There is an issue I have encountered many times working with teenagers in psychotherapy that is seldom talked about. The issue is teenager’s trying to act as a therapist to the friends or girl/boy friend. This issue is increasing due to the pandemic and quarantine. Many teenagers are experiencing more anxiety (CDC) and boredom due to being at home more and no school. There have been many times that a teen will tell me their girlfriend is suicidal and ask me what they should do to help her? Often a teen will ask could they just bring their girlfriend into one of their sessions. They argue since I am helping them, I can help their girlfriend. At this point we need to have a conversation about how therapy works and the situation that they are in at that point.
In terms of me just seeing the girlfriend, I explain I need parental consent because she is under 18 years old. I also explain if she is suicidal the parents should be involved. Sometimes the teen explains their girlfriend is living in an abusive household and the parents would never agree to psychotherapy. In these situations, I provide the suicide crises number and tell the teen to have the girlfriend call the crises line and they will get her help. Some teens will exaggerate a situation just so I will see the girlfriend. Therefore, it may be a normal argument between a teenager and parent that I may be entering. Therefore, I provide the crises line and 911 so the situation can be assessed. If the girl does need help, I don’t want to ruin the chances of her getting psychotherapy by acting too fast. I also need to be careful how I handle the situation with my patient. If he is wanting me to see his girlfriend, I have established a therapeutic relationship and trust with him and I do not want to spoil that bond.
The other part of this situation and the more important part is the teen trying to act like their friend’s psychotherapist. Many teens feel since they have been coming to therapy and making progress, if I give them some advice they can help their friend. I explain that they do not having the training needed to be a therapist. I also point out they are not emotionally ready to be a psychotherapist. Many teens feel a very close bond to their friends and girlfriends because they have shared a lot of very personal information and have been open emotionally. While this may be true, it is not the same as psychotherapy.
Why is it important to discuss this issue? What if a teen tries to be their friend’s therapist and the friend commits suicide. They teen will be emotionally devastated and blame themselves. The parent of the teen who committed suicide may blame the teen too. Maybe they were not handling the situation correctly and the teen might have been saved if they had been hospitalized. However, the teen was never hospitalized because their friend was acting as the therapist. The teen could be in a lot of trouble. I have seen this happen. I have had parents come in for grief therapy because their child committed suicide and their child’s friend was acting as therapist and keeping everything a secret. This is a very sad and tragic situation for all involved.
Any time I have a teen asking me about a friend I explore the situation to determine if they are acting as therapist. If they are I explain to the teen why this is inappropriate. I acknowledge how close they are to their friend and how much they care about their friend. I then point out because they care so much they want to do what is best for their friend. I ask them how they would feel if their friend committed suicide? I point out that they are in a very difficult situation that they are not emotionally prepared for or professionally trained for. We discuss that this doesn’t mean anything negative about them. We discuss how they are expecting too much of themselves. I explain if they really want to help their friend, they will encourage their friend to seek help or they may need to tell someone such as the school counselor or their friend’s parents. Sometimes they say, “but I promised to keep it a secret.” I explain sometimes you may need to break a promise to help someone. I also point out their friend may initially be mad but if they truly care they need to do what is best for their friend.
Teenage suicide is an epidemic. The CDC just moved suicide from the third leading cause of death to the second leading cause of death for teenagers. Also the CDC has noted there has been an increase in anxiety, depression and suicides since the beginning of the pandemic. Additionally, teenagers are turning to cutting more often to deal with their feelings about life and the pandemic. Therefore, at this time in our history, this issue has become a bigger issue and needs to be addressed. The situation where friends try to act like the therapist happens more often than people realize. I had a situation occur this week. After explaining the situation to the teen, they spoke to their friend and their friend is now in therapy. This was a good ending. I would estimate 1 out of 3 teens ask me about their friends and are trying to be the therapist to their friend. Besides teens feeling they can handle this situation because they feel so close to their friend, I believe this occurs due to our views on mental health.
Because of the mental health stigma many teens are reluctant to go to therapy. They don’t want to be labeled as “crazy” or “weird.” Furthermore, it is not easy for teens to get therapy. Many psychotherapist prefer not to work with this age group for various reasons. Also many families cannot afford psychotherapy and many insurance companies do not cover psychotherapy. As a result, teenagers tend to turn to each other when they are encountering emotional issues. Research indicates that teens turn to their friend first when they encounter emotional issues. If we want to stop teenagers from acting like psychotherapist and if we want teenagers to get appropriate mental health care, we need to talk to teenagers about why they can’t act as a friend’s therapist and we need to increase access for teenagers to mental health care and remove the mental health stigma.
Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers and children. For more information regarding his work visit his website http://www.RubinoCounseling.com or his Facebook page http://www.facebook.com/drrubino3