Blog

Jeremy Carter | Clinical Director of Capstone Treatment Center

MSMFT, LMFT-S, LPC-S, CSAT-S, CTT, EMDR II, Certificate in Traumatic Stress Studies

A few weeks ago, I was on Psychology Today looking for a therapist to refer someone to in Dallas, TX. There were over 3,000 therapists listed in the Dallas area. I went to the filters at the top of the page and clicked that I was looking for someone to work with an adolescent. Instantly, I lost over 1,000 therapists from the list of potential matches.

This is a glaring issue, not just from a “trying to build a sustainable therapy practice” standpoint, but especially when you consider the current mental health crisis facing adolescents.

Adolescents are grappling with record rates of depression, anxiety, and suicidal ideation, yet many therapists are reluctant to work with this age group. Why? The answer often boils down to safety, or more specifically, the lack of it, for both therapists and adolescent clients. Understanding this dynamic is the first step toward building a therapeutic approach that works for everyone involved.

The Therapist’s Perspective: Navigating Risk and Fear

Therapists often feel unsafe working with adolescents because of the inherent risks involved. Adolescents are at a developmental stage marked by impulsivity, emotional volatility, and a tendency toward risky behavior. A single session can include disclosures of self-harm, threats of suicide, or admissions of high-risk activities such as drug use. For therapists, the stakes are high, and the fear of “getting it wrong” is very real.

Unlike working with adults, where confidentiality is almost absolute, working with adolescents in therapy involves navigating a complex web of legal and ethical considerations. Therapists must determine when to breach confidentiality to inform parents or guardians of safety concerns while maintaining enough trust with the adolescent to continue therapy effectively.

This tightrope walk is not only emotionally draining but can also feel professionally risky. Therapists may worry about liability if something goes wrong or about backlash from parents who disagree with their decisions. These challenges, combined with the intense emotions adolescents often bring into the therapy room, can make some therapists hesitant to take on adolescent clients.

The Adolescent’s Perspective: A Perceived Lack of Safety

From the adolescent’s point of view, therapy often doesn’t feel safe either, but for entirely different reasons. For many teens, therapy is their first experience being asked to open up about deeply personal thoughts and feelings. However, the knowledge that their parents have the legal right to access their therapy records can create a significant barrier.

Adolescents are acutely aware of the power dynamics at play. They may fear judgment, punishment, or misunderstanding if their parents learn what they have shared in therapy. This fear can lead them to withhold information or avoid deeper, more meaningful conversations. Without the perception of confidentiality, the foundation of trust upon which successful therapy is built is shaky at best.

This perceived lack of safety undermines the therapeutic process, leaving adolescents feeling unsupported and misunderstood while therapists struggle to connect.

Bridging the Gap: The Role of Parental Involvement

The solution to these safety concerns lies in addressing the third party in the room: the parents. For therapy with adolescents to succeed, parents must be active participants in the process—not as overseers, but as allies.

One of the most effective ways to involve parents is to create a collaborative game plan that outlines how they will respond to various scenarios. Parents can prepare in advance for situations such as failed drug tests, missed curfews, suicidal threats, or even violent behavior. For example, if a teen fails a drug test, parents might decide ahead of time whether the response will involve a consequence, a conversation, or both, and ensure that it is communicated in a way that balances accountability with support. Similarly, having a plan for how to de-escalate a violent episode or respond calmly to a suicidal threat ensures that parents can act with clarity and confidence rather than react out of fear or anger.

By establishing these responses ahead of time, parents create a safer, more predictable environment for their adolescent while alleviating some of the pressure therapists feel when navigating high-risk situations. This collaborative approach strengthens the relationship between the adolescent, their parents, and the therapist, creating a foundation for meaningful progress.

Another crucial aspect of parental involvement is respecting the adolescent’s need for perceived confidentiality. Parents should focus less on the specifics of what their teen is discussing in therapy and more on the broader goals of the therapeutic process. While parents have the legal right to access therapy records, exercising restraint in this area can be transformative. Therapists can guide parents to understand that prying into the content of therapy sessions can damage trust and slow progress. Instead, parents can support their teen by fostering an environment where the adolescent feels safe to speak freely, knowing that their thoughts and feelings will not be scrutinized unnecessarily.

When parents respect the spirit of confidentiality, they empower their adolescent to engage more deeply in the therapeutic process. This approach not only benefits the teen but also reassures therapists, who often struggle with the tension between maintaining the adolescent’s trust and fulfilling their legal and ethical obligations. By working together, therapists and parents can create a therapeutic environment where safety and trust thrive, setting the stage for lasting change.

Shifting the Mindset: Why Adolescent Therapy Is Worth the Challenge

While working with adolescents presents unique challenges, it is also profoundly rewarding. Adolescents are at a critical juncture in their development, and effective therapy can change the trajectory of their lives. Therapists who are willing to step into this space with confidence and compassion can make an enduring impact.

To do this, therapists must prioritize their own sense of safety as much as their clients’. This means seeking ongoing training in risk management, consulting regularly with colleagues, and establishing clear boundaries and protocols. It also means embracing the messy, unpredictable nature of adolescence as an opportunity for growth for both the client and the therapist.

A Call to Action

The reluctance of therapists to work with adolescents is understandable, but it is also a problem we can solve. By addressing the safety concerns of both therapists and adolescent clients, we can create a therapeutic environment where everyone feels secure enough to engage fully in the process.

Parents play a pivotal role in this equation. When they become active, informed participants in their child’s therapy, they not only support their adolescent but also empower therapists to do their best work. Together, we can turn the challenges of adolescent therapy into opportunities for healing, growth, and connection.

Adolescents need our help now more than ever. It is time for therapists to rise to the occasion, equipped with the tools and strategies to make therapy safe and effective for all.