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When Your Child Is Resistant to Therapy

How You Can Help

By

Updated September 23, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

If your child is resistant to therapy or refuses to cooperate with his therapy treatment program for depression, you may wonder how he will ever get better. However, it is not uncommon for a child to be quiet during therapy or even refuse to attend sessions. In fact, it is a well-known reality among therapists and researchers that some children will be resistant to therapy. Fortunately, there are measures that parents can take to ensure that their children follow and benefit from their therapy treatment programs.

Factors That May Make Your Child Resistant to Therapy

It is possible that your child may feel some anxiety about speaking to a stranger about his thoughts and feelings. He may be worried about rejection, judgment or punishment from a therapist or that their sessions may not be confidential. These are just some possibilities for why your child may be resistant to therapy.

You are not alone, however, if life events are getting in the way of your child attending therapy.

Dr. Pamela Wilansky-Traynor and colleagues published findings on this very circumstance in the Journal of the Academy of Canadian Child and Adolescent Psychiatry in May 2010. In their study, they found that that stressful life events (such as family fighting or financial stress), and headache, belly ache or other physical complaints related to depression, have the potential to overshadow the importance of therapy attendance -- even when therapy has been showing success.

In some cases, this may just be in the eyes of the child. But even well-intentioned parents could fall victim to putting a child's therapy session aside in order to deal with a perhaps more in-the-moment issue.

The researchers found that parents have the ability to influence younger children to attend therapy more than older children, which may be something you have encountered yourself, particularly if dealing with a child in or approaching his teen years.

When Your Child Puts Up a Fight About Making a Change

Psychotherapy aims to change or correct problem behaviors, which requires the desire to change. A depressed child, who may already feel misunderstood or angry, may resent being told to change.

Drs. Theresa Moyers and Stephen Rollnick, who published a review on the topic in the Journal of Clinical Psychology in 2002, explain that a therapist who works with this fact is essential. Patients who have been forced to seek treatment are likely to be resentful and resist help. A therapist who shows empathy and support is more likely to encourage change than one who tries to push the child to adhere to her recommendations.

What You Can Do to Help a Child Who Is Resistant to Therapy

At times, you may be overwhelmed with frustration. That's understandable. But there are things you can do to help the situation:

  • Consider Combination Treatment According to the National Institute of Mental Health (NIMH), cognitive-behavioral therapy (CBT) in combination with an antidepressant medication is the most effective treatment for depressed children. Given this, you might suggest a combination approach to your child's pediatrician if your son or daughter is in therapy only.
  • Try a Different Therapist Very simply, your child may not like his or her current therapist. It is important that your child feel comfortable and safe during therapy. Meeting with the therapist before your child does will allow you to do a pre-screen. Additionally, it might be important to your child to have a therapist of the same gender, especially if they are discussing sensitive topics related to development or sex. Unsure of what your child thinks or would prefer? Sometimes all you have to do is ask.
  • Lead by Example Consider family therapy or individual therapy for yourself. Depression affects the whole family. Showing your child that the whole family is committed to mental health allows her to feel supported but not different from the rest of the family. However, family therapy should not replace your child's depression treatment program.
  • Find the Best Timing Examine small details of your child's therapy routine, like time of day or day of the week of sessions. Factors like fatigue, hunger, mood, and stress can affect a therapy session. If your child consistently has a test right before therapy, he may have a difficult time focusing. Find the best time for your child to attend and, whenever possible, incorporate something enjoyable into the treatment routine.

Finding the Right Depression Treatment It is important to aid your child in finding the right depression treatment. If your child is still not benefiting from therapy, despite your efforts, it may be time to try a different treatment option. Depression can have short- and long-term consequences such as poor social and academic performance, poor self-esteem, risk taking behaviors, substance abuse, and suicidal thinking and behaviors. Working with your child's pediatrician, school's counselor or psychologist may be helpful in providing guidance for new treatment options.

Sources

How Do Children and Adolescents Experience Depression?. National Institute on Mental Health. Accessed: May 30, 2010.

Theresa B. Moyers, Stephen A. Rollnick. "A Motivational Interviewing Perspective on Resistance in Psychotherapy." Journal of Clinical Psychology/In Session 2002, 58:185-193.

Teens with Treatment-resistant Depression More Likely to Get Better with Switch to Combination Therapy. Press Release. National Institute on Mental Health. Accessed: June 15, 2010. http://www.nimh.nih.gov/science-news/2008/teens-with-treatment-resistant-depression-more-likely-to-get-better-with-switch-to-combination-therapy.shtml

Willansky-Traynor, P. Manassis, K., Monga, S. et al. "Cognitive Behavioural Therapy for Depressed Youth: Predictors of Attendance in a Pilot Study." Journal of the Canadian Academy of Child and Adolescent Psychiatry May 2, 2010, 19.

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