Therapy for Teen Issues

Is your teenager acting differently, or shifting their priorities with respect to schoolwork, friends, and family?

Since the beginning of time, we’ve all heard our share of concerns about “kids these days,” and teens are the likely target of these comments. They are an easy target, especially when they have the deck stacked against them: How would you behave if your reward system (focused on experiencing every emotion, intimately and intensely) is fully developed, while your decision-making system (focused on carefully and rationally considering the dangers before leaping forward) is still under construction? Add that to an increasing list of demands from their elders who increasingly embarrass them, a one-size-fits-all academic environment, and an entire tech industry that profits off of their fresh crop of vulnerable dopamine receptors, and you can empathize immediately with their plight. It is tough to be a teenager in 2025. Pat Friman (see the video to the right) says this more eloquently than I can.

That said, it has probably always been tough to be a teenager, since neural and social development follows a predictable pattern across cultures. Struggles for independence can lead to clashes about homework, family time, substance use, peer influence, and other important topics, and leave parents wondering how to balance conflicting and legitimate priorities.

It is certainly puzzling to speak to someone who can be so understanding and articulate, yet act so shortsighted in the face of an uncertain future! The disconnect here is likely explainable by cognitive differences: We adults have a much more sophisticated ability to see and “feel” the future, and we also have had the benefit of experience to tell us which things last, and which things pass. This applies to a lot of things, and not just homework, but homework is especially vulnerable to “present-ism” biases: It’s boring, lacks resemblance to anything their parents do or that other adults do, and (perhaps most importantly) gets in the way of some of the most profound human experiences (e.g., falling in love for the first time, getting “good” at something, etc.).
It’s exhausting when it feels like nothing changes, no matter how many chances you give. Teens often push limits even when they know the rules, especially if they’re dealing with strong emotions, impulse control issues, or just trying to figure out who they are. It’s not always about not caring: Sometimes they genuinely struggle to think through consequences in the moment. Trust takes time to rebuild, and it’s okay to have boundaries while still wanting the best for them. Therapy can help by giving parents tools to set clear expectations without constant conflict, and helping teens to understand the value of these boundaries.
I have a saying, which is “I don’t make kids do therapy.” What I mean by this is that therapy is a tool that works best when you’re working with someone who really wants a change, and if you are still on this page, that person is probably you. Don’t worry, I still want teenagers to participate, but things might look a little different from what you were picturing. Typically, when teenagers realize that their parents are invested in making some changes as well, they are more willing to come to the table.
It is possibly just a part of maturing and growing up, but you should know that there are generally two trajectories when it comes to teenage behavioral issues. In one pathway, teens “get in with a bad crowd,” and the duration of the behavioral changes coincides with the duration of their participation with this crowd. This is usually the best-case scenario, and the most common. The other more concerning pathway is when behavioral issues existed before adolescence, and became worse in the teenage years. This group of teens is typically thought to be at greater risk of developing serious problems, including criminal activity, violence, and drug use.

How are teen behavioral issues addressed in therapy?

Because we are not talking about a specific syndrome here, answers may vary depending on the specific concerns you have. But on this page, I have focused on many of the challenging “growing pains” that are common in adolescence (e.g., underperforming in school, risk-taking behaviors, etc.) rather than issues like anxiety or depression. In this case, a family-focused approach is typically recommended. In more serious cases, approaches like Functional Family Therapy, Brief Strategic Family Therapy, or Multi-Systemic therapy (MST) were developed specifically with juvenile offenders in mind, and outcomes were focused on reducing recidivism for various crimes. However, most of the time these treatments are like Morphine when all that is needed is Tylenol. Behavior therapy with significant parent involvement is usually the best first step, with teen participation usually being the best practice as they get older. As I often say in treatment, “everything is a negotiation now”: Therapy will help you balance the fact that you are still “in charge” and also the fact that the person standing in front of you is cresting into adulthood and deserves a say in the ways that rules and expectations are discussed. Sessions would likely focus on age-appropriate communication, expression of feelings and boundaries, and building a reasonable contract of expectations that works for everyone.