When to take a teenager to a therapist: signs, routes and what if they refuse

“Is this still just puberty, or is it something more?”

The father asks almost in passing, between two other topics, as if it doesn’t matter. For the third week running, his fifteen-year-old son has come home from school, shut his bedroom door and only come out for dinner. His grades have dropped. He has given up basketball “because he’s not interested any more”. When his mother asks how he is, he says “fine” and looks at his phone. The father knows teenagers are like this. He remembers being like it himself. And yet something keeps him awake at night.

Almost every parent of a teenager asks this question at least once. There is no single simple answer — but there are signs that help you judge, and routes that are worth knowing before you need them. This piece is for parents: when it is time to seek professional help, where to turn in Slovenia, how to suggest it to your teenager, and what to do if they refuse.

Puberty or distress: why the line is so blurred

Adolescence is a period of great change. The brain is reorganising, the body is changing, the relationship with parents is being reshaped, and friends become more important than family. Mood swings, retreating to their room, arguments about boundaries and occasional listlessness are all part of it. The psychologist Laurence Steinberg describes adolescence as a period of particular sensitivity in the brain — to dangers and to opportunities alike. You can read more about the developmental tasks of this period in the knowledge base under Adolescence.

That is exactly why serious difficulties hide so well. An American study by Ronald Kessler and colleagues showed that half of all mental disorders people experience in their lifetime begin by the age of 14, and three quarters by the mid-twenties. So adolescence is not only a time when ups and downs are normal. It is also the time when depression, anxiety disorders, eating disorders and addictions first appear.

I have described in more detail how to tell ordinary mood swings from depression in Teenage depression: telling it apart from ordinary mood swings. Here I would like to take a wider view — not just of depression, but of the question of when to seek help at all.

Three criteria that help you judge

For any behaviour that worries you, ask yourself three questions.

• How long has it lasted? A bad mood after an argument with a friend is a reaction. A bad mood that lasts more than two weeks and doesn’t lift even with things that used to bring joy is a signal.
• How many areas does it affect? If the difficulties are only at school, the answer may lie at school. If at the same time they withdraw from friends, sleep worse, eat differently and drop their hobbies, something is happening at a deeper level.
• How different are they from before? A teenager who has always been quiet isn’t in trouble because they are quiet. A teenager who was talkative and went silent within a few months is a different story. Compare them with how they were, not with how they ought to be.

If the answers to all three questions point the same way — longer, more areas, a noticeable change — it is time to get advice. Not necessarily therapy straight away, but a conversation with someone who can assess what is going on.

Signs not to wait on

Some things don’t need two weeks of observation. If your teenager talks about death or suicide, even jokingly or indirectly (“it’d be better if I weren’t here”), if you notice cuts, burns or arms carefully covered even in summer, if they are losing weight fast or vomiting after meals, if they seem confused, hear things others don’t, or suddenly behave completely differently — act the same day.

The question about suicide may frighten you, because you fear that asking will put the idea in their head. Research doesn’t support this: a direct, calm question (“Do you ever think about hurting yourself?”) does not increase the risk, and it often brings relief, because the teenager sees that this can be talked about. I have described how to respond to self-harm in Self-harm: what it really means and how to respond, and you’ll also find a short explanation in the knowledge base under Self-harm.

With changes in eating, time matters especially, because eating disorders quickly become entrenched. What to look out for is described in Early signs of an eating disorder in a teenager. And when the signs are such that a medical or psychiatric assessment is needed first, you may find When you need a psychiatrist first helpful.

If your teenager is in immediate danger, call 112. Adults can call the crisis line Klic v duševni stiski on 01 520 99 00 in Slovenia (daily from 7 pm to 7 am) or the Samaritans helpline Samarijan on 116 123 in Slovenia (24 hours a day). A teenager can turn, on their own and anonymously, to TOM, the helpline for children and adolescents in Slovenia, on 116 111.

Where to turn in Slovenia

One of the things that confuses parents most is who the right person to go to actually is. Psychologist, psychiatrist, psychotherapist, school counsellor — I have explained the differences in Psychotherapist, psychologist, psychiatrist: who does what and where to go. For teenagers, a few particular things apply.

The first port of call is almost always the GP or paediatrician. They can help rule out physical causes — tiredness, low mood and irritability can also come with thyroid problems, anaemia or lack of sleep — assess how urgent the situation is, and refer you on if needed.

The school counselling service knows your teenager in the setting where they spend most of their day. It often knows things parents don’t — about peers, about possible bullying, about how they behave in class. A school counsellor can have a few conversations with your teenager and help judge whether further help is needed.

Centres for the mental health of children and adolescents have been set up across Slovenia in recent years as part of the national mental health programme. They are staffed by teams — psychiatrists, clinical psychologists, social workers and others. You are usually directed to them by your GP or paediatrician. Waiting times can be long; I have described how people actually get help here, and what the options are, in Referral, waiting list or self-funded.

A therapist for children and adolescents is a professional specifically trained to work with this age group. When choosing, it is worth asking whether they have experience with it — working with a teenager is different from working with an adult.

How to suggest help to your teenager

Australian researchers summarised in a systematic review what stops young people from seeking help. At the top of the list were stigma and embarrassment, difficulty recognising their own symptoms, and a wish to sort things out themselves. Among the things that helped were previous good experiences of help and support from people close to them.

For parents, this means two things. First: how you make the suggestion matters almost as much as the suggestion itself. If your teenager hears “something’s wrong with you, so I’m taking you to a psychologist”, they will hear a verdict. If they hear “I can see you’re having a hard time, and I don’t want you to carry it alone”, it’s an invitation. Second: a teenager’s wish for independence isn’t an obstacle but a lever. Offer as much choice as you can — when, whom to see, whether they go alone or with you.

The conversation might go something like this (a composite, not a real person):

“I’ve noticed that for the last few weeks you’ve hardly come out of your room, and even basketball doesn’t draw you any more. I’m worried.”
“Nothing’s wrong. I’m tired, that’s all.”
“Maybe that really is all it is. But if there’s anything else, I’d like you to have someone to talk to — it doesn’t have to be me.”
“A psychologist? I’m not mad.”
“I don’t think you are. You go to the doctor when your knee hurts, too. We could start with your doctor, and you decide what happens next.”

The father doesn’t dismiss his son’s explanation, but he doesn’t accept it as the last word either. He says what he sees, not what he thinks. He makes help ordinary. And he offers a step that is small and in which his son is in control.

What if your teenager refuses

This is one of the most common questions parents ask, and the honest answer is: it is hard to force a teenager into therapy in a way that works. If you bring them against their will, they may sit in the room and say nothing. But that doesn’t mean you have no options.

• Go on your own first. A parent consulting a professional is a legitimate step. It helps you assess what is going on and find a way to talk to your teenager. Sometimes the relationship at home changes simply because the parent changes.
• Give it time. “No” today isn’t always “no” in a month. You can repeat the suggestion calmly, without pressure.
• Find a go-between. The school counsellor, a form teacher, a coach or an aunt your teenager trusts — sometimes a suggestion is easier to accept from someone who isn’t a parent.
• Offer a joint session. Some teenagers who wouldn’t go alone will come to a conversation with the whole family, because there they are not “the problem” but one of the participants.

I have described how family therapy can open a conversation with a teenager who has gone quiet in When a teenager goes quiet: how family therapy opens the conversation.

When the difficulty isn’t only in the teenager

In relational family therapy, in which I am training, we see the family as a system: what happens to one member affects everyone, and what happens between everyone often shows up in one person. You’ll find a short explanation of this view in the knowledge base under The family as a system.

A teenager is often the one in whom tension in the family shows first. Parents who argue constantly or are separating, illness in the family, a loss, a move, money worries — a teenager senses all of it, even if nobody talks about it. Their symptoms can also be a message about what is happening around them.

Research supports approaches that involve the family. Guy Diamond and colleagues developed attachment-based family therapy for depressed teenagers, built on a simple idea: if trust between a teenager and their parents is repaired, the teenager once again has a secure base from which to face their difficulties. Studies of this approach have shown promising results.

This doesn’t mean the parents are to blame. It means parents can be part of the solution. When the difficulty is a tangle of relationships, family therapy can help — the family comes together, and the aim is not to find a culprit but a pattern.

What you will find out as a parent — and what you won’t

Parents often worry that once their child starts therapy, they will lose sight of what is going on. Teenagers worry about exactly the opposite: that the therapist will tell their parents everything. Both worries are understandable.

Therapy with a teenager only works if the teenager feels the space is theirs. If they know every word will reach their parents, they will speak cautiously or not at all. That is why therapists agree with the family at the start about what stays between the therapist and the teenager and what is shared. The line is almost always the same: when safety is at stake — a risk to life, abuse, serious danger — the therapist informs the parents. I have written about how confidentiality works and where its limits are in Confidentiality in therapy, and you’ll also find a short explanation in the knowledge base under Confidentiality.

For a parent this is sometimes hard. But think of it this way: your child will tell someone things they might not tell you. That isn’t betrayal. It is one more adult in their life standing by them.

Exercise: before you make the call

If you are thinking about seeking help, this exercise will help you put your thoughts in order — and it will also be valuable to the professional you see.

1. For two weeks, write down what you see. Not explanations, but observations: “On Wednesday he didn’t go to school; he said his stomach hurt.” “On Saturday he slept until two in the afternoon.” “He didn’t say a word at dinner.”
2. Write down when it started. Can you remember when you first noticed a change? Did anything happen around then — a move, a break-up, a death in the family, a change of school?
3. Check the areas. School, friends, sleep, food, hobbies, body, mood. In which of them has something changed?
4. Write down what is happening in the family. Honestly, including what isn’t connected to your teenager: tension between you and your partner, illness, worries.
5. Choose one first step. A conversation with your teenager, a call to your GP, a meeting with the school counselling service. Just one. Do it this week.

Take these notes with you to the first conversation. The professional will learn more from them than from a general description, and you will feel you haven’t come empty-handed.

When therapy isn’t the first answer

This piece would be one-sided if I didn’t say this too: not every teenage struggle calls for therapy, and therapy isn’t always the first or the only answer.

Some distress is a response to circumstances that need to change. If your teenager is being bullied, therapy can help them, but the school has to stop the bullying. If they aren’t sleeping because they are on their phone until three in the morning, the first step is an agreement about screens, not a psychologist.

Some difficulties need a doctor first. Physical causes, serious eating disorders, psychotic symptoms or severe depression need a medical and psychiatric assessment, sometimes medication too. Therapy can accompany this, but not replace it.

Some distress is part of growing up. A first love that ends, disappointment over a grade, a row with a friend — it hurts, but through it a teenager learns that they can survive difficult feelings. If we look for a professional at every sign of distress, we may unintentionally tell them they can’t cope on their own. Sometimes the best help is a parent who stays close and listens.

And finally: therapy helps, but not miraculously. A large meta-analysis by John Weisz and colleagues, covering five decades of research on psychotherapy with children and adolescents, found that the effects are moderate on average and vary considerably between different difficulties. Therapy can be a big part of the journey, but it is rarely the whole of it.

What to remember

• Half of all mental disorders begin by the age of 14 — adolescence is when a parent’s attention is most valuable.
• Three criteria help you judge: duration, number of areas affected and change from before.
• With self-harm, talk of suicide or rapid weight loss, don’t wait — act the same day.
• The first port of call is the GP or paediatrician and the school counselling service; a parent can also seek advice alone.
• A teenager’s distress is often also a message about the family — and the family can be part of the solution.