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What to do when therapy doesn’t work

Sometimes psychotherapy just doesn’t help, in spite of a cooperative child, supportive family, and a competent professional. This is a very frustrating situation, not only for the family seeking help but also for the therapist.  We’d all like to think that with persistence and professional competence, we have the skills to help any youngster with mental problems.

When a child’s problems don’t diminish, psychologists are ethically required not to continue doing something that doesn’t work.  I typically change approaches to better engage the parent and child. If there continues to be no progress, here are the options I present to the family:

  1.  Change therapists. Sometimes there is just not a good connection between a youngster and their therapist. This may be due to issues of gender, style, age, or race. I can’t honestly say that I have liked every child or parent that I’ve ever worked with over the years, and sometimes those feelings may be evident during our sessions. This transition is usually difficult for kids, who may interpret a change in therapists as a yet another rejection.
  2. Involve your child in special activities.  Some of the best therapists I’ve ever met have been Boy Scout leaders, sports coaches, and youth leaders at church. These caring adults connect with kids more effectively within the context of activities than what I can do within a 50 minute session in my office. Do your research carefully, and spend time talking with the adult in charge of the team or activity. Trust your gut if this is someone who can engage with your child.
  3. Get a job or volunteer. For teens, the real world of work can be a more effective therapeutic environment than my office. Kids learn about responsibility, communication, and consequences. They are treated as adults and given genuine responsibility and authority.  Feedback from a boss is generally interpreted differently than correction from a parent. If your child is too young to get a job, consider a volunteer position at an animal shelter or a social service agency. These types of activities can be extremely rewarding for children, and give them a sense that they can do something that really matters to others.
  4. Consider alternative therapies. Except in extraordinarily special circumstances, I’m not a big advocate of residential treatment, although in some situations it’s essential. Wilderness therapy (www.aee.org or www.natsap.org) has been very successful with some kids, although it can be expensive and is generally not covered by insurance.  These are not the old-style “boot camps” based upon tough-love, but therapeutic interventions in natural surroundings rather than traditional offices.

Please don’t get discouraged if your work with a therapist is not successful. Be persistent for the sake of your child.

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