How to Talk to Kids About Starting Therapy
Preparing kids and teens for that first appointment
Clinical Expert: Karol Espejo, LCSW
What You'll Learn
- How should I bring up therapy to my child?
- How can I talk about medication with my child?
- When is the best time to start the conversation about therapy?
Going to therapy for the first time can be scary. How parents talk to their children about starting therapy can make them feel more comfortable, open, and prepared to go into the first session.
Getting kids accustomed to talking about feelings is important to set the stage for what goes on in therapy, and it helps normalize the process. By talking openly about some of the concerning behaviors that you see, you are modeling that it’s not something to be embarrassed about.
Therapy, especially for children, is about learning new skills that will help them throughout their lifetime, so it’s essential that the child knows that this doesn’t mean something is wrong with them.
Timing on when to talk about therapy depends on the child. If a child deals with anxiety, it may be better to tell them a couple of days before the appointment so they don’t worry too much leading up to it. Parents may want to avoid bringing up therapy during sensitive times like bedtime and during conflicts.
The approach will also vary based on the child’s age. Young children benefit from simple language and several reminders about the appointment. For tweens and teens, focusing on how therapy can help them rather than presenting it as something meant to “fix them” is crucial. Direct and honest communication, respecting their autonomy, and assuring confidentiality in their therapy sessions is also helpful with teens.
When a child has had a negative therapy experience, parents can reassure them that finding the right match might take time.
Regarding medication, it’s helpful for parents to discuss it with their child’s therapist and other caregivers to ensure everyone is on the same page. The focus should be on how medication can aid in learning coping skills and reduce symptoms.
Starting therapy can be scary and uncomfortable, especially if your child isn’t used to talking about their emotions or if they don’t think they need help in the first place.
How you talk to your children about starting therapy can make them feel more comfortable, open, and prepared to go into the first session.
Getting kids accustomed to talking about feelings is important to set the stage for what goes on in therapy. “If we’re going to normalize talking about emotions and mental health conditions, notes Karol Espejo, LCSW, a clinical social worker at the Child Mind Institute, “we need to have open conversations.”
Talk about therapy as something that will help the child rather than making them feel like something is wrong. By talking openly about some of the concerning behaviors that you see, you are modeling that it’s not something to be embarrassed about. Espejo compares this to a toothache –– if your tooth hurts, you go to a dentist. Likewise, if a child is having issues regulating their emotions, a therapist can teach them how to do so more effectively. In both cases, the goal is to feel better.
Therapy, especially for children, is about learning new skills to help them throughout their lifetime. The therapist is like a coach –– their job is to teach, support, and help your child be the best version of themselves.
Timing for bringing up therapy is not one-size-fits-all, but Karol says a meal with the child, a drive in the car, or during the weekend when things are less busy are all good times to begin the conversation about going to therapy.
How far in advance the child should know about the session depends on how they will handle it. While every kid deserves a heads-up, kids with anxiety may worry themselves sick leading up to the appointment. “I would suggest about a week in advance for most children, but for anxious kids, the timeline should be shorter –– about two days before the first session.”
There are also specific times when bringing up therapy could do more harm than good. “I would avoid talking about it at bedtime as increased anxiety can impact sleep or lead to rumination ahead of sleeping,” Karol says. Another big thing is to never bring it up during an emotional conflict or argument or use therapy as a punishment –– “See, this is why you’re going to therapy!” The role of therapy is not to punish or shame.
How to talk to young children
Using developmentally appropriate language that connects to something your child is already familiar with is important in preparing them for therapy. Espejo advises being honest, direct, and simple for toddlers and preschool-aged children. Parents can say things like, “We’re going to see a doctor,” or “A support person who talks about feelings and emotions.” It’s important to clarify that this isn’t the kind of doctor who will give them a shot; this is a doctor who’s more interested in talking, possibly playing a game, or doing something fun together.
Also, try to avoid over-promising. Rather than saying, “We are going to meet a new friend today,” try, “We are going to see somebody who helps with emotions, and they will ask you some questions.”
Young kids also benefit from repetition and reminders to help them internalize their understanding of what’s happening. So, if you have the initial conversation a week before their first session, you might remind them a few times throughout the week leading up to the appointment. For example: “Remember, on Wednesday after school, I’m going to pick you up, and we’re going to see that adult I told you about. The one who helps us with our feelings.”
How to talk to school-aged children
For elementary-aged kids, comparing a therapist to their school counselor can be helpful. Even if they don’t see the counselor regularly, they likely know who the person is. And they’re familiar with the idea of kids speaking with that adult about feelings and behaviors. You can say something along the lines of, “You know how Ms. so-and-so in your school talks about feelings? We’re going to see someone like that who has their own office and will talk to you about the emotions that have been coming up for you.”
If your child seems reluctant or nervous about the appointment, you might say, “We’re going to meet someone new, and I know it can be scary. I know sometimes you feel nervous. But I’ve spoken to Ms. Espejo, and she told me I could be in the room with you initially. And I won’t leave until you’re ready for me to leave.”
It can also be comforting to let your child know that the whole family wants to support them through whatever is going on and that they aren’t alone.
There are things you can do before the appointment to help your child feel prepared. The therapist will likely send several questionnaires for both the parent and child to fill out before the first session. This can be a good segue into therapy, as the child can see what questions the therapist might ask.
“We want to lessen any anticipatory anxiety,” Espejo says, “so if your therapist has a website with pictures or videos of themselves, that can help make the child feel comfortable.”
How to talk to tweens and teens
Tweens and teenagers are generally much more aware of what’s happening and might be more resistant to therapy. Whereas younger children may not understand why their parents are seeking treatment, older kids have their own opinions and often object to outside intervention in their lives. So, what if your teen doesn’t want to go to therapy?
“We need to normalize therapy as a safe place to talk about emotions and feel better,” Espejo says. “I think sometimes parents approach the conversation from a problem. ‘There is this problem; let’s go to therapy to fix it.’ That can make kids defensive and feel targeted.” It’s important to talk about the therapist as an expert who teaches us how to process emotions to, for example, communicate better or not feel so nervous. In other words, focus on how therapy can help them.
No one wants to start therapy feeling blindsided by the process, especially not a teenager, who typically is starting to feel a little more control over their life. As with younger children, it’s important to be direct and honest with your teen about why you’re seeking treatment and how it can help them. If parents can get their children to try therapy, it will likely be more effective. You can say, “Let’s explore the possibility of therapy because I noticed that you’ve been sad more days than not,” or, “I noticed that you’re not interested in some of the things you were interested in before.” These conversations allow parents to model emotional recognition, and rather than blaming the teen –– “you need therapy because we’re always fighting” –– it shows an awareness that the child is struggling.
First and foremost, you can assure your child that whatever is said in therapy is confidential, and they can feel comfortable sharing information with their therapist. The therapist will not share any of what is said in the session with their parents. However, therapists must break confidentiality if the child is in danger of harming themselves or another.
What if your child had a negative experience in therapy in the past?
Therapy success depends on the relationship and rapport between therapist and child. And every therapist isn’t going to be the right match for every kid. If your child didn’t connect with a particular therapist in the past, it can be difficult to convince them to try again. Espejo suggests reassuring them that they just haven’t found the right match and encouraging them to try this new person. You can also urge them to be patient and give the new therapist a few sessions before judging the connection. Parents can say, “If after a few sessions, you still feel like this is not going to work with this person, we will find somebody you will connect with.”
Is it OK to tell people that your child is in therapy?
Some kids are open and comfortable about seeing a therapist, while others may want to keep it private. Kids may feel uneasy about explaining why they go to therapy, whether it’s to friends, extended family, or siblings. So, it should be up to them if and how their siblings or other kids in their social circle are told. Espejo suggests asking the child in therapy what language makes them comfortable –– therapist, counselor, feelings doctor, etc.
When explaining to a child that their sibling is in therapy for anxiety, for example, you could say, “Your brother gets really nervous every day, so we’re going to see somebody that helps reduce some of the nerves.”
How to talk about medication
If you and your child’s therapist think your child will benefit from medication, you will need to see a psychiatrist or other medical doctor. Ask the person prescribing medication any questions, and ensure you and any other parents are comfortable with the medication route before presenting it to the child. Medication may seem frightening to a child, and hearing conflicting opinions between caregivers will add to their confusion.
When discussing medication with your child, the goal is to emphasize that medication can make learning new skills easier. Espejo uses anxiety as an example: Sometimes, we are so anxious and constantly uncomfortable that we can’t practice the coping skills we’re trying to learn in therapy, like deep breathing.
It’s important that the child knows this isn’t their fault; instead, something is going on in their brain that they can’t control. Espejo does a lot of psychoeducation with the kids she sees so they understand that medication is there to help reduce the symptoms of their condition. If they are anxious, for example, medication may be used to help reduce panic attacks and extreme worry.