Adolescent Therapy

Adolescence can be a difficult time for many youngsters. Hormones are racing, the body is changing, and emotions are unstable. Human relationships are often difficult to deal with and life in general can be confusing and even frightening as the teenager, trapped between childhood and adulthood, struggles to make sense of their place in society and confronts their mortality. To those powerful insecurities can be added further stresses of peer pressure and school. It’s not surprising that some teenagers become ‘difficult’.

A troubled teenager may become confused, depressed or angry. What begins as occasional spells of brooding and melancholy may lead to frequent and very distressing periods of depression in which the mood is one of consistent sadness or a vision of life, now and in the future, as grim and bleak.

There are two basic types of depression: major depression, which lasts for at least two weeks, and the longer-term form of depression, dysthymic disorder. In the latter there seems to be a connection between the teenager's temperament or attitude and their long-standing depressed mood. 

What are the signs of teenage depression

Depressed teens do not always seem depressed. Instead, they may be irritable or moody: one moment sad, the next angry. They may be anxious, agitated or develop exaggerated fears. Another pointer to depression is loss of interest in an activity they previously enjoyed. They may sleep or eat too little or too much and have difficulty concentrating or making decisions. Feelings of worthlessness, guilt or anger may trigger suicidal thoughts or an obsession with death.

During a period of depression, a teenager may seem sad, tearful, withdrawn, uncharacteristically listless, and dull. He or she may appear to lack initiative, and may neglect their appearance, looking dirty, with mismatched clothes and dishevelled hair. This is not a fashion statement. Movements are slow; the voice sounds monotonous, with speech reflecting hopelessness and despair. Phrases such as “I'm stupid”, “No one loves me” or “I'm bad” may be used.

Naturally, this downbeat attitude often has a negative or depressing effect on others, causing them to avoid the difficult teenager.Teens with dysthymic disorder have milder symptoms of depression, but they may last for as much as for a year or more. The symptoms include a depressed, irritable, volatile mood; appetite and sleep changes; diminished energy; low self - esteem; feelings of hopelessness; poor concentration and indecisiveness. Their chronically depressed mood colours every experience, impression, and response, and they see most things negatively

What causes adolescent depression

Depression is a complex and multifaceted condition. Some sufferers may be genetically and/or biochemically predisposed to depression. It can also be linked to unresolved grief, perhaps in response to early loss of a nurturing figure. Some depressed adolescents may regularly witness or be a victim of parental aggression, rejection, punishment, or parents abusing each other.

Depression may be a reflection of the adolescent feeling helpless in the face of life's problems, rather than feeling empowered to seek solutions. And of course depressed thinking is usually negative, hopeless and self-defeating, which tends to reinforce the cycle of depression.Girls appear to suffer adolescent depression more often than boys, and this often continues into adulthood.

Complex neurobiological and socio-cultural factors are the likely explanation for this difference. Because boys are often encouraged to translate feelings into actions, their depression is more likely to produce external behavioural disturbances. Girls are usually more focused on their internal feelings, leading them to become acutely self-conscious about their bodies and performance.

What are the consequences of adolescent depression

Depression usually interferes with a teenager's social and academic functioning. School performance usually deteriorates because the teenager cannot concentrate and feels listless, incompetent and unable to finish schoolwork. He or she may skip classes and lose interest in extracurricular activities. And although teens naturally like to sleep on in the morning whenever possible, depressed teens may nap excessively throughout the day and go to bed early. They may complain of a headache or stomach ache, especially before a social event.

These emotions may lead to behavioural issues such as eating disorder, substance abuse or delinquency. In extreme cases, hopelessness, despair that things will never change, and a general feeling of deadness may lead to dangerous behaviour, such as self-harm, or even a suicide attempt. 

When is it right to seek help

To help decide whether symptoms are serious enough to seek assistance, talk with your teenager and let them know that you see their sadness. Showing interest and a desire to help will give them hope. You may find it difficult to understand why they feel such a catastrophic sense of loss or perceived failure, so it's important to listen carefully and to try to imagine yourself in their position. Without pressure, point to activities they enjoy and handle successfully.

Help them to build self-esteem by recognising small triumphs and admiring competence. Try to decide whether they seem capable of handling their feelings or are overwhelmed. Treatment may be necessary if the symptoms persist, especially if they begin to interfere seriously with their life.

What treatments are available

Therapy can be helpful for a variety of issues because it helps the adolescent to understand and overcome their emotional and behavioural problems. Individual psychotherapy  Therapy offers support and empathy while encouraging exploration of the depressed feelings and symptoms. While creating a sense of safety by setting limits on dangerous behaviour, a therapist will encourage a teenager to express the feelings that upset them.

Therapy helps the adolescent deal with these feelings rather than acting them out. If their self-esteem seems particularly low, the therapist may use skills training to improve their confidence and competence. If a specific circumstance or event has triggered the depression, therapy gives the youngster a chance to resolve their feelings and accept the reality. 

Cognitive Behavioural Therapy (CBT)

CBT is often effective in treating adolescent depression. It focuses on the irrational beliefs and distorted thoughts that are part of depression, such as a negative view of the self, the world, and the future. Usually a depressed teen personalises failure, magnifies negative events, and minimises positive events and attributes. Sometimes these negative thought patterns have been formed or reinforced by the teen's home environment. Cognitive therapy focuses on identifying negative thought patterns or distortions and on helping the adolescent to change their way of thinking.

Group Therapy

Group therapy for depressed teens can help them to develop or improve their social skills, which can lead to a greater sense of mastery and improved self-esteem. Teens may find it easier to express feelings in a supportive peer group environment. There are also support groups for parents, which can help them to manage specific problem behaviours, use positive reinforcement, communicate better, and listen better.

Family Therapy

If the teenager is willing and able to work within a family context, family therapy can address problems such as a lack of boundaries; severe marital conflict; rigid or chaotic rules; and neglectful or overly involved parent-child relationships. Family therapy can also help parents to manage specific problem behaviours; use reinforcement correctly; listen to and communicate with their teenager in an age-appropriate manner; and support the teen as they prepare to move beyond the family structure.