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 asking yourself, “Does my teen need therapy?” and trying to figure out whether your teen could use teen therapy in New York, here’s how I’d think it through.

Does my teen need therapy? 11 signs to watch for

• 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

If you’re asking “does my teen need therapy,” you don’t have to wait for a crisis. Therapy often works best when it starts before things hit bottom.

Does my teen need therapy, or is this normal teenage stuff?

This is the question parents ask me most. Some moodiness, eye-rolling, and pulling away from parents is part of normal development. The difference usually comes down to three things: how long it lasts, how much it gets in the way, and whether your teen seems to be suffering. If a change has lasted more than two weeks, is affecting school, sleep, or friendships, or your teen seems hopeless rather than just irritated, it is worth getting an evaluation.

If you are still asking yourself “does my teen need therapy,” a single consultation can help you decide. A good clinician will tell you honestly if what you are seeing sounds like a normal phase, and will suggest next steps if it does not. You can also read about our teen therapy in New York to see how we work with adolescents and their parents.

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 you have decided the answer to “does my teen need therapy” is yes but 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.

Once you have answered “does my teen need therapy” and decided to start, most teens are seen weekly at first, usually for 45 to 60 minutes. Early sessions focus on building trust and understanding what is going on, then shift toward practical skills for handling stress, mood, and conflict. Parents are usually included at the start and at regular check-ins, while the teen keeps a private space for the rest.

Progress is rarely a straight line. Many families notice small changes first, like a teen who talks a little more at dinner or recovers faster after a bad day. If you are wondering whether it is working, ask the therapist directly. A good clinician will welcome that question and walk you through the goals you set together.

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. Many parents who ask “does my teen need therapy” worry about being shut out. You will not be. You will hear about safety concerns and overall progress, and your teen keeps the private space they need.

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)

How to find the right therapist for your teen

Once the answer to “does my teen need therapy” is yes, fit matters even more with teens than with adults. A teen who feels judged or talked down to will often shut down after one session. When you look for a therapist, ask a few direct questions:

• How much of your caseload is teens, and what ages?
• What approaches do you use, for example CBT, DBT skills, or family therapy?
• How do you handle confidentiality with parents?
• How will you involve me, and how often will we check in?
• What happens if my teen does not connect with you?

Good answers are specific and relaxed. A therapist who works with teens every day will have clear, practiced answers to all of these. It is also fine to let your teen meet two clinicians and choose the one they feel more comfortable with. That small bit of control often makes them more willing to engage.

What parents can do at home in the meantime

While you are still weighing “does my teen need therapy,” or waiting for a first session, a few things at home can help steady things:

• Protect sleep. Phones out of the bedroom at night is one of the simplest changes with the biggest payoff.
• Keep some routine. Regular meals and a predictable evening rhythm lower the overall stress level in the house.
• Listen more than you fix. Short, low-pressure conversations in the car or on a walk often go further than a big sit-down talk.
• Notice the good days. Point out effort and small wins, not just problems.
• Take care of yourself. Teens borrow calm from the adults around them, so your own support matters too.

Does my teen need therapy? Getting started

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, or see how our teen therapy program works, including the approaches we use at each age and what it costs.

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.