Counseling for Teenagers and Adolescents

At First Line Counseling, we understand that the teenage years are difficult for adolescents and their families. When you're parenting a teenager, it's easy to fall into the trap of blaming them for their behavior and their attitude. After all, you've given them everything a parent could give them. You may have even given them opportunities you didn't have when you were growing up. Alternately, you may blame yourself. If your teenager is having problems at home, school, or with the legal system, you may ask yourself where you went wrong. At First Line Counseling, we can provide therapy for teenagers and adolescents to help them work through issues they may not be able to do so on their own. We also provide help for parents through psychoeducation, parenting tips, and helping communicate information to their teen. 




What We Do 


​One of the first things we do at FLC is help you understand that you're not alone in the difficulties you're facing. The teenage years are hard no matter how good your kid is at heart or how good a parent you've been. Adolescence might seem like a relatively carefree time to an adult who is juggling many responsibilities, but no other time in life demands as rapid or profound an adjustment. Challenges of adolescence include:

  • Establishing personal values

  • Making college and career decisions

  • Developing a healthy sense of identity

  • Succeeding in more difficult classes in school

  • Going through puberty and other physical changes

  • Getting into college or hired to work in a chosen trade

  • Making and keeping meaningful friendships and social roles

  • Falling in love for the first time and dealing with heartbreak

  • Confronting social and political issues in an uncertain world

  • Coping with social scrutiny, shame, and self-consciousness

  • Dealing with unpredictable moods and emotional turmoil

  • Becoming independent and preparing to leave home


Teenagers enjoy many exhilarating new experiences, but they are also under pressure to become independent. They are held more accountable for their mistakes, which are inevitable and often numerous during this period of exploration and experimentation. They often try to keep parents from finding out about situations that caused them pain and heartbreak. To avoid ridicule or social rejection from peers, many try to keep confusion about who they are and who they want to be hidden from the world.


Adolescence is also when many people experience serious mental health issues for the first time. Physical changes to the body and brain make emotions more volatile and can trigger bouts of anxiety or depression in sensitive teens. Some adolescents experience early symptoms of persistent and potentially chronic mental health conditions like bipolar or personality disorders. In response to these challenges, they may engage in risky or self-destructive behavior like self-harm or substance abuse.


Whatever your teen is struggling with, therapy at First Line Counseling can help by giving them the skills, knowledge, and confidence they need to overcome it.

Coping with Stress and Pressure


When adults think of what causes them the most stress, they usually think of task- or role-related stressors like pressures at work or the demands of caring for a family. Teenagers face this kind of stress, too. For many, there's a difficulty spike from elementary to middle and high school—socially as well as academically. Bad grades no longer just mean upset parents but can also mean lost hopes for college. Stakes get higher in sports, the arts, and other extracurricular pursuits. Teenagers wonder if they'll be good enough to achieve their dreams and can take even small mistakes and disappointments especially hard.


For adolescents, internal stressors can be even harder to deal with than external stressors. Teenagers have no choice but to ride out the sudden and intense changes happening in their bodies and minds. They may blame themselves for things that are out of their control and suffer in silence and shame for choices they make in the course of natural sexual development. The emotional pain of being mocked or rejected by peers can be particularly intense. Friendships become more complicated and early romance can feel like it has world-ending implications.


No matter how normal some of these struggles are or seem, they can trigger serious emotional and psychological reactions in some teens. There is no need for teenagers to struggle alone when therapy can help them adjust and gain insight into themselves and their place in the world.


Living in a Wired World


In the past, teenagers could take a break from social demands when they came home from school. They could choose to make a phone call or go over to a friend's house, but any additional exposure to school bullies was generally limited to after-school activities. Now, bullying on social media can be even worse than what adolescents face at school, and they may encounter it every time they use their smartphone or computer. Even though they can log off and walk away, they may lack the confidence or may see it as the price they have to pay to stay in touch with friends and keep up with what's going on at school and in the world.


Today's adolescents also have to cope with the never-ending news cycle that's always buzzing in the background. When they go online to do research for a school paper or to see what their friends are posting, they also see alerts about recent national or global tragedies. Banners and pop-ups threaten to pull their attention to another news story that reminds them that the world is unsafe and in turmoil. Even when teens feel comfortable coming to their parents with their fears and concerns, challenging topics like climate change and social injustice resist easy answers. Many teenagers now not only face anxiety about their personal lives, but about what kind of world they'll inherit.


Adolescent Identity Development


In his influential theory of psychological stages, Erik Erikson said the primary task of adolescence was to resolve the developmental crisis of "identity versus role confusion." To develop a healthy sense of self, adolescents have to figure out who they are personally and privately as well as publicly and socially. This is challenging even when they find acceptance, but it's even harder if they feel rejected or alone.


If aspects of their developing sense of self are met with judgment or ridicule from peers or family members, teens are likely to struggle with shame and confusion. Uncertain about who they are or who they should be, they may withdraw socially. They may also do the opposite, becoming fixated on proving themselves to their peers to the point it becomes self-destructive.


Teens often try to achieve a sense of independence and identity by challenging their parents and rejecting parts of their parents' world and values. Clashes between parents and teenage children are inevitable, but they can be more intense for some families. Parents don't always understand what their teenagers are going through and can inadvertently make things worse.


Adolescents often have a hard time expressing vulnerability or admitting how much they want their parents' acceptance and praise. When adolescents experience rejection, they take it harder than adults do. They may wonder if something is wrong with them or if no one will ever like or love them. These social doubts can lead to serious psychological crises for some adolescents.


Adolescent Behavior Problems


Sometimes, teenagers simply become more intense versions of their younger selves. An exuberantly extroverted child who grew up loving to be the center of attention might develop into a dramatic teenager, while a quiet introvert might begin to struggle with social isolation. For other families, however, adolescent behavior problems can come like a bolt out of the blue. A quiet and well-behaved child might turn into a rebellious teenager who's being disciplined at school and even having problems with the legal system.


With all the ups and downs that come with adolescence, it can be hard to tell the difference between a "normal" and a troubled teen. But whether a behavior is normal is less important than the risks that come with it and the pain it causes for a teenager and for the whole family. Some adolescent behavior problems can be especially difficult to manage, such as when a teen is:


  • Skipping school

  • Misusing drugs and alcohol

  • Getting into fights with peers

  • Breaking the law and getting arrested

  • Neglecting schoolwork and failing classes

  • Cutting or engaging in other types of self-harm

  • Acting out with self-destructive sexual behavior

  • Sneaking out and participating in dangerous activities


Parents can mistake these problems as simple "bad behavior" when they mean something more. Teenagers aren't always logical and sometimes are so afraid of how their parents will react that they do something that provokes an even worse reaction than if they'd just told their parents what happened. This usually isn't on purpose; adolescents don't always know how to talk about their struggles, especially when they feel ashamed. They may have experienced a traumatic event or may be suffering with depressed or hopeless thoughts. They might engage in problem behaviors as an outlet or as a way of asking for help when they don't know any other way to ask.


Teenage Depression and Anxiety


Teenage depression and anxiety are more common than many parents realize. Nearly one in eight adolescents experience depression and about one in three experience clinical anxiety. These issues are also on the rise; the number of adolescents who experienced a depressive episode increased 37 percent from 2005 to 2014.


How can you tell the difference between the typical moody teen and an adolescent who is in need of treatment for anxiety or depression? Of course, it's important to talk to your kid, but they might not always tell you if they're having anxious or depressed thoughts or are thinking of harming themselves. Some warning signs of depression and anxiety that you should look out for can include:


  • Worry

  • Fatigue

  • Irritability

  • Social withdrawal

  • Persistent sad mood

  • Changes in appetite

  • Changes in energy level

  • Changes in sleep patterns

  • Changes in academic performance

  • Loss of interest in favored activities

  • Difficulty concentrating or making decisions

  • Recurrent thoughts about death, dying, and suicide


Many anxious and depressed teenagers never become suicidal, but it's important to talk to your teen and not just hope they're not thinking of harming themselves. Suicide is the second leading cause of death for adolescents in the United States, and teen suicide rates are rising.


Most teenagers who are thinking about suicide make statements that express or suggest suicidal thinking, and it's not true that talking about it increases the risk of suicide. In fact, the opposite is true. People who are suicidal need someone to listen and definitely need professional help. And while teenagers don't need to be in crisis to benefit from mental health counseling, teens who are in crisis definitely need it, and we are equipped to help them at FLC.


Please don't wait to contact our office if your teen is at an immediate risk of harm, though—please call 911 or go to the emergency room, then follow up with us after they are stabilized.


Teenage Substance Abuse


Many teenagers experiment with drugs and alcohol, but some do more than experiment. Regular or heavy substance use can lead to addiction or other issues related to substance abuse. Adolescents who use drugs and alcohol are at increased risk for negative outcomes including legal problems, accidental injury, and mental health complications including self-harm and suicide.


Many parents are aware of these risks and don't know what to do when they catch their teen under the influence or with drug paraphernalia. While other actions are sometimes required, it's good to get substance-abusing teens into counseling, where they will be treated with compassion as they discover the reasons they are using these substance and learn new coping skills to replace them with.


As a clinician, Matt has expertise in treating substance use disorders, and as a veteran first responder, he understands their legal and social impacts. He knows one of the difficulties about talking to teens about substance use is that they feel like adults are being dishonest with them. Lectures about the dangers of drugs often have the opposite effect and end up enhancing their mystique. At FLC, we avoid lecturing in favor of focusing on the reasons a teen is using substances.


Many adolescents who experiment with substances don't start using them on a regular basis. Those who do often have another reason beyond simple curiosity, and that reason is often an undetected mental health issue like grief, trauma, anxiety, or depression. By identifying and treating the underlying causes of substance use, FLC can help teenagers change their behavior before developing addictions that follow them into adulthood.

Teenagers and the Legal System


Two of parents' worst fears are that their teen will get hurt or that their teen will get arrested. Some teenagers have their first encounters with the legal system because they experimented with drugs or did something risky to impress or entertain their friends. Other reasons teenagers get arrested reflect deeper issues. Angry teens who aren't talking about their feelings may act out violently and get in fights, while undiagnosed mental health issues can be a factor in compulsive behaviors like shoplifting. Sometimes an arrest can be a necessary wake-up call.


At FLC, we understand that it's not "too late" for your teen if they've been charged with a criminal offense. On the contrary, counseling can help teens cope with the issues behind their behavior and take a different course. With the right help, a first incident can be a learning experience that they move past instead of the beginning of a life of involvement with the criminal justice system.

Adolescent Counseling Techniques and Therapy Approaches


At FLC, we employ a range of effective counseling methods for adolescents. These include:


  • Family therapy

  • Psychoeducation

  • Mindfulness-based therapy

  • Cognitive behavioral therapy (CBT)


What method we use depends on the issues a client needs to address. A teenager who is having difficulty communicating with one or both parents may benefit from family therapy sessions. When a teenager is depressed, anxious, or otherwise suffering from negative thoughts, CBT can help them turn their thinking around. Mindfulness-based practices can help teenagers navigate emotional turmoil and help them learn how to be present in the moment and pay attention to their thoughts and actions. Psychoeducation helps adolescents understand what they are going through and that they are not alone.


One of the biggest challenges in treating teenagers is engaging them in therapy. Often, they don't come to therapy because they chose to come, but because a parent made them. For this reason, the therapy method a therapist uses is often less important than the therapist's ability to meet a teen where they are and establish rapport with them. At FLC, we have extensive experience building effective therapeutic relationships with teens and know that honesty, compassion, and humor are all essential ingredients for success.


Goals of Therapy with Adolescents

Therapy can help teenagers in many different ways. Goals of teen therapy can include:


  • Learning coping skills

  • Improving self-esteem

  • Processing trauma or grief

  • Reducing negative self-talk

  • Developing a strong identity

  • Improving communication skills


The goals of therapy depend on the issues a client wants to address. Teenagers who are acting out in destructive ways or struggling with emotional dysregulation benefit from learning self-regulation and coping skills. Teens who have been traumatized need to process and resolve the trauma. An adolescent who has recently been diagnosed with a mental health condition needs to learn about the condition and to start treatment for it. Treatment may include referrals to additional professionals if medication management or additional therapies are needed.


When Does a Teenager Need Therapy?

Parents often struggle with the decision to refer their teenager to therapy. They may worry that there will be worse consequences of going than not going, that they are overreacting, or that they will be saddling their child with unnecessary stigma. They fear sending the message that their sensitive teen is not normal or that something is wrong with them.


Fortunately, the world is changing. People are becoming more aware of mental health issues and the value of therapy. Teenagers may hear favorite podcast hosts, musicians, or YouTubers talking about their mental health struggles or how much they love going to therapy, and they may be more open to the idea than you realize. Ultimately, therapy can do little harm; at worst, a person who could have gotten by without it gets to be heard and to learn some useful skills for managing their mental states. If you're not sure, you can always try an initial session and go from there.


If you notice some of the following changes it may be time to seek professional help:

  • Sudden or dramatic change of attitude and behavior over time

  • The appearance of a lack of caring

  • Hopelessness

  • Loss of friends and social support

  • Withdrawal

  • Excessive anger and/or sadness

  • Vague or overt comments about suicide and self-harm

    • I.e. “I just don’t want to wake up anymore”, “I don’t want to be here”, “I hate myself”, etc.

  • Drug or alcohol use

  • Behavioral issue in and out of school

  • Sudden change in friends

  • Too much or not enough sleep

  • Dramatic change in eating habits

  • Giving up things they used to enjoy  i.e. Sports, hobbies, friends, personal items.




If you know your teenager needs help, or need more information, please contact our Gaithersburg therapy office at (240) 452-0872. We'd be happy to talk to you about our services and set up an initial appointment. You and your teen don't have to go through this alone.