How To Handle When A Teen Refuses To Go To Counseling
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Parents, caregivers, and adults who work with teens may feel unsure about how to respond when they recommend counseling or therapy to a teenager but the teen refuses to go. Perhaps the adult feels it’s clear that the teen needs to attend therapy for the sake of their mental health, but the teen isn't interested. This situation can feel very frustrating, but arguing with a teenager or trying to force them to seek counseling can backfire and erode trust. Below, we explore why teens might refuse counseling along with ways to handle this situation.
Understanding why a teen refuses to go to counseling
While one teen refuses counseling, another may happily try it. Whether or not a particular teen is willing to try therapy as a mental health treatment may seem unpredictable to the adults in their life. Understanding why a teen isn't willing to attend a few sessions with a mental health professional can be confusing or frustrating, especially if the teen isn't able or willing to plainly explain their reasoning.
When your teenager or a teenager you work with won't try counseling, the best approach is often for you to try to understand them and foster an open, trusting dialogue on the topic. Adults are used to being authorities and may feel tempted to try and force a teen into therapy by arguing with them or telling them it's not optional. This approach can backfire, however, leading the reluctant teen to dig in their heels and continue to refuse therapy in a way that is defiant or even antagonistic. A more effective approach is often to ask questions and listen actively, which is more likely to lead to a deeper understanding and, perhaps, a change of heart in the teen.
Questions to help you better understand why a teen refuses to go to counseling
Asking questions can be an effective way to get a teen to open up and reflect on why they're resistant to counseling, if done at the right time and in the right tone. Here are some questions you might want to consider asking:
- What is your impression of what happens in counseling or therapy?
- What do you know about your school's guidance counselor?
- Do you know anyone who has gone to counseling or therapy before? If so, what were their experiences like?
- Have you seen any TV shows or movies in which characters attended counseling or therapy? If so, what were those like?
- Even though you don't want to seek help right now, do you think there are any areas in which counseling or therapy might benefit you in the future?
- What types of people do you think counseling and therapy are most helpful for?
- Can you think of any problems or challenges that could arise in your life that you would want to seek counseling or therapy for?
- If you were hypothetically willing to try counseling or therapy, what would you want your counselor or therapist to be like?
- I know you aren't interested in one-on-one therapy right now, but what are your thoughts on family therapy?
Keep in mind that it's typically important to ask questions in a calm, gentle way. While mental health is a serious topic, it can help to come off as calm as possible, without being flippant or dismissive. You likely won’t want to ask questions while crying, yelling, or carrying a tone of blame.
You also don't want to leave a teen feeling like they are being interrogated or like they've done something wrong. That’s why it’s not usually helpful to ask all of these questions back-to-back in one conversation. Instead, you might pick a couple that feel most relevant and ask them when both you and the teen are in a good mood. Try to ask questions in the spirit of curiosity and compassion. If the teen shuts down the conversation, don't force it. You can bring the topic up again later, when they seem more receptive.
How to gently bring up therapy with a teen
Therapy can be a difficult topic to bring up with a teenager, especially if they've already shared that they aren't interested in it. However, when you see teens struggling, you might want to bring up the possibility of attending therapy in an effort to help them.
Instead of directly suggesting a teen attend therapy after they've already refused in the past, you might consider mentioning therapy in a more roundabout way so the teen doesn't feel like you're nagging or pressuring them to try it out. For example, you might bring up the topic by mentioning your own therapy experiences or the experiences of other friends or family members (with their permission). These casual mentions can stand on their own, and they generally shouldn't be used as ways to force the teen back into a conversation that they don't want to have.
Ways to talk about mental health with a teen
In addition to gently mentioning therapy in conversations with a teen who refuses to go, you might also discuss mental health more generally. Sometimes teens don't want to attend therapy because they don't realize that they are struggling with mental health. Helping them better understand common mental health challenges, substance misuse, and mental health more generally may help raise their awareness and eventually warm them up to the idea of therapy.
If you have a mental health disorder or personal experiences related to mental health that you feel comfortable sharing, you could let a teen know. It’s usually best to not overload them or overshare, but you might briefly describe any diagnoses you've received, how they've impacted your life, and what you do to maintain good mental health. If you've been wanting to discuss mental health with your child and there's a family history of certain mental health disorders, you could also start by sharing that information.
Normalizing therapy in conversations with a teen
Sometimes teens don't want to attend therapy because of the stigma surrounding it. Many teens just want to fit in with their peers and feel “normal.” The idea of therapy may suggest to them that there's something wrong with them or that they are more flawed than their peers. They may also fear that their friends or classmates could find out that they're in therapy and tease or bully them. Normalizing therapy may help combat some of these concerns, even if the teen hasn't articulated them.
Ways to normalize therapy
A teen might not feel like therapy is "normal" if they don't know anyone who has attended it. Normalizing counseling could be as simple as bringing to a teen's attention the many people in their life who have attended it in the past or still attend it now. If you have attended therapy, you could start by sharing that with your teen. The conversation need not be long; you could briefly describe when you attended therapy, what prompted you to consider it, and how it helped you.
You might also draw your teen’s attention to statistics about the popularity of therapy today. For example, the American Psychiatric Association reports that almost one in three adolescents in the US received mental health care of some kind in 2023. That means your child almost certainly has peers who have been to therapy.
What not to do when a teen refuses to attend therapy
When a teen refuses to attend therapy, there are things you can say and do that might make the situation worse. Any attempts to argue, threaten, blame, nag, shame, punish, or scold them for not going may backfire. Most people do not like when others attempt to control them, and teens are especially likely to try and assert their independence.
Things to avoid saying when a teen refuses to attend therapy
According to the International OCD Foundation, there are many approaches you may want to avoid when your teen refuses to see a school counselor, attend online counseling, or receive any type of mental health help. Here are examples of how not to approach your teen in this situation:
- Arguing with them and repeatedly telling them they're wrong for not receiving counseling
- Attempting to force them to attend therapy against their will, such as by driving them to a therapist when they think you're going somewhere else
- Punishing or threatening them if they refuse to go to therapy, such as by taking away privileges or making them do extra chores
- Yelling at them or otherwise shaming them for their choice and telling them they're making a bad decision
How therapy can support a teen’s mental health
According to the NHS England, one out of five children and young adults in England likely had a mental disorder in 2023. Among eight- to 16-year-olds, around 20% likely had a mental disorder. Among 17- to 19-year-olds, about 23% had such a disorder and 12.5% had an eating disorder. The NHS' mental health director, Claire Murdoch, notes that "it is vital" that any young person struggling with mental health receive help. Therapy is one such form of help.
Research on the effectiveness of therapy for teen mental health
Research suggests that talk therapy can be an effective approach for treating many different types of mental health conditions in both adolescents and adults. Cognitive behavioral therapy (CBT) is one of the most common talk therapy approaches used today. Research suggests that it can be effective in addressing mental health conditions such as “anxiety, depression, obsessive compulsive disorder (OCD), autism spectrum disorder (ASD), externalizing disorders, and post-traumatic stress disorder (PTSD)” in young people.
Types of therapy for teens
There are many types of therapy available that may be helpful to teens. If the provider is a teen's school guidance counselor, there may not be multiple options for the approach the counselor takes. If a teen goes to an outside therapist, they likely can find someone offering the specific type of therapy they may need.
As mentioned, cognitive behavioral therapy is a common type of treatment that can be effective for many teens. Group therapy, school- and community-based programs, and family and parent training programs geared to improving teen mental health may also be effective.
Exploring online therapy for parenting stress
Raising or working with teenagers can feel stressful at times. While you might be hoping a particular teenager will consider therapy, you may also want to consider it for yourself to learn to manage stress and have a safe space in which you can talk through your thoughts and feelings. Plus, attending therapy yourself may make your teen more likely to consider it for the challenges they're facing.
Online therapy can be a particularly attractive option for many people because it provides the option to receive care without the extra time and effort required when traveling to speak with a therapist face to face. Connecting with a therapist online is possible from most anywhere with a wi-fi connection. Plus, online therapy is often more affordable than in-person therapy without insurance.
What the research says about online therapy
Research suggests that online therapy can often be as effective as face-to-face therapy. For example, a systematic review and meta-analysis of 54 randomized controlled trials involving a total of 5,463 participants suggests that there may be "little to no difference in effectiveness" between online therapy and in-person therapy. The study included participants with a variety of concerns, including anxiety disorders, depression, insomnia, chronic pain, fatigue, eating disorders, substance use disorders (formerly “substance abuse disorders”), and others.
Takeaway
What do you do when your child refuses to talk to a therapist?
If your child refuses to talk to a therapist, you might ask if they might be willing to talk to try online therapy. Some teenagers may feel hesitant to attend traditional in-person therapy for a number of reasons, including misconceptions about therapy based on TV or movies. However, if you tell a teenager that they can choose their own therapist and participate in therapy by audio, video, or live chat, they may be more willing to talk to a therapist.
Can a teenager refuse mental health treatment?
The laws regarding refusal of treatment may depend on the state. In general, teenagers can often refuse treatment if they don’t meet the criteria for hospitalization against their will.
What is a mental breakdown in a 15-year-old?
A 15-year-old with a mental breakdown may find it difficult to function in daily life at home and at school. They may experience overwhelming stress or anxiety. However, the symptoms may vary in different people.
What are 5 symptoms that a child may have a mental health disorder?
Symptoms of mental illness may vary by person and disorder. However, the following are five symptoms that may indicate the presence of a mental disorder:
- 1. Emotional outbursts
- 2. Low mood and lack of a sense of hope
- 3. Lack of interest in activities previously enjoyed
- 4. Change in performance at school
- 5. Changes in eating or sleeping habits
How do you tell your child they need counseling?
Before determining that your child needs counseling, you might ask your child what they’re experiencing. If they tell you something that requires counseling, you might acknowledge that counseling is normal for a person’s well-being and that many people receive counseling at some point, whether at an early age or in advanced years. Communication about therapy as part of the healing process may encourage them to agree to talk to a counselor.
What should a child therapist not do?
A child therapist might be more successful if they avoid getting right into deep questions before building a rapport with children. They might also try to avoid making assumptions about a child’s cultural background, as there is diversity within each group.
What can you do when your parents won't let you go to therapy?
If your parents won’t let you go to therapy, you might consider asking if your school has someone you can talk to. A counselor at your school may have information about free local groups for teens to discuss mental health challenges and emotional needs. In the meantime, you might consider implementing some self-care strategies on your own. For example, you may find it helpful to self-soothe by practicing a relaxation technique that works for you. For example, some people find it helpful to do some basic mindfulness exercises. To do this, you can recognize any thoughts that arise without judging yourself. You may also find it helpful to do some self-reflection by writing down your thoughts in a journal. The process of thinking about your own feelings may help you accept yourself just as you are.
How much does therapy cost for a 15-year-old?
The price of therapy for a 15-year-old may vary by region and therapist. Teens and their families may be able to save by using an online therapy platform. Online therapy platforms tend to be more affordable than in-person therapy without insurance. For example, Teen Counseling tends to cost $70 to $100 per week, billed monthly. Cost is based on factors such as your location, referral source, preferences, therapist availability and any applicable discounts or promotions that might apply.
How do you help a teenager with mental health challenges?
One of the best ways to help teenagers with mental health challenges may be to emphasize acceptance and how common it is to seek help for mental health. It may help to dispel any myths about therapy, such as that people who go to therapy demonstrate self-centeredness, are self-involved, or are influenced by emotional contagion. If a teenager doesn’t want help, you might leave the door open to talking with a counselor in the future so that they can come to you at any time.
How do you know if your child needs psychological help?
It may be challenging to determine for certain if a child needs psychological help. If a child exhibits sudden changes in behavior and lack of interest in activities, it may be a good time to seek psychological help. Also, a child doesn’t have to have a mental disorder to benefit from seeing a therapist. A therapist can often help with stress related to school and social anxiety.
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