Helping Resistant Teens Into Treatment

It can be hard to get kids to agree to see a psychologist or a psychiatrist. In fact this is a common stumbling block for many parents of teenagers struggling with anything from anxiety to ADHD, depression, or an eating disorder. It’s not enough for you to see them suffering, or for it to be obvious to everyone around them that they’re not themselves and they need some kind of intervention. Adolescents need to want to get better, and be willing to work with someone to make that happen. For treatment to work kids need to buy into it, at least a little.

So it is important to get to the bottom of why kids are being resistant and try to change their minds. Here are some common reasons why a kid might say no to treatment:

• They don’t think they need help. They might say, “This is just how I am.”
• They don’t think therapy or medicine would work.
• They’ve already tried it and didn’t like it.
• They think getting help is embarrassing.
• They’re feeling defensive. Not only is this a common posture for teens, it’s also an understandable reaction from someone who is tired of repeatedly struggling or getting negative attention over something.
• They’re feeling hopeless. They can’t imagine that it’s possible for them to feel better.

Understanding the reason or reasons your child has for being resistant will help you tailor how you respond. As parents of teens know, convincing older kids to do something they don’t want to do is difficult, to say the least. That’s because teens are growing up, which means they want — and, developmentally speaking, they need — to have more control and independence.

Teens might not always be the best judge of what they need, but it’s essential for parents to give them a chance to explain how they feel and then give a thoughtful response. Not only will it improve your relationship with your teen, it will also make them more likely to listen to you. Here are some strategies to try:

The way you frame treatment is important. There is sometimes an unfair bias against getting help for mental health issues. People go to psychologists and psychiatrists for the same reason they go to their other doctors — they want to feel better. And forget about the Freud stereotype — getting help in this millennium generally does not mean “talking about your deepest darkest feelings with some guy,” as Jerry Bubrick, PhD, a clinical psychologist at the Child Mind Institute, puts it. “The truth is we now have much more scientifically driven treatments.”

For reluctant patients, Dr. Bubrick sometimes likens therapy to working with a coach: “If your son is playing basketball, of course he’s going to have a basketball coach. Even professional basketball players need coaches to learn new strategies, learn new skills, think about different ways to succeed. Your son can do therapy to learn these skills and practice them over and over, and eventually he won’t need the coach anymore.”

Depending on what your teen needs help with, it might also be a good idea if the entire family came in for treatment. This is a good strategy to use when kids are getting defensive because it doesn’t single your teen out as the patient — the whole family is working on this issue.

Sometimes teens will disagree that they have a problem, or think that what they are struggling with is a part of them that can’t or shouldn’t be treated.

When kids think that they can’t get better it is sometimes a symptom of their disorder. For example when kids are depressed it affects how they think, so they might not be able to imagine feeling better. Kids can also start identifying with their disorder and even find comfort in it, so the idea of getting treatment can actually be scary.

When kids don’t think they have a problem or are ambivalent about what treatment can do for them, clinical psychologist David Anderson, PhD, recommends starting by asking the teen what they want to get out of it — not what you or their teachers or anyone else wants: “We would work on getting buy-in by focusing initially on their priorities. What are they looking for at this stage? What kinds of things would they like to be able to improve, like homework or making friends? Then we can outline how the things they’re motivated toward might be achieved in our work together.”

This is similar to a technique called motivational interviewing, which is a collaborative approach some therapists use to help kids resolve their ambivalence and find their motivation for getting better.

It is important to find a treatment provider who is a good match for your child’s personality. If they don’t like or respect the person that they’re working with, or think they can outsmart the clinician, it isn’t going to be a good fit.

Although it’s very frustrating, you may need to keep looking until you find the right person for your teen. Sometimes parents decide to come in first themselves, without their child, to meet the clinician and ask some questions (a good one is how they would approach working with a reluctant teen). Clinicians should also have good pointers on what you can be doing at home to help.

If your teen has already tried getting treatment but it hasn’t helped, or they didn’t like the person they were working with, psychologist Stephanie Dowd, PsyD, recommends asking them why they think that is. For example, what wasn’t helpful or what didn’t they like about therapy? What did they like? You can keep these qualities in mind and work together to find a therapist who does more of the positive things. Many kids prefer working with clinicians who are active participants in conversations — not just passive listeners.

“Find two or three therapists they can interview and tell them that they can choose the one that they feel most comfortable with, and think will help the most,” Dr. Dowd suggests. “Finding a therapist who is a good fit is extremely important, and making the choice your child’s will help them feel ownership over their own treatment, which is extremely important to teens and sets the stage for effective therapy.”

If your child says no the first time you talk about starting treatment, keep trying. Use the strategies above and try asking clinicians what they would recommend.

It’s also important to continue making an effort to listen to how your teen is feeling and what they think they need. Important things usually aren’t settled in one conversation. Progress may come gradually. “If you lay the groundwork by strengthening your connection with him now, they’ll be more likely to turn to you for support when they’re finally ready,” says Dr. Dowd.