with teenagers and addressing your teen’s specific concerns.
Clarify parental expectations and how involved guardians should be during sessions and/or in-between sessions.
Ask how progress is measured and how they develop a treatment plan.
Discuss confidentiality, what information remains private, and what circumstances must include parental involvement.
Ask about practice policies, such as attendance, cancellation, communication, and scheduling.
Format also matters: Individual, group, or online therapy
Therapy format makes a difference, too. Teens often feel more comfortable meeting with a clinician virtually, especially if they’re new to therapy and the idea of sitting face-to-face with a provider feels awkward or intimidating.
Others may prefer in-person sessions because face-to-face connection helps them feel more engaged. Group therapy is another option. It can feel reassuring to hear other people talk about similar experiences.
Here’s a closer look at the different formats:
Individual therapy: One-on-one sessions with your teen and a clinician. This is the most common therapy format and a good starting point.
Group therapy: A clinician works with a group of seven to 10 teens who may be experiencing similar challenges. This format can be helpful when connection, peer support, and normalization are part of the treatment plan. Some groups have more than one clinician leading the sessions.
Online therapy: In online therapy, sessions take place virtually through video calls. Online therapy makes treatment more accessible and often more comfortable. According to a 2021 meta-analysis published by the American Psychological Association, teletherapy can be equally effective as in-person therapy in most cases. However, if your teen needs a higher level of support or has more complex or urgent needs, in-person care may be more appropriate.
What actually happens in a therapy session with teens
If you want a closer look at what typically happens in sessions, here’s what you can expect:
The initial session
The first session is generally more comprehensive, with the clinician gathering information about the teen’s history, struggles, and current needs. The clinician will explain how therapy works, what the treatment process looks like, and how progress will be measured. This is also when the clinician reviews important topics, such as informed consent, confidentiality, and a clinician’s duty to warn the parents when there’s a serious safety concern. Depending on the case, parents may participate in the initial session to provide additional context and information.
Subsequent sessions
After the initial assessment, building rapport and establishing trust are foundational to the therapeutic process. Teens don’t need to jump straight into discussing their difficult experiences. Instead, the clinician will take time to get to know the teen and their interests. “Therapists can successfully accomplish this by talking about teen interests such as school, relationships, music, shows, hobbies, sports, and anything else the teen finds interesting,” explains Schweizer.
As the therapeutic relationship develops, sessions start to focus on goals outlined in the treatment plan. “Throughout ongoing sessions, teens may participate in CBT exercises, DBT skills, mindfulness, problem solving, communication skills, role-playing, EMDR, identifying thoughts and emotions, reframing negative thoughts, and talking through current situations,” says Schweizer.
How confidentiality works
During the initial session, a clinician will discuss the specifics of informed consent and confidentiality, including what information remains private and what circumstances require the clinician to share information with parents. Since the age for consent and confidentiality vary by state and provider policy, these guidelines will depend on where the teen receives care. In general, therapy will be private for most teens and parents should expect not to be privy to information about what’s specifically being discussed during sessions.
Confidentiality is a crucial conversation to have in the initial session. “This step is important, especially with teens, because they often struggle to trust and open up due to fear of information being shared,” explains Schweizer. In many ways, explaining confidentiality is part of building rapport and establishing trust from the beginning.
Can teen therapy approaches be combined?
Therapy approaches can be combined to support your teen’s individual treatment plan. “Most therapeutic approaches are not ‘one size fits all,’ and many therapeutic approaches are designed to help target multiple presenting challenges, so it’s important for both clients and therapists to be open to various approaches,” says Charlley Labik, a licensed professional counselor and Program Manager of Behavioral Health Services at Blackbird Health.
For example, a clinician may use DBT tools, such as mindfulness and emotional regulation, alongside traditional CBT to help a teen with BPD manage intense emotions. These tools can also help teens navigate other areas of daily life, including relationship-building and communication. If one type of therapy hasn’t felt effective for your teen, a combination approach may better fit their needs.
Is the teen therapy approach helping? What to look for
It’s common for parents to wonder if their teen’s therapy is actually working. You don’t have to rely on a gut feeling to figure this out. Here are some signs that it is and when it’s time to reassess.
Signs therapy is working:
Your teen feels validated, heard, and safe.
Your teen is using skills and strategies outside of sessions.
Your teen shows up to therapy sessions.
Your teen is becoming more self-aware.
Your teen is making progress according to the goals in the treatment plan.
Quantitative assessments, such as a Patient Health Questionnaire-9 (PHQ-9) or Generalized Anxiety Disorder Tool (GAD-7), show improving scores.
Signs therapy is not working:
Your teen dreads going to sessions with noticeable resistance.
Your teen is not able to apply what they learned outside of sessions.
Your teen does not feel connected, validated, or safe with their therapist.
Your teen feels confused or distressed after sessions.
Your teen feels like they are “going in circles” without progress and clear established goals.
Assessments such as the PHQ-9 or GAD-7 are not improving as desired.
What if the approach doesn’t seem to be working?
If your teen isn’t making progress in therapy or you're noticing some of the signs above, have an open conversation with their provider. Maybe the therapy type isn’t the best match for what your teen is currently going through. Maybe your teen hasn’t connected with their therapist. Or perhaps there’s more beneath the surface than was originally understood. Taking a step back and looking at the bigger picture can help clarify what needs to change. The periodic treatment planning check-ins are a great opportunity to have this discussion.
With that in mind, it takes time to establish a healthy therapeutic relationship. “I would encourage teens to give the therapeutic relationship at least three to five sessions to feel out their level of connection and comfort,” says Labik, who recommends giving the therapeutic approach itself anywhere from three to six months to assess whether or not the approach and techniques are working.
Finding the right fit for your teen
If you’ve spent some time researching therapy options and still aren’t sure what’s the best fit, a comprehensive evaluation can point you in the right direction. At Blackbird Health, the New Patient Evaluation will give a clinician a better understanding of what’s going on with your teen, including their challenges and what’s driving them. From there, the clinician can help identify a therapy approach (or a combination of approaches) that aligns with your teen’s individual needs.
The bottom line
There are many different types of therapy that can support your teen’s mental health. Understanding why your teen is struggling and how it’s affecting them can help guide the decision. Your teen’s provider can help determine which type of therapy (or combination of approaches) best fits their needs.
Finding the right fit can take time, as does finding a provider your teen feels comfortable with. If something doesn't seem to be working, talk with your teen’s provider about what you’re noticing and whether a different approach can better support them.
Frequently asked questions (FAQs)
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There are several types of adolescent therapy that can help teens work through challenges, including CBT, DBT, ACT, family therapy, trauma-focused therapies, IPT, art therapy, and more.
The best approach depends on your teen’s individual needs and what they are struggling with. What works well for one teen may not work for another, and sometimes it takes trial and error to figure it out.
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Mindfulness techniques to help manage emotions
Cold therapy such as holding an ice cube for a few seconds to activate the parasympathetic nervous system
Creative exercise, such as drawing, building, writing, or listening to or producing music
Movement, including dancing, running, stretching, or yoga
Journaling
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Whether or not you’re legally able to make them go varies by state. In Pennsylvania, for example, teens have a say in whether they participate in therapy. “If the law states that a minor cannot object to outpatient treatment services, as Pennsylvania’s law does, it does not account for a teen who refuses to go to therapy,” explains Schweizer. “As a social worker, I provide psychoeducation on what therapy is and is not, and I use motivational interviewing to determine how motivated a refusing teen may be and if they are willing to explore the therapeutic journey.”
According to both Schweizer and Labik, clinicians should respect a teen’s rights and their decision whether to accept care. Clinicians can support both parents and teens by explaining what therapy involves and how it can benefit them, as well as building rapport and clarifying misconceptions about treatment.
How can Blackbird help?
Our goal is to initiate the right course of treatment as quickly and as smoothly as possible, so “how it works” can be a little different for everyone. We customize your treatment plan to meet your unique needs, on a timeline that works for you. Click here to get started today.
