Last updated: April 2026 · 10 min read
Therapy with teenagers is its own clinical discipline. The evidence base is solid — CBT, ACT, DBT-informed approaches, and exposure-based work all produce meaningful outcomes with adolescents — but the delivery has to be different. Teens are at a developmental stage where being talked at feels like school, sitting across from someone asking probing questions feels like an interrogation, and anything that looks too much like a worksheet from a mental health book will be completed with minimal engagement and immediately set aside.
The activities below are designed for the reality of working with adolescent clients: they are engaging without being juvenile, clinically grounded without announcing it, and flexible enough to adapt across the range of presentations therapists actually encounter with teens — anxiety, depression, OCD, identity difficulties, social challenges, family conflict, and more.
They are organised by clinical function rather than by modality, because most therapists working with teens draw from multiple frameworks depending on the client in front of them.
Building Engagement and Alliance
1. The Interest Inventory
A structured but conversational first-session activity: rather than a standard intake questionnaire, the therapist explores the teen's genuine interests — music, games, sport, creative pursuits, online communities, niche knowledge — with real curiosity. The clinical purpose is alliance-building and information-gathering simultaneously. What a teenager is interested in tells you how they think, what engages them, what metaphors will land, and what formats will work. A teen who is passionate about strategy games thinks differently about problems than one who is immersed in creative writing, and the treatment should reflect that.
Best for: First session with any teen client. Sets a relational tone that makes every subsequent session more productive.
2. The Two Truths and a Lie Check-In
A low-stakes session opener: the teen shares two true statements about their week and one false one, and the therapist guesses which is the lie. Then reverse it. The game format reduces the pressure of the direct "how was your week?" opener that many teens find hard to answer honestly — and often surfaces material that a direct question would not. Once the game reveals something worth exploring, the therapist can follow it naturally into the session content.
Best for: Resistant or quiet teens, early sessions, re-engagement after a session that felt stuck. Useful as a regular check-in format for teens who struggle with open-ended openers.
3. The Emoji Check-In
A visual, low-verbal session opener: the teen selects an emoji (from a printed sheet or their own phone) that best represents how they are feeling right now, and one that represents how they've been feeling across the week. The choice is the starting point for the session — "tell me about that one" — rather than the answer. Emoji check-ins work particularly well with teens who have limited emotional vocabulary and for whom "how are you feeling?" produces one-word responses.
Best for: Teens with alexithymia, low verbal engagement, or limited emotion vocabulary. Good regular check-in format across all presentations.
4. The Soundtrack of My Week
The teen identifies a song that matches how their week has felt — not necessarily lyrically, but tonally, energetically. The therapist listens (or the teen describes it), and the song becomes a conversation starter about the week's emotional texture. Music is one of the most emotionally resonant entry points for adolescents, and this activity consistently generates richer material than direct emotional questioning. It also tells the therapist something about the teen's emotional and aesthetic world that builds the alliance over time.
Best for: Teens with strong music engagement. Excellent regular check-in format. Works particularly well with depression presentations where direct emotional questioning produces flatness.
Emotion Identification and Regulation
5. The Feelings Wheel Exploration
A structured emotion vocabulary exercise using the Plutchik or Junto emotion wheels: the teen identifies what they are feeling starting from the broad outer categories (angry, sad, fearful, happy), then navigates inward toward more specific emotions. The wheel format externalises the process of emotion identification and makes it feel like a puzzle rather than a therapeutic demand. For teens who consistently report "fine," "stressed," or "don't know," the wheel often unlocks vocabulary they have but haven't been applying to their own experience.
Best for: Limited emotion vocabulary, alexithymia, depression presentations. Good early-session tool that builds capacity for all subsequent emotional processing work.
6. The Thermometer Rating
A simple visual scale — a drawn thermometer from 0 to 10 — used to rate emotional intensity across different situations, relationships, or time points. The teen fills in ratings for different contexts: at school, at home, with friends, when alone. The resulting picture shows variation the teen may not have consciously mapped, and often identifies situations that are significantly more activating than others. The thermometer format is concrete, non-threatening, and easy to return to across sessions as a progress measure.
Best for: Anxiety, anger, and mood presentations. Good early-stage assessment tool that doubles as a psychoeducation activity.
7. The Volcano and the River
A psychoeducation metaphor for two common emotion dysregulation patterns in teens: the volcano (suppression followed by explosive release) and the flooding river (immediate, overwhelming emotional expression with no containment). The teen identifies which pattern is more theirs — or whether different relationships bring out different patterns. The metaphor gives language to dynamics that teens often experience but can't articulate, and sets up the work of identifying early warning signals before the volcano or flood arrives.
Best for: Anger, emotional dysregulation, DBT-informed work. Particularly engaging for teens who don't recognise "emotion regulation" as relevant to them but immediately identify with one of the metaphors.
8. The Trigger Map
A visual mapping activity: the teen identifies their main emotional triggers across different contexts — school, home, social situations, online — and maps them on a large sheet with connecting lines to the emotional and behavioural responses they produce. The map makes visible the patterns that feel chaotic and unpredictable from the inside, which is itself regulating. It also identifies the highest-priority targets for intervention: the triggers that produce the most disruption most frequently.
Best for: Anger, anxiety, and emotional dysregulation presentations. Particularly useful for teens and families who describe the teen's reactions as "coming out of nowhere."
🗂️ Done-for-you worksheets for teen clients
Clinically grounded, adolescent-appropriate worksheets covering CBT, ERP, emotion regulation, and more — structured, printable, and session-ready.
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9. The Thought Detective
Create a case file of a real-life scenario. Teens investigate the character’s automatic thought, examine the evidence, identify possible thinking traps and decide on a more balanced way to view the situation. Finish by discussing how the new thought could change what happens next.
Best for: Anxiety, thought challenging, low self-esteem. Good introductory cognitive distortions.
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10. The Externalising Character
Give the teen's anxiety, depression, OCD, or inner critic a character — a name, an appearance, a voice, a set of favourite phrases. The character is drawn or described collaboratively, and the "catchphrases" — what it always says — are the automatic thoughts that are hardest to elicit directly. Once the character exists, the teen can engage with it differently: "there's Anxious Alex again, saying the same thing." The externalisation creates the distance that makes cognitive defusion possible without naming the technique.
Best for: Anxiety, OCD, inner critic presentations. Particularly effective with creative teens and younger adolescents.
11. The Hot Seat Debate
A role-play activity: the teen's anxious or depressive belief sits "in the hot seat" and is cross-examined. The therapist plays the belief ("I'll never be good enough") and the teen plays the prosecutor, finding evidence against it. Then swap — the teen defends the belief, the therapist prosecutes. The adversarial format engages teens who resist direct cognitive challenge, and the physical act of arguing against their own belief — even performatively — often produces genuine cognitive shifts.
Best for: Depression, low self-esteem, core belief work. Works particularly well with teens who are argumentative by nature — their natural tendency becomes the therapeutic tool.
12. Flip that Thought!
Write scenario cards describing situations relevant to the teen's presentation. Players explore thoughts that might come up in that scenario and how that thought could affect their feelings and actions, then “flip” it into a more balanced and helpful thought. Discuss what might change—and remember, there can be more than one useful way to flip it.
Best for: Anxiety, thought challenging practie.
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Identity and Values
13. The Values Compass
Draw a compass on a large sheet. Each direction represents a life domain — friendships, school, family, personal interests, future. For each domain, the teen identifies one value that matters to them and one small action that expresses it this week. The compass format is visual and concrete without being juvenile, and gives behavioural activation — or any goal-setting work — a values foundation. Teens who struggle to articulate why they should try at school often find that "curiosity" or "becoming someone who knows things" as a value gives them something more meaningful to work toward than grades.
Best for: Identity work, depression, motivational difficulties, disengagement. Good mid-treatment activity once some trust is established.
14. The Social Media vs. Real Me Activity
Two columns: "my online self" and "my real self." The teen populates both — what they present, what they hide, what they exaggerate, what they minimise. The activity surfaces the gap between performed and authentic identity that is a significant source of distress for many adolescents, and opens conversation about which version of themselves they want to grow toward. This is not a social media critique activity — it is an identity clarification tool that happens to use a frame immediately relevant to most teens' daily experience.
Best for: Identity difficulties, social anxiety, low self-esteem, social media-related distress. Highly engaging for teens who spend significant time in online spaces.
15. The Future Letter
The teen writes a letter from their future self — 5 or 10 years from now — back to their current self. The future self has navigated the current difficulties and is writing with the perspective of having come through them. The letter format accesses hope and self-compassion through the device of temporal distance. Many teens find it easier to be kind to a slightly younger version of themselves than to themselves in the present moment. The letter often surfaces values, strengths, and aspirations that direct questioning misses.
Best for: Depression, hopelessness, identity work, end-of-treatment consolidation. One of the most emotionally resonant activities in this list when used at the right moment.
Social and Coping Skills
16. The Boundary Role Play Game
Scenario cards describing social pressure situations — a friend asking for something the teen doesn't want to do, a group expecting them to go along with something uncomfortable, a romantic interest pushing past a limit. For each scenario, the teen writes or says what they'd actually say — not the "correct" answer, but their honest first response. The honest responses are the clinical material: they reveal the automatic language patterns that collapse under pressure, which becomes the target for script-building work.
Best for: Boundary difficulties, social anxiety, assertiveness skills, peer pressure presentations. Maps directly to boundary workbook content.
17. The Friendship Audit
A structured reflection on the teen's key relationships: for each friendship, what does the teen give, what do they receive, and how do they feel after spending time with that person? The audit is not designed to produce judgements about specific friends but to build the teen's awareness of how their relationships affect their energy and wellbeing — and to introduce the idea that they have some agency over which relationships they invest in. Teens who feel trapped in draining friendships often find the audit validating in a way that direct advice about "toxic friendships" is not.
Best for: Social difficulties, enmeshed or draining friendships, boundary work, low self-esteem. Good mid-treatment activity.
18. The Coping Menu
Collaboratively built across several sessions: the teen populates a menu of coping strategies they have personally tested and confirmed as helpful, organised by difficulty and context. Easy options (reliable, low-effort mood lifters — a specific playlist, a particular game, a short walk), medium options (require some effort but reliably help), and stretch options (harder to initiate but most effective). The menu format removes in-the-moment decision burden — when regulation is needed, the teen picks from the menu rather than trying to generate options from a dysregulated state.
Best for: All presentations. One of the most practically useful between-session tools. Its value compounds as more strategies are added across treatment.
19. The Boss Battle Exposure Ladder
The standard exposure hierarchy reframed using video game structure: each avoided situation is a level, the most feared item is the final boss, and the teen rates each level by difficulty. Between sessions, levels are attempted and reported back. The language normalises the difficulty — bosses are hard by design — and frames completion as an achievement. The game metaphor also introduces the concept of repeated attempts without shame: in games, you expect to fail a level and try again. Applying that framing to exposure work reduces the catastrophising around partial success.
Best for: Anxiety, OCD, avoidance-based presentations. Works broadly even with teens who don't game heavily — the metaphor is culturally accessible enough to land across most adolescent clients.
20. The Progress Playlist
A consolidation activity for mid-to-late treatment: the teen builds a playlist where each song represents something they've learned, a moment of progress, a strength they've discovered, or a value they've connected with during treatment. The playlist is built across sessions and reviewed together at termination. Hearing the teen articulate why they chose each song — what it means in the context of their journey — is often the richest reflection on therapeutic progress available. The playlist also gives the teen something concrete and personally meaningful to return to after treatment ends.
Best for: Any presentation, mid-to-late treatment. Particularly powerful as a termination activity for teens who struggle to acknowledge their own progress.
What Makes These Activities Work With Teens
A few principles that run across all of the above:
Don't explain the technique before doing it. With adult clients, naming the CBT rationale can build buy-in. With many teens, knowing they're about to do a "thought record" or an "exposure exercise" activates resistance before the activity has a chance. Introduce the activity first. If they ask what it's for, answer honestly — but lead with the activity itself.
Let them change things. If a teen wants to rename something, adapt the format, or do it completely differently — let them. Their version will work better than yours because it's theirs. Clinical fidelity matters for treatment protocols; it matters much less for individual activities used within a therapeutic relationship.
Be in it with them. Teens notice when a therapist is observing rather than participating. Picking up a pen, doing your own version, engaging with the activity as a collaborator rather than an administrator — these adjustments shift the relational dynamic in ways that matter for engagement.
Not everything needs to be homework. Between-session tasks work well when they're short, specific, and have a clear return purpose. If a teen consistently doesn't complete between-session work, that is clinical information worth exploring rather than a compliance problem to manage.
Done-For-You Resources for Teen Clients
- OCD & ERP Workbook for Teens — structured ERP worksheets for adolescent OCD including boss battle and scenario activities
- 20 CBT Activities for Teenagers (That Don't Feel Like Therapy) — CBT-specific activities for adolescent presentations
- 20 Therapy Activities for Anxiety — anxiety activities adaptable for teen and adult clients
- Best Therapy Worksheets for Therapists — Done-For-You — broader resource guide across presentations and modalities
📋 Done-for-you worksheets for teen therapy
Clinically grounded, adolescent-appropriate worksheets for CBT, ERP, emotion regulation, and more — structured, engaging, printable, and ready for your next session with a teen client.
Browse teen worksheets →