Inside My Therapy Sessions: Helping Teens Untangle Overthinking

One thing I think about a lot is what it feels like for my clients to start therapy with me for the first time. There’s often this weird invisible barrier between therapists and new clients before the first session. You know almost nothing about the person you’re about to open up to, and for a lot of teens (and honestly parents too), that can feel intimidating.

Some teens are nervous to start therapy, while others mostly just want to figure out whether I’m “cool” enough to talk to.

I wanted to make therapy feel a little less mysterious and a little more human.

That’s actually what inspired Inside My Therapy Sessions, a little series here on the blog where I share more insight into what therapy can actually look like with me, Erica, and the kinds of things we work through together in sessions.

A lot of teens start working with me because they are exhausted from the constant thinking going on in their brains. Sometimes the teens are the ones that ask their parents for therapy, and other times, well-meaning parents realize that their child can use some outside support.

Teens often replay conversations after they happen, overanalyze text messages, worry they said the wrong thing, and spend hours thinking about decisions other people seem to make easily. Some constantly look for reassurance, while others stay completely inside their own heads.

And honestly, a lot of them already know they’re overthinking, but truly do not know how to stop.

They know their anxiety is making things feel bigger. They know they’re spiraling. But knowing that and knowing how to stop it are two very different things.

Inside My Therapy Sessions With Teens

Initial sessions with teens usually look a lot like following their lead.

I spend time sharing a little about who I am, how therapy works with me, and asking what they actually want to get out of therapy. I’m also really clear about confidentiality because teens deserve to know what is private, what is not, and what they can expect walking into the process.

I try really hard to treat teens like teens, not mini adults and not little kids either. They’re at this stage in life, where they truly need a little bit of a leeway, but also boundaries too.

A lot of teens are surprised therapy does not feel like talking to a teacher or parent every week. Rapport is everything with teens. If they do not feel emotionally safe, comfortable or understood, therapy usually is not going to feel very helpful.

I’m big on using whatever teens like in sessions to connect. We use music, art, and even humor a lot in sessions. Sometimes we process situations happening in real time that week. A lot of sessions involve talking through friendships, school stress, relationships, identity, family dynamics, and all of the pressure teens quietly carry around every day.

I tend to work with a lot of thoughtful, sensitive, high-functioning teens who are perfectionistic, people-pleasing, creative or emotionally aware in ways that other people do not always notice right away.

Many of them already have insight into how they feel. What they often struggle with more is slowing down enough to notice what is happening in their bodies, understanding what is actually within their control, and learning how to stop treating every thought like an emergency.

I also remind teens often that they are allowed to challenge me, disagree with me, tell me if I misunderstood something or let me know if something is not working for them. I strive for honesty in the room because they are not going to offend me by having feelings, opinions or boundaries.

Sometimes we role play difficult conversations. Sometimes we work on coping skills or emotional regulation tools. Sometimes we untangle reassurance-seeking patterns or practice tolerating uncertainty. And honestly, sometimes therapy is simply having one hour a week where they do not feel completely alone inside their own head. It’s truly tailored to the person.

Final Thoughts

A lot of teens who struggle with anxiety and overthinking are carrying more pressure than people realize.

Many are thoughtful, emotionally aware, deeply caring people who have spent a long time trying to hold everything together internally while still functioning on the outside. And while they often look high-functioning, that does not mean things feel calm internally.

One thing I remind teens often is that not everyone is going to like them, understand them, or validate every choice they make and that is super uncomfortable. Part of growing emotionally is learning how to tolerate that discomfort without letting it completely define your self-worth.

Therapy is not about becoming a completely different person or never feeling anxious again. A lot of the work is helping teens feel more confident, more emotionally safe, and more connected to themselves instead of constantly fighting their own thoughts.

Over time, that confidence starts showing up outside the therapy room too. Teens begin advocating for themselves more, trusting themselves more, setting boundaries, speaking up honestly, and making changes that once felt impossible or overwhelming.

Need More Support?

If you’re a parent looking for support for your teen or a teen reading this wondering if therapy might help, I hope this series makes therapy feel a little less intimidating and a little more human.

Therapy can be a space to slow things down, make sense of what’s happening beneath the surface, and build more confidence, emotional safety, and self-trust along the way.

I provide virtual therapy for teens and young adults across New York, with a focus on anxiety, overthinking, perfectionism, emotional overwhelm, and life transitions.

If you’d like to learn more about working with me, you can find more information and reach out here. Reach out to me here.

Learn more about how I approach therapy for teens and therapy for young adults here.