Parents often notice a change before they know what it means. Your teenager may be sleeping differently, pulling away from people, struggling at school, or getting angry over things that used to feel manageable. You may be asking yourself: Is this a phase, or should I be more concerned?
There is no single behavior that proves a teen needs therapy. Pay attention to patterns, how long they last, and whether the changes are interfering with daily life. In 2023, about 40% of U.S. high school students reported persistent sadness or hopelessness that affected usual activities, according to the CDC’s mental health data. A statistic cannot tell you what is happening for your child, but it is a reminder that emotional struggles are common and worth taking seriously.
Changes that may be worth a closer look
-
Noticeable shifts in sleep, appetite, energy, or concentration.
-
Pulling away from friends, family, or activities they used to enjoy.
-
Increasing irritability, anxiety, sadness, or frequent emotional overwhelm.
-
School avoidance, a marked drop in performance, or trouble getting through ordinary routines.
-
Or, on the contrary, an extreme sense of pressure around school, grades, sports and performance in general.
-
Comments about hopelessness, feeling like a burden, self-harm, or not wanting to be alive.
These signs can have many causes, including stress, health concerns, bullying, grief, family changes, or a mental health condition. You do not need to diagnose your teen. You can start by asking what they have noticed and whether they want help figuring it out.
How to open the conversation
Choose a moment when neither of you is rushing. Try a specific, non-accusing observation: “I’ve noticed you’ve been staying in your room more and missing soccer. I care about you. What has this week been like?” Then make space for the answer, even if it is short.
It can help to offer choices rather than a demand: “Would you rather talk with me, your doctor, or a therapist?” If your teen is hesitant, ask what worries them about therapy. They may be concerned about being judged, having to retell private details, or not knowing what to say. A first appointment can be a conversation about goals and fit – not a requirement to share everything at once.
What to ask when looking for teen therapy
Ask whether the therapist regularly works with adolescents, how they involve parents, what confidentiality means for a minor, and what situations require information to be shared for safety. Clarify how progress will be reviewed. Your teen’s willingness matters; a teen who knows they have a problem and wants to work on it is a great candidate for therapy.
I see teens ages 14 and older as clients both in person in Raleigh and by telehealth for clients located in North Carolina. My teen therapy page describes my approach if you’d like a little more information. I offer a free 15 consultation with parents where you ask all the practical questions and decide whether therapy with me might be a good fit for your child.
If you are worried about immediate safety
If you’re concerned that your teen may hurt themselves or someone else, take the concern seriously and seek immediate help. In the U.S., call or text 988 for 24/7 suicide crisis support. If there is immediate danger, call 911 or go to an emergency department. Do not wait for a routine therapy appointment when urgent safety support is needed.
