Outpatient depression help for teen just finishing freshman year?

Our teen is in his first year of college and is so unhappy that he does not want to go back to college in the fall.  He is too exhausted and lethargic from sadness to think of doing anything over the summer.  He has been seeing a therapist who has been doing talk therapy, but that has been going on for a while, since before he went to college, and he is sinking more and more into sadness and depression.  It had looked like worries about college, before he left. We are working hard to understand where he, is of course, and how to help.  We are of course very alarmed and worried and sad for him.  Meeting a therapist once a week does not seem sufficient if he is sleeping at home in bed the rest of the day and week, once he comes home.  We know residential programs exist, but wondered in the east bay area if there was something like an outpatient program where he could go somewhere 9-5 daily, or maybe see someone 3 times a week for counseling and then we/counselor could put together activities that would support this, a bit of structure, so he could slowly get back to the idea of not being sad?  (Yoga, dog-walking, whatever? He's a gentle and kind person.)  He is also a homebody and loves his room and is socially anxious, so being able to go to that comfort, to recharge, and then go out daily a few times a day for something structured and positive might be a way to help him start feeling better.   He is happier if a parent is with him when he goes outside, one of us has a flexible enough job that we can just be there with/for him, for these excursions out into the world.

At college he looks fully functional, but it is taking all he has to keep that facade up, and when the structure ends, this summer, he just wants to rest.  He is so incredibly tired.    We had thought he was just lonely from starting college, but the nice people and clubs and all of that are there, at his school, and he acknowledges that, he just can't pull together to go try them.  Possible programs, things that could work-residential,outpatient, etc., therapists, all advice would be welcome.  Many thanks!

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One thing that I noticed in your post is that your son is doing talk therapy with a therapist, but there is no mention of a psychiatrist or medication. I know that many people resist medication and anti-depressants for a host of reasons, but if he's so sad that he can't engage, trying that would be my first "stop" once your teen comes home. It can take a few tries to get the right one, but it can make ALL the difference in giving him the space and energy to make progress, gain clarity, and work more effectively with his therapist. Summer is a good time to try medication when he's not trying to deal with school pressures and has the support of home. Good luck. It's hard.

Talk therapy will not help IME. Cognitive behavioral therapy is what he needs. My 15 yr old saw Neil Howell MFT in Berkeley, and he really helped her so much with her anxiety and depression. He uses CBT, and it really works. I have also done CBT and talk therapy for my anxiety, and CBT is by far superior. Neil is really good with teens. neil [at] neilhowellpsychotherapy.com

Has your son considered medication? It might help him get to a baseline where the talk therapy would be more beneficial and he would be able to be to do more, which will make him feel better. I don't think I'd just accept that he's not going to work or do something productive with his time over the summer, unless a professional is telling you he's too disabled and needs full time treatment. Your son's situation may be completely different but one of my kids was very depressed his first semester of college and revealed that this was a long term problem. He came home (in part so he could get treatment at Kaiser although we ended up paying for some private help), and got on anti-depressant and ADHD medication, but he continued college full time at community college plus part time work. He's now off the medication although he has it available, doing well and looking forward to leaving home round 2 (as a junior year transfer from cc, preceded by out of state summer job.)
 

There are two types of programs that he might benefit from:

- Partial Hospitalization Program (PHP): he would go for full days, 5 days a week but come home in the evenings. These include group and individual therapy, as well as meeting with a psychiatrist who may recommend medication. There is one of these at Alta Bates, and I believe at John Muir. There may be others.

- Intensive Outpatient Program (IOP): these are usually about 3 hours per day, and 3 or 4 days per week. They are intended to accommodate people going to school at the same time. In addition to Alta Bates and John Muir, there is one called Bay Area Clinical Associates in Oakland, which my daughter did. I think it was a great program, but there has been almost complete staff turnover there, so I'm not sure about the current therapists.

There are many other programs in the Bay Area that can help.

I would start by calling your insurance company--ask for a Behavioral Health Case Manager. Tell them what you are looking for.

I know from experience that caring for a depressed child is difficult and challenging. My heart goes out to your and your son. When one of my sons had a hard time with anxiety and depression, and once a week talk therapy wasn't helping, we turned Coyote Coast in Orinda [https://www.coyotecoast.com/early-interventions]. We worked with Alex Georgekopolis. They work with the child struggling as well as the family. We are a very close family but their assistance in handling this need was helpful on many fronts. If they aren't what you're looking for, they are well connected and can probably give you some suggestions.

Wishing you all health and the best support and care available.

All best,

TerryB

I'm so sorry to hear that your son (and you) are going through this. We had a similar need for something more intensive than weekly therapy but less so than residential treatment. I believe that BACA (Bay Area Clinical Associates) has what you are looking for. https://www.baca.org

Best of luck to your son in getting the help he needs!