Therapy doesn’t come without resistance, especially when you’re dealing with a teenager. It can be very difficult to get a teen on board with therapy because there’s usually a lot of defensiveness. I want to discuss a handful of reasons why teens resist treatment:
1. Social stigma. Anything associated with therapy or mental health issues is a little bit of a taboo. Kids worry about people pointing their fingers and saying they’re crazy.
2. Rebelliousness. No matter what you suggest, some kids will just go against you because you’re an authority figure to knock heads with.
3. Poor insight. Teenagers have a limited capacity to look at themselves honestly or realistically. They often don’t understand how their behavior or problems are affecting them.
4. Fear. They’re afraid of being “crazy,” that others will perceive them as such, or that they can’t get better. They also may be scared to death of having to take a deeper look at themselves or their problems.
5. Embarrassment. They’re embarrassed that they can’t straighten themselves out, and therefore, accepting help from others can be difficult.
6. Facing their problems may be too painful or overwhelming.
7. Misconceptions. Most teens don’t know how psychotherapy works, and they’re worried about what will happen if they admit to things. They don’t know that the therapist cannot give their parents the information (therapist-patient laws prohibit that, even with minors).
8. Concealment. They don’t want to admit that they’re hiding something – cutting, abusing drugs, etc.
9. Holding on. This is what my book, Bad Childhood – Good Life, is all about. They’re holding on to the drugs or other habit. They’ve become so dependent on a way of thinking and behaving that it has become their identity. They’re scared to death of giving up their self-protective mechanism of hiding from reality because it means they will be stripped naked in their own mind, and that’s pretty scary.
10. Unworthiness. Some kids get so beaten down and depressed that they don’t feel like they’re worth much or that anyone would care about them.
So, those are some of the main reasons kids resist treatment. But the question still remains: How do I get my child to attend therapy?
First off, don’t trap them. For example, don’t say you’re going to the mall and then drop them off at a therapist’s office. That doesn’t work well. There are two really good techniques I have always suggested to parents:
1. Make it a team effort. Say something like, “You know, you and I have been fighting a lot lately, and there’s just so little happiness in the house. So, I’m thinking if you and I went into counseling together, maybe a therapist could help us sort all this stuff out and make things better. You’ll be happier and you’ll be able to do all the things you used to enjoy and probably miss. I’m not sure how to make things better myself, but a therapist could help us work it out.” That way it’s not, “You wacked-out kid, I’m putting you in therapy because I can’t stand it anymore.” Make it about how “we” – you and me – can’t figure it out and that you need to get somebody who can help.
2. Make a definitive statement (e.g. “I’m going to schedule the appointment so we can sort it out together”) and then talk about it in the days before the appointment. For example, say, “Are you a little nervous about the therapy? Because I am.” If you tell your kid that you’re having apprehension about the therapist saying you didn’t do everything right, they are going to look at you and think, “All right, this is more even-steven. It’s not only about me.” The fact that you are both feeling discomfort will be comforting to them.
When they start therapy, tell your child you want them to go to four sessions, and then after that, you, your child, and the therapist will discuss if there is more to do. During the first session, your teen will usually be angry. I remember I used to have so many kids come in to my office and just sit there and glare at me for an hour: “Is it over yet?!”…”Is it over yet?!”… The second time they come in, there will typically be a little less anger and more movement toward talking about their pain. At that point, a good therapist will say, “You know, last week you were pretty angry about having to be here, and I don’t blame you.” The kid is immediately going to be surprised: “She doesn’t blame me?!” Being forced to do something you really don’t want to do and open up to a stranger about very painful things (which you really don’t want to do), is hard. However, a good therapist will make your teen feel like they’re not being forced to do any of that, and instead, simply help them be happier and figure out their parents better. Slowly but surely, by the third and fourth sessions things will be less forced and more about reducing the pain.
While your child is in therapy, the family has to be very supportive at home. They should never ask what happened in therapy – that’s none of their darned business! Instead, it should be all about subtle reinforcement (e.g. “You seem more creative and relaxed right now, and I think that’s wonderful”). Remember: a hug and a kiss can go a long way.