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My 15-year-old needs therapy, but refuses. How can I get him the help he needs?

It's not easy, but the right therapist makes the difference. 

Alan Ravitz, MD, MS

Senior Pediatric Psychopharmacologist, formerly with the Anxiety and Mood Disorders Center
Child Mind Institute

Q: Hi. I have a 15-year-old son who desperately needs regular psychotherapy but refuses to cooperate. He is diagnosed with a mood disorder, ADHD, mild ODD, and anxiety. He says that therapy is a waste of time and money. How can I get him the help he needs if he refuses to cooperate? And how do I find the right therapist who is experienced in dealing with kids like this?

A: I would begin by saying that psychotherapists are highly variable in terms of both therapeutic approach and personality. I know it can be hard to find the treatment that works for your son and the right person to provide it, but you are on the right track—you've recognized your son's need for help despite his resistance.

It's possible that the pervasive pessimism your son exhibits is not just based on his experiences in therapy, but is also a symptom of his mood disorder. It is not at all uncommon that the symptoms of a psychiatric disorder are the main barriers to treatment.

Although therapy is not a waste of time and money, sometimes it may feel like a waste of time and money until you locate the therapist who fits your son's personality and needs, at which point it will feel more like a difficult journey with a sizeable reward at the end. Getting to that new understanding of the journey should be your, and your son's, goal.

Not having evaluated your son, I can't offer specific advice about the therapist you need. But I can say that the two evidence-based psychotherapeutic treatments for depression are cognitive behavioral therapy, or CBT, and interpersonal therapy, or IPT. (You can learn more about these therapies here, in a video from Dr. Neal Ryan.)

Furthermore, it helps to think about treatment in terms of a "therapeutic alliance," a group of people including yourself, your son, and professionals working together to make his life better. This alliance only functions if your son likes the person he is seeing, which I'm sure you understand. But if he has only seen one or two therapists, it's not time to give up. Not every therapist is going to be a good fit, but the one who is can really help your son.

And the person who will be a good fit will likely be an active personality who engages in the conversation instead of passively listening. Patients in general like dynamic therapistsand if your son likes the therapist, as I said above, he will be more willing to build the alliance and work towards accepting treatment.

It also might be helpful to understand something called "motivational interviewing," a treatment that's usually applied to substance abuse but could be appropriate here. That's because motivational interviewing is based on meeting a patient where he is in terms of ambivalence and his own self-assessment, and working to understand and change problem behaviors. I am not saying that motivational interviewing is right for your son, but thinking about the approach could help you interact with him, and might even lead you to a therapist he can have a meaningful interaction with.

Finally, I should note that a course of appropriate medication, while not a cure-all for mood, anxiety, and behavior issues, can often make the difference between the pessimism your son exhibits and his being available for treatment. I suggest you consider consulting with a child and adolescent psychiatrist at the same time you pursue other professionals. It may provide the opening your son needs to let others help him help himself.

Published: April 17, 2012

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