4 Common Types of Counseling, Explained

In honor of National Counseling Month,here are the different types of counseling we offer at Doorways (photo credit: BigStockPhoto.com)

In honor of National Counseling Month, here are just four different types of counseling we offer at Doorways (photo credit: BigStockPhoto.com)

April is Counseling Awareness Month which provides us with an excellent opportunity to talk about the different types of therapy that are often grouped under the “counseling” category.

For anyone new to mental health services, it can feel like the providers you are working with are speaking a different language.

Because there are several different therapeutic techniques available, seeking out services for your teen can easily become overwhelming.

To help you feel more comfortable reaching out and getting your teenager the help he or she needs, here is a breakdown of the most common types of psychotherapy in use today.

Gaining a basic understanding of the types of services available can help you to make an informed decision.

To help, here is a basic overview for each of the four most common types of counseling or therapeutic techniques used with teens.

Cognitive-Behavioral Therapy (CBT)

When people talk about going to “therapy” this is generally what they mean.  CBT is one of the most common types of therapy provided to teens and is often used as a foundation for treatment that can be combined with other types of therapy.

The premise of CBT is that our early lives including our childhood, upbringing, and the environment in which we were raised dictate who we become.

This means that the dysfunctional patterns and coping strategies we learned in our childhood and adolescence follow-us into adulthood.

CBT works to identify and replace the dysfunctional areas with healthy alternatives primarily through talk therapy.

Behavioral Therapy

Behavioral therapy uses key behavioral modifications to effect change in thought patterns and emotional responses.

It is much more structured than CBT and focuses on changing behaviors in order to overcome challenges.

Dialectical Behavior Therapy (DBT)

DBT uses the same techniques for learning to regulate and manage emotion as CBT but pairs them with practices like mindfulness and acceptance.

Although this type of therapy was originally developed as a way to treat people with borderline personality disorder (BPD), it is also proving to be effective at helping those who participate in self-harm like cutting and those with mood spectrum disorders.

Humanistic Therapy

Humanistic therapy takes a completely different approach to helping those with mental health concerns that the behavior-based therapies listed above.

Here, any dysfunction resulting from childhood experiences, traumatic events, or learned behaviors is irrelevant.  Instead, this method of treatment centers on self-actualization, fostering the idea that people are responsible for their own choices and that what matters is taking responsibility for the thoughts, feelings, and behaviors that are being experienced.

It is important to remember that these are only the most common therapeutic approaches used in treating mental health concerns that are often combined with these foundational techniques to better meet the needs of the individual client.

Most mental health providers will have a variety of tools in their toolbox which enables them to tailor their approach to treatment to the strategies, techniques, and tactics that are the most suitable for the situation.

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6 Tips for Helping Teens Manage Social Anxiety

It is normal for teens to experience anxiety. But, do you know when it crosses the line to become something more? (photo credit: BigStockPhoto.com)

It is normal for teens to experience anxiety. But, do you know when it crosses the line to become something more? (photo credit: BigStockPhoto.com)

It is normal for teenagers to experience anxiety as they make the transition from childhood to adulthood.  From changing bodies to changing schools, teenagers can feel like everything in their world is in a constant state of fluctuation.  They worry about fitting in, making friends, getting good grades, being popular, and being accepted.  This kind of anxiety is normal and can be beneficial.  If a teenager is worried about making the basketball team, that anxiety can inspire them to practice more over the summer.  However, when the anxiety centers on social interactions or relationships it can impose unnecessary limitations on our teenager’s lives.  While some teenagers experience this kind of anxiety to such a degree that professional help is warranted, every teenager can benefit from parents who offer support and guidance to help manage these social anxieties.

Whether your teenager’s social anxiety is severe or not, here are some things you can do to provide a supportive environment.

1.     Know the Signs

In order to be helpful and supportive, parents need to be able recognize the signs of social anxiety.  After all, it is very difficult to help if you don’t know there is a problem.   Here are some of the most common signs:

  • Intense fear of social situations
  • Intense fear of having to perform in a social situation
  • Avoidance of social situations
  • Experiencing significant distress when in social situations
  • Limited interaction with peers
  • Sits alone in social environments like the library, classroom, or cafeteria
  • Excessive concern about being embarrassed or humiliated
  • Difficulty speaking in public
  • Unwillingness to participate in class

2.     Know the Severity

While some social anxiety is normal for any teenager, this kind of anxiety can develop into a debilitating disorder.  If you feel that your teen’s social anxiety is significantly impacting their life and future, seek the advice of a qualified mental health professional to determine if additional support is needed.

3.     Work with the School

If your teenager is struggling with social anxiety, set up an appointment with their guidance counselor and/or teachers to discuss your concerns.  Since many of the social situations your teenager experiences happen during school hours, enlisting the support of their educators can make a significant difference in the outcome.

4.     Don’t Enable Avoidance

As parents, we hate to watch our children struggle but this can lead to unhelpful behavior on our part.  Don’t reinforce the anxiety by trying to help your teen out in uncomfortable social situations like ordering food in a restaurant or taking care of phone calls.  While it may seem like you are helping your child, you may actually be reinforcing the idea that they cannot handle the task.  Encourage your teen to participate rather than participating for them.

5.     Strategize

Help your teen brainstorm ways to handle situations that make them anxious.  Support them in developing their own solutions to the problems they are facing.

6.     Support Rather than Reassure

One of the ways teens seek to manage their social anxiety is to seek reassurance over and over again, especially from parents.  While it may feel like you are being supportive by reassuring your teen, you may actually be preventing them from developing the coping mechanisms they need to learn to manage their anxiety constructively.

Understanding, Diagnosing and Treating PTSD

Post Traumatic Stress Disorder, which can affect anyone at any age, can be difficult to diagnose because there may be a lag between the start of symptoms and the triggering traumatic event.  In fact, it is not uncommon for symptoms to start slowly and increase in frequency and/or severity over time.  This is one reason that understanding the signs and symptoms of PTSD

Heed these warning signs that your teen may have PTSD (photo credit: BigStockPhoto.com)

Heed these warning signs that your teen may have PTSD (photo credit: BigStockPhoto.com)

is crucial for anyone who has experienced trauma or who has a loved one that has been through a traumatic event.  The key to managing and overcoming the disorder is timely diagnosis and treatment which underlines the importance of knowing what to look for and knowing when it is time to seek help.

There are many challenges for those living with and working with PTSD.  Diagnosis can be challenging because symptoms do not present the same way in every person.  The start of symptoms may not seem to link back to the trauma which can also lead to missed or misdiagnosis.  Because there is still much we don’t know about the disorder, it is difficult to predict who will experience it and who won’t.  There are, however, some common risk factors that seem to make people more susceptible to PTSD.

  • Previously experiencing a traumatic event
  • History of mental illness
  • Lack of social support following the trauma
  • Being injured in the course of the event

Diagnosis is made by a qualified mental health practitioner based on a discussion with the person experiencing the symptoms.  In order to be diagnosed with PTSD, the National Institute of Mental Health indicates that a person must be experiencing at least one of the following for a month or more:

  1. One or more re-experiencing symptoms which include nightmares, flashbacks, and frightening thoughts
  2. Three or more avoidance symptoms like avoiding places, objects, or events that are similar to the traumatic event, experiencing a consistent feeling of being numb, losing interest in favorite activities, and difficulties with memory related to the event
  3. Two or more hyperarousal symptoms like being easily startled, feeling tense, feeling on edge all the time, and having angry outbursts
  4. Other symptoms that make it difficult to participate in daily life

While PTSD is treatable, it rarely resolves itself without the assistance of professional help.  Most people with the condition recover fully after treatment.  The most common forms of treatment are therapy and medication.  A variety of therapeutic approaches have been used successfully to treat the disorder including cognitive behavior therapy, talk therapy, and exposure therapy.  Most treatment plans use a mix of these methods to achieve the best overall result.  When medication is used as part of the treatment plan, it’s job is often to alleviate the symptoms of other underlying conditions like depression or anxiety that can exacerbate the symptoms of PTSD and make recovery more challenging.

If you are concerned that your teen is suffering from PTSD, don’t wait to schedule an appointment with a qualified mental health practitioner.  Remember that PTSD is treatable and complete recovery is possible, but getting help is the fastest path to those outcomes.

How is DBT Different and How Does it Help?

DBT stands for Dialectical Behavior Therapy and it is a therapeutic approach for treating certain conditions that commonly impact teenagers.  Although it was originally created as a way to help those diagnosed with borderline personality disorder, it is also proving effective at helping teens who are participating in self-harming activities and those who have acknowledged having suicidal thoughts.  It is an approach to treatment that combines several different kinds of therapy and mental health coping mechanisms into a single overarching program.

One of the most important aspects of a DBT program is the type of relationship that the provider strives to achieve with the client.  In some programs and even during individual therapy practices, the practitioner operates in an adversarial capacity, especially in working with teenagers.  However, in DBT programs, the provider’s goal is to build a different kind of relationship, one where the teen feels supported and the provider is their ally rather than another enemy.

The program also pulls from a variety of therapeutic approaches and techniques aimed at treating the whole person as well as the whole problem.  DBT generally include individual cognitive behavioral therapy, group therapy sessions, mindfulness training and activities, reality testing, distress tolerance, and some assertiveness training.  Let’s look at each of these individually.

  • Individual Cognitive Behavioral Therapy Sessions –This type of therapy helps clients address issues with emotional dysfunction and behavior modification.
  • Group Therapy Sessions – This type of therapy works on building the client’s skills in regulating their own emotions, modifying their behaviors, and tolerating stressors in a more productive way.
  • Mindfulness Training – This practice can help with stress reduction, present awareness, relief of anxiety and depression symptoms, and overall wellness.  This is a core part of DBT as it provides the foundation for accepting, enduring, and overcoming the powerful feelings that clients may be using unhealthy behaviors to manage.
  • Reality Testing – This helps clients understand and differentiate between what is happening in their mind and what is happening in the outside world.
  • Distress Tolerance – This approach helps clients learn to tolerate pain and distress in a non-judgmental way so that they can make decisions and react without becoming besieged by the torrent of negative emotions and self-destructive behaviors they have been using to cope.
  • Assertiveness Training – This part of the program helps clients learn to create healthy boundaries, say no, and handle conflict with other people.

The combination of all this components is what makes DBT such an effective form of treatment for teens.  By learning mindfulness techniques, teens can learn to pause before reacting to negative events.  The distress tolerance and reality testing elements build from there, providing teens with new skills to cope with painful circumstances and past stressors while also being able to separate what is happening from their perception of what is happening.  In their individual sessions, they gain a better understanding of themselves and their emotions and learn new skills for challenging and changing their behavior.  Group sessions provide an opportunity to practice the skills they have learned with their peers and improve their interpersonal skills.  Lastly, the assertiveness training gives them a framework for using the things they have learned out in the world.   When you combine all the skills, strategies, techniques, and tools together, clients get the attention they need to work through complex emotional issues while also building a solid skill set that will enable them to self-manage.  This comprehensive approach is what makes DBT so successful at treating maladaptive behaviors like cutting, self-harm, and suicidal tendencies.

DBT helps because it enables teens to develop a more balanced approach to their lives.  For teens that feel overwhelmed or out of control emotionally, this type of program can provide a sense of regaining some control.   By enabling teens to replace unhealthy behaviors with higher distress tolerance and more appropriate coping mechanisms, it enables them to become better self managers now and as they move into the future.  It is most effective at treating teens with the following problems:

If you have a teenager who is experiencing any of these problems, participation in a DBT program may offer real and lasting benefits by providing your teenager with a safe space to work through their emotions and a new set of skills.

What is DBT and How Can it Help My Teenager?

As parents, there is nothing more frightening than watching our children suffer and struggle, and feeling powerless to help them.   When teens are injuring themselves and struggling with suicidal thoughts and tendencies, that powerlessness can feel overwhelming.  Too often, parents disregard the signs and ignore what is right in front of them because they don’t know how to help.  This “ignore the problem in the hope that it will go away” approach can have serious consequences for their teenager.  Other parents see what is going on but don’t know what to do or how to help.  The first step in getting your teenager help is to acknowledge that there is a problem.  The second step is to find a professional mental health practitioner that can help.

When most people think of getting mental health, they likely envision traditional talk therapy or individual cognitive behavioral therapy, both of which are standard therapeutic approaches used to treat teenagers who are participating in self injuring activities and those who have expressed suicidal thoughts.  Both of these approaches can be very effective in dealing with these issues and any underlying issues like depression and anxiety.  There is also an emerging approach called Dialectical Behavior Therapy (DBT) that has is also proving to be very effective at helping teenagers overcome these challenges.

DBT was originally developed as a way to treat women with borderline personality disorder (BPD).  It combines individual cognitive behavioral therapy techniques, mindfulness, reality testing, distress tolerance, and the concepts used in assertiveness training.   One of the hallmarks of DBT is that the mental health practitioner strives to create a relationship with the teenager that is allied rather than adversarial.  In effect, the therapist or counselor acts as an ally, validating feelings and offering acceptance while helping redirect feelings and behaviors that are destructive or harmful.

DBT also uses a combined approach which incorporates both individual therapy sessions and group sessions.  The group sessions focus on building a skill set that helps teens in four key areas, regulating emotions, practicing mindfulness, increasing effectiveness, and tolerating distress.   One of the reasons DBT can be so effective in helping teens is this two-pronged approach.   While the group sessions give teens the skills they need to overcome these challenges and the opportunity to practice utilizing these skills with other teens, the individual sessions ensure emotional issues and suicidal thoughts and tendencies get the attention they need while the teenager is building the skills they need to self-manage.

DBT can help teenagers who are already engaging in self-harm and may also be helpful in preventing self-harm behavior from occurring.  By giving teenagers the skills they need to regulate their own emotions, become more resilient in dealing with distressing situations, and embrace a mindfulness approach to their lives, DBT can help troubled teens before they seek relief from maladaptive behaviors.   DBT can be effective method for helping those who are already cutting and struggling with suicidal tendencies overcome those challenges as well as a way to prevent these problems before they start.

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Common Types of Psychotherapy

For parents new to the world of mental health, the different types of practitioners and the different therapeutic techniques can seem overwhelming.  The good news is that you don’t have to know all the answers in order to find a mental health professional that can help your child.  However, it is helpful to have a basic understanding of the most common types of psychotherapy in use today so that you can feel like you are making an informed decision.  To help you with that understanding, here are the basic definitions of the most common types of psychotherapy.

Cognitive-Behavioral Therapy

One of the most common types of psychotherapy in use today, Cognitive Behavioral Therapy is often combined with other techniques and methodologies to provide the most comprehensive treatment for a client.  In essence, the cognitive-behavioral approach to mental health rests on the idea that children learn what they live.  The environment a person is raised in, the circumstances of their upbringing, and the major events of their childhood and adolescence play a large role in who they become.  If a child is raised by parents that don’t express their emotions in a healthy manner, the child will mimic this dysfunctional response and may struggle to identify and express their own emotions.   Cognitive-Behavioral therapy (CBT) works to replace those dysfunctional thought patterns, responses, and behaviors by introducing healthy alternatives and reinforcing the change through positive experiences.  As the problems each client is facing are different, the techniques, tools, and strategies used in CBT can vary and are generally specific to the needs of the individual client.

Behavioral Therapy

Behavioral therapy is also based around behavior but differs in that it seeks to use changes in behavior to change thought patterns and emotional responses.   This approach to psychotherapy is very structured and includes techniques like self-monitoring, role playing, and behavior modification.

Dialectical Behavior Therapy 

This type of psychotherapy combines cognitive-behavioral techniques geared at learning to regulate emotions and learn to identify reality versus perceptions with practices like mindfulness, acceptance, and distress tolerance.  It was primarily developed as a way to treat people with borderline personality disorder (BPD) and is the first therapy to prove effective in helping those with BPD.  It also shows promise in helping those with spectrum mood disorders like self injury and can an effective approach for treating teens who exhibit cutting behaviors.

Humanistic Therapy

The Humanistic Therapy method of treating those with mental health concerns takes a very different approach than the behavior-based methodologies.  It centers on the concept of self-actualization and the idea that people are responsible for their own choices.  This means that childhood experiences, learned behaviors, and any resulting dysfunction are irrelevant, what matters is taking responsibility for the thoughts, feelings, and behaviors experienced.   Therapy may focus on major internal conflicts like acceptance, authenticity, and individualism.

Psychodynamic/Psychoanalytical Therapy

This is one of the oldest schools of thought around treating mental health concerns and centers on how someone’s childhood, upbringing, and parental relationships are impacting their current lives.  Although psychodynamic analysis may be part of a mental health professionals approach to treatment, it is not generally the only tool in their toolbox.

It is important to remember that these are not the only types or techniques used by mental health practitioners.  There are many other approaches and methods that are valid and proven to help those in need.  The most important factor in getting your child the help they need is to find a mental health professional that your child is comfortable with and partner with them to find the right approach for your child’s needs.

Generalized Anxiety Disorder: What Parents Need to Know

A teen singing.

Generalized anxiety disorder most commonly affects those between adolescence and middle age. Image via Wikipedia


Everyone worries about things, even children and teenagers.  Whether the worry is over the upcoming history test, getting a date to the prom, or making the soccer team, anxiety is a normal part of everyday life.  However, in some people, normal everyday worries can become excessive and everyday things can cause severe anxiety.  This type of anxiety is called Generalized Anxiety Disorder (GAD) and it affects about 3% of the U.S.population each year, including one in eight children.

Generalized Anxiety Disorder is characterized by exaggerated anxiety and unwarranted worry about everyday problems.  People with this disorder may obsess about the worst case scenario in every situation and are unable to stop their anxiety from spiraling out of control.  Women are two times as likely to have the disorder and it most commonly affects those between adolescence and middle age.

Teens and young adults with the disorder may not do as well in school, may be susceptible to substance abuse problems, and may struggle with social milestones if it is not treated.  However, with the right combination of treatment, support, and assistance, children with GAD can learn to manage their symptoms and successfully navigate their lives.


People with GAD experience consistent, persistent, chronic worry or anxiety about things that do not warrant this level of anxiety for more than 6 months.

One of the key differences between the anxiety everyone experiences and GAD is that everyday anxiety is temporary and GAD is not.  Adults and children with GAD can experience heightened anxiety all day, every day and it can interfere with their normal activities.  It is common for those with GAD to use avoidance as a tool for managing their anxiety.  An adolescent who is experiencing temporary anxiety will respond to comforting words, reassurances, and a list of the reasons they don’t need to be anxious.  The anxiety of a child or teen with GAD will not be soothed by these techniques.

In addition to the chronic nature of the anxious thoughts and feelings someone with GAD experiences, there are also some physical symptoms that are often present with the disorder including:

  • Unexplained fatigue and problems sleeping
  • Restlessness, edginess, and irritability
  • Gastrointestinal problems including  nausea and diarrhea
  • Difficulties concentrating and headaches


Generalized anxiety disorder has no known cause but stress, traumatic events, heredity, and biological factors may contribute to its onset.  It is relatively common and can affect people of all ages.  Although it generally develops gradually over time, many people with the disorder cannot remember a time when they did not experience some level of anxiety.


Many people with GAD respond well to cognitive behavioral therapy, medication, or a combination of both.  Therapy can be beneficial in helping a person with the disorder to identify their triggers and modify their thought patterns and behavior.  Techniques for easing anxiety and promoting relaxation can also be beneficial to those with GAD.

It is very common for people with GAD to have a co-existing disorder.  Depression, substance abuse, and other anxiety disorders are commonly seen in those with the disorder.  Getting diagnosis and treatment for any co-existing conditions is an important part of overall treatment for GAD.

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Is Obsessive Compulsive Disorder Affecting My Teenager?

Person washing his hands

Does your teen struggle with OCD?  (Photo credit: Wikipedia)

It can be difficult in this age of acronyms to know when your teenager’s behavior is appropriate for their developmental stage of life of when it’s something that a parent should be concerned about.   With anxiety disorders like Obsessive Compulsive Disorder (OCD), it is even harder to find.  The difference between the two is the impact it has on the child’s daily life.

What is Obsessive Compulsive Disorder?

Obsessive Compulsive Disorder (OCD) is an anxiety disorder that causes those who suffer from it to experience persistent anxiety, fear, or distressing thoughts and/or exhibit a ritualized behavior as a method to control their anxiety.  For example, a child might be so afraid of germs, they wash their hands every 15 minutes.  The obsessive nature of these thoughts and their compulsion to perform the ritual interfere with the teenager’s daily life.

Someone who is afraid of germs may develop a ritual that involves washing their hands a certain number of times at certain points over the course of the day.  A child who is worried about their house burning down may develop a ritual involving checking their smoke alarms and fire extinguishers to ensure they are operating.  It is important to remember that someone with Obsessive Compulsive Disorder does not believe they can control their compulsions and that these rituals offer only a temporary respite from their anxiety.

People with Obsessive Compulsive Disorder, both children and adults, may realize that their behavior is out of the ordinary but this is not always the case in children.   OCD may be accompanied by other conditions including depression and eating disorders and affects the same number of males and females.  In many cases, Obsessive Compulsive Disorder first presents during adolescence or the teen years.

What Causes Obsessive Compulsive Disorder?

Obsessive Compulsive Disorder is a brain disorder.  Research has shown that it does tend to run in families but there is no clear indication of why one person develops the condition and another doesn’t.  But the truth is clear, that OCD is no one’s fault, and especially does not occur because of something a parent did, or did not do.

What are the Symptoms of Obsessive Compulsive Disorder?

A person suffering from Obsessive Compulsive Disorder will display many of the following symptoms:

  • Repetitive thoughts that are distressing or cause anxiety about several different things.  Common obsessive topics include germs, dirt, crime, sexual acts, cleanliness, violence, or hurting others.
  • Ritual behavior patterns associated with their obsessions that they complete over and over to alleviate the anxiety.  Rituals can involve actions like repetitive hand washing, locking and unlocking doors or windows, counting, and performing things in a specific way again and again.
  • Performing rituals can be distressing and are not a source of comfort or pleasure although they do alleviate feelings of anxiety temporarily.
  • Obsessive thoughts and rituals occupy at least one hour a day and impact the person’s daily life.

Symptoms may come and go over time and it is not uncommon for people suffering from OCD to use avoidance techniques to try and keep their anxiety from being triggered.

How is Obsessive Compulsive Disorder Diagnosed?

As with many mental health conditions, start with your medical provider who can rule out any physical conditions that may be contributing or causing the symptoms.  This doctor can refer you to a mental health practitioner for diagnosis and treatment.

How is Obsessive Compulsive Disorder Treated?

Traditional treatment for Obsessive Compulsive Disorder involves both medication and exposure therapy.  This type of therapy is often combined with cognitive behavioral therapy to provide desensitization and alternative coping strategies.  Recent research supported by the National Institutes of Health’s (NIH) National Institute of Mental Health shows that children and teens respond most effectively to treatment with antidepressants in conjunction with therapy.

If you are concerned that your child or teen is experiencing obsessive thoughts and compulsive behaviors, work with a professional who can assess your child’s behavior and advise you on the appropriate course of action.