When teens in Seattle need someone to talk to, many are starting with their phones.

The city launched a free virtual therapy program for teens and young adults in December. It’s open to residents ages 13 to 24 and includes unlimited messaging with a licensed therapist, one live video session per month, and access to a self-guided mental health app called Talkspace Go. No insurance is needed, and teens in Seattle can sign up without parental permission.

More than 55,000 young people are eligible. The CDC reports that 40% of high school students felt persistently sad or hopeless in 2023, which is slightly lower than in 2021, but still far higher than a decade ago.

But what does the program look like in practice?

Seattle magazine spoke with Erin Mack, a licensed therapist who works with teens at Talkspace and leads the platform’s risk escalation team. She tells us what she’s seeing so far, including the kinds of issues teens are bringing up, how texting changes the dynamic, and why this format is getting through in a way traditional therapy sometimes doesn’t.

What kinds of issues are teens bringing to therapy right now?

A lot of times they’re coming because they’re experiencing some sort of stress. Sometimes they’ll label it as anxiety and say that they’re anxious. A lot of instances also are when they’re feeling sad or down. They have the language for mental health-related symptoms and diagnoses. So they’ll say, “I’m feeling depressed.”

Another thing that often comes up is teens wanting to work on relationships — family, friends, romantic interests. A lot of that ties into learning better ways to communicate, but also ways to have better boundaries.

Why do you think teens are more comfortable talking about mental health now?

There’s been an overall increase in media that has allowed teens to say, “It’s okay to talk about this.” We could definitely do more to help, and it may vary depending on where people are or their cultural backgrounds. But being able to see more discussion about mental health has helped teens say, “Oh wow, I’m experiencing this. Let me get some help.”

From what you’ve seen, how is Seattle doing on that front?

Seattle does a really good job with expanding mental health services. That’s something a lot of other cities and even states can learn from, just having more openness and creating spaces for access.

The great thing about Washington is that teens can sign up for services without parental consent. It just means that teens are able to take the initiative on their own and get care. Then they can work with their therapist to determine what their needs are and what kind of involvement they want from parents or guardians.

Have you seen a shift in how many teens are reaching out?

Definitely. The more we provide access, the more we’re going to see teens and young adults try to use it. That may be intermittently. Some people may show up for a month or two and say, “Hey, I’m feeling much better,” and stop. Then three months later, they may need to come back. That’s part of the natural flow of treatment.

Let’s talk about texting. Why is it such a useful tool for teens?

It’s quite literally in their pocket. They’re able to pull out their phone and express how they’re feeling. And even if it’s not instant, they know the therapist will see it and respond. That’s helpful, just knowing they can share their thoughts, have a space where they can keep it, refer back to it, and process it later.

It’s different from journaling by yourself. You’re messaging a licensed professional who can support you through that process.

Are there certain issues that text therapy works especially well for?

Self-esteem, definitely. A lot of teens that I’ve worked with on Talkspace have significant self-esteem issues and they don’t want to be seen right away. They’ll think, “I don’t have to turn on my camera or get on a call when I’m maybe feeling really down, but I’m still able to express myself.” 

It’s also about building trust and feeling comfortable. Being able to send a message is a lot less scary for teens to say, “This is how much I’m gonna give you now. Let me see how you respond.” And giving them time to respond is really important. It helps teach teens that they can take their time. They don’t need to have immediate responses to things that aren’t urgent.

How is trust built over text?

Just being human. I always encourage an audio or video message from the provider. Even if the teen isn’t matching that, that’s OK. But it breaks down the wall a little bit. I always remind my teen clients, “Yes, I’m a human. I’m not a bot.”

And then it’s things like: if they like cats and I have a cat, maybe I share that. Ask questions. Let them know you’re really there.

How are teens different from adults in how they use the platform?

They’re so much more likely to say, “I did this thing.” If we talk about a grounding exercise one day, they’ll come back the next and say, “I tried that.” It’s such good feedback. Adults often take longer. But teens are in that space where their brain is still growing, and they’re just much more receptive.

What should parents know about how teens experience stress today?

It shows up in different ways depending on the kid. Sleep is a big one — are they sleeping more or less? Irritability is a big marker too. And sometimes we forget that. Depression or anxiety in teens doesn’t always look like sadness. Sometimes it’s just a shift in behavior.

You want to normalize those symptoms. Whether it’s general or something more significant, talk about it.

If a teen is resistant to therapy, what can a parent say to encourage them?

Ask them why. A lot of teens I’ve worked with say people don’t ask them questions. And that’s the biggest thing. We fall into that expert role, thinking we know better. And yes, a lot of the time we do, but they need to be heard.

You could ask: What would be the worst thing that could happen if you reached out? What are you worried about? If you could picture the ideal person to talk to, what would they be like? It helps break down that image they have of what a therapist is supposed to be.

What does a first session usually look like?

Teens will get a welcome message, maybe a few follow-up questions. The provider might say, “Let’s get on a call and get to know each other,” or they’ll just work through things via text. It’s all about creating a treatment plan together. Some teens start with messaging and switch to video later. Others stick with text the whole time.

We also give them the ability to switch therapists. They can do it on their own with our self-switch wizard or reach out for help finding a better match.

Body image is a big concern for teens, especially with social media. Are you seeing that?

Absolutely. It’s being talked about more now across different communities and backgrounds, which is good. Therapists are also getting better at asking about it directly — without making assumptions.

It’s still under-addressed in boys and young men. They’ve been taught not to talk about it. But that doesn’t mean they’re not struggling with self-esteem or internalized body image issues. As providers, we need to make space for that too.

So what’s your big takeaway from working with teens in this format?

That flexibility matters. Access matters. And teens are showing up. Even if they don’t always do it in a traditional way, they’re talking, they’re trying things, and they’re coming back. It’s just great to see that happen in real time.

 

Seattle’s virtual therapy partnership with Talkspace is part of a $14.55 million investment from the City of Seattle and Seattle Public Schools to expand mental health support for youth. Talkspace is free for local residents ages 13 to 24, with no insurance or diagnosis required.

For more insight on how teens communicate what they’re feeling, Talkspace created an emoji-based guide to teen mental health.