When should a teenager see a psychologist? Criteria for telling ordinary adolescence from struggles that need support, overlooked signs and what happens first.
Your thirteen-year-old son was on the basketball team for two years; this autumn he stopped going to training. At weekends he sleeps until midday, and when he wakes up he turns to his phone without speaking to anyone. He snaps back at even the smallest question. His grandmother says, "It's hormones, it'll pass"; your partner shrugs and says, "We were like that too." But a voice inside you asks, "What if it's something else?" This is the question many parents find hardest: Is this an ordinary wave of adolescence, or a struggle that calls for seeing a teenage psychologist? In this article we look at criteria that can help tell the two apart, the signs families frequently overlook, and what happens at a first meeting with a specialist.
What Does a Teenage Psychologist Do, and Which Ages Do They Work With?
A teenage psychologist is a mental health professional who works with young people, usually from around eleven or twelve, when adolescence begins, up to eighteen, and with their families. Because young people in this period have developmental needs that differ from both childhood and adulthood, the way of working is shaped accordingly.
Psychological work with teenagers has several distinctive features. First, the young person is at the heart of the sessions; what they themselves say, not their family, takes priority. Second, confidentiality is especially important in this age group, and its limits are set from the start. Third, the family is not left out of the process; parents are also seen at regular intervals, but in a way that protects the young person's trust.
Psychologists do not prescribe medication; they work with methods based on talking, building skills and changing behaviour. Whether medication is needed is determined by a psychiatrist's assessment. You can find the differences between these two professions in detail in the article on the difference between a psychologist and a psychiatrist.
Ordinary Adolescence, or a Struggle That Needs Support?
Adolescence is a period of emotional ups and downs, in which moving away from the family and the search for identity intensify. The door being shut more often, talking less with parents, friends coming to the fore and occasional outbursts of anger are ordinary parts of this period.
To distinguish what is ordinary from what needs support, three criteria that specialists also often look at can be helpful:
Duration: A few days of unhappiness or moodiness is ordinary in adolescence. But if a marked change has been going on for more than two weeks and is not easing, it needs a careful look.
Intensity: There is a difference between an occasional outburst of anger and anger in which things get broken every day. Getting tense before an exam and vomiting, being unable to breathe and being unable to go to school on the morning of the exam are not the same thing either.
Functioning: This is perhaps the most important criterion. Can the young person go to school, keep up with their lessons, see at least a few friends, sleep and eat? If the struggle has started to disrupt the young person's life noticeably in one or more of these areas, the time to get support may have come.
Let's say there are two young people in the same class. The first is unhappy, quiet and off their food for a week after breaking up with their boyfriend or girlfriend; but they still go to school, agree to go to the cinema with friends at the end of the second week and gradually recover. The second, with no obvious reason, has lost interest in lessons for three months, can't get up in the morning, misses school two days a week and doesn't answer messages from friends they used to see every week. The feeling the two young people are experiencing may look similar; but there is a marked difference between them in duration, intensity and impact on their life. The second young person's need to see a specialist is far more urgent.
If more than one of these three criteria are present together, or if the change is observed not only at home but also at school and among friends, it is appropriate to see a specialist.
When Should a Teenager See a Psychologist? The Signs Families Overlook
Some signs are easily overlooked because they don't obviously look like a "problem", or they are brushed aside with the label "adolescence".
Constant irritability and intolerance
While depression in adults often shows itself as sadness and crying, in young people it can appear as marked irritability and intolerance. A young person who snaps back at everything and explodes at the smallest thing may be perceived as "rude" or "disrespectful"; yet this picture may be the expression of underlying unhappiness.
Unexplained physical complaints
Recurring stomach aches, headaches, nausea or tiredness, especially in the mornings on school days, may be the bodily language of anxiety or stress if a doctor's examination finds no clear cause. Pains that disappear at weekends and come back on Monday morning are notable in this respect.
Giving up things they love
Suddenly giving up, without explanation, a sport, instrument or hobby they have kept up for years may be a sign of a reduced capacity for enjoyment, if no new interest takes its place. It is even more important if answers like "I don't feel like it" or "It's boring" start being given to almost everything over time.
A sudden change in their relationship with school
A marked drop in grades within a single term, frequent absences, not wanting to go to school, feedback from teachers that "they're not the same as before". Especially in the years of preparation for the LGS or YKS (Turkey's national high-school and university entrance exams), these changes are often interpreted simply as "not studying"; yet anxiety, attention difficulties, bullying or depression may lie underneath.
Withdrawing from friends
Changes in the friendship group are ordinary in adolescence. But you need to be careful with a young person who moves away from old friends without replacing them with new ones, who only communicates online, or who chooses to be completely alone.
Marked changes in sleep and eating patterns
It is ordinary for teenagers' sleep times to shift. But being unable to sleep at all, staying awake until morning and sleeping all day, or skipping meals, going to the bathroom after eating and marked changes in weight are signs that need to be assessed separately.
The overly compliant, "trouble-free" teenager
This is perhaps the most overlooked group. A young person who always gets high grades, never causes trouble and tries to please everyone may be struggling inside with intense anxiety and perfectionism. These young people, who overreact when they make a mistake, can't sleep the night before an exam and think "I'm not good enough", are usually noticed last because they don't cause problems.
Getting lost in the screen
Teenagers spending long periods on phones and computers is considered ordinary today. But if the screen has started to replace everything else in the young person's life, if they experience intense anger or collapse when it is taken away, and if it has become a way of escaping relationships in real life, this can sometimes be a cover for underlying anxiety, loneliness or unhappiness. At this point, rather than simply restricting screen time, you need to try to understand why the young person stays on the screen so much.
Risky behaviour
Behaviour such as substance or alcohol use, coming home late or not at all, dangerous driving, or meeting people they don't know from the internet can show that the young person is trying to manage a struggle in risky ways.
You can find more detail on how anxiety appears in young people in the article on anxiety symptoms in teenagers.
Getting Support After Life Events
Sometimes, even without a clear symptom, an event that has happened makes seeing a specialist worthwhile. After the following situations, a few sessions with a teenage psychologist can help the young person process what they have been through and help the family learn what to look out for:
- Parents divorcing, the family being restructured
- The death of someone close, especially the loss of a parent, sibling or close friend
- Exposure to a traumatic event such as an earthquake, fire or accident; for example young people who lived through the 6 February 2023 earthquakes or lost loved ones in them
- Moving to another city or country, changing school
- Being subjected to peer bullying or cyberbullying
- Being exposed to any form of abuse or violence
- Serious illness, job loss or severe financial hardship in the family
Not every young person who goes through these events develops a psychological problem. But having a space beside them where they can talk about what they have been through without being judged is a protective factor.
In Which Situations Should Support Be Sought Without Waiting?
Some situations require action immediately, without waiting to weigh up the criteria:
- If you notice that the young person has harmed themselves, or if they talk about harming themselves
- If they talk about death, wanting to die or ending their life
- If there are words or behaviours suggesting their grip on reality has weakened
- If they have almost completely stopped eating, or there is rapid and serious weight loss
- If there is a danger of harming someone else
In these situations, turn to a specialist and, if necessary, to a hospital emergency department. If there is a danger to life, call 112 (emergency services) without delay.
What Happens at the First Meeting?
The first meeting with a teenage psychologist is usually an introduction and assessment process involving both the parents and the young person. It can be planned in different ways; sometimes parents are seen first and then the young person, and sometimes everyone attends part of the first session together.
In the part with the parents, the young person's developmental history, family structure, school situation, recent changes and the family's concerns are discussed. In the part with the young person, their point of view is heard: they explain in their own words what they are going through, what is difficult for them and what they expect from this process. How confidentiality will work, in other words which information will be shared with the family and in which situations, is discussed openly in these first meetings.
A few small preparations before the meeting also make things easier. Briefly note down the changes you have noticed recently, when they started and in which situations they increase. School information such as teachers' feedback and school reports can also be useful. If physical complaints such as headaches, tiredness or changes in appetite are prominent, having had an examination by a paediatrician or family doctor to find out whether there is a physical cause makes the assessment sounder.
When preparing for the first meeting, it is important to talk honestly with your teenager about why you are going. Present it not as a punishment or a surprise, but as a step taken to understand them. Some young people may not be keen on this step at first; we discuss what can be done in that case in the article my teenager refuses to see a psychologist.
Deciding to see a teenage psychologist is not admitting that "something is wrong" with your teenager; it is making room for one more person to be by their side during a period when they are struggling.
How Are Teenagers' Struggles Addressed in Therapy?
In the process of adolescent counselling, the way of working is shaped by the young person's age, needs and the issue they bring. For anxiety, depressive symptoms, anger, school problems and difficulties in peer relationships, Cognitive Behavioural Therapy is a frequently used approach whose effectiveness is supported by research. The aim is for the young person to notice the relationship between their thoughts, feelings and behaviour, to evaluate difficult thoughts in a more balanced way and to gain concrete coping skills.
Where recurring relationship patterns and deep-rooted beliefs are to the fore, a schema-focused perspective can also contribute to the process. For example, for a young person who holds the belief "Whatever I do, I'll never be good enough", understanding where this belief comes from and questioning it is an important step.
The family is an important part of the process. In parent sessions, work is done on building supportive communication at home, applying rules consistently and making room for the young person's change. Where needed, there is collaboration with a psychiatrist.
Frequently Asked Questions
From what age can a young person see a teenage psychologist?
In most children adolescence begins between the ages of ten and twelve, and work with teenagers is generally done from these ages. For younger children, a child psychologist and play-based approaches may be more appropriate. The young person's developmental level and needs matter more than their age.
Is it enough to see the school counsellor?
School counsellors are a very valuable support for problems within school, for initial assessment and for building a bridge between the family and the school. However, with long-lasting or intense symptoms, a regular therapy process outside school, with confidentiality assured, may be needed. Seeing the school counsellor can also be a good start towards this step.
How long do sessions with a teenage psychologist usually last?
This varies according to the type and intensity of the struggle the young person is experiencing. Work focusing on a specific issue may be completed within a few months, while with more deep-rooted problems the process may be longer. After the first sessions, goals and the expected duration are discussed together with the family and the young person.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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