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For Therapists: The Challenges of Working With Teenagers

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT
Meet The Team >

At Evolve Treatment Centers, our mission is to support adolescents with mental health, alcohol, and/or substance use issues. Our clinicians are committed to helping each of our teens create a life worth living, despite the challenges they face. Whether those challenges are related to emotional disorders/dysregulation, defiant/life-interrupting behavior, or the disordered use of alcohol or drugs, Evolve clinicians work with teenagers because at their core, they feel that’s where they belong and believe teenagers are the population for whom their clinical skills and instincts will make the most difference.

That’s our default position: we love our teens and use every ounce of energy we have, every therapeutic technique know, and all of our experience to help them improve their lives. At the same time, we understand that a variety of factors make the adolescent population unique.

That understanding begs a question: do the factors that make the adolescent population unique also make working with them more stressful or difficult, as compared to working with other populations?

In order to find out, we posed the following questions to our clinicians in a survey just before the holidays:

  1. Do you feel that working with adolescents is more stressful than working with other populations? Why?
  2. What other factors do you think makes working with adolescents uniquely stressful?
  3. As a clinician, how do you practice self-care/manage stress related to working with adolescents?

We collected their answers this week and share them below. It’s our hope that their insights help other therapists and clinicians who work with teenagers, because that’s who this article is really for: our colleagues. We want you to know we’re thinking of you and the challenges you face, as therapists who work with teens, and we also want you to know there’s a supportive community of adolescent clinicians – the Evolve team – ready and willing to share their experiences with you.

What Evolve Therapists Say About Working With Teens

We want to offer you their responses with virtually no editing and as little commentary as possible, because we want you to hear their voices and their opinions as they are, not as we wish them to be. We want to give you the straight goods, as it were, so you know that the people on our team are real, pragmatic, and when you ask them a question, they give you an honest response. That’s also our way of offering this disclaimer: some of these responses are unflinchingly direct.

With that said, we’ll jump right in with the first question:

Do you feel that working with adolescents is more stressful than working with other populations? Why?

Our therapists were almost evenly divided on this question and its short follow-up. Roughly half answered “No” and roughly half answered “Yes.”

Here’s a sample of what those who answered “No” had to say:

No – I think it depends on the individual client, rather than the population.”

“Not necessarily. I’ve worked with adults and older adults in the psychiatric hospital and outpatient settings and the stress level was quite high.”

“No, adults are more stubborn and set in their ways.”

“No. Once you find a way to connect with them and build rapport, adolescents are easier to work with and more receptive and open to change than adults.”

“No, the only thing stressful is dealing with enabling parents.”

[This one of the “unflinchingly direct” answers we alerted you about. There will be more.]

“No, I feel that working with adolescents is rewarding because they are more open to making long-lasting change.”

“Actually, I find working with adolescents to be far more creative, exhilarating, and enjoyable than working with other populations. I’ve known for a long time this is the population I find most challenging and engaging and hope to spend much of my career working with adolescents.”

Now, here’s a sample of what those who answered “Yes” had to say:

“Yes, because of family systems, you’re not working with just one client, you’re working with many individuals that care about the teen’s wellbeing.”

“Yes. Figuring out what is typical teenage behavior and what is problematic behavior [is a challenge], because they can look very similar, i.e. mood swings, impulsivity, etc.”

“Yes! They require more creativity and flexibility to work with than smaller kids or adults since they are still cultivating their sense of self.”

“Yes, you have to work with the parents and family system as well. Which is typical in all therapy, however, there is an added layer when working with teens.”

“Yes – working with adolescents demands constant energy and often on-the-spot crisis response. For some professionals, working with adolescents may be more rewarding. At times, our staff is exposed to traumatic circumstances, with the added challenge of having to remain hopeful and impartial when supporting our clients”

“Yes, at times, because we are working with the entire family unit. Parents will also need to make changes to assist the client with sustaining their stability and recovery.”

“Yes, most do not want to be in treatment, so an initial main focus becomes getting them on board for therapy. Many teens are forced to treatment by their parents, and in adult populations, they can sign themselves out when they want.”

We think those responses speak for themselves – however, we will point out that family involvement is an aspect of treating teens that creates both challenges and opportunities. The challenges come when parents resist or doubt the validity or effectiveness of elements of their teen’s treatment. The opportunities come when parents accept their role in the treatment process and are willing to learn, grow, and change along with their teenagers.

And for the record, the vast majority of Evolve parents are in the latter category, and fully support their teens and their teen’s therapists during the treatment process.

Let’s move on to question #2:

What other factors do you think make working with adolescents uniquely stressful?

Answers to this question were not binary, like the answers to our first question. We divided them into three categories:

  1. The developmental phase – adolescence – creates challenges and adds a unique layer of stress.
  2. Parents and the family dynamic create challenges and add a unique layer of stress.
  3. Other factors create challenges and add a unique layer of stress.

We’ll start with answers from those who identified adolescence itself as the source of unique challenges or stress. Here’s what they said:

“I think watching adolescents struggle with the ebbs and flows of being an adolescent [is hard].  [Watching teens] struggle with a mental illness or substance abuse issue alongside that makes it more difficult for the client. Being a clinician watching teens navigate the difficulties that come with that stage in their life is taxing in that you want so badly, at least I do, to let them know that everything they feel will pass as they grow up. However, you know they won’t believe that until they experience it themselves.”

“Teens are trying to discover themselves and are not necessarily ready for change. [When teens are] forced into recovery working with [them] is difficult. It’s always easier when you have the teen’s buy-in.”

“Stage of change – less buy in or motivation.”

“Constant mood swings due to hormones and dysregulation.”

“Developmentally speaking teens are more temperamental and have more mood swings.”

“The most stressful part of working with teens in RTC  [residential treatment] would probably have to be getting them to commit to treatment and committing to their recovery.”

“Their fluctuation from willingness to willfulness.”

“It can be challenging since they don’t have full autonomy. Some changes are not within their power to make.”

Here are the answers from those who identified parents and the family dynamic as a source of unique challenges or stress. We’ll reiterate our disclaimer: some of these are unflinchingly simple and direct.

“You’re not only managing the adolescent’s mental health/treatment, but also addressing issues within the family system and managing the dynamics and issues of the family as well.”

“Family work can be difficult. Finding a middle path for parents and adolescents can be difficult when trust has been broken in a family unit.”

“I find working with adolescents to be challenging because you are expected to manage not only their treatment interfering behaviors but also their parents’.”

“Their parents.”

“Their parents/caregivers!”

“When they are willful and working with difficult parents.”

“Working with parents and trying to make positive changes in the family system to promote recovery.”

[We told you they’d be direct.]

Here are the answers from those who identified “other” factors as a source of challenge or stress:

“Suicide culture.”

“Having to send them to the hospital can be stressful because you always want the best for them and will not [always] know what happens to them once they leave the program.”

“You have to share a bit more of yourself in order to build rapport and still maintain boundaries. It’s challenging!”

“They can feel as though goals are too hard to reach and too far in the future. Sometimes a life worth living is more difficult to believe in when all you know is mental illness.”

We’ll take a moment to address the first answer, “suicide culture,” since the others are self-explanatory. As a therapist reading this, you know exactly what we’re talking about: the suicide contagion effect. This phenomenon is exacerbated by shows like “13 Reasons Why” and the tendency of teens on social media to glorify suicide. For more information on this topic, please read our articles “The Suicide Contagion Effect in Teens” and “Research Report: Teens Who Self-Harm Often Learn from Friends.”

How Our Clinicians Take Care of Themselves

One thing we haven’t mentioned about working with teens is something most therapists like you know already. Teenagers can smell insincerity a mile away. That’s why our therapists walk the walk as well as talk the talk – as you’ll see below. Mental health professionals like you and us do everything we can to get our teens and their parents to practice self-care. We cajole, we convince, we persuade, we bargain, we implore – but most of all, we set a good example.

Our therapists teach our teens effective self-care skills because they know how valuable they are in their own lives. As you read through the answers to our final question – As a clinician, how do you practice self-care/manage stress related to working with adolescents? – you’ll see many of the things that you advise your teenage clients to do. You’ll probably also recognize some things you do for yourself – and you may find an idea or two to integrate into your own self-care regimen.

Here’s what our clinicians do to manage the stress of the job:

“I am a constant seeker of knowledge (reading, exploring, collaborating, listening). I am very close to my chosen family and my pets which helps [prevent] burnout.”

“Rest. Workout. Take care of my skin. Get massages. Write.”

“Compartmentalize, set healthy boundaries.”

“Socialize, work out, and share a laugh with coworkers.”

“I run almost daily, leave my phone at home when I go for walks, and spend quality time with my loved ones.”

“Spend time with those close to me, hike, and vent to coworkers.”

“Try and find a way for work/life balance and create a routine that incorporates self-care. This is very difficult to do.”

“Prioritize my own ABC-PLEASE skills.”

[If you’re a DBT therapist you know what ABC-PLEASE skills are. If you’ve never heard of them, please refer to our articles here and here.]

“I fill my bucket by taking some time for me. This can be a break from paperwork or eating a tasty treat. On the weekends it means hanging out with family and friends. Even if it means Zoom or FaceTime.”

“I prioritize getting good sleep each night, I see my own therapist, and I hike with my dogs each morning.”

“Case collaboration with peers, massages/facials, spending time with friends.”

“When COVID-19 is not present, time with friends and family as well as weekend getaways when not on call.”

“I go running, I work out. and spend time with family.”

“Spend time with family and friends, do a twice daily skin care regimen, and weekly masks.”

“I talk to my Program Director and my co-therapist. I practice self-care by playing with my dog.”

We think that’s a good note to end on. To mitigate job stress, one of our therapists talks through things with coworkers, then goes home and spends time with their furry four-legged friend. There are more elaborate approaches to self-care out there, certainly. But we like that one, because it’s simple and repeatable – two important elements of any self-care routine.

Finally, we’d like to thank you – as our colleague in adolescent behavioral health – for taking the time to read this article. We tried to stay out of the way as much as possible, editing-wise. We wanted to let our clinicians speak to you, clinician to clinician, without sugar-coating their words or tweaking them for marketing purposes. In the spirit of open and honest collaboration, we encourage you to reach out to us. If you have a relationship with Evolve, we want to enhance it. And if you’ve never worked with us before, we want to build a relationship and learn from you, so that we may better serve and support our teens.

And one more thing:

Happy New Year!

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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Connect with Other Parents

We know parents need support, too. That is exactly why we offer a chance for parents of teens to connect virtually in a safe space! Each week parents meet to share resources and talk through the struggles of balancing child care, work responsibilities, and self-care.

More questions? We’re here for you.