My Depressed Teen Refuses Therapy. How Do I Help?

Ask Lisa Podcast, Ep. 65: My Depressed Teen Refuses Therapy. How Do I Help?

The Ask Lisa Podcast does not constitute medical advice and is not a substitute for professional

mental health advice, diagnosis or treatment. If you have concerns about your child’s well-being,

consult a physician or mental health professional.

REENA: I always remember you saying it’s right around this time of year where you would get a lot more people showing up asking for help.

LISA: Yeah, it’s interesting. I’ve always done my billing by hand. I actually keep a written ledger and, you know, it’s a little old fashioned, and so I can see how far down a page each month goes and I remember, especially when I was practicing a lot, that suddenly January and then February I would go so much further down the page than I did in other months. It’s tough. It’s a hard point in the year under normal conditions. The weather’s bad, the days are short, the light is rare. People feel it, really feel it in January and February.

REENA: I think there are a lot of people struggling just to find somebody they can talk to, a medical professional that they could talk to and we got this letter that really caught our attention talking about a depressed teen who needs help: ‘My son is 17 and in the twelfth grade. His high school experience has been anything but normal due to heavy lockdowns in Ontario. He’s apathetic and spends all his time gaming or on his phone and has few connections in the non-virtual world. He has very little motivation to prepare for college or to even think about what a gap year would look like. We’ve tried many approaches, including a virtual therapy session which he claimed was not needed. He’s adamant that he does not want therapy, so I feel we’re really hitting a wall right now, and of course the more I encourage him to open up or seek help, the more he withdraws. We’re here to support him and encourage but I feel like I’m at a total loss. Do you have any recommendations?

LISA: Oh, man.

REENA: Yeah, Lisa, how do you get a kid who doesn’t want to go to therapy to get help?

LISA: It’s so hard, and this, Reena, this letter, I am hearing this story everywhere.

REENA: Really?

LISA: And I’m hearing it in different versions. There’s kids who, like the kids in Ontario where the lockdowns have actually been pretty intense, who, you know, just have checked out from the world outside their rooms, and then there’s kids who go to school, but school’s not that fun, Reena. It’s really, you know, it’s so important to wear masks and yet they they just take the fun out of a lot of it, you know, just the playful aspects of school, and so kids are pretty reserved, I’m noticing, or checked out, and then the other thing I’m noticing is the kids who are really scared that the schools are going to close and so there they don’t feel like teenagers at school. You know usually teenagers at school there’s a little action, there’s a little friction, whereas what I am seeing are kids were very sedate, very compliant because I think they’re scared that the school’s might close, and like whatever else they just want to be in school, and it’s just, this story, Reena, is so many families’ story of of looking at a teenager and thinking, kid, you are so not yourself, you are so suffering, you are in so much pain, and like let me help you, let me get you to help, and the kid basically, you know, stonewalling on it, and it’s terrible, Reena, it’s terrible. Okay, so what do you do? So what do you do? So, the first thing I would say, I’m going to throw out every idea I can think of just because I think one thing will work for one family, another might work for another family. So, the first thing you can do if you can find a therapist, and we will come back to that, is reach out to a clinician who cares for teenagers and get guidance from them. Ask them for a session or two, and there’s a few things that can happen when you do this. One is you can meet with them and they might have good ideas about how to help your kid, though I’ll also try to come up with some ideas about what you can do before you even meet with the clinician, but get them thinking with you about, you know, have you tried this at home? Have you tried that at home? Another thing that clinicians help with, and I will help with this and this episode, is how to talk to teens about coming into therapy, and kind of lower the barrier to that, and then the third thing that can be really great is if you’re successful and your teen can go see that therapist and you come back all the way out, now that therapist is kind of hitting the ground running with your teen. You know they’ve gotten a background on your teen, they understand them a little bit, and that can then grease the wheels if the therapy gets up and running. So, one option is just to try to locate a clinician and actually, given how hard it is to get in with clinicians these days, especially people whose teenagers, I would do it like to get on someone’s calendar while you’re working on getting your teen open to the idea. Like get that slot, hold that space, even if it means getting on their waiting list for you to have the meeting with them, that is tactical at this point.

REENA: So, walk me through this. If I’m the teen and you’re my mom and I’m like, mom that’s just sort of stupid. I’m not going to go talk to some stranger about how I feel. I’m not going. If you have that resistance, how do you respond?

LISA: You totally nailed it, right? This is how teenagers feel and, you know, frankly, Reena, let’s acknowledge it is a somewhat bizarre arrangement. I’m going to walk in and talk to this random person, and I will tell you, actually, have you ever watched “Dog the Bounty Hunter”?

REENA: No.

LISA: Okay, do you know what it is?

REENA: I do know about it, yes. The show where he’s like hunting down criminals essentially, right?

LISA: Yeah, so Dog the Bounty Hunter’s like this giant human who looks kind of looks like a WWF wrestler type guy, and his job, he goes and finds people who have fled bail, jumped bail, and had to bring him back, and, Reena, I was like flipping through channels one night and like kind of stopped on Dog the Bounty Hunter, I was like, let’s just check this out, and he taught me something that I have used clinically for years with teenagers who land in my office. So, here’s what happened. So, Dog, you know, knocks on some perps door, and the guy opened the door and he says to him, look, you don’t know me and I don’t know you, but we have to leave together, so we can do this the easy way or the hard way. And I was like, oh my gosh that is brilliant. Brilliant. So, here I am, five foot four myself in my little shiny office. When a teenager can get to my office, and we will help families figure out how to make that happen, and they’re sitting there looking at me like, lady, why would I talk to you? I use a gentle dog the bounty hunter and I say to them, look, you do not know me. I do not know you I know this is very strange. I am here to try to be of use. I want to be helpful to you, but I know that this is a really weird scenario, and it works, Reena, because teenagers are like, okay so you’re not going to pretend like this is normal. You’re not going to try to be nice to me until I soften, and so I just want you to know that that piece matters. Okay, but how do you get them in the door? How do you even get them to a clinician who can try the Dog the Bounty Hunter move on them? Okay, so what I always think about in these moments is something that was said to me in my training, which at the time I thought, that can’t be true, and now I think it’s a 100 percent true, and it was one of my supervisors who said to me, you need to operate with the idea that every teenager secretly worries that they’re crazy. Were her words to me.

REENA: What? Really?

LISA: Yeah, and that’s how I reacted when she said it. I was like, oh come on, that doesn’t likely, but I actually think it was spot on, and here’s why. Right? So, you’re 10, 11, you’re a pretty steady person, you don’t get that upset about anything, and all of a sudden like, wham, 12, 13, your feelings go through the roof. We’ve covered this in a million ways on this podcast. Wham, 14, your mind is changing and you see things in very exciting but also very complex ways, and it’s a lot, and they can feel pretty internally disorganized, and so there is this kind of harboring this worry of like, what’s wrong with me? That I think we have to always assume lives in every teenager, and so then when a grownup’s like, you know what you need? You need therapy. The kid’s like, oh no, it’s true, like I’m broken. So, with that framing in mind, one way to approach this is to say to a teenager, look, this is not about you being broken. This is about you deserving support that I’m not equipped to give you or I don’t know how to offer right now, and there’s never been a better time to say this to teenagers because it’s so bad right now for so many of them that you can really say this with no, you know, qualifications are reservations. You can still look, you have been through a horrible two years. Anybody in your shoes would be, you know, you deserve more support than I can get you, or I can provide here. Like let’s get you a pro. So that can help as one way to try to re-frame it so it doesn’t seem to them about being damaged and instead is quite a bit more accurately about them deserving more support than they have.

REENA: Wow. I love that line. You deserve more support than I can give you. Lisa before we talk about what do you do if your kid actually wants to go to therapy but you can’t find someone, do you have any other ideas about that stubborn teen who just doesn’t feel ready to go?

LISA: Yeah, yeah. So, a few more things that can work. Another thing is that, you know, as this parent wrote this letter, I mean her son’s depressed, you know, it’s very clear that this young man is depressed, and one of the symptoms of depression is feeling hopeless, feeling like nothing’s going to help, like nothing’s going make a difference, and so one of the most powerful lines that parents have at their disposal is to say, you know, if you say to a kid, I want you to talk to somebody, and they’re like, nothing’s going to help, it’s not to make a difference. It’s really important to say back, that’s your depression talking, and when your depression is treated, you won’t feel that way. So, let’s get your depression treated.

REENA: But wait a second. Going back to your point about how teens kind of feel like they might be going crazy, doesn’t it take them down a rabbit hole by saying, you’re depressed? Doesn’t that then make them freak out? It would make me freak out if you were my mom and you said, you’re depressed. Like what? You think I’m depressed? I’m not depressed.

LISA: That’s a good point. So, let’s think it through. I know it’s a good line, but I think you’d really want to establish with the kid first, you know, I’m worried that you might be depressed. You have every reason to be depressed. It makes sense and, you know, this is so not like you. You know that. You know, so I think if you have a kid who’s just really shut down, who is, you know, not engaging the world at all, I think you could probably say, you know this isn’t like you at all, and I and worry you’re depressed and you feeling like this won’t help, that’s the depression talking. Let’s get that treated, but I think that’s right, Reena, like we have to be really careful when using diagnostic terminology around teenagers, when offering medication to teenagers because again, you know, it even though can often be a great thing for a lot of teenagers that are like, oh, man, now I need pills? Like definitely I’m broken. So, thank you for pointing that out because we have to tread so carefully around those kinds of things. There’s one other thing I want parents to have as a line, right? I mean it’s so interesting, a lot of being a clinician is just having your, you know, your effective language for trying to communicate, and so I think about this boy and I think about this parent who wrote, and this boy has come up, in some ways, with his own solution. He’s on his phone, he’s in his room he’s, you know, he’s trying to cope in ways that really reveal how much the suffering, and in the parent’s might say, look, I don’t want you to talk to a therapist, and he’s like, no, no, no. I got it, and I would have the parent say back something like, look, what you’re doing isn’t working, and so we need to do something else and there are people I can think of. If you’ve got ideas, I’m open to them, but I’m putting therapy on the table as one idea here. So, I would have parents move in all of these spaces, and I just want to say before we move on anything else, you can ask your kid, if you’re really worried about if your kid might harm themselves or is thinking about that, you can ask, and asking kids does not give them this idea. That’s something that people worry about sometimes, and so whatever else, it’s also okay to say to your teenager if you have reason to worry, like, this has been such a hard time. Are you worried at all about your ability to stay safe? Do I need to worry about your ability to keep yourself safe? And get an answer to that question, and if your teen’s unsure about their safety, call your pediatrician or take them to the ER. That piece, you move on fast.

REENA: Wow.

LISA: Getting them into therapy, you can work on that, but if you have any reason to be concerned about safety, get an answer to that question from your teen.

REENA: Wow. I never thought about asking them just directly because you kind of think, as a parent, oh my gosh, if he’s going to harm or she’s going to harm herself, I need to do this quietly with a clinician of some sort, but you’re saying, ask the question. Just ask them.

LISA: Yeah, and we have data showing that kids often actually are glad you asked. You know, especially kids who are in danger. There are some data showing that they actually appreciated that somebody asked them. So, I think it’s asking in that way where we say, look, anyone in your shoes would really feel pretty, you know, pretty low, and, you know, you can say, this may feel like a weird question to ask, but, you know, I love you and I’ve got to ask it, like do we need to be worried about your safety here?

REENA: Yeah, yeah. I want to ask you what do you do if you can’t get in somewhere or, you know, if you want somebody of a particular race or religion or gender and you just can’t find that, what do you do?

LISA: The thing is this is the part, honestly that’s breaking my heart more than anything, it’s, you know, hard enough to get a teen to therapy, but now to find a clinician, first of all there’s not that many of us who see teens, and then to find a clinician who’s available. So, here are the strategies I would have parents consider. One is, call your pediatrician, again because pediatricians are plugged into the local talent clinically. They’re often collegial with those people, and sometimes they can help you in, right? They can call a colleague and say, look, I’ve known this kid forever, you know, I want you to see this child. Is there any way you can squeeze them in? So, that can happen. Same with your school counselors. If you feel comfortable sharing with your school that you’re looking for somebody, they can sometimes make a call, fast track things, push things along. So, I would just use your resources as much as you can. Another option that I want people to consider, you know, is to just start calling, right? And getting on waiting lists, and don’t hesitate to get on a waiting list, you know, you may come up much faster than you thought you would, and then there’s something else that is new and the consumer side of it is not as worked out as it should be but it’s very promising, and it’s that there is now a national license available for psychologists. So, this is fascinating, so the way it’s always been is you’re licensed in the state where you practice. So, I am licensed in the state of Ohio, and, until recently, I could only care for people who were sitting physically in the state of Ohio while I was sitting physically in the state of Ohio. Maybe I could be out of town, but like they had to be in Ohio. And prior to the pandemic, psychologist, I mean bluntly, we kind of look down our nose at telehealth. We’re like, oh, it’s not the same. Then of course it turns out it’s fine. It works great, you know, it often helps people get into therapy that they don’t have to deal with the logistics of getting to an office, and so, in a kind of stunning and wonderful development, a group called Psypact – P. S. Y. P. A. C. T. – put together all of the back-end needed to develop a license that lets you let you practice across state lines, and what it comes down to is state legislatures enacting this, and as it stands right now, I think 27 states and the District of Columbia have enacted this law, and I think there’s a few more where it’s in process, and so then, psychologists who are interested, and I did this even though I’m not taking anyone new into my practice, it took like a week of my life to apply for the license. I mean I’m dragging out my, you know, supervision stuff from when I was in my mid-twenties, I mean it’s it’s sort of amazing, but I have this license now, and I use it to actually care for teenagers who I saw in my practice who are now college students in other states.

REENA: Oh, wow.

LISA: And so when this is really up and running, what it means is you are not limited anymore to your local talent, and so I’ve actually been in touch with the Psypact people asking, you know, when will there be a searchable directory that parents can go in and search for people who specialized in adolescence and, you know, can see them, you know, wherever they are, and so parents can start to pay attention to this. I would have you look on the Psypact website just to see if your state’s already passed the legislature, I’d have you push your state if they haven’t, but that’s another option I just want consumers to be aware of because it’s happened very quietly, but it’s kind of a game changer, Reena.

REENA: Wow, that is a huge game changer because then it opens up, you know, if there’s a particular person or or just a set of experiences or something that you want, then you could search that. That’s great, Lisa. Can we put that in her show notes as well? So people can search that website if they want more?

LISA: Absolutely.

REENA: I want to go back to this letter because this parent, this child is in the twelfth grade, Lisa, and this is such an important year where things matter. I know the parent said they’re thinking about maybe trying to get this teen to think about a gap year or something, but I do feel like the sands of time here are running out. That window. Like what do you suggest if you’re sort of in those later years of high school and you really want to get this right?

LISA: You know, I think I would just push really hard on trying to get this kid back on track, and back engaged with the world, and it gets to this other idea. So, I, of course, am a big fan of therapy, I would love to see this kid in therapy. My view of what is therapeutic has expanded a lot the longer I have practiced.

REENA: How so?

LISA: Well, what we want, for some kids, is therapy, and some kids, absolutely that has to happen, but I’ve also watched kids make all the changes I wanted to see made because they joined a theater program or because they started volunteering at a local animal shelter or because they got a job or because they started exercising when they hadn’t been exercising or because they got much more serious about not having tech their bedrooms and were able to get a good night’s sleep, and so back to the idea of saying to this boy, look, what’s happening here is not working. Something has to change. I do think, with or without therapy, parents should say, we need to come up with some things you’re going to try to help yourself feel better whether it’s that you’re out getting fresh air for an hour a day or you’re exercising or you start, you know, helping down the block with this family who’s got young kids, and they’re sort of overwhelmed, but pushing for this idea that what teenagers need really need is to be engaged in the world beyond their own heads, and what the pandemic has made so painfully obvious is that when you rob teenagers of that outside world, when they take all of that attention and focus and energy and it gets catalyzed inward, it’s not good for them. Like they need to be pulled out, and so I would, while waiting for therapy or alongside therapy, try to be as creative as absolutely possible in light of the conditions created by the pandemic to get your kid, to get this kid, back into the world. I would love for this guy to have a job. Like a job right now would be a game changer, I think, for this kid, if that’s an option, which of course is the big question right now.

REENA: Can I tell you? That’s just great advice for everybody. That you need to get engaged beyond your own head. So many of us are at home and we might be working or dealing with the kids or the family, but finding things to be engaged with beyond just your house, I guess, right?

LISA: Absolutely. Absolutely. It’s so, so important.

REENA: Before we go, I want to ask you, at what point do you feel that parents should be really worried if they find themselves with a teen who’s super depressed?

LISA: Definitely if there’s any question about safety. That is the, you know, that is the red line. That is something that needs to be taken very seriously, and I think, you know, you should be worried if it’s getting in the way of what we call progressive development. You know, if they’re not growing as a person. The heart of adolescence is that they’re growing, right? They just change so fast and they’re expanding their capacities and they’re moving out into the world, and that has been so badly disrupted by the pandemic, and yet a lot of teenagers are still figuring out ways to grow. They’re thriving academically or they’re still being creative in their own ways, but if your kid looks stalled developmentally, which I think a lot of kids are going to look that way right now, that’s concerning, and you want to work with them, work with your resources, to get very, very creative about how to get them moving forward developmentally again, even if it’s not in the ways we would have normally seen it or at the rate we would have normally seen it.

REENA: Wow. That’s really, really good. There’s just so much to digest here. I just can’t get over it. So, Lisa, what do you have for us for parenting to go this week?

LISA: For parenting to go, what I want parents to help teenagers appreciate is that their distress makes sense. You know, it makes me think about our episode from the start of the year where, you know, we said one of our resolutions is to expect distress, and I think that for teenagers they can start to feel so divorced and alien from the world when they’re unhappy and when we can say to them, you know, I think so many people are suffering right now, and especially so many people your age are suffering right now. There’s nothing wrong with you. This is not a sign that, you know, there’s something about you that doesn’t make sense. This makes a ton of sense. Let’s get you the support you deserve.

REENA: I still can’t get over that you watched Dog the Bounty Hunter.

LISA: You know, I will take wisdom wherever I find it, Reena.

REENA: That’s brilliant. Absolutely brilliant. And, Lisa, next week we’re going to talk about whether you should bribe your kid. I’ll see you next week?

LISA: See you next week.