How Online Therapy Can Work for Adolescents and Teens

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February 20, 2020
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Online therapy, sometimes referred to as online counseling, has become a major player in the mental health provider landscape. Online therapy has proven to be a convenient and cost-effective alternative to traditional in-office therapy. While it’s utilized by users from diverse demographic groups, online therapy seems to be exceptionally appealing to adolescents.

Adolescent Mental Health by The Numbers

While teenage angst is not uncommon, most teens get through these years just fine. However, when that angst doesn’t get better, symptoms of depression and anxiety can persist, affecting the teen’s daily functioning, social and family relationships, schoolwork, sleep and appetite, and more.

The most recent surveys have found that about one in five, or 20%, of teens, experience significant mental health issues, with the average age of onset about 14 years old.

Depression, the most common mental health issue experienced by teens, affects nearly one in eight adolescents. And the numbers are on the rise. From 2005 to 2014, the number of teens who experienced a major depressive episode increased by nearly one third.

Getting a teen to treatment is hard but it can be lifesaving. Major depression, along with a few other mental health disorders, are major risk factors for suicide.

  • Suicide is the second leading cause of death for 15 to 24 year-olds.
  • In 2013 and 2014, children ages 10 to 14 were more likely to die from suicide than in a motor vehicle accident.

Adolescents are historically not the easiest clients to engage in sessions. They are often resistant, aloof or otherwise unimpressed with traditional talk therapy approaches. If you’re working with an adolescent, you have to work hard to gain their trust and speak their language. Online therapy taps into their world in ways routine talk often cannot. For teens, the world revolves around technology. It’s a space they know well and operate in every day in some capacity. Online therapy with adolescents feels like a perfect fit.

A Little History

The idea of providing healthcare remotely first emerged in the late 1800s as telephones became more common. Using the technology of the day for mental health care began in the late 1950s when psychiatrists at the University of Nebraska used two-way closed-circuit television to provide consultation for patients and training for students between the Nebraska Psychiatric Institute and Norfolk State Hospital in Nebraska.

Over the following years, telemental health services continued to grow. Research has followed and online therapy has proven to be an effective alternative or adjunct to, in-person therapy. Using the latest teleconferencing technology, online therapy is now considered part of mainstream mental health care.

Why Consider Online Therapy with Adolescents

Teens are hooked into technology unlike other demographics, and it has become their primary mode of social connection. A recent survey found that well over 85% of teens own a smartphone. Watching videos, gaming and social media dominate their time spent online. It’s where they are and how they communicate. And communication in the virtual space requires a different way of interacting. There is less reliance on non-verbal cues and more on emojis, acronyms and 280- character limits…a kind of virtual shorthand.

It hasn’t gone unnoticed that more and more kids born in the smartphone era seem to have lost some of their ability to engage socially in non-tech situations. They often appear uncomfortable and struggle with conversation. Teens and heavy tech users seem to struggle the most. Studies with teens have found that face-to-face social interactions tend to elicit feelings of discomfort or social anxiety. The level of social anxiety experienced seems to be associated with the amount of time using technology.

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Teens tend to be quite standoffish when it comes to therapy. About 80% of teens who need treatment don’t get it for various reasons. Some teens embrace therapy but most of them have genuine concerns. A therapist’s office, no matter how inviting, can feel uncomfortable or even intimidating.

Teens tend to have a preference for self-reliance or, at least, not taking help from grownups. They report concerns about confidentiality, or being stigmatized or judged in some way for needing help. It’s no wonder their first response is to avoid.

For teens, it’s hard to accept help. It’s harder when they’ve been mandated by the court or brought (they often use the word “forced”) into therapy by their parents. This flies right in the face of their developmental progression and sets up quite a battleground.

During the adolescent developmental period, teens are struggling with identity vs. role confusion. Essentially, they are trying to determine who they are and how they want their lives to be. Independence is the end game and they begin the process of pushing away from parents and others in authority.

However mature they may seem on the outside, they are still adolescents with a lot of learning and growing to do. Even their brains are still growing. The pre-frontal cortex, the part of the brain responsible for emotional regulation and decision-making, will not fully mature until early adulthood. So, the resistance also comes from their drive for independence and the short-sightedness of adolescence.

For teens who are resistant, uncomfortable or just curious, online therapy can be an effective and familiar alternative to traditional in-person counseling. Online therapy can help teens feel in control and in turn, coming to therapy on their own terms. By utilizing digital techologies, the therapist can meet adolescent clients where they are and in a space in which they feel comfortable and safe.

Who Can Online Therapy Help?

Online therapy  is effective for a number of mental health issues, typically depression, anxiety, and substance-related disorders. Some disorders, such as eating disorders, may also have significant medical co-morbidity that requires closer monitoring than online therapy will allow.

Such disorders may not preclude the use of online therapy but may require some combination of in-person and online. Those are decisions you would make with your therapist. While not every person or situation is appropriate for online therapy, many are.

Depression

As noted above, depression affects about one in eight teens. Online therapy has been shown to be an effective intervention for treating depression in teens. One approach in particular, internet-based Cognitive Behavioral Therapy, has demonstrated significant positive impacts on symptoms of depression and anxiety in teens.

Anxiety

Anxiety disorders are the most common mental health disorders seen in adolescence, with about 5-12% of teens being affected. While it is transient for many teens, for others it can become more pervasive. Left untreated, it can have long-reaching impacts in functioning and symptoms can become chronic and severe. CBT has been a staple in treating anxiety disorders of all kinds. Online CBT has been shown to significantly reduce anxiety symptoms.

For teens who are also dealing with trauma issues, treatment was historically office-based. Recently, researchers have looked at the possibility of delivering services via online therapy. Studies on the use of trauma-focused CBT (TF-CBT) in an online therapy format are promising. Participants reported significant reduction in their post-traumatic symptoms.

Social Issues, Peer Pressure, and Bullying

These types of issues are very common among teens but are not often the initial focus of therapy. They are not “disorders” per se, but they are nonetheless a source of distress for many teens. A number of online therapy programs have been developed to help teens deal with issues related to social relationship issues such as bullying, peer pressure and social adjustment.

Some programs use a pre-designed web-based format while others have a human support component – often a therapist or coach. It has been shown that these internet-based programs are effective and even more so when there is human interaction.

Gender Identity and Sexuality

Online therapy can be particularly helpful for individuals dealing with gender identity and/or sexuality issues. Like some other groups, barriers to mental health care have been an issue for members of the LGBT community, whether it’s finding a knowledgeable therapist, accessibility or fear of stigma. As a group, they have higher rates of mental health issues and an increased rate of suicidality. Online therapy is proving to be an effective, safe and supportive alternative to in-person sessions.

Family Issues

Online therapy involving families is a popular mode of therapy. It can be hard to get everyone in one place at the same time. The capabilities of this type of therapy allows for multiple participants and can bridge that gap, bringing everyone together.

What’s A Parent to Do?

The first thing to do as a parent is to be observant. Know what is “normal” or what is out of the ordinary behavior for your child. If something persists over time, it’s cause for concern. Some teenage angst is normal and expected but when it lingers or you see dramatic changes, it’s time for action.

Here are some warning signs to look for:

  • Isolating or not doing the things they used to enjoy
  • Struggling in school or missing excessive days
  • Sleeping too much or not enough
  • Crying spells or lingering bouts of sadness that go beyond just the blues
  • Dramatic change in appetite
  • Panic attacks
  • Excessive worry
  • Acting out (theft, fighting) or risky behaviors (running away, sexual acting out)
  • Abrupt changes in friends
  • Increased conflicts with friends and family, fighting or aggression
  • Drug use
  • Self-harming behaviors or pre-occupation with death and dying

Other reasons to seek counseling might be to deal with a recent change or loss. Your teen might be struggling with peers or self-esteem. He or she may even just be wanting someone neutral to talk to.

Whatever the reason, online therapy might just be the right fit. The important thing is that your teen knows you support their decision and respect their privacy with no judgment.

Dawn Ferrara is a Licensed Professional Counselor and Licensed Marriage & Family Therapist with additional certification in the telemental health. She is passionate about helping people find solutions that work and believes that every person has the power to successful. Her practice is in South Louisiana.