The One Thing Gen Z Brings Up the Most in Therapy, According to Therapists

Ashley Broadwater
·8 min read
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Gen z woman speaking to her therapist

While Gen Z might be known for their fashion choices (we’re looking at you, “ugly cute” pants), or specific emoji use (is the laughing face really *that* cringe-worthy?), perhaps their most valuable take is about the importance of therapy. 

In fact, Gen Zers are more likely to report fair or poor mental health, and to receive treatment from a mental health professional, than other generations, according to the American Psychological Association.

Whether this is because of their openness or the real impacts of the world they’ve grown up in—one with political unrest, a rising cost of living and the ongoing pandemic, for example—isn’t entirely clear. What is clear, however, is the fact that many Gen Z folks are more willing to be vulnerable and transparent in discussing their mental health—and on large platforms, such as TikTok. This can be helpful in decreasing stigma, encouraging professional support and addressing systemic issues. 

So when Gen Zers go to therapy, what topics are most common in sessions? How might they differ from other generations' challenges? Ahead, therapists share what they hear most from Gen Zers.

The #1 Thing Gen Z Clients Bring Up the Most in Therapy

Several therapists say loneliness and isolation are the most common concern. Further, most of them say a major contributor is one you may or may not expect: the rise of social media.

And that could be for several reasons, one being FOMO (fear of missing out). “Because this generation is posting so much more of what they're doing and who they're with, it is almost instantaneous that they also learn that they weren’t invited to gatherings and are feeling not good enough or left out,” says Antionette Bonafede, LMSW, a senior associate therapist at Gateway to Solutions.

And the truth is, those outings might not even be meaningful. If you’ve ever been with people but felt alone, you probably know what we’re talking about here. “Because so much is posted, it also can make outings or events less mindful and more performative,” Bonafede adds. She’s found many of her Gen Z clients are people-pleasers, concerned with how they appear to others and busy getting their validation from external sources alone. 

These feelings can also correlate with other common topics this generation shares in sessions. “The primary concerns I tend to see Gen Z bringing into therapy are depressive and anxious symptoms, concerns over changes in relationships, and struggles with self-esteem,” says Marisha Mathis, LCSW, a licensed clinical social worker with Thriveworks in Raleigh, NC who specializes in depression, anxiety, and self-esteem.

Regarding relationships specifically, roughly 45 percent to 51 percent of Gen Zers point to relationships as a major contributor to their mental health concerns, according to a Thriveworks study.

More specific examples Mathis lists that could tie closely with feelings of loneliness include feelings of worthlessness, losing a friend or partner, social media-related comparison and self-esteem. Interestingly, what this data says to Gen Z clients is exactly what they need to hear: they couldn’t possibly be alone in the struggle of loneliness since it's so common. 

Related: 11 Phrases That Signal a Person’s Lonely, According to Psychologists

What Therapists Advise Their Clients

When Bonafede works with a client struggling with loneliness and isolation, she likes to go deeper with self-esteem and self-concept work.

“I spend a lot of time doing self-exploration of values and ethics with Gen Z,” she says. “It significantly helps them break away from norms and expectations and helps them focus more on the importance of meaningful connections that match what they think is important and less of what is ‘trendy.’”

As clients reflect on this, she continues, they try to unlearn judgmental ways of thinking and build confidence around living in accordance with their values.

Another option for handling the concern is addressing its root. This is what Mathis likes to do with her clients. “Once we identify the underlying factors, or what I like to refer to as ‘roots,’ we choose interventions,” she says.

With self-esteem, she notes, this could look like practicing affirmations. With anxiety, she encourages her clients to challenge their negative thoughts and replace them with positive ones. More generally, she also recommends journaling, engaging in hobbies and spending time with loved ones.

Related: Journaling Is Packed With Health Benefits, so Get Started With These 88 Prompts on Life, Love, and Gratitude

3 Other Common Therapy Topics Among Gen Z and What Helps

While isolation or loneliness was the most common concern among the Gen Z crowd, according to the therapists Parade spoke to, here are a few additional topics they’ve often seen with Gen Z clients in their practice.

1. A lack of motivation

Feeling unmotivated can be tied to not knowing what you like, being unsure about your purpose, and other contributors (that are probably exacerbated by capitalism and a focus on work and making money).

“Gen Zers describe feeling a lack of passion and like they don’t know what they enjoy,” says Dr. Melanie McNally, PsyD, a clinical psychologist who is deeply committed to guiding Gen Zers toward their authentic selves. “This lack of passion creates a lack of purpose and fulfillment, resulting in symptoms of anxiety and depression.”

This concern isn’t brought up by only Gen Z clients, Dr. McNally clarifies, but by their parents too. The parents want their children to spend less time on their phones and more time engaging with life.

What she suggests: Dr. McNally implements psychoeducation, explaining how motivation is made up of three skill sets: drive, grit and goals. In other words, what’s missing: the feelings of passion, the willingness to push through hard situations, or direction?

“Once we have a better understanding of where their struggles are, we can create a path forward,” she continues. This might look like exploring curiosities, deleting distracting apps and building upon what they want to pursue further.

2. A diagnosis they think they have

With the rise of TikTok (and TikTok therapists, coaches, etc.) comes the rise of TikTok diagnosing and mental health talk. To be clear, this isn’t necessarily a bad thing. It raises awareness and encourages reaching out for support; it normalizes mental health and makes it less taboo.

“What sets this generation apart is that Gen Z clients do an incredible amount of research on different mental health concepts, such as attachment styles, and often research about various diagnoses,” says Janet Bayramyan, LCSW, a licensed psychotherapist specializing in trauma resolution, relationship work, and transformative self-development. “And while this research is wonderful, oftentimes Gen Zers come into therapy sharing that they believe they have ADHD, or that they're on the autism spectrum, or even bipolar disorder, without a formal evaluation or assessment.”

According to a Thriveworks representative and research summarized in the platform’s self-diagnosis report, 53 percent of Gen Zers have diagnosed themselves or another person with a mental health condition, and 63 percent have had a clinician back it up.

What she suggests: First, Bayramyan says, list your thoughts, symptoms and behaviors. Then, if possible, discuss them with a clinician. This can ensure you get the most accurate information, and therefore, the right treatment.

At the same time, she encourages not depending too heavily on a label, noting they can pathologize “normal” reactions and make us feel worse.

“Instead of focusing on the label, focus on what you can do to support yourself,” she adds, “and speak with a professional who can validate your concerns while also helping you identify the ways in which you can better your life.”

Related: The 10 Unexpected ADHD Signs Most People Miss, According to Psychologists

3. Everyday concerns and a desire for wellness

At the same time, many Gen Z clients recognize that therapy is helpful (and important) even before you hit rock bottom or feel like you might have a diagnosable condition.

“A pattern I have recognized for Gen Z clients is that they commonly seek out counseling for everyday concerns and overall preventative wellness,” says Natalie Grierson, LSW, LPCC-S, a counselor, supervisor, and social worker with Choosing Therapy.

With previous generations, she adds, clients usually came in when they felt something was “wrong” or their symptoms became significant.

“The difference among generations is likely due to decreased stigma around mental health treatment and how normalized going to therapy has become in recent years,” she says.

What she suggests: First and foremost, Grierson wants to acknowledge and celebrate this proactive approach to mental health management. Next, she discusses how to maintain self-care practices and prevent symptoms of mental illness. This might look like getting enough sleep, spending time in nature, praying and eating enough, for starters.

“Similar to how we routinely bring our car to the auto shop for an oil change instead of waiting for it to break down, attending therapy even when nothing is ‘wrong’ helps to promote healthy coping skills, self-concept and mental wellness,” she adds.

So if you take anything away from this article, let it be these two messages: You’re not alone in what you’re going through, and therapy is an important part of proactive wellness.

Next up, check out the 5 questions your therapist wants you to ask.

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