Therapy for Teens
Kathryn Graham, Ph.D.
I know how to work with reluctant teens and their families to help them face anxiety, depression, and trauma together.
Does your child struggle to relax, especially at nighttime?
Is your child asking to avoid things like school, social events, or doctor’s appointments?
Are they often complaining of nausea, hot flashes, or heart palpitations?
Are they struggling to make friends?
Are they constantly seeking reassurance from you when everything is fine?
Are they struggling to prepare for college?
I know parents and children feel isolated from each other when a teen is experiencing anxiety, depression, or trauma. My role is to keep the family functioning and working together like a team to feel better together.
Mental health for teens doesn’t look the same as it does for adults.
For teens, anxiety, depression, and trauma can appear as intense, sudden emotional responses such as anger, sadness, shame or panic or as if the teen is shutting down. They may repetitively seek reassurance from parents or trusted friends to determine if they feel safe. They may struggle to eat, sleep, participate in activities, or turn in assignments at school. They might express feeling paralyzed by a decision or needing to follow a rigid routine in order to feel comfortable.
Regardless of how your teen may be manifesting a mental health struggle, their ability to cope with distress shifts dramatically during the teenage years. As children, we have two emotion regulation systems: ourselves and our parents. As teenagers, we learn to begin coping on our own and learning how to manage distress. Parents come to me when they are worried about their children and feel as though their child’s anxiety has taken over their household, with most family members walking on eggshells to avoid triggering anxiety.
One of our primary goals with child and teen anxiety therapy is to help your child recognize their current safety and self-regulate. Our other primary goal is to help parents learn to help their child regulate in a supportive way that fosters the parent-child relationship without catering to the anxiety.
My Anxiety Specialties Are
I specialize in helping pre-teens and teens learn to regulate their anxiety including:
Panic attacks- sudden, intense surges of adrenaline that lead to a flood of physical symptoms of anxiety such as heart racing, hot flashes, difficulty breathing, nausea, and dizziness
Specific phobias- a specific targeted fear for something such as animals, flying, natural disasters, medical exams, etc.
Generalized Anxiety Disorder (GAD)- anxiety that shifts focus frequently leading to an overall sense of dread and an inability to relax
Obsessive-Compulsive Disorder (OCD)- repetitive intrusive thoughts accompanied by repetitive behaviors or thinking patterns to reduce or prevent the intrusive thoughts from coming true
Social anxiety- a persistent fear surrounding social perception that might make it difficult to speak in public, make new friends, or be around people that you are not familiar with
Separation anxiety- fears in childhood that occur when separated from your parents in which you are afraid for your safety or the safety of your loved one
Anxiety Therapy Techniques I Use
My approach to child anxiety therapy uses a blend of evidence-based practices that emphasize the following:
Recognizing physical symptoms and using coping skills. Anxiety symptoms often feel very alarming and can appear as though something is wrong with our body. We learn to recognize which physical sensations are due to anxiety and how to cope with these symptoms and self-regulate. If deep breathing isn’t your thing, that’s okay! We have plenty of options to work with.
Noticing and challenging anxious thoughts. It’s important to recognize your anxious thoughts to avoid getting trapped in a thought spiral. Once identified, we need to challenge any unhelpful anxious thoughts through examining the evidence. This can include recognizing that the worst case scenario is unlikely to occur, that you could handle the worst case scenario if it did occur, or noticing cognitive distortions.
Facing your fears. This can be in the form of exposure therapy, through setting boundaries, and/or through reducing any repetitive or safety behaviors you might do to reduce feeling anxious.
Anxiety Treatments That are Tailored to Your Child
While most evidence-based treatments for anxiety maintain the same three core ingredients, different treatment approaches work better for different forms of anxiety.
-
Cognitive Behavioral Therapy (CBT) is the primary evidence-based treatment for anxiety. Through CBT we focus first on regulating emotions with coping skills, then on recognizing and challenging unhelpful anxious thoughts. Treatment then focuses on changing behavioral patterns around anxiety to reduce avoidance and increase confidence with facing fears.
-
Exposure and Response Prevention (ERP) is the gold-standard treatment for OCD and focuses on reducing avoidance and gradually facing fears. Elements this treatment, especially facing fears are crucial in most anxiety treatments.
-
Inference-based Cognitive Behavioral Therapy for OCD (ICBT) is an evidence-based treatment for OCD that focuses on recognizing how OCD changes one’s perception of reality, leading to doubts. Through this treatment, we focus on questioning the doubts and challenging OCD’s perceptions.
-
Supporting Parents of Anxious Childhood Emotions (SPACE) is an evidence-based treatment designed to coach parents through how to support their anxious children. This treatment focuses entirely on behaviors within a parent’s control and focuses on building support in the parent-child relationship.
Results From
Anxiety Therapy With Me
After therapy, my clients and their parents report:
Having more flexibility to do the things they enjoy, with the people they love
Trying more new things
Feeling more confident in their decision-making
Being able to enjoy more experiences without focusing on their internal monologue
Learning to relax
Being able to recognize when an anxious thought is truly helpful
Learning to accept uncertainty
One of my primary goals in treatment is to help children and teens develop greater self-confidence to trust their bodies, their thoughts, and their emotions so that they can make decisions based on their needs, not on what anxiety needs.
About Kathryn Graham, PhD
I have specialized in treating anxiety my entire career, first through running a structured social anxiety group at a college counseling center, and through my work in private practice providing both individual anxiety and OCD treatment with children and teens with anxiety and providing both individual and group SPACE therapy to support parents of children with anxiety.
My therapy is designed for preteens and teens struggling with chronic anxiety, whether that comes in the form of specific fears, panic attacks, repetitive intrusive thoughts, or an overwhelming sense of uneasiness or dread. We will work to understand your child’s anxious patterns including the triggers for their anxiety, underlying thoughts or doubts, and history that led to their current responses. We will then learn tools for calming down any physical symptoms, and focus on recognizing and challenging any unhelpful anxious thoughts. Once they feel comfortable using these skills, we will focus on gradually changing their responses to anxious moments, such as through facing a fear, limiting reliance on a safety object, asserting themselves, etc. True progress and healing in therapy comes from this final phase of treatment in which we focus on changing their responses to the anxiety.
Early in anxiety therapy with children and teens, I emphasize that parents will be working as teammates with their child and will help their child practice therapeutic skills at home. Facing fears and making changes is very challenging, but we feel more comfortable when we have a support network around us. As difficult as it can be to face fears as an adult, children often do not make the choice to attend therapy on their own. I therefore focus on recognizing your child’s strengths and building their confidence to face their fears with your support. When working primarily with parents to provide SPACE, I emphasize skills that enhance the parent-child relationship and focus on goals for gradual change.
Early in all anxiety treatments, I typically focus on acclimating a child to therapy through teaching how to recognize emotions and the connections between our thoughts, feelings, and behaviors. I usually try to frame these conversations around a child’s interests whether that be their fantasy football team, their favorite book series, or other pop culture references. We then focus on learning coping skills to regulate anxiety and I encourage children to teach their parents these skills at the end of sessions or assign them homework to practice coping skills together as a family. We then shift into learning how to recognize helpful versus unhelpful anxious thoughts and how to challenge the unhelpful ones. I do not want children feeling as though they cannot trust their emotions, so we spend time learning how to examine the evidence for an anxious thought.
As we begin to work on facing your child’s fears, I have compassion for how challenging it can be to change our responses to anxiety. Our body’s instincts are to avoid what makes us afraid and it takes courage and confidence to fight these instincts. I therefore collaborate with you and your child every step of the way and make sure that we are continuing to make progress while also continuing to grow their self-confidence.
Getting Started Together
-
Click the link to request an appointment or consultation, and specify what you are looking for .
You will be contacted within 24 business hours. I respond to weekend messages on Monday mornings. -
After receiving your contact, options will be provided for having a free 15 minute phone consultation to discuss what is bringing your child in for therapy and your goals for treatment.
-
The first appointment will be a 1 hour parent only intake session. The goal is to learn about your child’s history and background so that I can formulate a treatment plan to meet their needs.
-
The pace and frequency of your child’s appointments will be discussed and decided during the parent intake session. Appointments are typically 45 minutes and we can meet weekly, bi-weekly, or rotate weekly between child and parent sessions.
Therapy FAQs
-
I work to include parents of children under 18 from the beginning and emphasize that parents are the child’s teammates in fighting their anxiety. I often debrief with parents at the end of sessions and encourage children to share what they have learned so that they can practice therapeutic skills with their parent at home. If your child is over 14, they have more autonomy in therapy and may request more privacy. I therefore may not debrief at the end of sessions but will share with you and your child updates on skills to focus on between sessions. If you are participating in SPACE, therapy primarily occurs with you, the parents, rather than with your child and focuses on teaching you skills to support your child and reduce their anxiety.
-
During our initial phone consultation and our intake session, I’ll work to understand your child’s unique experiences and symptoms to determine which treatment approach would be best for them. I often recommend a blend of in-person individual therapy with your child to teach them effective emotion regulation skills as well as parent SPACE sessions to focus on reducing parental accommodations. If your child is struggling to engage in treatment, I often shift over to focusing more on SPACE.
-
While some people prefer the benefits of in-person therapy for the human connection, anxiety therapy can typically be done virtually. I typically recommend virtual therapy for people completing exposure exercises but do suggest coming in-person if your child’s fears are keeping them from leaving your home or if they struggle to maintain focus on the computer. I always recommend that parent SPACE sessions be completed virtually and typically schedule these sessions during times when children would be at school to allow for uninterrupted time during the session.
-
All anxiety therapy involves eventually changing responses to anxiety, but this does not always look like a clear exposure exercise, such as when you might practice public speaking to overcome social anxiety. Depending on your child’s needs, we can also focus on limiting safety behaviors to anxiety, such as not carrying an object with them that makes them feel safe, or reducing seeking reassurance. Many of these exposure exercises can be guided and supported by parents. If participating in SPACE, parents would focus on gradually reducing their accommodations to their child’s anxiety rather than having their child engage in exposure exercises. If we determine that your child would benefit from exposure exercises, we create a hierarchy to start with lower levels anxieties and gradually proceed to higher levels as your child feels more confident.
-
Treatment for anxiety typically lasts between 10-20 sessions depending on the intensity of your child’s symptoms, how long they have been feeling this way, and on their ability to practice skills between sessions. Most preteens and teens progress at a faster pace when they are able to practice daily with the support of their families rather than just during therapy sessions.
