By the time a millennial lies down on a therapist’s couch, she’s already been analyzed to death.

Millennials are “the worst,” “lazy,” and “screwed.” They’re “selfish and entitled,” “crybabies,” and obsessed with themselves and taking ‘selfies.’

They’re also “not as different as you thought.” The idea that they’re all the same is a “myth,” just like the idea that they’re all “lazy,” “work-hating narcissists.”

If America can’t seem to decide what to make of the generation, neither can mental health professionals. There’s widening disagreement over whether millennials — those aged 18 to 34 — are fundamentally different from the generations that preceded them and, if so, how to translate that to therapy.

Some self-described “millennial therapists,” mostly millennials themselves, now argue that the generation needs a tailored approach. And they say they’re better able to relate to young adults’ concerns others might dismiss.

Others dispute the need for special treatment, saying good care meets people where they are, whatever their generation. But if the profession can’t decide how best to serve millennials, some wonder, will they get the care they need?

And even professionals who don’t believe millennials have unique needs agree that they see significant anxiety and depression among their ranks.

Satya Doyle Byock, a licensed psychotherapist in Portland, Ore., only treats millennial clients, calling them “totally neglected.” Young people today are an “underserved population in my mind,” said Byock, “with some pretty epidemic mental health needs that aren’t being addressed.”

Related: Read this if you work with a millennial

The rise of the ‘millennial therapist’

Liz Higgins, a 28-year-old “millennial therapist” in Dallas, is used to her title sparking interest — and an occasional snicker. Recently, after moving into a new office building, she overheard some neighbors talking.

“She said she’s a millennial therapist,” Higgins, a licensed marriage and family therapist associate who treats mostly millennials, recalls hearing. “What does that even mean?’”

It’s hard to say how many of the approximately 500,000 mental health professionals in the U.S. specialize in treating millennials — or, for that matter, how many now visit millennial therapists. But many therapists say millennials are increasingly requesting referrals to those with experience treating their generation.

And there’s evidence of a need for more help: millennials report above average stress levels, according to the American Psychological Association, and government data indicate they visit emotional and behavioral therapists at a slightly higher rate than others.

Read more: 5 charts that prove millennials are worse off than you are

Millennial therapists, who likely make up a tiny minority in their field, say the term is less a technical designation than a signifier of their perspective. Licensed mental health counselor Jennifer Behnke, a marriage and family therapist, says it describes a “fresh” take on the practice, with updated viewpoints on topics including marriage and relationships.

Being a millennial helps, some therapists say. Higgins says it lets her access an “extra depth of knowledge” that shapes the rapport at the heart of all therapeutic relationships.

Liz Higgins, 28, is a millennial therapist in Dallas, Tx.

That, she and others say, means a shared understanding of the ways economic uncertainty, student debt, helicopter parents and the intense interactions and competitions that take place on social media have affected the generation.

Millennials are now “wondering ‘Who am I in this world that is constantly changing? There isn’t a predictable path forward for me to fall into,’” said Higgins. While previous generations — people now in their 40s, 50s and 60s — often repressed those uncertainties until later in life, she said, today’s millennials address them earlier and more openly.

Read: Orwellian economy? Millennials get paid like it’s 1984

Another difference some millennial therapists employ: shorter engagements between doctor and patient. While therapist-patient relationships can last years, Behnke tailors hers to three to six months, focusing on tips and insights that can be used immediately.

Jennifer Behnke, 31, is a millennial therapist in Juno Beach, Fla.

“Millennials would prefer short-term therapy,” said Behnke. “I don’t think it’s reasonable financially — or even time-wise — for millennials to go through a six-year process of psychoanalysis.”

Ashli Haggard, a 23-year-old who works for a Washington, D.C. nonprofit, said she’s thought about generational differences when looking for a therapist in the past.

Read: More than half of millennials have less than $1,000

“I very much wanted a therapist that was old enough to be my grandmother, because I trusted the wisdom,” she said. “But I also didn’t want somebody who leaned heavily into the millennial stereotypes and treated me like I was an entitled brat.”

Her current therapist, with whom Haggard has discussed subjects including her mostly virtual relationship with her West Coast boss — Haggard says she struggles to read tone in communications that aren’t face-to-face — is in her 60s.

“I think it’s possible to communicate between generations,” Haggard said. “But I think sometimes it doesn’t work.”

Growing up in ‘Generation Text’

The central difference between millennials and previous generations is how they communicate, experts say. That translates to the therapist’s couch, some argue, because technology has so dramatically changed the nature of interactions, particularly between younger people.

Eric Owens, a licensed professional counselor and associate professor at West Chester University who has taught and counseled college-aged millennials, says he is increasingly concerned about how a generational communications culture clash is affecting therapists’ relationships with clients.

Read: Millennials engage with their smartphones more than they do actual humans

When millennials interact with someone, he says, they are usually texting or using a social media platform. Awareness that such connections are now normal, rather than an aberration, is critical to a mental health professional’s work, according to Owens.

Eric Owens, 44, says mental health professionals must be aware of millennials’ different, digital style of communication.

Some analysts find it difficult to adjust to the cellphone’s elevated role, said April Feldman, a New York City psychotherapist who estimates that three-quarters of her clients are millennials. Owens, 44, says older generations “tend to look at the way millennials communicate as a negative thing — ‘this is bad, or wrong,’ and a value judgment is placed on it.

Read: Millennials are clueless about cellphone etiquette

“To say, ‘We meet people where they are — except this generation and how they communicate’ is really kind of odd,” Owens continued. He believes therapists should help patients understand their habits, not try to change them — though he also thinks those habits are largely why millennials seek mental health professionals in the first place.

Some of his colleagues disagree: The shift to adulthood has always challenged young people, they say, so is it really different if they’re Snapchatting along the way? But while the reasons millennials seek help might be similar to past generations’, Owens says, the forms they now take are unprecedented.

Unlike schoolyard bullying, for example, cyberbullying can follow people into their homes via the internet. And experts say today’s relationships — even those that last months — now sometimes end particularly abruptly and without explanation, a painful phenomenon called “ghosting.”

Many say social media is a major source of anxiety for young people, fostering unhealthy comparisons with a seemingly infinite number of people and their glamorous, busy, high-achievement lives — or, at least, the ones that look that way on Facebook’s FB, +2.66% Instagram.

Feelings of inadequacy can arise even when people realize intellectually that they shouldn’t, according to Feldman. “There’s this unspoken idea that we know this is bullshit, but is it? Are their lives better?” she said. “Everyone’s doubting it in the background but still affected by it nonetheless.”

And since so much communication is electronic, mental health professionals must consider the platform when discussing patients’ lives: When clients describe conversations, Owens often finds upon probing that they happened by text message or on social media, formats that can foster misunderstanding.

“Communication tends to be briefer, more succinct and to the point,” said Owens. “It can be great, but other times it prevents you from getting deeper into a story.”

For young adults, a ‘quarter-life crisis’

There’s a reluctance among mental health professionals, including some who work closely with millennials, to frame the generation as fundamentally different. Many of the factors that complicate their lives — challenges finding steady work, for example — have long existed, and young adulthood has always been hard.

And neither the economy nor the transition to adulthood are permanent. “At the heart of it, identity issues when you’re living on your own…[are] what any 18 to 30-year-old would feel,” said Kelly Conover, a 31-year-old New York City psychotherapist who mostly treats millennials.

Still, mental health professionals intimately familiar with young people’s difficulties today agree that they need a lot of help — and a lot of empathy.

Byock believes the struggle with the transition to adulthood is exacerbated by a cultural emphasis on quantifiable success — things such as good grades, brand-name colleges, sports trophies and Facebook likes. “Everything is so quantified that the quality of life becomes less important,” she said.

And that quantification, some say, has been coupled with an erosion of many of the institutionalized paths forward — establishing a steady career, starting a family, and becoming part of a local community, for example.

Raised to believe they can become whatever they want, Byock says, millennials struggle to choose a path, at times grappling with depression, anxiety, sexual problems, binge drinking, suicidal thoughts and questions of sexual, gender and racial identity as they try “to understand how to be human.”

See: How the lack of good jobs, pay for millennials fouls up the economy

Cyrus Williams, a member of the American Counseling Association, says many of his millennial clients feel they should be further along in their lives and careers than they are.

Cyrus Williams, a licensed professional counselor and an associate professor at Regent University in Virginia Beach, Va., says he spends a lot of time normalizing things with clients — telling them “it’s normal not to be married at 24. It’s normal…not to launch your career and be successful at 28, ruling the world at 28.”

Read more: Millennials think they’ll earn six figures by age 30, expect to work until age 90

For some, it’s ‘a failure of culture’

For some mental health professionals, belonging to the millennial generation is seen as an advantage. For their patients, though, it can feel like part of the problem.

Byock says she doesn’t like — or use — the term “millennial,” which even millennials use as a kind of epithet, minimizing their problems for fear of appearing “stereotypical.” (She calls them “quarter-lifers” or “20-somethings” instead.)

Satiya Doyle Byock, a licensed psychotherapist, only treats young adults in her “Quarter Life Counseling” practice in Portland. Ore.

Professionals say there’s hope for the generation: Most quarter-life crises, says Williams, are simply transitions that are likely to pass. “They just have to get their bearings straight and just kind of step through it,” he said.

But when they struggle to do so, Byock believes, it reflects a “failure of culture” to show and support young people as they move into adulthood.

Her clients often come into therapy facing the third wall, Byock says, rolling their eyes at their own problems, and saying “‘I know this is something that’s really stupid for me to be feeling’” — in part, she suspects, because of their constant public dissection by themselves and others.

That “self-mockery,” she says, breaks her heart. “I see it in the very very vast majority of the people I see,” said Byock. “It’s making it so much worse — so much worse.”

This story was first published on Sept. 30, 2016.