Therapy that makes teens feel comfortable to open up and explore what’s really going on is crucial for successful treatment. A cornerstone of my approach to treating teen depression is accepting teens for exactly who they are without criticism or judgement. As we dive deep into painful emotions, I work hard to see a teen’s perspective on what’s going on in their lives rather than imposing my own views or aligning with their parents. Most importantly, I show up as a real human and bring my own personality and authenticity into the therapy room. I trust teens to take us where we need to go in our work together and follow their lead. This approach helps teens feel that they are able to bring the whole, messy truth of themselves to therapy and that their therapist will trust them as the expert in their own lives. Teens who can connect with a therapist who believes in them and their ability to change while not flinching at the darker or embarrassing parts of themselves experiencing reductions in internal criticism and worthlessness, learn to identify and process their emotions in a healthy way, and become more confident that they can handle life’s stressors without collapsing into a deep depression.

Teens who are depressed often feel bad but don’t have confidence in their ability to get unstuck. They want things to get better but they bristle against adults who suggest they they need to be fixed or act like they know the solution to the teen’s problems. As a result, depressed teens often come to therapy hesitant to buy into the process and fearing that the therapist will try to tell them what to do or who to be. Instead of ending up in a useless power struggle, I work with teens to understand their own reluctance to engage in therapy, identify good reasons not to change, and explore what life might be like if changes were made without forcing compliance. When teens know that they’re in the drivers’ seat of their own lives and that the therapist is a partner in supporting their own goals for themselves, motivation to take steps to resolving depression increases and teens can benefit from treatment.

When teens are depressed, relationships suffer. Often, relationship problems contribute to depression in the first place and then become more difficult to overcome the more depressed that teens feel. The vicious cycle keeps teens locked into feeling bad. In therapy, we work collaboratively to figure out what’s breaking down in relationships that might be contributing to depression. It may be conflicts, life changes (like starting middle or high school, parental divorce, moving to a new place), grief or loss, or difficulty with social skills or being a naturally shy person. Once we figure out what’s going on, we work to address problems through improved communication that helps teens have supportive, lasting relationships with peers and family members and promotes social engagement while decreasing depression.

Sometimes teens become or stay depressed because they’re stuck inside of painful thought patterns. Because it isn’t fun to feel bad, teens might try to avoid or fight these thoughts and the feelings that come with them. Unfortunately, this can backfire and make things even worse. The cycle of feeling bad and then avoiding feelings cuts teens off from valuable sources of information about what they want and need for themselves. In therapy, we work to notice and tolerate emotions without judgement and get curious about feelings rather than pushing them away. We disentangle who the teen is as a person from the thoughts they have and start to discover deeper truths about their personality, values, and goals. Instead of stopping at insight, we take things a step further and help teens identify tangible steps that they can take to get them closer to the outcomes that they want to see in their lives and problem solve any obstacles that arise in the process.

Teens are learning and growing at lightning speed. Sometimes, their emotional experiences outpace their ability to handle them. Things can feel intense, overwhelming, and scary. When teens are depressed, they may understandably search for ways to manage feelings of numbness, worthlessness, and intense sadness. This might lead to self-destructive coping like substance use, impulsive actions, or self-harm that meets the goal of briefly managing the emotional intensity but boomerangs back into depression eventually. In therapy, depressed teens learn how to connect to how they’re feeling in a given moment and put words to it, find ways to sooth intense emotions that aren’t destructive, cope in advance of potentially stressful situations, maintain healthy habits, and create escape hatches if emotions become too much to handle. Over time, teens develop the skills to communicate their needs effectively, seek appropriate support, and see the perspectives of others. With the right skills, depressed teens can learn to strike a balance between accepting difficult emotions and situations and taking control of their situations to improve their quality of life and emotional health.

When teens are depressed, they often stop doing the things that once made them happy like engaging in hobbies, going out with friends, and being physically active. For teens who are feeling the crushing weight of depression, disengaging feels like the only option. Over time, withdrawal makes depression worse and teens might find it overwhelming or impossible to jump back into things. In therapy, we work together to figure out what things teens want to do even if they can’t right now because of depression, track for shifts in mood throughout the day to see what helps even a little bit, break things down into manageable chunks to increase the likelihood that teens will have the capacity to engage, and troubleshoot any issues that arise. The sooner that we can get teens out of their heads and back into their lives, the faster their mood will improve.

Teens who are struggling with depression often express intense feelings of worthlessness, low self-esteem, poor body image, and hopelessness. All of these combined make a big hit to teens’ confidence. As teens make changes in therapy, their ability to see themselves as capable, resilient people improves. I genuinely believe in teens’ ability to navigate life’s challenges and I work hard to draw on my client’s unique strengths and spotlight their ability to problem solve, endure challenges, and grow—especially when the weight of depression drowns out their own confidence.

While depression has many causes and triggers, deep and persistent emotional pain is often a signal that something in a teen’s life is out of alignment or isn’t working for them. If teens recover from depression and then go straight back into a life that continues to generate pain, they’re getting set up for failure. Therapy is the place where teens can come to start to build a life that doesn’t cause them to suffer. Teens are often constrained by family and school expectations despite desperately wanted to create their own life. Together, we work to figure out what counts as a good life, what is in the teen’s realm of control, and what steps the teen can take to create a life where they are happy, healthy, and balanced.

Whether family life is a contributor to depression or not, parents play a vital role in their teens recovering from depression. When needed, I work with parents to create conditions at home that support recovery and overall wellbeing. This might include joint sessions with teens and parents or dedicated parent sessions to help parents improve their relationships with their teen and sustain an environment where their teen can grow and thrive outside of the therapy room.