Guide: What Teen Therapy Actually Looks Like
Every therapist and mental health practice have their own procedures and policies, but overall, the process looks similar wherever you go. Having a good idea of what to expect in the process can be helpful for those who are hesitant to try therapy, so this blog post will take you through the general therapeutic process at Meadowlight Counseling from start to finish. As always, therapy isn’t one size fits all, so your experience may differ slightly.
Step 1: Reach Out
The very first step to starting therapy is reaching out to a therapist or practice. For more information about how to choose the right therapist, see my post How to Find the Right Therapist for Your Teen. Once you’ve settled on a therapist, you’ll reach out to them via their website, phone number, or Psychology Today profile.
For Meadowlight Counseling specifically, you can reach out easily via my contact page. When you reach out, you’ll want to include some basic information: your name, whether you’re reaching out for yourself or for a dependent, whether or not you want to use insurance (if yes, also include the insurance company you have), and how you’d prefer the therapist to contact you (e.g., phone number or email address). At Meadowlight Counseling, you’ll always receive contact back within 1 business day. Other therapists may have different timelines for contact, but generally you should expect to hear back within a few days.
Step 2: Consultation
Not every therapist offers free consultation calls. At Meadowlight, I always offer a free 15-minute call to make sure I can actually provide you with the help you’re looking for. If I can’t meet your needs, I’ll always do my best to connect you with a therapist who can. In a consultation call, you can expect to talk about the primary reason you’re seeking therapy, insurance/fee and scheduling details, and the opportunity to ask any questions you have. This also gives your therapist a chance to tell you about their approach to therapy and the kinds of problems they treat.
Step 3: Initial Appointment (Intake)
The very first session you’ll have with a therapist is called the intake appointment. Terms are interchangeable, and it may also be called an initial appointment or assessment. If you’re using insurance, you’ll see the name of this appointment on your explanation of benefits as “psychiatric diagnostic evaluation,” and this is the appointment in which you’ll receive a diagnosis.
In this section I’m going to describe a usual intake appointment for a teenager specifically with Meadowlight Counseling — if you’re over 18, the parent involvement process won’t apply, and if you have an intake with a different practice, your experience may be slightly different.
Once you schedule your teen’s intake appointment, you will receive a few emails. The first email comes from TherapyPortal to set up your teen’s patient portal and complete the intake documents. Parents should always sign any forms that require signature, and your teen should always be the one filling out any symptom questionnaires (unless it is specifically designated as a parent-report questionnaire). The second email you’ll receive is a welcome email with additional information such as office directions and appointment instructions.
On the day of your teen’s intake appointment, at least one parent should be there to review documents and formally begin the therapeutic process. The middle of the intake session will be one-on-one with your teen, where I’ll ask them a variety of questions about themselves and why they’re coming to therapy. At the end of the appointment, you’ll re-join the session to discuss diagnosis and treatment recommendations. If the recommendation is to continue individual therapy, then we’ll schedule ongoing appointments.
The intake session can be a little daunting and, frankly, very administrative. There is little about the initial evaluation that resembles the actual work we do in subsequent therapy sessions. However, the intake session is still a crucial part of orienting you and your teen to the therapeutic process.
Step 3: Treatment Planning
At your next appointment following the intake, I’ll spend time with your teen ironing out the goals they have for therapy. Teens often know how they want to feel differently, but they may not have the words to describe what change might actually look like in their lives. In the treatment planning phase of therapy, I work with teens to understand what’s getting in their way and what might be different about them if these barriers were lifted. Parents are always part of the treatment planning process, either via email/phone calls or by joining part of the session(s) to discuss goals. Parents always sign and have ongoing access to therapy treatment plans.
The treatment plan is like a road map for therapy. It informs the topics that will be discussed, the interventions that the therapist will use, and the ways in which progress will be measured. By using a treatment plan, we can turn your teen’s vague goal of wanting to be happier into tangible, attainable success that they can feel proud of achieving.
Sometimes parents and teens have different goals in mind for treatment. For example, a parent might want their teen to work on being more motivated or responsible, while the teen might want to work mostly on improving their personal relationships. In these cases, I’ll work with both you and your teen to understand the primary motivations for these goals. Oftentimes, a difference between parent and child in therapy goals comes down to two things: either parent and child have different perspectives of the same issue, or parent and child are focused on two completely different problems. I will never force a teen to set a therapy goal that they don’t want, as it only sets them up for failure. However, if a parent’s goal for their child is relevant to the teen’s identified problem or diagnosis, I’ll work with your teen to help them understand your perspective as a parent and potentially revisit that goal at a later time.
Step 4: Therapy Sessions
This part of the therapeutic process is highly dependent on the therapist’s approach, the diagnosis and treatment goals, and your teen’s preferences. In general, I use a talk-therapy approach (verbally discussing issues and teaching new concepts to facilitate change) along with experiential exercises (skills led in session that focus on one’s personal cognitive, emotional, or physiological experience in the moment).
The first handful of sessions is always about establishing the therapeutic relationship. I spend time getting to know your teen and getting a fuller picture of your teen’s life experiences. It’s common to feel like the first few sessions aren’t really focused on learning new skills or changing anything, and that’s by design. Taking time to build rapport creates the space and safety necessary for vulnerability, trust, and change to take place. Teens often comment that just getting the chance to talk about their problems in the first few sessions helps them feel better. After they let the initial steam out, and are able to trust their therapist, they can engage more fully with the process of therapeutic change.
The middle part of therapy is the hardest to explain because it depends so much on specific factors. However, generally these sessions are focused on building new coping skills and new behaviors to help your teen change their relationships or their view of themselves and/or others. I also involve parents in their teen’s therapy in multiple ways: joining parts of therapy sessions when appropriate, parent sessions or phone calls, and resource emails. I find that teens have the most success in therapy with me when parents are involved in the process and are able to fully support their child’s treatment goals at home. This often requires willingness to make some changes to parenting strategies or work on the parent-child relationship.
Step 5: Progress Review and Closure
Any therapist should work with you and your teen to regularly check treatment progress throughout the course of therapy. I usually include parents in parts of therapy sessions once every 4-6 sessions to review progress, address any new concerns, and ensure everyone is on the same page. As your teen begins making progress toward their goals, you will hopefully notice a difference in their demeanor, mood, or actions. As progress continues throughout therapy, we will start discussing closure of services. If we are not making progress, then we will discuss changes we can make in the treatment plan or potentially discuss alternative options for treatment. This most commonly occurs when teens need a higher level of care, such as intensive outpatient therapy, if once-weekly services are not enough (particularly when safety is a concern).
Remember: Progress is not always linear. Teen mental health frequently revolves around the academic calendar, so you may notice differences in your child around important exams, social events, and breaks from school. For example, your teen might do really well over the summer because they don’t have any academic responsibilities, but once they get to October and have their first midterms of the year, they may not be able to cope well with the pressure. Or you might notice the opposite, that your teen does very well with structure and socialization during the school year, but they seem to hole up in their room as soon as school lets out for the summer. For the therapeutic process, this means that we can expect a few setbacks and can actually use these setbacks to practice new skills in real time. When teens successfully overcome obstacles, their self-esteem improves and they are better able to utilize healthy ways of coping in the future.
Once your teen is showing steady and stable progress, we’ll start talking about closing services. I usually start off by reducing the frequency of sessions. If your teen is coming to therapy every week, then we’ll try meeting every 2 weeks to give them more opportunities between sessions to maintain their progress. If this doesn’t go so well, we can always return to weekly sessions until your child is ready. Once your child is stable and maintaining progress with 2 weeks between sessions, we have a family meeting to discuss progress and schedule a one-month visit. If everything has gone well in that month, then we close services. If it hasn’t gone well, we return to biweekly sessions until they are ready to close.
Once your teen is done with therapy, they can always return if the need arises. I consider the motto “once a client, always a client,” meaning that even if your teen is no longer officially a client in services with me, my door is always open in the future if needed.
Overall, my hope is that anyone leaving my office feels supported through every step of the journey.
Starting (and finishing) therapy can be a daunting process. Some people want to go full-throttle and dive into the deep work early on, and some people need to ease into the process gently. My job is to meet you wherever you are in this so I can hear you and help you get to where you want to go. Whether you’re a teen client, a parent, or an adult client, I hope that this article has given you a sense of familiarity with my process and approach to counseling.
About the Author
Marlee Gordon, LPC is a licensed professional counselor and the founder of Meadowlight Counseling LLC, a private practice in Goodyear, Arizona. Marlee has over 13 years of experience working with adolescents in educational and therapeutic settings, including school-based therapy and intensive outpatient programming for teens. She treats a wide variety of mental health concerns but focuses primarily on treating anxiety, perfectionism, life transitions, relationship challenges, and academic/athletic performance concerns.