Giving Thanks for Psychotherapists Who Treat Teenagers

During this holiday season, it is customary to give thanks. I don’t have much use for the Pilgrims and Native Americans’ peaceful Thanksgiving narrative, but I do appreciate taking time to reflect on the past year. Of course, I am most thankful for my family and the fact that so far we have made it through the pandemic.

I honor the lives of the over 780,000 people in the United States who have died during the pandemic

These numbers are so large as to be difficult to imagine. Think about a situation in which all of the people in a city the size of Denver or Seattle had just disappeared. So many devastated families and grieving adults and children.

The U.S. leads the world in the number of deaths, but we should remember that we have lost 5.1 million people worldwide. We remember them. The journal Pediatrics estimates that for every four COVID-19 deaths between April 1, 2020, and June 30, 2021, one child lost a parent or caregiver. I give thanks to those taking care of these children.

This year, I give special thanks to the mental health professionals who treat children and adolescents

Although, of course, I also give thanks to all the health care professionals who have risked their lives to treat people suffering during the pandemic. According to “Stress in America: 2020,” the American Psychological Association’s annual report, “We are facing a national mental health crisis that could yield serious health and social consequences for years to come.” The authors added that young people aged 13-19 are experiencing elevated stress and reporting symptoms of depression. The majority of parents in every age category reported increased stress; this was especially true of parents of teenagers, with two-thirds of parents of teenagers reporting that the 2019-2020 school year was “extremely stressful.”

Multiple additional studies have now documented increases in depression, anxiety, and PTSD symptoms in teens. In a review article, Racine and others (2021) reported in JAMA Pediatrics that symptoms of anxiety and depression in teens had doubled during the pandemic, with a greater increase as the pandemic continues in older adolescents and in girls. This, then, is the new world for all psychotherapists but especially those of us who treat teens and young people.

Part of my clinical practice is supervising and collaborating with physicians and mental health professionals. The past 18 months have been devastating to all and psychotherapists who treat children and adolescents have unique burdens. More than one mental health professional has shared with me that it is difficult to keep going in this environment of overwhelming sadness and loss.

Others have shared the stress of the large amount of screen time that is necessary for doing virtual psychotherapy. It leads to a type of exhaustion that some have described even described as “brain fog.” Doing psychotherapy virtually means not only concentrating on any visual cues but trying to maintain an emotional connection. In this critical moment, many have chosen to retire early or cut back on their practices. This is a necessity for many people in order to continue self-care, but at the same time, the trend exacerbates the crisis of a lack of adolescent mental health professionals.

As difficult as the pandemic has been for adults to process, teens have less historical and less neurological development in place to do so. We know that the number of adverse childhood events (ACEs) lead to short-term and longer-term damage and the combination of losses, not only health-related but economic and educational, are adding up.

The academic year 2020-2021 was an educational disaster for many teens. Without any preparation, schools and teachers were not able to adjust quickly to online learning. Being alone at home also deprived teens of their psychological nutrient: social interaction. Teenagers who look forward to school rarely do so for the learning alone but rather for the social aspects of seeing other teens and engaging in activities.

The loss of teachers also cut off pathways to learning from a variety of adults. Meanwhile, due to virtual learning, many teens performed their online school work in their pajamas while eating breakfast, having stayed up watching social media or movies even later than usual and disrupting their sleep schedules. Even in late 2021, school are continuing to send students home if a number of them test positive for COVID-19.

So those of us who see adolescents and young adults are struggling with more than the basic paradigm of pandemic—>increased stress —> increased psychological distress and disorders. This has been a mental health catastrophe because the psychological fallout of the pandemic occurred in the midst of an ongoing epidemic of psychological disorders in adolescence. As mental health professionals, we are all citizens and have been traumatized directly or indirectly to one degree or another. The problems now are not “burnout,” “compassion fatigue,” or anything else. We have anxiety, sadness, and a variety of post-traumatic responses while still having an enormous responsibility to provide care for adolescents, who we must remember are still children.

I don’t use the word “trauma” lightly. Trauma is defined as a major event that we could not have imagined. According to the American Psychological Association, “Trauma is an emotional response to a terrible event like an accident, rape, or natural disaster. Immediately after the event, shock and denial are typical. Longer-term reactions include unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea.”

Note that it is normal to have long-term consequences. In other words, to some degree, we have been traumatized, directly or indirectly, and now all our patients are trauma patients; psychotherapists know that trauma work is extremely challenging. Those who are working with adolescents and young adults have the additional challenge of maintaining emotional equilibrium to support them in the face of their intense developmental changes during a time of trauma. And most of us also have families we want to take care of as well.

Overall, however, I continue to give thanks for this creative and meaningful work

Engaging in psychotherapy with adolescents is among the most meaningful careers and allows us to contribute to a society that desperately needs our help. Let’s hope we can continue to do our productive work.