Ask An Expert / Diagnosis

Our daughter doesn’t accept her diagnoses of anxiety and depression, and we aren’t thrilled with the psychologist. Any suggestions?

People think that you don't need to like a therapist, but that just isn't true.

Alan Ravitz, MD, MS

Our daughter was recently diagnosed with anxiety and depression, however she won't accept the diagnosis and refuses to get treatment. And we aren't thrilled with the psychologist. The psychologist suggested we just demand counseling but let her choose who she sees.In her testing her brain functioned at different speeds — not ADHD, but the change in how she processes is inhibiting her from processing logically so she misreads social cues. She is increasingly irritable. She does not seem to have suicidal thoughts or feelings, but has quit all things that she enjoys.We don't know how to get her into therapy. Any suggestions?

That’s a hard question. Let’s take a look at the different components.

Your daughter’s brain functioning “at different speeds” might mean slow processing, which means that even though she’s smart it takes her some time to understand things. I’m not sure how she does in school, but for instance a lot of times kids with slow processing do better if they have extended time on tests. If you look at the same problem in the social realm, where she needs more time to process interactions than is available or considered “normal,” you can see how she might get anxious or depressed — which brings us to her diagnoses.

First, it does sound as if your daughter has classic signs of depression. Often when kids are depressed they don’t experience sadness, they experience irritability. And the fact that she doesn’t enjoy the things she used to in a very dramatic fashion is what we call “anhedonia,” another red flag. This might be clear to you — but the first thing we have to understand is that when you get a diagnosis of anxiety and depression, that’s bad news! A lot of people don’t want to get treatment because treatment is an acknowledgment that something’s wrong, and they would rather pretend that nothing’s wrong.

Next, if she’s a teenager it’s going to be very difficult to drag her in to treatment in the first place, as I think you understand; and in addition, she’s not going to benefit from treatment unless she buys into it. So you have to find someone your daughter can engage with.

Which brings me to number three: if you’re not crazy about the psychologist, it’s not surprising that your kid isn’t crazy about the psychologist either! So you need to try and find somebody that you feel comfortable with.

And then, perhaps the way you should begin is by doing some family treatment, so your daughter doesn’t feel identified as the sole cause of the problem. This is a good route into therapy for teens, because a lot of times they identify their emotional problems with their life situation-she might say “I’m not depressed, I just hate my family.” I don’t know the particulars of your daughter’s case, but going into treatment as a family means the family takes some of the burden, as it were.

I need to stress again that finding someone you can work with is paramount. When people enter treatment, sometimes they are under the impression that it’s not that important to like the person they see — but that’s just not true. Part of what makes treatment work is the fit between the patient and the provider — a good fit means success is more likely. This is really, really important.

So, start with the family, but make sure you find somebody you like!