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Common Therapeutic Practices in Youth Mental Health

As school counsellors, we want to foster the health and wellness of youth to whatever degree we can. We want to see them succeed, and help them tackle the issues that may be holding them back. When it comes to mental health, this can be difficult at times, as school counsellors typically have neither the training, nor the mandate to engage in mental health therapy with our students. Sometimes youth are engaged with therapists outside the school, and it can be helpful for school counsellors to have an understanding of the work that they are doing, in order to support and reinforce that work at school. At other times, if a youth is not engaged in therapy, it might be useful to have a basic understanding of some therapeutic practices in order to build up our toolkit of helpful strategies and learn new ways of talking to youth about their difficulties.

When we refer to therapy for mental health, we are most often talking about “talk therapy” – specifically therapy where a youth learn to talk through their struggles and use language to explore their feelings. While certainly not the only form of therapy, many types of “talk therapy” are highly effective in treating issues such as depression and anxiety, and in changing the perspectives and behaviour of youth.

Cognitive Behaviour Therapy

Cognitive Behaviour Therapy (CBT) is probably the most common type of therapy used with youth when it comes to mental health, and may be the one school counsellors are already the most familiar with.  CBT is rooted in the theory that our feelings arise out of maladaptive thought patterns, and that by changing our ways of thinking (and shifting our behaviours), we can increase our mood or decrease our anxiety and distress.  CBT has been found to be very effective with Depression and Anxiety, but is also often used with symptoms of eating disorders, phobias, anger issues, substance use, and trauma.

Youth are taught first to become aware of the thoughts they have, to articulate them, and to reflect on whether or not they are helpful. A youth will learn to identify distorted thinking patterns, for example:

  • Black-or-White thinking (“if I’m not perfect, then I’m a failure”)
    • Overgeneralization (“nobody likes me”)
    • Jumping to conclusions (“My boyfriend is talking to that girl – he must be cheating on me!”)
    • Catastrophizing (“If I fail this test, I’ll never get into University”)
    • Mind reading (“I saw how she looked at me… she must hate me”)

Once they have learned to identify distorted thinking patterns, CBT teaches youth to challenge the negative thoughts with more realistic ones, or to reframe situations in a more helpful, effective light. 

CBT also teaches strategies such as muscle relaxation and deep breathing to help youth become more aware of their body and physical reactions. While relaxation strategies will not make anxiety or depression disappear, they will help increase a youth’s ability to ride out their feelings and more effectively engage their rational brain. 

CBT treatment will generally occur over a period of 8-20 sessions. It is a very practical therapy, and can be used even with very young children.

Mindfulness

Mindfullness-based therapies have gained in prominence in the last decade, and may also be very familiar to school counsellors.  The practice of mindfulness is rooted in the belief that much of our distress comes from placing too much focus on what has happened in the past, or what might happen in the future, rather than focusing on the present. As well, we become distressed when we judge ourselves harshly. Mindfulness teaches youth that they can decrease their distress by learning how to focus on the present moment, and by accepting the moment (and themselves) with a lack of judgment. Mindfulness can be taught in a therapeutic context, but also in classrooms, and other less formal environments. Mindfulness is appropriate for all ages, and is even used with children as young as 2-3 years of age. Mindfulness skills can be highly effective on their own, but are also often taught alongside (or as a component of) other therapies.

Dialectical Behaviour Therapy

Dialectical Behaviour Therapy is a type of Cognitive Behavioural Therapy that teaches youth how to manage difficult emotions and have more effective interpersonal relationships.  It is typically recommended for those youth who have already tried other types of therapies, but who have not seen a significant improvement in their lives or functioning. It is used most often with youth who display chronic suicidal thoughts or self-harming behaviour, impulsive risk-taking behaviour, difficulty maintaining relationships, substance use, or eating disorders. The “Dialectical” in DBT can be confusing as it is not a commonly used word, but essentially means coming to a place of balance between two things that are seemingly opposite – for example, accepting who and where you are and seeking to change. It can be thought of as moving from a framework of “either/or” to a framework of “both/and”.

DBT is typically broken down into the acquisition of 4 different types of skills:

  • Mindfulness – How to be present in the moment, fully, and without judgement
    • Emotional Regulation – Moving away from the intense highs and lows of emotion, and finding ways to bring oneself back to a more stable emotional middle-ground
    • Interpersonal Effectiveness – How to establish positive, healthy, and effective relationships and interactions with others
    • Distress Tolerance – How to ride the wave of difficult emotions, and get through them without resorting to unhealthy or harmful behaviours

DBT is not a brief therapy, and typically lasts at least 6 months. Youth who are engaged in a DBT program will typically be involved in both individual therapy as well as a skills group. Parents are often included in the therapy as well.

Interpersonal Psychotherapy

Although Interpersonal Psychotherapy (IPT) has been modified for use with a variety of issues, it is primarily intended for the treatment of depression. It focuses on our relationships, our life transitions, and the way we relate to others. It is premised on the theory that while a youth’s relationships will not cause depression, depression occurs in an interpersonal context – a youth’s relationships will affect, and be effected by, depressive symptoms. IPT teaches youth to identify links between their emotions and the events/relationships in their lives. IPT will also teach youth to identify more effective of ways communicating or expressing themselves with others. IPT can vary in length, but typically comprises a fairly structured 12 -16 week course.

Emotion-Focused Therapy

Emotion-Focused Therapy (EFT) is more commonly used in family therapy or couples therapy, but can also be used individually with youth. It focuses on how a youth experiences and deals with their emotions, and is premised on the theory that much of our distress comes when we avoid or distance ourselves from our emotions. It might be used to address symptoms of depression, trauma, substance use or eating disorders.

Family Therapy

Family therapy is not designed to treat a particular mental health concern, but can sometimes be a very helpful option for a youth who is struggling. When a youth is in individual therapy, their family may be engaged by the therapist to support them in some way, or to reinforce skills and strategies that they are learning. In family therapy, however, the “client” is the entire family, not just the youth. Family therapy looks at the roles that each family member plays, and the systems that are in place within the family, and then seeks to understand how these roles and systems contribute to the health or distress of the family members. It is not uncommon for a youth to be engaging in one of the individual therapies above, while also engaging in family therapy with their parents and siblings. One will help the youth learn skills to better tackle the issues in their life, while the other may help the youth’s family live together more supportively and cohesively.

By: Laura Hamilton


For more information on these therapeutic practices, counsellors can refer to these helpful links:

Kelty Mental Health: http://keltymentalhealth.ca/types-of-therapy

Mindfulness: http://mindfulnessforteens.com

CBT: www.anxietybc.com/help-resources/cbt/self-help-cognitive-behavioural-therapy

DBT: https://childmind.org/article/dbt-dialectical-behavior-therapy/

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