Each day seemed harder than the next for Amy*, especially since starting ninth grade this year. Her parents had warned her that high school would be different and her grades and activities might be more scrutinized. Looking back, Amy realized she had always struggled with feeling “nervous,” but recently it seemed to be worsening. She could no longer concentrate on one activity at a time; she was withdrawing from friends and family, and she was experiencing physical issues, such as a racing heart, upset stomach and headache. She found herself constantly thinking things would improve, if she could just “do better” and “had more time.” About a month into the school year, Amy’s parents and two younger siblings shared their concerns with her over dinner. Realizing she was causing her family distress, Amy agreed to talk with a counselor.

Amy found herself opening up to the counselor more than she expected. She discussed the standards she had set for herself and her extreme stress when she found herself unable to meet them. She described her family as supportive and involved, yet she had a tendency to compare herself and her abilities with those of her siblings. Although this helped Amy push herself, she saw how it also caused her a great deal of anxiety. Amy admitted to feeling some symptoms of depression, including withdrawal from friends and family, irritability, crying spells, and lack of interest in activities she typically enjoyed. She couldn’t recall the last time she had gone out with a friend or talked with anyone about anything besides schoolwork and her extracurricular activities. She was tearful during the first session and admitted she would like to develop better ways to cope with stress and anxiety, as well as to improve her overall sense of self.

Amy’s counselor began by helping her identify negative thinking patterns and challenging these thoughts. For example, Amy often criticized herself by saying she would never get into a good college because of missing a personal goal on an exam or assignment. Her counselor assisted her in identifying  the “worst case scenario” of each feared event and how might she work through that. At first, this increased Amy’s anxiety level, but gradually she came to gain more perspective. It also was apparent to her counselor that Amy had been seriously neglecting her self-care by prioritizing schoolwork and sports commitments over taking time for herself.

Amy missed being with her friends and even just taking time to read, or watch television. The counselor helped Amy set a goal of starting with at least one enjoyable activity per week and sharing with the counselor and her parents how this affected her mood. Amy admitted she had difficulty at first, as she was often thinking of how she should be working on things for school. However, she was able to note a significant improvement in her mood within about a month. She was crying less, she was more interested in preferred activities, and she was smiling and laughing more at home. Amy also permitted her parents to occasionally attend her counseling sessions and learn additional ways to support her, such as understanding her treatment goals and providing regular encouragement.

Amy’s parents helped keep her accountable by reminding her to take time for herself. Both Amy and her parents agreed that counseling helped them improve their communication, as well as their understanding of anxiety and warning signs of depression.

“Amy” represents a typical Outreach client. Details do not correspond with any specific case in order to protect client anonymity. Outreach Teen & Family Services is a nonprofit, confidential counseling service.