When Your Teen Is Struggling and You Don’t Know How to Help
Updated: Sep 3
When your teen is struggling, it can feel unsettling and confusing. You may notice changes in their mood, behaviour, relationships, sleep, or energy and find yourself wondering whether what you are seeing is part of growing up or a sign that they need more support.
It is natural to feel unsure about what to do. You may want to help without hovering, respect their growing independence without stepping back too far, and avoid turning every difficult conversation into an argument.
If this feels familiar, you are not alone.
Adolescence brings significant emotional, social, and developmental changes, and some young people experience mental health difficulties during this period. Not every struggle requires therapy, but when distress persists, becomes more intense, or begins interfering with everyday life, professional support can make a meaningful difference. Research consistently supports psychotherapy as an effective treatment for a range of emotional and behavioural difficulties in children and adolescents. (Wuthrich et al., 2023)
Understanding Teen Mental Health Struggles
Teen mental health challenges do not always look the way parents expect.
A young person who is struggling may appear sad or anxious, but distress can also show up as irritability, anger, withdrawal, perfectionism, changes in motivation, difficulty sleeping, or a noticeable change in relationships. Some teens continue to do well academically and socially while experiencing significant distress internally.
The important question is not whether your teen occasionally feels overwhelmed. Difficult emotions are part of growing up. What matters more is the pattern, intensity, duration, and impact of what you are noticing.
A change that continues for weeks, keeps getting worse, or interferes with school, friendships, family life, sleep, eating, or activities they usually enjoy may be worth paying attention to.
Signs Your Teen May Be Struggling
There is no single checklist that can tell you whether a teenager needs therapy. You might, however, notice persistent anxiety or low mood, increasing irritability, withdrawal from friends or family, a significant change in sleep or appetite, loss of interest in things they previously enjoyed, intense fear of failure, difficulty managing emotions, or a drop in day-to-day functioning.
Self-harm or thoughts about suicide require particular attention. These experiences should not be dismissed as simply attention-seeking or typical teenage behaviour. They deserve a calm, compassionate response and appropriate professional assessment.
Research on treatment for adolescent self-harm is complex, and no single therapy works for every young person. Current evidence suggests that some structured psychological treatments can reduce self-harm for certain adolescents, although the overall research remains mixed and continued assessment and support are important. (Torralba-Suarez & Olry-de-Labry-Lima, 2024; Wright-Hughes et al., 2025)
If you are concerned about your teen's immediate safety, therapy should not be the only response. Urgent professional or emergency support may be needed.
Why Teens Sometimes Do Not Talk to Their Parents
A teen's reluctance to talk does not necessarily mean they do not trust you.
Adolescence is a period in which young people are developing greater independence and becoming more aware of how they are perceived by others. Talking about painful emotions can feel vulnerable, embarrassing, or difficult to put into words. Some teens may also worry about upsetting their parents or triggering a reaction they do not know how to handle.
For some young people, the hardest part is simply figuring out what they are feeling. Anxiety, sadness, anger, shame, loneliness, and overwhelm can become tangled together, making it difficult to explain what is happening.
A therapist can offer another relationship in which a young person has room to explore these experiences. That does not replace the role of parents. Ideally, therapy becomes another source of support within a young person's broader network of caring relationships.
What Can Adolescent Therapy Help With?
Adolescent therapy is not about fixing a teenager or teaching them how to behave.
Good therapy gives young people an opportunity to understand what they are experiencing and develop skills that can help them navigate difficult emotions, relationships, stress, and change. Depending on the teen and the concerns they bring to therapy, treatment may draw from approaches such as cognitive behavioural therapy, emotion-focused approaches, family-based interventions, or other evidence-supported therapies.
Research has found psychotherapy to be helpful for internalizing difficulties such as anxiety and depression among children and adolescents, including when treatment is delivered in routine clinical settings rather than only in research studies. (Wuthrich et al., 2023)
Therapy may help a young person develop a better understanding of their emotional reactions, recognize patterns that are making things harder, develop more effective ways of coping, communicate more clearly, and feel less alone in what they are experiencing.
For teens experiencing self-harm, treatment can also focus on understanding what is happening before and after self-harm, strengthening emotional regulation and coping skills, and developing safer ways of responding to overwhelming emotions. The research suggests that specialized interventions can be helpful, although outcomes vary and treatment needs to be individualized. (Torralba-Suarez & Olry-de-Labry Lima, 2024)
Parents Are Part of the Picture
One of the most important things for parents to know is that involving you in your teen's therapy does not necessarily mean sitting in every session.
Parental involvement can take many forms. A therapist might meet with a parent separately, check in periodically, provide guidance about how to respond at home, or invite parents into selected portions of treatment when that would benefit the young person.
Research on parental involvement is encouraging but nuanced. A 2024 meta-analysis of psychological interventions for adolescents found that interventions including parents produced a small overall advantage compared with adolescent-only interventions, although the effect varied depending on the type of difficulty being treated. (Pine et al., 2024)
Research focused specifically on adolescent anxiety has also found that involving parents can be useful, although studies have not consistently shown that adding parents produces better outcomes in every situation. (Byrne et al., 2023)
In other words, there is no one-size-fits-all formula. The right level of parental involvement depends on the young person's age, concerns, wishes, family circumstances, and treatment approach.
What If My Teen Does Not Want Therapy?
This is incredibly common.
A teenager who is already feeling overwhelmed may not be excited about adding another appointment to their schedule. They may worry that therapy means something is wrong with them, fear being judged, or simply not believe that talking to someone will help.
Pushing too hard can sometimes make resistance stronger.
Instead, it can help to approach the conversation with curiosity. You might acknowledge that therapy can feel strange at first and let your teen know they do not have to know exactly what to say before they go. Giving adolescents some voice and choice in their mental healthcare is important. Research on youth involvement in mental health services suggests that being meaningfully involved in decisions about their care can contribute to treatment satisfaction and a stronger sense of participation.
Your teen may not agree immediately. That does not necessarily mean therapy is off the table. Sometimes the first step is simply allowing them to meet a therapist and decide what they think.
Will I Be Involved in My Teen's Therapy?
This is one of the most common questions parents have.
The answer depends on your teen's age, the nature of the concerns, the treatment approach, and the therapist's professional and legal responsibilities.
Adolescents need a degree of privacy in therapy if they are going to feel comfortable speaking honestly. At the same time, parents remain an important part of their support system, and safety concerns may require information to be shared.
A good therapist should explain these boundaries clearly at the beginning rather than leaving everyone to guess what confidentiality means.
The goal is not to create a secret relationship between therapist and teenager. It is to create enough privacy for meaningful therapeutic work while keeping parents appropriately informed and involved in their teen's wellbeing.
Is Therapy Confidential?
Generally, what a teen discusses in therapy is private, but confidentiality has important limits.
Those limits are particularly relevant when there is a concern about serious harm or safety. A therapist should explain confidentiality and its limits in age-appropriate language so that both the young person and their parents understand what to expect.
This conversation is worth having before therapy begins. Knowing what is private, what may be shared with parents, and what would require a therapist to take action can help build trust and prevent misunderstandings later.
What If My Teen Is Self-Harming?
If your teen is self-harming, you do not have to figure out the right response by yourself.
Try to respond with curiosity rather than punishment or shame. Self-harm can serve different functions for different young people, so understanding what it means for your particular teen is important. A therapist can help assess the situation, explore what is contributing to the behaviour, and work with your teen and family on safer ways of coping.
It is also important to distinguish self-harm from suicidal behaviour while taking both seriously. A young person who self-harms may or may not have suicidal intent, and an appropriate assessment should explore this rather than making assumptions.
The evidence base for psychological treatment of adolescent self-harm continues to develop. Recent reviews support the use of targeted psychological interventions in some circumstances, but they also highlight that outcomes are not uniform across treatments or young people. (Wright-Hughes et al., 2025; Torralba-Suarez & Olry-de-Labry-Lima, 2024)
If your teen is expressing suicidal thoughts, has made a suicide attempt, or you believe they may be in immediate danger, seek urgent help rather than waiting for a routine therapy appointment.
How Long Does Teen Therapy Take?
There is no universal timeline.
Some young people come to therapy with a specific concern and benefit from a relatively focused period of support. Others are dealing with several overlapping challenges and may benefit from longer-term therapy.
The length of treatment can depend on the nature and severity of the concerns, how long they have been present, the goals of therapy, and how your teen responds to treatment.
Therapy should not continue indefinitely simply because it has started. Your therapist should periodically assess whether treatment is helping and whether the goals need to change.
What If My Teen Feels Awkward at First?
That is okay.
The first few sessions can feel unfamiliar, particularly for a teenager who has never talked to a therapist before. Building trust takes time, and the therapeutic relationship matters.
Your teen does not have to walk into therapy with a perfectly organized explanation of what is wrong. They can start with "I don't know" or "My parents think I need to be here."
Sometimes that is where the conversation begins.
Finding a therapist who connects well with your teen can make a significant difference. Adolescents are more likely to engage when they feel respected, heard, and included in their own care.
Can Therapy Actually Help?
Yes, although no therapy can promise a particular outcome.
Research supports psychotherapy for a range of emotional and behavioural difficulties in young people, and the strongest approach depends on what a particular teen is experiencing. A large systematic review and meta-analysis of psychotherapy delivered in routine settings found meaningful benefits for internalizing symptoms in children and adolescents. (Wuthrich et al., 2023)
The purpose of therapy is not to make a teenager happy all the time or eliminate every difficult emotion. It is to help them understand themselves, develop healthier ways of coping, and have support while navigating experiences that may feel too difficult to manage alone.
Therapy Is Support, Not Failure
It is understandable for parents to wonder whether reaching out for therapy means they have failed somehow.
It does not.
Parenting a teenager is complicated, and even loving, attentive parents cannot solve every problem their child encounters. Mental health difficulties are influenced by many factors, including individual vulnerabilities, relationships, stress, environment, and life experiences.
Asking for help is a way of responding when something is hard. It does not mean your teen is broken, and it does not mean you have done something wrong.
You also do not have to wait until things reach a crisis point. If something has been worrying you for a while, an initial conversation with a qualified therapist can help you understand what you are seeing and consider what kind of support might be appropriate.
Adolescent Therapy at Authentic Living London
Adolescent therapy is available through Authentic Living London with Karissa Paterson, who works with teens experiencing concerns such as anxiety, depression, self-harm, and emotional overwhelm.
Therapy is offered both in person in London, Ontario, and virtually across Ontario.
If you are wondering whether therapy might be helpful for your teen, you do not need to have all the answers before reaching out. A first conversation can be an opportunity to talk about what you have noticed, what your teen is experiencing, and whether therapy seems like the right next step.
Your teen does not have to navigate everything alone, and neither do you as a parent.
References
Byrne, S., Cobham, V., Richardson, M., & Imuta, K. (2023). Do parents enhance cognitive behavior therapy for youth anxiety? An overview of systematic reviews over time. Clinical Child and Family Psychology Review, 26(3), 773–788. doi:10.1007/s10567-023-00436-5
Pine, A. E., Baumann, M. G., Modugno, G., & Compas, B. E. (2024). Parental involvement in adolescent psychological interventions: A meta-analysis. Clinical Child and Family Psychology Review, 27(3), 1–20. doi:10.1007/s10567-024-00481-8
Torralba-Suarez, C., & Olry-de-Labry-Lima, A. (2024). An umbrella review of cognitive behavioural and dialectical behavioural therapies to treat self-harm and suicidal behaviour in adolescents. Actas Españolas de Psiquiatría, 52(4), 549–560. doi:10.62641/aep.v52i4.1631
van Aswegen, T., et al. (2023). Effectiveness of family-based therapy for depressive symptoms in children and adolescents: A systematic review and meta-analysis. International Journal of Psychology, 58(6), 499–511. doi:10.1002/ijop.12926
Wuthrich, V. M., Zagic, D., Dickson, S. J., McLellan, L. F., Chen, J. T.-H., Jones, M. P., & Rapee, R. M. (2023). Effectiveness of psychotherapy for internalising symptoms in children and adolescents when delivered in routine settings: A systematic review and meta-analysis. Clinical Child and Family Psychology Review, 26(3), 824–848. doi:10.1007/s10567-023-00433-8
Wright-Hughes, A., Farrin, A. J., Fonagy, P., Ougrin, D., Stahl, D., Wright, J., Irving, D., Mughal, F., Truscott, A., Diggins, E., Chanen, A., Cooney, E., Carter, G., Clover, K., Dadds, M., Diamond, G., Esposito-Smythers, C., Green, J., Griffiths, H., Hassanian-Moghaddam, H., Hatcher, S., Hazell, P., Husain, N., Kaess, M., King, C., Morthorst, B., O'Connor, R. C., Santamarina-Perez, P., Tyrer, P., Walwyn, R., & Cottrell, D. (2025). Systematic review and individual participant data meta-analysis: Reducing self-harm in adolescents: Pooled treatment effects, study, treatment, and participant moderators. Journal of the American Academy of Child & Adolescent Psychiatry, 64(9), 997–1029. doi:10.1016/j.jaac.2025.01.017
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