How Trauma Therapy for Teens Works

While trauma therapy for teens can be a valuable tool to heal trauma, It’s understandable that teens beginning therapy for the first time might feel intimidated and parents might feel uncertain. A common worry is that teens will have to retell traumatic experiences immediately to their therapist, but that isn’t the case. Teens should expect for their therapist to help build a level of comfort, safety, and agency in which they have a say in their goals. Learning more about the process and what to expect will help going into the first session and beyond.

This article will help answer the questions teens may be wondering, such as:

What will I have to talk about?
Will my parents find out what I say?
Will I get to choose what we work on?
What if I don't like my therapist?

What is Trauma Therapy for Teens?

Experiencing something scary, painful, or unsafe can have a deep affect on a person’s emotional, physical, and psychological wellbeing. Your nervous system can be on high alert for a long time after a traumatic event causing you to feel anxious, stressed, or to not feel anything at all. Trauma therapy is meant to be a safe place to process memories, to help you learn coping skills, and to heal in your own time. This is accomplished with a trauma-informed therapist who can help guide you within your own comfort limits.

What Can Be Considered Trauma?

Trauma can occur as a result from any event that is overwhelming, scary, or painful. While some trauma can stem from a single occurrence or traumatic event, trauma can also develop over time subtly. It might come from an unsafe or difficult home environment, physical or mental abuse or neglect, or another experience that impacts your sense of safety, trust, or self-worth.

At the same time, not every difficult family experience or event should be labeled as “trauma.” Difficulties are a part of everyone’s lives. You can recognize trauma, however, if your sense of safety or security has been threatened. Actual trauma can cause your nervous system to become stuck in fight, fly, or freeze. With other events, you will be able to process them and eventually move on.

How Trauma Can Affect Teens

Trauma affects everyone differently, but there are common noticeable patterns that emerge through trauma responses. These responses are essentially survival mode responses that automatically kick in and are meant to keep you safe. However, if you’re always on constant alert even after the event has passed or have lingering symptoms that come from repeated traumatic experiences, then this can become a challenge.

For example, your trauma might be a result of a single event yet you still experience anxiety, fear, anger, or irritability because of it. Those who grew up in certain environments with critical or emotionally immature parents can experience ongoing trauma over years and years. This trauma can lead to difficulty trusting others, relationship problems, low self-worth, difficulties with setting boundaries, and trouble with regulating emotions. No matter your experience, it can be difficult to battle trauma on your own; sometimes, you need help from a trauma-informed therapist.

What to Expect When You Start Trauma Therapy

Nervous going into your first trauma therapy session? Let’s look at what you can expect.

Before the First Appointment

Before you even begin therapy, take advantage of any consultations or intro calls a potential therapist offers. These are usually free and meant to see if you are a good fit for each other. Some are done over the phone, and some may be held over a video call.

Intro calls are a great place to ask the therapist questions. Ask what their style of therapy is and what it’s like working with them. Ask if they work with their clients as collaborators. Ask how they establish a sense of safety with their clients. Do they have experience in working with your type of trauma or background? It’s important to be on the same page as your therapist and feel like your needs will get met.

A consultation or intro call would also be a great place to discuss confidentiality and parent involvement with both the parent and teen at the same time. This way, both can feel aligned on what to expect and know what details will remain private versus what can be shared to update the parents on progress. The therapist should also clearly explain the boundaries of their patient’s right to privacy, like in the event of abuse or harm to themselves or others.

You can also discuss practicalities like logistics to make sure your schedules will align for sessions as well as making sure the therapist accepts your health insurance if needed.

What Happens in the First Session?

Your first session with your therapist will be about getting to know one another, establishing a safe and trusting environment, and helping your therapist learn more about what brought you into therapy. Your therapist will ask about your background and history, current concerns and your initial goals. You can ask questions about your therapist and the process.

It can be especially difficult as a teen to share about yourself, but understand that your therapist is here to help you reach your therapy goals and should feel like a safe person to confide in, though that will take time to build.

Do You Have to Talk About Your Trauma in the First Session?

The first session won’t be about immediately diving into your trauma or details of your experience. You should expect that your therapist will want to get to know you and understand your goals so they can help guide your treatment. Therapy may first focus on safety, coping skills, emotional regulation, and understanding what’s happening before moving into your specific experience. As sessions progress, they will continue to follow you and your comfort to help set a pace that doesn’t overwhelm your nervous system.

Will My Therapist Tell My Parents What I Say?

A major concern teens may have about starting trauma therapy is if what they share with their therapist is really confidential. You have a right to privacy and to be free from the fear that your parents may learn what you think of them or their actions. The good news is therapist-client confidentiality is still upheld when it comes to teens.

What Does Confidentiality Mean in Teen Therapy?

Therapy relies on a trusting relationship between the therapist and client. Your privacy matters and experiencing non-judgemental feedback to help regulate your emotions or work on your therapy goals from a trusted therapist can do wonders for your self-esteem and overall wellbeing. You can express your thoughts and feelings freely without worry. Therapists are professionally required to establish boundaries with parents for them not to ask for specific details of what is said in therapy. This protects your privacy.

However, mental health laws are not universal for teen therapy confidentiality. They vary based on location, age, consent arrangements, and the therapist’s policies. Depending on the state, a 12 to 14 year old would be considered old enough to legally consent to their own mental health treatment while in other states the age is 18. In Nevada, the age of medical consent is 18 years old (with some exceptions). If a parent arranges the therapy, then they generally have a right to be updated on progress and have a legal right to treatment records.

What Might a Therapist Share With Parents?

As mentioned above, parents are not given access to any specific details of what their teen says in therapy without their consent. However, they are allowed to receive general information about the treatment and updates on how things are progressing. This broader information that could be shared with parents might include:

On-time attendance
Whether the teen is participating actively or not
General themes that are being worked on (coping skills for high stress or communication strategies)
An overall picture of the treatment goals like working on particular symptoms, sleep habits, or managing behaviors
How the teen is progressing
Guidance of how the parent(s) can help at home

When Does a Therapist Have to Break Confidentiality?

Your therapist operates under the ethical principle of “do no harm” just like a medical doctor does and must walk a careful balance between protecting your privacy and also ensuring your safety and the safety of others. There are two very specific instances when a therapist is required by law to break confidentiality. These include circumstances that require mandated reporting and those that fall under the imminent danger category.

Mandated reporting is a legal requirement to report known or suspected abuse, neglect, or harm to state protective agencies. They legally must report this information even if a client asks them not to. Mandated reporting focuses on past or ongoing abuse, neglect, or harm to a child or minor by someone else.

Imminent danger means that self-harm or harm to others is likely to occur. At all times, if a teen or client tells their therapist about self-harm or suicide, the therapist will take the disclosure seriously. Depending on the circumstances, the therapist will have to assess the safety and risk and whether or not they need to take action. Depending on the circumstances, parents or other supports may need to be informed. When possible and clinically appropriate, the therapist can explain to the teen what they're going to share and why.

Who Decides What You Work on in Therapy?

Ultimately, therapy is for your benefit so you need to be the deciding factor when it comes to choosing what to work on in your therapy sessions.

Creating a Treatment Plan

Your personal goals for therapy are a major part in having a successful therapy experience. It’s important to help your therapist understand why you’re seeking therapy so that you can come up with goals to get you there. Expect to discuss your goals early on with your therapist.

Once your therapist understands your goals, they will be able to develop the clinical recommendations on how to get to those goals safely and efficiently. This might look like recommending certain types of therapy, recommending behaviors to help make adjustments, or working on certain skills to mention a few. Oftentimes, your work will need to continue outside of therapy and you and your therapist can come up with a plan of what to focus on during sessions.

Goals should be seen as dynamic and evolving. What you might consider as your goal to start with might reveal itself later to be working on a symptom of a deeper problem. As you work through and achieve milestones, you’ll naturally need to move on to others.

What to Expect Your Teen Therapist Will Help Support With

Therapy can support teens in a variety of areas that include relationships, friendships, past abuse, healthy boundaries, as well as self-confidence.

Examples of possible goals:

To trust people again.
To stop getting so angry.
To feel more confident.
To create healthier relationships
To set healthy boundaries (with parents, friends, in relationships)

Work together with your therapist on coming up with goals that best fit your needs right now. Just remember that it’s normal for those goals to change.

How Do I Know If My Therapist is a Good Fit?

While it’s true that not every therapist will be the best fit for you, there are some important qualities you should consider when assessing a potential therapist. Trust takes time to build with your therapist, but in general, you should feel respected and heard in sessions and that you are in a safe and caring environment. If things feel off or like it’s not a good fit, you can let your therapist know and look for another one. Here’s what to look out for in a good teen therapist.

Your Therapist is Open to Feedback and Working With You

Your therapist should be a collaborator who works with you on reaching your therapy goals and giving you guidance on how to get there. They should still respect your agency in deciding which goals you want to focus on, how comfortable you are with the pacing of your treatment, or communicating positive or negative feedback about your treatment.

How you might communicate with your therapist:

"I don't want to talk about that yet."
"I don't understand why we're doing this."
"I'd rather work on something else."
"I think I need more practical tools."

Communication with your therapist is key. Pay attention to how your therapist responds and if they are open to working alongside you to make necessary changes or pivots as needed. Therapy will have uncomfortable parts as well so just remember that as you go and keep communicating with your therapist if you need to change pace or try something else.

There are Good Boundaries in Place With Your Therapist

Your therapist should establish good boundaries with you early on in your work together. Communication should mainly happen in your sessions. Do not expect to have much communication with your therapist between sessions.

Between therapy sessions, your therapist should share with you how to contact the practice if needed and give you a clear picture of when it would be appropriate to do so. Your therapist should also share what constitutes an emergency situation versus non-emergency and how to handle communication in those situations.

Signs the Relationship is Productive

In general, a good therapist is one that helps you progress in your personal therapy goals and makes you comfortable enough to be able to share your thoughts and feelings with them honestly. If you feel heard and respected, that you can ask questions without being dismissed or shamed, that you can disagree freely with something your therapist says or asks you to do, and in turn your therapist explains things patiently and is helpful, then you have a productive client-therapist relationship that will really serve you well.

You Don’t Have to Figure it Out Alone

Making a decision to begin therapy is a huge step toward your healing, and it can feel like an especially big and possibly overwhelming choice for a teen. You don't have to know exactly what's wrong, know what your goals are, or be ready to talk about everything that happened. The first step is simply finding a therapist you feel comfortable working with and beginning the conversation.

Trauma Therapy for Teens: What to Expect, How It Works & Finding the Right Therapist