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Members of Generation Z — typically defined as those born from the mid-1990s to the early 2010s — have little to no memory of a life without smartphones or access to the internet, which is why they are often dubbed “digital natives.” They have also grown up in a world where social media, political polarization, racial unrest, school shootings and climate change are ever-present realities. 

All of that turmoil and uncertainty is affecting their mental health, with 70% of teenagers across genders, races and socioeconomic status reporting anxiety and depression as major problems among their peers, according to the Pew Research Center. A report by the American Psychological Association found that Generation Z is 27% more likely than previous generations to report their mental health as fair or poor. On a brighter note, they are also more likely than older generations to seek mental health therapy or counseling, with 37% of Gen Zers reporting having worked with a mental health professional.  

Roshelle Johnson, a licensed professional counselor (LPC) and clinical director at Light and Power Counseling in Phoenix, works with a number of Gen Z clients who are struggling with anxiety or depression. Recently, she received three calls from parents whose children had just attempted suicide. “That spoke to me about how hopeless our young people are feeling,” she says. 

Addressing anxiety

Nichole DeMoya, a licensed mental health counselor and qualified supervisor in Florida, finds that many of her clients are in a constant state of worry. Her teenage and college-age clients commonly voice concern about future careers, school shootings, financial security, climate change and societal unrest. These clients are “very worried about the future because things are so unstable for them right now,” DeMoya says. She doesn’t dismiss their concerns; instead, she helps them learn to shift their focus to the present and on what they can control. 

DeMoya also considers the individual client’s home and school environment to see if they are adding additional layers of stress. She recalls working with a 12-year-old girl who struggled with anxiety. During one session, the client revealed she was scared that a foreign country was going to bomb her city. In learning more about the client’s home environment, DeMoya discovered that the girl’s father watched the news around the clock, and this was contributing to her anxiety. 

“She was starting her day already in that fight-or-flight [mode], already in a heightened state of anxiety,” says DeMoya, a clinical director at River’s Edge Counseling, a group private practice in Jacksonville, Florida, that specializes in treating trauma. “And then she went to school where she didn’t feel safe because school shootings are an ever-present threat.” 

DeMoya wasn’t able to help the client challenge her anxious thoughts because everything the client was being inundated with told her she should be anxious. So, DeMoya spoke to the parents and explained how the news was negatively affecting their daughter’s mental health. The father had been oblivious to this and was supportive of helping ease that stressor in his daughter’s life by no longer watching the news around her. That simple change made a big difference, helping the girl to regulate her nervous system and start her day on a positive note, DeMoya says. 

Jayna Bonfini, an LPC at Associates in Counseling & Wellness in McMurray, Pennsylvania, works with several teenage girls who experience anxiety and have histories of self-injury. By engaging in self-injury, they are taking their emotional pain and distress and turning it into a physical act, Bonfini says, so she uses dialectical behavior therapy (DBT) techniques to help them learn how to better regulate their emotional distress.

“Sometimes clients will use negative coping skills to escape painful emotions because it feels like it’s the easiest way to handle them,” Bonfini says. She instead helps clients learn healthier coping strategies with DBT skills. If a client is sad, for instance, they may isolate themselves from others. Bonfini may have the client use the DBT skill “opposite action,” which encourages them to choose the exact opposite of what their emotions tell them to do. So, instead of isolating, the client would go out and engage with others or perhaps even address the situation that is causing them distress rather than avoiding it. This approach helps clients build mastery over their emotions, she adds. 

Lauren Bellenbaum specializes in working with youth ages 10-24. She ensures that her clients leave counseling with a few practical skills they can use when they have a panic attack or feel extremely anxious (such as when they have to give a speech in class). “This generation … really want[s] skills,” she says. “Talk therapy is great, and they do need that too, but they also want to come out of sessions with some practical skills … [and] practical, straightforward advice.”

Bellenbaum, an LPC, often discusses different sensory skills that clients can use to help ground themselves when they feel anxious. For example, intense sensory experiences, such as eating sour candy, smelling essential oils, using very cold water, doing high-intensity exercise or engaging in paced breathing, can decrease anxiety, she says. She often advises clients to keep grounding objects nearby in case they find themselves feeling anxious throughout the day. Other sensory skills clients may use to help decrease anxiety or stress include having a calming Pinterest board or pictures to look at, a soothing Spotify playlist to listen to or their favorite blanket or sweater to wear. 

Improving interpersonal relationships 

Many of Bonfini’s clients seek counseling for anxiety, and social anxiety in particular. It is common for many young people to dislike phone calls, but Bonfini once worked with a client whose phone phobia was so intense that it prevented her from making necessary calls, including to the financial aid office at her college. Bonfini built an entire session around preparing the client to make this call, including practicing what the client would say and engaging in some deep breathing and interpersonal effectiveness skills with her. And then they made the call together.

“They have this impending sense of doom if somebody says, ‘We need to talk,’” notes Bonfini, an associate professor of counseling at University of the Cumberlands. “It’s this whole anticipatory anxiety that they all get, [wondering,] ‘What’s coming? What’s coming?’” 

Bonfini, who presented on supporting Gen Z’s mental, emotional and social needs at the American Counseling Association’s 2021 Virtual Conference Experience, also finds that friendships are difficult for several of her Gen Z clients. They often make casual connections with people online or at work or school, but that is different from a deep, personal form of friendship, Bonfini says, and that is where they struggle. 

Online friendships further complicate their ability to make and maintain meaningful relationships. Many of Bonfini’s clients say they mainly socialize online while they are alone in their room, which can be lonely and isolating for them, she says. Some of her clients even prefer online relationships, she adds, because when they have a problem, it’s easy to block this “friend” or create a new avatar and move on.

Bonfini, co-editor of the second edition of Casebook for DSM-5: Diagnosis and Treatment Planning, observes that Generation Z as a whole lacks many of the social skills that previous generations learned through face-to-face interactions. She finds DBT techniques helpful for teaching these (and other) clients interpersonal effectiveness, conflict resolution skills and ways to communicate their needs. 

Bellenbaum, owner of Transform Youth and Family Counseling, a group counseling practice in Grants Pass, Oregon, also finds DBT useful in helping clients learn a variety of skills, including emotion regulation, distress tolerance, mindfulness and interpersonal effectiveness. These skills are important for this generation, she says, because they often struggle with healthy communication and conflict resolution. One DBT skill she often uses to help clients communicate more effectively is DEAR MAN, an acronym that stands for the behavioral strategy of Describe, Express, Assert, Reinforce, be Mindful, Appear confident and Negotiate. This strategy supports clients in expressing and getting their needs met and in telling others “no” in a respectful way, thereby increasing the likelihood of a positive outcome. 

Bellenbaum also makes use of role-plays in session to help with interpersonal issues. A client may be having conflict with a friend, for instance, and isn’t sure how to address or handle this difficult situation. So, Bellenbaum has them act it out in session. She would play the role of the friend and have the client practice using their skills to approach the friend and have a conversation about their conflict. This makes it easier for the client to have the actual conversation later in person.

Johnson, a licensed independent substance abuse counselor, and Amber Samson, a licensed clinical professional counselor in Maryland, have both found that members of Generation Z sometimes have trouble differentiating between friends and acquaintances (terms that are often conflated because of social media) or recognizing healthy versus unhealthy relationships. There can be an expectation for this population to be “friends” with everyone they talk to online or in person, notes Johnson, who runs an anxiety management group for teens. They have followers on Instagram and friends on Facebook, she says, and this can lead to them being hurt when some of these acquaintances fail to meet their expectations or aren’t there for them. 

When a client refers to someone as a “friend,” Johnson asks the client to tell her more about the relationship. If, for instance, she learns that this friend is someone the client met online and plays video games with, she explores with the client what friendship means and how not every acquaintance is a friend. 

Johnson explains the concept of friendship using a dartboard illustration, with the inner target in the shape of a heart. She points out how the dartboard has different rings, which represent different levels of friendship, and how not everyone in the client’s life can fit in the inner circle or bull’s-eye — that area is reserved only for close, personal relationships. She finds this exercise particularly helpful with teenage clients, who are typically still figuring out these relationship dynamics.

Johnson encourages clients who are struggling with social anxiety after returning to in-person education to find a club or group that caters to their strengths. One client she worked with enjoys watching indie movies, so they joined a movie club at college. The group isn’t large — just four or five other students — but it’s a great way to meet others with similar interests and safely practice social skills, Johnson says. 

Relationships can be hard enough without adding in the complications of social media. One negative social media post can sometimes ruin a person’s day, so Bellenbaum often teaches clients how to cope and handle distress when things are outside their control. 

If someone made a rude comment about the client on social media that caused them to have an automatic negative thought such as “It’s true; I am a horrible person,” then Bellenbaum would use cognitive behavior therapy (CBT) to help the client identify, challenge and replace the negative thought with a healthier, more realistic one. But if the client is upset, angry and embarrassed about the mean comment, then Bellenbaum might teach them distress tolerance and distracting skills using DBT. This strategy allows them to tolerate difficult emotions and feelings so they can get through the rest of their day until they are in a space where they can get help or process their feelings. 

Samson, a therapist at Choice Clinical Services in College Park, Maryland, works with Gen Zers, millennials and people of color. She observes that members of Gen Z often struggle with interpersonal boundaries, largely because they have grown up in a digital world where they are constantly connected and expected to communicate with others. She advises her clients to take breaks from social media and engage in activities they find relaxing. Samson has noticed that if her clients dedicate some of their day to relaxing by themselves, then they typically feel better and have the energy to be available and interact with others. 

Some Gen Z clients may find it difficult to start a conversation with their counselor, Samson adds. They may not know how to explain or even identify what they are feeling, so she goes back to the basics and helps educate her clients on identifying feelings by using the feelings wheel. The wheel contains words identifying basic emotions in its middle and branches out to more complicated aspects of these feelings on the outer perimeter of the wheel.

Being authentic 

DeMoya, a certified child and adolescent trauma professional, stresses the importance of being authentic with this generation. “As therapists, we have to move away — as I think we are — from the disconnected, Freudian approach where we just put on our glasses, have our clipboards … and don’t engage in a more relational way,” she says. “You have to be willing to put the clipboard down.” Although there is nothing inherently wrong with taking notes in session, DeMoya says, it can sometimes be a barrier to developing a closer connection with Gen Z clients. 

This generation often wants to know more about the counselor they are working with, and as Bonfini points out, they are likely to have Googled the clinician before the first session. Bonfini recalls being taught as a counseling graduate student not to self-disclose with clients, but she has learned that some limited disclosure helps build rapport with this population. Her clients often ask if her high school or college experience was similar to theirs. She shares with them the ways it was different, such as not having a smartphone and having to make sure that she showed up on time to meet friends or else she would miss them. But she also normalizes and validates common adolescent experiences such as feeling uncomfortable in one’s own body, navigating romantic relationships and being unsure of what’s next after graduation. 

Being authentic also includes working collaboratively with this population to determine their treatment plans and therapeutic goals. Bonfini likes to use motivational interviewing to build rapport and let her clients know that she is working in partnership with them. She often requests that they rank and rate various mental health issues they may want to work on in session. And she asks them, “When will you know therapy is over? What does that look like for you?” This process not only lets the client know that counseling is a partnership but also provides her with useful information about the client’s core issues and treatment goals. 

Today’s counselors must also be willing to learn more about the world these digital natives inhabit. “If you want to be an effective therapist and connect with youth, you have to know social media,” Bellenbaum asserts. Bellenbaum familiarizes herself with current social media trends and has Instagram, YouTube, TikTok and Facebook accounts to help her better understand this culture and what her clients reference. She doesn’t play the video game Minecraft or games such as Dungeons & Dragons or Magic: The Gathering, but she’s aware of what the games are because younger populations often play them. Knowing about current social media trends will help clinicians better understand the challenges this generation faces, she says. 

But counselors don’t necessarily have to be familiar with all the latest trends to build rapport with this population. It’s great if you are, DeMoya says, but what’s more important is showing up authentically in session. 

Making counseling more friendly for Gen Z 

Counselors can also adjust their clinical environment to make it more welcoming for Gen Z individuals. One simple change is to offer electronic communication options for making initial contact with the counselor or setting up an appointment. Bonfini has found that Gen Z clients are less likely to reach out via phone, and when they do call, they don’t say much beyond “I want to make an appointment” or “Call me back.” Secure messaging platforms, text messaging and online forms allow clients to go into more detail and explain why they are seeking counseling, their current schedule and the best way to get in touch with them, she says. 

Bellenbaum uses the app Talkroute, a virtual phone system, for her business because it allows clients to call and text her business line for scheduling purposes. Bellenbaum can also access this app on her laptop or phone, which makes it convenient for her as well. In her client intake packet, she stresses that texting is only for scheduling issues because she cannot guarantee confidentiality through text, but she likes having this option because she knows Gen Z clients are more likely to text than to call. 

Bellenbaum mentions the importance of counselors having office décor that clients can relate to. She has tailored her space to the Gen Z age group by having modern décor with comfortable chairs, blankets, pillows and inviting colors. She also keeps fidgets and snacks in her office in case clients want them. Bellenbaum says her clients often notice and comment on how they like her wall color or décor.

DeMoya’s goal is to create a therapeutic environment that feels like two friends hanging out in a living room. She invites clients to bring in their own coffee or snacks, and she also keeps drinks and snacks in her office. She tells clients to sit where they feel most comfortable — whether that’s on the couch with their feet up or on the floor — and DeMoya will join them in sitting on the floor if they ask her to. 

Bellenbaum also knows that, as digital natives, Gen Z clients prefer electronic forms over paper ones, so she has made all her paperwork electronic and uses an electronic health record. In fact, she doesn’t even keep a filing cabinet in her office. “A big piece of working with Gen Z [is using] … what works for them,” Bellenbaum says. 

If clinicians use a lot of paper worksheets and homework assignments, there is a good chance the forms will be lost or not filled out, Bellenbaum says, so she finds electronic copies more useful. She also suggests counselors get creative in how they incorporate electronic therapeutic techniques. For example, she may ask clients to keep a thought journal on a note app on their phone, and she often recommends that they use apps such as Calm or Headspace when they are working on mindfulness techniques. When she has assignments for clients, Bellenbaum may give them an electronic worksheet, have them take a picture of a worksheet on their phone or email them a link to a counseling exercise because she says they are more likely to engage with the activity if it can be accessed electronically. 

Samson also uses therapeutic apps with her clients. For instance, she sometimes recommends that clients who are struggling with obsessive-compulsive disorder use the GG OCD app, which converts CBT techniques into short games that challenge intrusive thoughts and promote positive self-talk. 

DeMoya has learned that many Gen Z clients prefer counseling approaches such as mindfulness and eye movement desensitization and reprocessing (EMDR) that allow them to be in the moment targeting specific issues. When doing bilateral stimulation as part of EMDR, DeMoya gets creative to keep these clients engaged. For example, she gives clients who are musically inclined drumsticks, sets a metronome and has them drum to the beat, or she may have a client use boxing gloves and punch left and right for bilateral simulation.

“Generation Z is all about experiences,” DeMoya says. “If you can make the counseling [process] … something that touches all of their core senses — sight, sound, touch, taste, smell — and you can create something that is an experience in the counseling room, that’s how you’re going to get a whole lot of momentum from them.”

“They’re so stimulated in every area of their life,” she adds. So, “the counseling session has to be something that engages them in multiple, different levels.”

Considering developmental and generational factors

Counselors know Erik Erikson’s stages of psychosocial development well, and they often think about how a client’s life stage (say as a teenager or emerging adult) might be affecting their mental health. But should counselors also consider the generation that a client belongs to? 

Amber Samson, a licensed clinical professional counselor in College Park, Maryland, thinks counselors should consider both. From a life-stage approach, counselors can reflect on what it was like to be an adolescent and emerging adult and how they are thinking about issues socially, she says. And from a generational perspective, counselors “can see the unique challenges that Gen Z clients face with communication and the constant access they have to their peers, which heightens the judgment and pressure they feel at this age.” 

Jayna Bonfini, a licensed professional counselor in McMurray, Pennsylvania, and a counselor educator, agrees that it’s important for counselors to be aware of how generational factors affect clients’ mental health and development. Drawing from psychologist Urie Bronfenbrenner’s bioecological theory of development, which argues that human development is a transactional process in which surrounding environmental context shapes an individual’s development, she points out that one’s sociopolitical time influences one’s development. Every generation faces different environmental and societal factors, and Bonfini argues that with increasing technology and climate change, Gen Z is dealing with a lot of issues and crises that previous generations didn’t have to think about in the same way.

At the same time, counselors must guard against pigeonholing clients based on “membership” in any particular generation. “A big hurdle that we can all get into as humans is looking at the next generation and automatically putting them in boxes [e.g., boomers are selfish, millennials are entitled, Gen Z is antisocial], and it [often] comes into the counseling session,” says Nichole DeMoya, a licensed mental health counselor in Jacksonville, Florida.

DeMoya encourages clinicians to be aware of their generational biases and to make sure that they do not intrude on their work with clients. It’s easy to criticize, blame and label, she notes, so Gen Z clients often want to know if they have credibility with their counselor and if their worries and concerns are going to be taken seriously.