By line :
Jennifer L.W. Fink
When Hayley Stulmaker, PhD, LPC-S, started her counseling career, most of the teenagers she saw did not want to be there — at least initially.
“It was pretty much the parents who told them they need to come,” says Stulmaker, a licensed professional counselor in private practice in Texas. “Now, I have parents who call me and say, ‘My kid told me that they want to see somebody.’”
Watch for these red flags:
Scrolling passively for hours with no processingDecreasing mood after time onlineFeeling “on-call” or unable to disconnectWithdrawing from offline lifeTurning to AI for emotional supportShifting or frequent self-diagnosis
Chris Hennington, PhD, LPC-S, has seen an increase in adolescent self-referrals in recent years, as well. “In 2020, my caseload of college students jumped up,” says Hennington, a faculty member and licensed professional counselor supervisor at the University of Oklahoma. The COVID-19 pandemic had shut down campuses, and the adolescents who came to his office were “burnt out on technology,” he says.
Hennington, Stulmaker and other counselors around the country have also noticed an uptick in the number of teenagers who arrive with a diagnosis in mind. “They’ve gone online, decided what’s wrong and want to know what to do,” Hennington says.
For better and for worse, today’s teenagers are steeped in internet culture. Siri, Apple’s now-classic voice assistant, has been around their entire lives. So have Snapchat, Instagram and YouTube. Teens (like the rest of us) navigate life both on- and offline. Increasingly, digital algorithms are shaping what teenagers see, hear, experience and prioritize.
Even teens who don’t have smartphones are affected because trends and social norms migrate from the internet into homes and hallways almost instantly. Because digital influences affect how teenagers think, relate and cope, counselors must adapt their approach to most effectively meet adolescents’ needs.
The Digital Context
Approximately one-third of U.S. teenagers are on YouTube, TikTok, Snapchat or Instagram “almost constantly,” according to the Pew Research Center’s Teens, Social Media and Technology 2024 report. Much of their time is spent interacting with friends and classmates or watching videos that interest or amuse them. But teens are also actively and passively consuming mental health content. Nearly 40% of teens surveyed by Pew say they’ve searched YouTube for mental health information; 34% have used TikTok, and 23% have used Instagram to look up mental health topics.
Three-quarters of teen boys encounter masculinity content and messages about what it means to “be a man” online, even though two in three boys don’t seek out this content, according to a 2025 Common Sense Media report, Boys in the Digital Wild: Online Culture, Identity, and Well-Being. A 2023 Common Sense Media report noted that teenage girls say they see more helpful mental health content online than harmful content. Yet, 2023 research supported by Amnesty International found that after watching just a few mental health videos, accounts designed to mimic 13-year-old users were rapidly flooded with content about anxiety, depression and self-harm.
Much of that content is misleading or flat-out wrong. One-third of #mentalhealth TikTok videos analyzed by researchers in October 2021 were misleading; these videos got more engagement than scientifically accurate videos. A 2025 analysis of TikTok videos noted that approximately 16% include what appears to be deliberate misinformation about mental health.
No wonder so many teens are showing up in counselors’ offices stressed, overwhelmed, scared and confused. “I’ve had kids say that they got pulled into watching videos for eight hours,” Hennington says. “They’re consuming endlessly and not processing anything.”
Even teens who aren’t online chronically feel the pull to be constantly in touch. “It’s sort of like they have to be on call at all times,” says Cory Clark, PhD, LCMHCS, president of the Association for Child and Adolescent Counseling, an ACA division.
Because mental health is now frequently discussed in school, online and in the community, many teens feel a responsibility to check in on one another. “Whether they acknowledge it or not, they’re being asked to be available to each other as sort of ‘therapist counselors,’” Clark says.
Teens regularly use terms such as gaslighting, trauma and boundaries, and many come to counseling sessions with a good idea of what they’d like to work on.
“The amount of information they’re consuming prior to their first session is unlike it’s ever been before,” says Olivia Uwamahoro (Williams), PhD, LPC, ACS, a clinical assistant professor at William and Mary College in Williamsburg, Virginia.
The information they bring isn’t always accurate, but it offers valuable insight into their thinking. Clinicians who respond with curiosity and compassion retain teens’ trust and set the stage for a flexible, collaborative counseling relationship that can help teens thrive.
What to Do Differently
The following four-pronged approach can help counselors adapt their practice to the needs of today’s teens:
Assess digital influences
Clark includes a digital assessment in the intake process for all new clients. He uses both standardized tools, including the Problematic Media Use Measure, and a more informal set of questions he’s developed to check what he calls “media mindfulness.”
“It’s really assessing peoples’ understanding of how tech is impacting them, of how they feel before, during and after use,” he says.
Broad measures of “screen time” aren’t particularly helpful because what a person is doing on a screen matters greatly. Ask your client which digital tools they use — including video games and artificial intelligence (AI) chatbots. Ask them to describe their activities on- and offline over a typical week.
If a teenager comes to you with a specific diagnosis or treatment plan in mind, ask why they think it fits them. “Ask ‘What is your understanding of X? What are you hearing?’”
Uwamahoro says. Be sure to ask where they’re getting their information, as well. A teen’s answers will give you more insight into their baseline knowledge and typical information sources.
Lead with curiosity
Don’t dismiss or belittle a teen’s self-diagnosis, even if you can immediately spot three reasons it’s probably off base. Lead with curiosity, rather than judgment, and you’re likely to surface additional information you can use to help your client.
When a teenager says, “This is what I have, and this is what we need to do,” Stulmaker responds with, “Tell me more about that.” Often, she says, adolescents recognize some of their own habits or characteristics when they see others on social media talking about their personal experiences with things such as autism, anxiety, depression or obsessive-compulsive disorder. A teen with similar symptoms may conclude they have the same condition — and find a sense of relief and a built-in community. Understanding why and how they’ve come to their conclusions will help you focus your conversations.
“I try to come from a place of understanding what purpose this may be serving for the client,” she says. “Why does it feel beneficial to them to have this knowledge or identity? Oftentimes, it boils down to the fact that they’re scared.”
When you have a feeling for the developmental, social or psychological concerns that may underpin your client’s self-diagnosis, you can sensitively begin to explore their sources of information.
Uwamahoro invites her clients to share some of their sources of mental health information with her during a session. Together, they discuss and assess the content, noting things such as personal opinions versus professional expertise. If Uwamahoro spots misinformation, she’ll gently point it out, discuss it with her client and direct them toward more reliable sources of information.
Hennington uses psychological testing with validated instruments to address client concerns and chart a path forward. When a client arrives with a specific diagnosis in mind, he’ll say, “Let’s back up. Let me give you a couple of tests to see if what you’re thinking and experiencing lines up with what the tests give us. If it does, we can move forward. If it says something different, we may need to go in a different direction. Are you OK with that?” Hennington says his clients always say yes.
Expressing curiosity, empathy and your desire to help are key to getting client agreement. The same is also true for discussing test results that don’t confirm an adolescent’s initial self-diagnosis. Hennington reminds clients their results are based on information they provided and may provide a fuller explanation for the issues they’re experiencing. “I can usually frame it as, ‘The tests help us get clarification on what we really need to work on,’” he says.
Build offline skills
Teenagers need help honing their communication and connection skills. That’s always been true, but it’s even more critical today. Education and socialization moved online during the COVID-19 pandemic, so today’s adolescents have less experience with in-person interactions than perhaps any previous generation. They need concrete assistance (and practice) to develop their emotional regulation and interpersonal skills.
You can use technology to help boost teens’ offline skills. Clark, for instance, will often teach teens TIPP skills — temperature, intense exercise, paced breathing and progressive muscle relaxation — to help them modulate intense emotions and reduce distress. He then encourages interested teens to use AI tools (like ChatGPT) to review, study and explore how to apply TIPP skills to real-life situations.
“It’s almost like studying for a test,” Clark says. “It can be helpful for them to ask AI to talk them through what using a particular skill may look like when they’re struggling with their grades, putting everything off and feeling overwhelmed.”
At the same time, counselors can help adolescents and their caretakers learn when human connection is needed. During a time of distress, posting on social media may elicit some thoughtful responses, but it won’t generate the kind of support that comes from spending time with a caring human. Digital devices, including AI chatbots, “should ideally be used as supplemental tools, not as a substitution for a human support system,” Uwamahoro says. Explicitly discussing when, how and why human support is necessary — and when tech tools may be helpful — is essential.
It’s equally important to clarify when technology should not be used. Just as medical providers explicitly tell patients when to call 911 versus calling a nurse hotline or sending a message, counselors should give teens (and their guardians) clear guidance as to when to use various support options. An adolescent with active suicidal ideation should not turn to an AI chatbot or social media; human assistance is needed. “You really have to talk through this with teens: ‘Don’t use AI as your therapist or at 2 a.m. when you’re in crisis,’” Clark says.
Teenagers need time to practice offline skills, so Hennington often introduces his clients to the idea of a “digital diet,” a plan to deliberately decrease online time and increase interpersonal interactions. “Perhaps after an hour online, you go do something analog like walking, playing a board game or doing your homework in the kitchen where you’re not isolated, something where you have some interaction.”
Teach digital literacy
Learning how to responsibly use digital tools is perhaps the most critical 21st century skill.
Clark encourages his clients to pause for a moment before opening their phone or an app. “Ask yourself, ‘What am I doing? What am I looking for?’” he says. Naming the intent can prevent mindless scrolling, especially if the client also introduces additional friction. Clark moved all apps off the home screen of his phone so he’s not immediately met with multiple distractions. He shares that fact with clients to help them think through how they may be more mindful and intentional in their tech use.
Providing teens with metrics they can use to assess the legitimacy and quality of the content they consume online is another way to support their mental health and overall well-being.
“Instead of trying to curate a list of all the reliable podcasts and platforms, we should focus on helping our clients recognize reliable sources,” Uwamahoro says. She teaches clients that reliable content typically features vetted, expert sources and provides clear explanations of diagnoses or treatment approaches.
Counselors remain well-positioned to help teens through the turbulent years of adolescence. “We’re there to help them process all the information they’re taking in. In my mind, it’s all about creating safety for kids within themselves, their world and their environment,” Stulmaker says. In a world where algorithms amplify misleading or extreme content, human guidance is more important than ever.