How to help teens who don’t want help

Most kids who need mental health therapy never receive it. Some of our neediest kids, typically teenagers, sometimes refuse to meet with a clinician. How should parents handle such situations?

1. Frame the issue carefully. Kids' behaviors can be outrageous at times, and it's easy for parents to blame teens entirely for such problems. Mental health issues are rarely that simple. It's important for teens to feel that therapy is intended to help, not punish. Keep it simple. "We love you, and don't know how to help. You seem unhappy. We need to figure this out as a family so we can make things better."

2. Manage expectations. Kids get anxious about what they don't know. After you've located a great clinician, get specific information about what will occur during the first few sessions.

In my practice, I initially meet alone with the parents. I want their frank input, without the burden of having to be careful about what is said in front of their child. I also ask questions about their marriage or other issues that may be affecting their youngsters. During the same session, I’ll meet alone with the youth. During the second session, I’ll meet first with the young person, and then discuss a treatment plan with the entire family. Share that level of detail with your child.

3. Focus on the goal. Please don't tell your child that you are taking her to meet with a therapist so that she can talk about her feelings. Simply talking is never a legitimate goal of therapy, only a means to an end. Therapists focus on helping kids change what they do and how they think about the world. Good feelings then follow.

4. Be careful about confidentiality. Never tell a teen that whatever they say to us is confidential. That's not true. We are required to disclose certain types of information, such as child abuse or situations where a youngster is a danger to himself or others. We discuss those rules during our first session.

5. Make a deal. Some kids come into my office and initially refuse to talk. I ask them to cooperate with me for three sessions so we can get to know each other and determine if I can be of help. In return for their cooperation, it will be their decision if they want to return. When treated with respect and given a reasonable degree of control, I've found that teens are engaged and responsive.

6. Go by yourself. Seek a professional consultation even if your teen refuses to go with you, although do this as a last resort.

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