When Your Child or Teen is Resistant to Therapy: What to Do

There are lots of first phone calls that start with “my child [or teenager] needs therapy, but I don’t know what is going to work”. Some parents will say: “maybe I’m the one who needs help!”. Or they say: “we’ve tried therapy before, but it didn’t work. I don’t know what to do!”

It’s OK.

There are lots of different ways good therapy can be approached. Part of it is just knowing what to ask for or what to try. As therapists, we have lots of experiences working with people, whether they are adults, teenagers or kids, that don’t want to be there.

Let’s talk about some different kinds of resistance and what can be helpful.

Your child is not one to open up, can tell if you are trying to get them talk about something vulnerable and will shut it down:

Kid #1: This is a kid or teen that probably has some pretty good insight on their own. It might not seem like it as they have things they need to work on emotionally, but their friends might actually come to them for support. They might hold their cards close to the vest, but they have some valuable wisdom. They might be more reserved in general as well.

With this child or teen, you want a therapist who can start by acknowledging their strengths and wisdom. Instead of trying to figure out “what’s wrong”. That might include some psychoeducation, meaning putting labels/words to the things they already intuitively know. By looking for the strengths first, that lets your child/teen know they are respected and seen and can create space for them to open up a little.

Key words to look for: strength based therapist

Kid #2: This can be a kid that wants to talk about what they want to talk about. Meaning they might not really engage fully in a conversation about a topic that does not interest them.

A creative therapist can find a way to engage your child/teen in conversations about what interests them and draws ties back to emotional coping strategies as well as opportunities for insight. An art therapist or creative arts therapist is trained to work inside of the metaphor. There is over 1000 hours of training after grad school focused specifically on being able to work through the metaphor.

Key words to look for: art therapist, expressive arts therapist

Kid #3: This might be a kid who is just prone to be a little more defensive or defiant temperament wise.

A child or teenager like this will benefit from someone respecting their boundaries and instead focusing on finding ways to channel their energy and attention. Sometimes this can be done by finding ways for your child or teenager to help or care for others.

This could be volunteering in with a group for kids struggling with social skills like being an “expert player” in one of Our Village‘s groups.

This could be through working with a therapist that has a therapy dog, like Kryss Castle, MFT. She doesn’t mention it on her website, but you can ask her about her sweet Boston Terrier, Bella, who loves to be in session.

Think about the Reading Education Assistance Dogs project where children who are resistant or have trouble learning to read teach dogs to read. It might feel too vulnerable for your child to focus on themselves, but they may be able to tolerate focusing on helping others to acquire their skills.

Again, this is another case where art therapists are a good match. They are trained to think creatively about how to reach goals, even when clients are resistant. Social action art therapy is also a very helpful and empowering modality for kids like this.

Key words to look for: volunteer opportunities, pet assisted therapy, therapy dogs, art therapist, social action art therapy

Your child or teenager is avoidant. They try to find ways around everything:

Kid #4: Your child or teen is smart so they will tell you everything you want to hear. You might uncover lies or see side effects like difficulty with friendships, slipping grades, health issues like stomach aches or headaches.

This is a kid who is going to benefit from “experiential therapy”. That means that you want to find a therapist that they can connect with and like. Let them start to build a relationship with that therapist (about 4-6 weeks) and then make sure that the sessions include some kind of activation of reasons you are seeking therapy.

For example: If they need to work on frustration tolerance, an art therapist can easily find ways to safely illicit frustration through the art process and support dealing with the frustration “in vivo”. There has to be enough of a relationship built up with the therapist for your kid to tolerate this, but it most definitely is possible for that frustration to be triggered and for your child to learn how to work through it with the support of the therapist.

Or, let’s say your child needs to work on their communication skills. It’s a great idea for you to be in the room if you guys have trouble communicating about important stuff so that communication trouble can get activated and worked through.

No use in talking about hypotheticals or making plans about how to handle situations because your kid will have all the right answers and never practice a single skill. They have likely already found ways to work around their discomfort.

You probably also need to participate in sessions to bring important events and topics into the room. Otherwise, your child or teenager may NEVER bring any of that up.

Key words to look for: experiential therapy, family therapy, art therapy, expressive arts therapy

Kid #5: Your child or teenager just does not want to approach heavy emotional content and they are pretty up front about that.

This is a client who is going to benefit from graded exposure. First, you want to find a therapist that is a good match (maybe that means your child or teen will tolerate that person) and give a little time for the therapeutic relationship to be established. Then the therapist can bring into the room the issue that needs to be addressed.

We pick a certain amount of time that that issue needs to be discussed directly, we put it on a timer and we keep our word.

Most of the time, the trouble is that your kid thinks approaching that topic is just going to be so awful and terrible, they don’t want to even go there. But they learn they can because we keep that part of the session contained. As they build tolerance and confidence, that time can expand. We’ve seen it work time and again.

Key words to look for: Cognitive Behavioral Therapy, graded exposure, experiential therapy

Your child or teenager is into physical activity or is very physical, but pretty reluctant to talk about their feelings even though you can tell they are emotional:

Kid #6: This is a kid who has probably been physical (maybe they played hard at recess, had a hard time keeping their hands to themselves, used their behavior instead of their words to express feelings or interested in sports) their whole life.

Some people really do process their emotions in a primarily physical way. It is hard for them to sit down and talk through their feelings. They might not even have the words for it!

These are kids who are going to benefit from play therapy (we like Jessica Plotin, MFT, ATR, Monica Fyfe, MFT, BCBA, RPT-S and Bryana Kappa, MFT (especially for 0-5 year olds) when they are younger or sports psychology based therapy or mindfulness based outside focused therapy (like a therapist who would take the session outside, meet for a hike or a beach walk) when they are a little older. It allows them to be in action while they process and work through things. It is just going to be a much more naturally aligned modality for them.

Key words to look for: play therapy, expressive arts therapy, movement therapy, sports psychologist, nature therapy, eco therapy, hiking therapy

It’s true that there are times when a kid doesn’t need to be in therapy because it is not the right timing. Stay tuned for a more detailed post about that coming soon!