Counseling Athletes of All Levels and Life Stages

Though athletes at different stages of life may all benefit from counseling, their needs—and the related approaches—differ in accordance with age, emotional and physical development, life experiences, sports-related injuries, and many other dynamics.

This month we spoke with four NCCs who specialize in sports counseling and have worked with athletes from the youth and high school levels to those competing in collegiate and professional sports. They discussed the nuances of sports-related counseling and what they’ve learned along the way.

Youth Sports Counseling

Sarah Vanderpool, NCC, LPSC, LCMHCA, is a former competitive athlete whose niche is sports psychology. She is also a figure skating coach and enjoys working with young athletes, helping them manage stress, anxiety, concentration, confidence, anger, and depression. 

“The most common mental health struggles among young athletes are anxiety and depression,” she says. “Parents and coaches should regularly check in and ask open-ended questions about how their athlete is feeling, especially regarding their sport. Is the athlete still excited about their sport? Are they getting along with their team?” 

Signs of anxiety and depression in children can look different from child to child, Vanderpool says. Some behaviors that counselors, parents, and coaches should look for to determine whether a young athlete may be depressed include a significant decrease in the athlete’s enthusiasm or work ethic, a significant increase in anger or frustration, or withdrawal from the activities or team.

Additionally, Vanderpool suggests the following presentations from child athletes who may be suffering from anxiety:

• undue or excessive stress and worry about the outcome of a game or competition
• perfectionist tendencies or setting impossible, unrealistic goals for themselves
• physical symptoms such as nail-biting, breathing rapidly, trembling, or feeling weak and tired

Children can benefit from sports in many ways, Vanderpool says.

“Sports can help children learn teamwork, dedication, perseverance, and grit,” she continues. “Playing a sport as a child has also been linked to improved sleep habits, self-confidence, and exhibiting leadership qualities. Participating in athletics can also help children navigate what it is like to fail, and provide learning opportunities for managing feelings that come with failure, such as disappointment and frustration.”

On the contrary, sports have the ability to negatively impact a child’s mental health if they don’t know how to handle training and competition appropriately, she says, adding that pressure to be perfect and fear of failure may lead to depression, anxiety, and disordered eating.

Mental health professionals can be an important part of an athlete’s support team, Vanderpool says. 

“Ultimately, parents and coaches need to remember that children are a product of their environment. They will behave in the way that is modeled for them, so making sure the model is positive, motivating, and excited will help them know how to appropriately respond to the challenging situations and feelings that can come with competitive sports.” 

High School Sports Counseling

Kate Martino, NCC, LPC, CMPC, is a mental performance coach who provides tools to help athletes improve their performance, addresses mental health issues, and develops individualized treatment plans to fit each client’s needs. A former athlete, she became an assistant high school lacrosse coach in 2017 and began working in private practice in 2020. 

Martino frequently sees anxiety and depression, but also sees obsessive-compulsive disorder and disordered eating among her clients. She notes that individuals don’t need to present with a clinical diagnosis to benefit from the therapeutic experience of counseling. “Athletes are at increased risk of developing mental health issues because of injuries, physical strain, pressure, and stress,” she says.

That being said, participating in high school sports can have a positive impact on an athlete’s mental health in many ways, Martino says.

“Research shows exercise positively impacts serotonin levels in the brain and reduces cortisol, the stress hormone. In addition, team sports offer a sense of connection and social support. High school sports are supposed to be fun. The world we live in today places emphasis on the outcome as opposed to the process.”

Self-care is critical, Martino says.

“Elite-level athletes invest just as much of their time on recovering as they do training, and this should be no different at the high school level. Young people generally do a poor job of listening to their bodies, pushing themselves a little too hard. It is at these times I advise the athlete to listen to their needs and give their body and mind a break. Signs of overtraining are unique to every individual, for example high school athletes dealing with depression or anxiety tend to experience increased negative self-talk, irritability, difficulty focusing, uncharacteristic decline in performance, and decreased interest in their sport.” 

“Counselors can help by normalizing the importance of strengthening one’s mental fitness,” she continues. “Athletes spend so many hours a day developing their physical bodies. How many hours are spent on developing their minds? I see my role as helping individuals find their true potential on and off the field of play.”

Counseling College Athletes

Molly Casebere, NCC, LCMHC, has 17 years of experience working with college athletes, including 6 years at a college counseling center addressing a variety of mental health concerns before moving into private practice. Most often, athletes seek counseling because they aren’t performing at the level they want, she says.  

“I have found that college athletes are more likely to seek performance enhancement services rather than mental health care,” she says. “When an athlete presents for performance enhancement services, a clinical assessment will reveal underlying mental health concerns that can then be addressed.” 

Casebere says athletes experience unique stressors. 

“Athletes face the same mental health concerns as the general population, only with added layers of pressure and public visibility. Thanks to social media, nearly everything they do—in or out of their sport—is open to the court of public opinion, which puts a lot of pressure for them to always be ‘on,’ needing to present themselves in a certain way. They often experience trauma, eating disorders, burnout, depression, and anxiety.” 

Participation in college sports has its pros and cons, she says.

“Protective factors include social support, building self-confidence, feelings of belonging, and having a routine. On the other hand, expectations, time demands, lack of autonomy, and physical wear and tear often take a significant mental and emotional toll on athletes. Many feel as though they are working two full-time jobs, without any extra hours in the day, or days in the week.”  

Understanding an athlete’s self-identity can help make a connection and aid in developing their whole selves, she says.

“I think you need to meet them where they are. You need to understand how much they have invested in their sport, the sacrifices they (and their families) have made, and how much of their identity is comprised of their athletic performance, and therefore, why their performance trumps their overall health and wellness on the priority list. Once you validate their reality, then you can begin to shift the ‘balance’ to recognize that they are in fact, more than an athlete. I say balance in quotes because there is very little balance in collegiate athletes’ lives. Creating balance in their lives looks very different than the average college student. I try to help student athletes identify areas of their lives that they would like to expand and begin to implement strategies to slowly do so. I help student athletes identify other areas of success in their life, who they are outside of their sport, and explore and develop the person they want to be.”

Counseling Professional Athletes

Leah Howard, MEd, NCC, APC, began her career as a school counselor working with youth and adolescent athletes before gaining exposure to college athletics by working and researching at Georgia State University and Mercer University. After becoming a licensed counselor, she began to work with professional athletes in private practice and hospital settings. Her clients have included the Atlanta Falcons Player Development Program and the NCAA Southeastern Conference Football Program, among many others.

Professional athletes experience a variety of stressors, Howard says. 

“Some of the more common reasons professional athletes seek counseling are anger management, anxiety, eating disorders, depression, retirement from professional sports, injuries, and societal and family pressure. Anxiety is commonly found to be linked to athletic performance, and depression is commonly linked to chronic pain from athletic injuries. At some point, every athlete will have a moment in their career in which they will experience transitioning out of the highest level of professional sports. Many athletes struggle with finding their identity beyond sport and their purpose.”

Injuries can also have a tremendous impact on a professional athlete’s mental health and well-being.

“In more serious cases, a player’s career may be at stake,” Howard says. “Addressing the psychological issues that may appear as a result of an injury is a significant component of the decision-making process. There are a few common emotional and physical responses to which an athlete may react. They may emotionally feel shame, guilt, irritability, and frustration. Their body beyond the injury may respond in ways that appear similar to migraines, nausea, excessive sweating, aches and pains, and changes in breathing.”

Meeting athletes where they are and addressing their mental health concerns may aid in their ability to perform, Howard says.

“Despite the fact that they can do incredible and extraordinary things within their sport, they are human,” she says. “They experience success and struggle, and like all of us, they need support, respect, understanding, and space to be who they are.”

A solid understanding of the realm of professional sports is essential when counseling these athletes, she says.

“The world of sports is a subculture within the larger society, and some of the unique aspects of this subculture translate to unique experiences for athletes. Therefore, when working with athletes, a large part of the difference is related to understanding and working with the person within the specific sport context. Intense performance demands, constant evaluation, managing athletic identity, and trying to excel in an environment where uncertainty is the norm and where value is more often placed on what you do versus who you are, are some of the unique elements that may show up in work with athletes versus non-athletes. Understanding the culture helps with understanding the athletes and their experiences, which will hopefully make the work more impactful.”

In conclusion, athletes at all ages and levels of competition experience many stressors in their quest for peak performance. Though anxiety and depression can be somewhat common, as counselors, we can help these clients to nurture their whole selves through self-care, have a healthy sense of competition, and achieve and maintain a more balanced life, on and off the field.

Sarah Vanderpool, NCC, LPSC, LCMHCA, earned master’s degrees in school counseling and clinical mental health from Butler University. She has worked with youth as a school counselor, college and career counselor, and an athletic coach for the past decade.

Kate Martino, NCC, LPC, CMPC, earned her bachelor’s degree in psychology from The College of the Holy Cross and her master’s in clinical mental health counseling from Fairleigh Dickinson University. She is a Licensed Professional Counselor in New Jersey and Certified Mental Performance Consultant. She played Division I Lacrosse in college, which gives her the ability to connect with athletes who are striving to perform at an elite level. 

Molly Casebere, NCC, LCMHC, received two master’s degrees from the University of North Carolina at Greensboro, one in counseling and one in sport and exercise psychology. She is a National Certified Counselor, a Licensed Clinical Mental Health Counselor, and a CCSPA member.

Leah Howard, MEd, NCC, APC, received her bachelor’s degree from Spelman College and her Master of Education degree from Georgia State University. She has a certificate in Sports Counseling and Student Athlete Mental Wellness from California University of Pennsylvania. She is also the former captain of her college tennis team and is a wellness contributor for Thrive Global and GladiatHers, an organization that promotes the professional achievement of women in sports.