Finding the right therapist to help your anxious teen is an important first step in helping the teen who is suffering with anxiety and stress. By therapist, I mean a mental health professional trained to provide your teen with psychological rather than pharmacological (medication) treatment for anxiety. Typical mental health professionals include psychologists, social workers, mental health counselors, and marriage and family therapists. At times, a psychiatrist can provide both psychological and pharmacologic treatments.
Regardless of the mental health professional’s title or license, you’ll want to find someone who is an expert in anxiety disorders in youth and in cognitive-behavior therapy (CBT), the psychological treatment of choice for anxiety disorders. Most therapists will tell you that they do some CBT while others exclusively provide this form of treatment. It’s not only important for your teen to feel comfortable with the therapist with whom the teen might work, but also to feel confident that the therapist understands anxiety disorders in youth and is competent to treat them.
During the evaluation process, the therapist probably asked you and your teenager a lot of questions. Now it’s your turn to ask the therapist some questions too. Don’t shy away from asking the tough questions that will help you decide whether the therapist has the knowledge and skills to treat effectively your teen’s anxiety disorder:
What specific training have you received to treat anxiety disorders?
Ask prospective therapists whether they received specialized training in CBT for anxiety disorders, if they have, ask them to tell you a little about the training and the types of anxiety disorders they’ve treated. Typically, it takes more than a workshop or class to learn cognitive-behavior therapy (CBT). Furthermore, in order to learn CBT for anxiety disorders, it’s important that the therapist has been supervised for a period of time with a CBT specialist. Therapists who were trained in anxiety disorder specialty clinics within universities are likely to have received adequate supervised training in CBT. At times, therapists will seek intensive training in CBT through universities where many of the effective treatments for anxiety disorders were developed, such as the Center for Treatment and Study of Anxiety at the University of Pennsylvania in Philadelphia. Typically, these intensive trainings include ongoing supervision for a period of time by experts in CBT with youth who have anxiety disorders.
In some areas of the United States, it’s very difficult to find a qualified mental health professional in the community, much less someone with specific training and expertise in CBT for anxiety disorders. Nevertheless, you don’t want your teen to begin treatment with someone who will not provide your teen with the treatments known to help. It may be worth the drive to see someone outside your community if that person has the expertise your teen needs. In addition, if you cannot find a qualified cognitive-behavior therapist qualified in your community, you can still benefit from medications, and it may be easier to find someone who can prescribe the right medications that will help your teen.
To what professional organizations do you belong?
Ask therapists to name the organizations to which they belong. The professional organizations to which therapists belong can tell you something about their interests and expertise. For example, if the therapist is a member of the Association for Behavioral and Cognitive Therapies, the therapist likely has expertise in cognitive-behavior therapy. Similarly, the Academy of Cognitive Therapy and the Obsessive-Compulsive Foundation are organizations that include experienced cognitive-behavior therapists with specific expertise in treating anxiety disorders. If they describe organizations not mentioned above, ask them whether they belong any of the three mentioned above.
Ideally, you are looking for an anxiety disorder expert, that is, someone who not only has received adequate and appropriate training in CBT but also someone who has treated more than a few cases. A true expert might evaluate and treat 40 or 50 people with anxiety disorders in a year, perhaps more if the therapist practices in a specialty clinic or within a large urban center. Although it’s not necessary that the professional treat a large number of teens with anxiety disorders each year, you do want someone who has treated more than just a couple over the last several years. Again, you may not be able to find someone with this level of experience in your community but asking about the number of cases of anxiety disorders they’ve treated can help you compare the experience of therapists with whom you speak.
What does CBT with an anxious teen look like?
Ask therapists to tell you a little about how they go about treating youth with anxiety disorders. If they are vague or don’t mention CBT, you can assume that they have not received much training in CBT for anxiety disorders. Therapists experienced in treating anxiety disorders will be able to answer your questions directly and give you many examples to illustrate how they apply CBT to your teen’s specific anxiety-related symptoms. Also, listen for key terms, such as hierarchy, in vivo or imaginal exposure, particularly exposure. Exposure is essential if you want your teen to recover from an anxiety disorder, and research tells us that not every therapist includes exposure when treating teens with anxiety disorders. If the answers to your specific questions are vague, or the therapist suggests a treatment approach other than CBT or medications, you may want to consult with another therapist.
How long do you think the treatment will last and how much do you think my teenager will improve?
Because we have many research studies into the effectiveness of CBT with youth who have anxiety disorders, therapists who is familiar with anxiety disorders and these studies can tell you how much improvement you can expect in your teen’s anxiety symptoms and how long you can expect them to remain better. If therapists cannot answer these questions or give you vague answers, such as, “Well, these things take time. It’s really up to your teen,” approach with caution.
Are you willing to leave your office to treat my teen’s anxiety disorder?
A central feature of any anxiety disorder is some degree of avoidance of activities, objects, or situations. In order for teens to recover from an anxiety disorder, they must learn to face what they fear and learn that they can handle the fear and that what they predict will happen doesn’t happen. Often, this means designing exposure experiments with the teen that may mean the teen and the therapist must leave the therapist’s office to do this. Many therapists aren’t comfortable providing treatment outside their office. However, experienced cognitive-behavior therapists do this all the time. They drive with a teen who is afraid to drive over bridges or climb outside stairs with a teen who is afraid of heights.
In conclusion, it’s essential that your teen and you are assured that you have the right plan and the right people to help you. Asking questions can help, as can doing a little homework before the consultation with prospective therapists. Good luck!
More Help for Anxious Teens
In The Relaxation and Stress Reduction Workbook for Teens, Michael Tompkins and Jonathan Barkin, specialists in teen anxiety and stress, have developed skills for teens to identify the things that tend to stress them out and make a plan to relax and reduce stress in their lives. The workbook offers teens proven-effective CBT interventions with over 40 simple age-appropriate evidence-based activities.