Teletherapy Solutions cannot help people in crisis. If you are worried about your or someone else’s safety, click here for resources.
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Teletherapy solutions cannot help people in crisis. If you are
worried about your or someone’s safety, click here for resources.
Teletherapy solutions cannot help people in crisis. If you are worried about your or someone’s safety, click here for resources.
Teen Counseling
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Teen Counseling
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The structure of teen therapy varies widely based on your specific needs. At times a therapist may recommend active participation from guardians, other times it may be in the best interest for your teen to work individually with their therapist. Regardless of the structure of therapy, both written and verbal consent from a legal guardian is required to begin treatment. Guardians must be present to provide verbal consent at the onset of the first session
Legal Guardian's Name
*
First
Last
Teen's Name
*
First
Last
Date of Birth
*
Date Format: MM slash DD slash YYYY
Age
*
School
Grade
Looking for a therapist with specialized knowledge in LGBTQ affirmative therapy?
*
Yes
No
Looking for a counselor with experience incorporating religion and/or spirituality?
*
Yes
No
What will our work focus on?
*
Depression
Anxiety
Relationship Issues
Recent Breakup
Family Conflict
Trauma Recovery
Anger
Substance Abuse
Grief
Perfectionism
Feeling "Stuck/Lost"
Eating/Appetite
Chronic Physical Pain
Problem Behaviors (i.e. breaking rules, concerns for internet safety, stealing)
Overwhelming Emotions
Learning Issues/Attention Deficit Issues
Seeking to Improve Athletic Performance
Seeking to Improve Academic Performance
Seeking to Improve Occupational/Work Performance
Interest in Self-Exploration/Increased Understanding
Seeking Support for Self-Care
Have you noticed a sudden change in your teen’s mood, school performance, or behavior?
*
Yes
No
Do they often seem irritable/angry, or the inverse, have they become withdrawn?
*
Yes
No
Have you noticed a decrease in their ability to function at school, or their motivation to learn?
*
Yes
No
Has your family recently experienced a change such as, a move, divorce, or loss?
*
Yes
No
Does your teen seem self-critical, and overwhelmed by stress?
*
Yes
No
Does your teen exhibit perfectionist tendencies that get in the way of his or her functioning?
*
Yes
No
Does your teenager easily become embarrassed or self-conscious, subsequently withdrawing from social situations?
*
Yes
No
Have they begun avoiding events or situations that trigger their anxiety?
*
Yes
No
Are you worried that your teen may be sad, lonely, or experiencing feelings of hopelessness?
*
Yes
No
Has your teen suddenly lost interest in engaging in activities that he or she once enjoyed?
*
Yes
No
Does your teen seem to have a negative view of who they are, the world, or do they express minimal hope for the future?
*
Yes
No
Do you find yourself wishing that you knew how to take your teen’s pain away and help him or her recognize the positive aspects of life?
*
Yes
No
Are you concerned about your teen’s decision-making abilities and judgment?
*
Yes
No
Are you concerned about internet safety?
*
Yes
No
Would you like to improve the trust between yourself and your teen?
*
Yes
No
Now we will be asking some more serious questions. It is important to answer honestly so we can be sure to help find the right therapist for you. Your safety is our top priority.
Has your teen disclosed, or at you worried they may have a plan to kill or harm him or herself or someone else?
*
Yes
No
Do you have any reason to believe they are engaging in self-harm behaviors? (i.e. cutting or burning)
*
Yes
No
When was the last time they attempted suicide?
*
Less than one year
More than one year
Never
Do you have any reason to believe they may be in need of substance abuse treatment?
*
Yes
No
Are you seeking treatment that has been mandated by a court?
*
Yes
No
When was the last time your teen was hospitalized for mental health issues?
*
Less than one year
More than one year
Never
When was the last time your teen received care at a residential treatment program?
*
Less than one year
More than one year
Never
Name
This field is for validation purposes and should be left unchanged.
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