Reflections Mental Health Services

By Alphonso Gaita, LCSW, Reflections Mental Health Services. Telehealth across New York State.

Being a teenager is hard, and it’s harder now than it was for most of us. Rates of anxiety, depression, and self-harm among American teens have climbed a lot since 2012, and the pandemic sped all of it up (CDC, 2023). If you’re a New York parent trying to figure out whether your teen could use teen therapy in New York, here’s how I’d think it through.

Signs your teen might benefit from therapy

• Withdrawal from friends or family for more than a few weeks
• Drop in grades or sudden disengagement from school
• Sleep changes: sleeping much more or much less, or insomnia
• Significant mood changes: irritability, sadness, hopelessness
• Loss of interest in things they used to love
• Talking about being a burden, hating themselves, or wishing they didn’t exist. Take this seriously and call 988 or 911 if active.
• Self-harm: cutting, burning, or hitting themselves
• Disordered eating patterns
• Significant change in social media or phone use
• Substance use beyond experimentation
• A specific event that’s hard to process: loss, trauma, breakup, parents separating

You don’t have to wait for a crisis. Therapy often works best when it starts before things hit bottom.

How to bring it up with your teen

• Lead with care, not concern. “I love you and I want to make sure you have what you need” lands better than “I’m worried about you.”
• Frame it as a resource, not a punishment. Therapy is something they get to use, not something they have to do because they’re broken.
• Offer choice. “Would you want to try a few sessions and see how it feels?” gives them some agency.
• Acknowledge it’s hard to talk to a stranger. Don’t gloss over it.
• Let them choose the therapist if you can. Show them a couple of profiles and let them pick.
• Don’t oversell it. They’ll see through it.

If your teen flatly refuses, the most useful next step is often parent therapy first. Working with a therapist on how you parent and communicate can shift the family dynamic enough that your teen warms up to the idea later.

What teen therapy actually looks like

• Build rapport before pushing for content. The first few sessions are usually more about trust than insight.
• Talk about safe topics first (TikTok, friends, school) to make room for the hard ones later.
• Use evidence-based approaches like CBT, DBT skills, and motivational interviewing, adapted for teens.
• Negotiate confidentiality clearly. Most things stay between teen and therapist; safety concerns are the exception, and the teen knows the rules upfront.
• Loop parents in periodically, usually through brief check-ins or family sessions, without breaking the teen’s trust.

Does telehealth work for teens?

For older teens (14 and up), telehealth often works better than in-person. They’re already comfortable on video, they can take the session from their own bedroom, and they don’t have to be “seen going to therapy” by classmates or neighbors. Studies show telehealth therapy is as effective as in-person for adolescent depression and anxiety (Comer et al., 2017).

For younger teens or kids under 13, in-person play-based or art therapy is often a better developmental fit. Talk it through with a clinician.

What about confidentiality?

• What the teen shares stays between teen and therapist, with three exceptions: imminent danger to self, imminent danger to others, and disclosure of abuse.
• Parents are generally told that therapy is happening, that the teen is engaged, and what overall themes are being worked on, but not session-by-session detail.
• If a parent has serious concerns, they can request a parent meeting, and the therapist will handle it with the teen’s awareness.

Strong confidentiality is a big part of what makes therapy work for teens. Their trust is fragile and easy to break.

If you’re worried about safety

• Call or text 988 (Suicide & Crisis Lifeline). There’s a Spanish line and an LGBTQ+ youth line.
• Call 911 or go to your nearest emergency room if there’s immediate danger
• Don’t promise secrecy. Be honest that you’ll do what it takes to keep them safe.
• Remove access to means (firearms, large quantities of medication, and the like)

Starting teen therapy in New York

Several of our clinicians at Reflections work with adolescents and teens over secure telehealth. We’re in-network with Aetna, Blue Cross Blue Shield, Highmark, Carelon, and Cigna, and we offer no waitlist therapy across all of New York State. Make an appointment and we’ll talk through what your teen needs.

References

• Centers for Disease Control and Prevention. (2023). Youth Risk Behavior Survey: Mental Health.
• Comer, J. S., et al. (2017). Internet-delivered, family-based treatment for early-onset OCD. Journal of Consulting and Clinical Psychology, 85(2), 178-186.
• New York State Mental Hygiene Law § 33.21. Mental Health Treatment of Minors.
• Twenge, J. M. (2020). Increases in depression, suicide ideation, and suicide attempts among U.S. adolescents. Clinical Psychological Science, 8(3), 369-377.