If you’re worried your child’s therapy isn’t working, don’t despair! There’s a lot you can do to get things back on track. Photo by SHVETS via Pexels.
Therapy can be a transformative experience for kids, helping them overcome challenges, devleop essential skills, and thrive in their daily lives. If you’ve reached this page, you’re probably a believer in the many benefits therapy can provide for children. So what do you do when…it just doesn’t seem to be working?
We all know that growth isn’t linear, change takes time, and all that good stuff. But it’s still disheartening when, after all hard work finding a therapist and attending sessions, things don’t appear to be improving for you and your child. Sometimes, despite everybody’s best efforts, progress in therapy can seem slow or nonexistent. The good news is there’s a lot you can do to get things back on track.
What Should You Realistically Expect From Therapy?
No matter what kind of therapy you choose for your child, you should expect that it will likely take some time before you see major results. In my counseling practice, the average length of a child’s therapy is about six months. Of course, some kids need a lot less time, and some need a lot more.
This lines up with what the big therapy organizations say about how long therapy takes. The Association for Play Therapy estimates that kids will need an average of 20 sessions to resolve the problems that brought them to therapy. According to the American Psychological Assocation, 50% of people in therapy will be ready to go after 15 to 20 sessions, and the rest will need more time. Even “short term” forms of therapy may take longer than you might expect: TF-CBT, a short-term trauma therapy, usually requires 18 to 24 sessions.
If you’re meeting once a week, that means you’re looking at 5 months or more of therapy before your child will be fully ready to move on. Given that estimate, I think it’s safe to start questioning whether a therapy approach is effective around the two month mark.
Here are some other points to keep in mind as you evaluate whether therapy is working out:
Early therapy sessions focus on relationship building: your child might learn about their diagnosis and feel a lot more hopeful about therapy, but you probably won’t notice huge changes during the first few weeks.
It’s not typical to notice big, positive changes after every session. Over time, though, you should see gradual improvement.
Sometimes, symptoms may get worse before they get better, especially if your child is in anxiety or trauma therapy that involves exposure (facing feared situations).
Pretty much every kind of child therapy requires some level of parent involvement. Even though kids need their privacy, you should expect to be kept in the loop by their therapist about their progress and how you can help.
If your child is new to therapy, it’s possible that you’re just too early in the process to see changes. On the other hand, if you’ve been in the therapy game for a while and progress has slowed or stopped, keep reading to learn what might be getting in the way.
What Are the Signs That Your Child’s Therapy Might Not be Working?
Stalled progress, difficulty using skills in real life, feeling uncomfortable in sessions, communication struggles, and worsening sypmtoms can all be signs of problems in therapy. Photo by Monstera via Pexels.
So, let’s say you have realistic expectations for therapy: you’ve been at it for 8 sessions or so, and you know change isn’t going to happen overnight. You’re still not seeing the differences you’d hoped for. How can you tell if you’re on the right track? Here are some indicators that something about your current therapy approach isn’t working for your child:
Lack of improvement over the long term
In therapy, progress tends to happen in fits and starts. You might have a big breakthrough one session, followed by a week or two that are relatively quiet. It’s even possible that symptoms will become more intense for a little bit, if your child is confronting tough stuff in therapy that they have avoided until now. If you zoom out and look at the big picture, though, you should notice an upward trend over time.
Skills aren’t translating into real life
Many forms of child therapy, like CBT, put an emphaisis on learning coping skills and other practical strategies a child can use to manage their feelings and handle tough situations. There’s a big difference, though, between learning these skills and putting them into action. If your child is consistently unable to use what they’re learning outside of therapy, it means something is getting in the way.
Your child feels uncomfortable in therapy
It’s pretty normal for kids to be reluctant to go to therapy some of the time. This is especially true if therapy is getting into difficult subjects, like facing anxiety fears or talking about trauma experiences. This can usually be figured out with your therapist. On the other hand, if a child consistently dreads therapy and really doesn’t want attend, this might indicate a bad fit or lack of trust in the relationship.
Communication isn’t clear
Does it feel like stuff is always getting lost in translation with your child’s therapist? Maybe it feels like your child is avoiding the big issues in sessions, and you never get a chance to meet with the counselor to bring up concerns. Or, maybe you’re not sure what’s being worked on and how you can help at home. Kids need some privacy in order to make therapy work, but as a parent you should always know what the current therapy goals are, and have a way to check in with the therapist.
Things are getting worse
Okay, this one may seem a little obvious, but it’s true! If you haven’t been warned that your child’s symptoms might flare as a part of the therapy process, and things are getting worse at home, its’s time for a talk with your child’s counselor. This is especially true if you’re noticing worsening depression, thoughts of self harm, or aggressive and destructive behavior.
It’s important to note that seeing one or more of these signs doesn’t necessarily mean you have a bad therapist or that you have completely wasted your time and money. It’s absolutely a sign, though, that you need to have a conversation with your child’s therapist and figure out how to make things better, so you don’t spend additional weeks or even months doing something that’s not working.
Please, Talk to Your Child’s Therapist!
If you are feeling frustrated and don’t think your child’s therapy is working, please don’t keep this to yourself! As awkward as it might feel, telling your therapist you are concerned is a really important part of turning things around. You aren’t going to hurt your therapist’s feelings if you tell them you’re not loving how things are going!
Speaking from experience, I always want to know when something I’m trying is not landing with a client. It’s a huge bummer to hear that something wasn’t working long after the fact. We could have changed approaches so much sooner if I’d known, and saved that kid a lot of unnecessary suffering!
Pretty much every therapist out there cares more about kids getting better than they do about their own ego. Your therapist wants to hear from you. In fact, hearing feedback from parents—the good, the bad, and the ugly—makes it much easier for us to do our jobs.
When you talk to your child’s therapist, try to be as specific as you can about what you’re seeing at home and what doesn’t seem to be improving. You can mention things like:
How often your child is struggling, and how severe or long-lasting these episodes seem to be. For example, is your child having anxiety about school 4 out of 5 nights a week? Are tantrums lasting 30 minutes or more?
What you’ve been trying in order to help your child at home: what strategies are you using? How are you implementing them? What doesn’t seem to work out when you do?
Any concerns you feel haven’t been addressed yet in the therapy process
Anything you’re confused about, like how a specific strategy works or what the current therapy goals are
One final note about having this talk with your child’s therapist: please set up a time to meet with the counselor when your child isn’t present. You want to be able to speak openly about behaviors you’re seeing at home or family dynamics that might be getting in the way of completing therapy goals at home. Kids tend to personalize these conversations and may believe that it’s their fault if therapy isn’t going well.
Common Therapy Problems, and How to Handle Them
Often, an honest conversation with your child’s therapist is enough to clear up issues that are keeping you from progressing. You may need to clarify treatment goals, rethink your child’s diagnosis, figure out what’s getting in the way of using skills at home, or consider switching approaches or therapists in order to get things working again. Photo by Cottonbro via Pexels.
Hopefully, you are able to bring these concerns to your child’s therapist, along with some specifics about what doesn’t seem to be going well. Together, you can figure out what the roadblock might be that’s preventing therapy from being effective. There are all kinds of reasons therapy might not work, but here are a few common ones to consider, along with ways you can help things improve:
Unclear Treatment Plan
I often hear from parents that they’re not sure what’s going on in their child’s therapy aside from “just playing.” This should never be the case! Start off your troubleshooting process by making sure you and your therapist are on the same page regarding your child’s therapy goals.
Every therapist is required to create and maintain a document called a treatment plan. This outlines what problems brought a child to therapy in the first place, and what goals have been set in order to make those problems better. If you’ve been in therapy a while, this document has likely been updated to show how much progress your child has made toward these goals.
If you aren’t clear on your child’s treatment plan, you can:
Ask to meet with your child’s therapist to review the treatment plan together
Let the therapist know that you’d like to get clear on what the current goals are, and be more direct in working toward them
Get feedback from your therapist on what they’ve observed in sessions and how they feel your child is progressing
Ask how you can support your child in achieving treatment plan goals at home
If your child’s therapist doesn’t have a treatment plan, can’t give clear answers about goals, or isn’t able to provide specific responses to your questions, you may not be a good fit for each other.
Treating the Wrong Problem
It’s also possible that your therapist has a clear, detailed treatment plan…and you’ve been focusing on the wrong problem. Sometimes, one mental health problem masquerades as another. Girls with autism, for example, have a harder time getting diagnosed and their symptoms might be mistaken for anxiety or another disorder at first. Trauma symptoms can look an awful lot like ADHD. Children who have OCD might take a while to get the right diagnosis, as well, because the behaviors can be hidden or hard to spot.
If you’ve been diligently working on your treatment plan, trying to follow through with things at home, and nothing seems to be moving the needle, it’s worth questioning if something else might be going on.
If you’re wondering if there’s another diagnosis at play, you can:
Ask your child’s therapist if there are any other diagnoses (sometimes called “differential diagnoses”) they have considered for your child.
Give a thorough review of any possible symptoms, behaviors, or difficulties you’re seeing at home,
Reflect on your child’s history: have they lived through anything that might be considered a traumatic or highly stressful event? These are good for your therapist to know about, even if they seem unrelated to the problem at hand.
Consider getting an evaluation from a psychologist to screen for ADHD, autism, or other developmental or learning conditions
Depending on what you learn, you may find that your goals in the therapy process need to change—or you may discover that your child is a better fit for another kind of therapy altogether.
Trouble Following Through
What happens outside the therapy room matters just as much as what goes on inside of it. This is especially true if you’re in a skills-based form of therapy, like CBT, or treating a problem like anxiety or behavior difficulties where a lot of the struggles occur at home.
Kids are still in the process of learning to regulate their emotions, and need an adult’s help to do this. Even if they’re learning skills perfectly in session, they won’t be much use if there isn’t a parent or caregiver helping with follow-through in real-world situations.
Of course, this is way easier said than done. Working on therapy skills can be time-consuming and emotionally draining. It can be really hard to find the time and emotional reserves to work on therapy when you’re managing a busy and stressful life. It’s also possible that a plan that sounded really good in the office falls apart when you get home: either your child is reluctant to do it, or you encounter some kind of issue that you can’t figure out how to navigate.
If you’re having a hard time following through on therapy goals at home, try the following:
Be honest with your therapist about what’s going on. You aren’t getting graded, so there’s no need to lie about not doing your homework!
Make sure you feel clear and confident about what your assignment is: you should know exaclty what you’re doing, and what to say when
Sometimes, a plan sounds okay in the office but feels difficult, uncomfortable, or scary to a child when it’s time to follow through at home. If this is the case, you may need to adjust the goal or come up with a plan to support your child through it.
Let your therapist know about any sticking points that you’re tripping up on when you try to practice at home
If you’re in the middle of a major life transition, experiencing trauma or loss, or feeling totally overextended by work and family obligations, you may just not have the reserves to fully participate in therapy right now. It may make more sense to focus on those life stressors first, and return to therapy once things have settled down a bit.
Child Needs Higher Level of SuPport
If you aren’t seeing improvement, and especially if things are getting worse, you may simply not be getting enough help. Some issues need more attention and support to resolve than a 50-minute sit down with a therapist once a week can provide. This is kind of the “bare minimum” of therapeutic support, and there are a lot of other options to consider when it isn’t enough.
Somtimes, families opt to try therapy on an every other week or even monthly basis. This may be due to financial concerns, time constraints, or limited availability from your therapist. While this can be a good option for kids with mild symptoms, kids who are really in the thick of it will have a hard time keeping momentum up if they’re only coming every other week.
If you feel like things are steadily worsening, and particularly if your child is struggling with suicidal thougths or self-harm, it’s worth talking to your therapist about ways to increase support. Here are some possibilities to consider:
You child may need more frequent sessions: weekly if they’re coming every other week, or twice a week if they’ve attended weekly.
Adding group therapy, like a DBT skills group, can add another layer of support for kids struggling with suicidal thoughts or self-harm.
Consider meeting with a psychiatrist to see if medication could help your child make more progress in therapy: you can talk this over with your therapist and pediatrician.
If finances make it hard to attend therapy more often, ask about a sliding scale or consider making a transition to a therapist who takes your insurance or can offer a lower rate.
If your child is not safe at home, intensive outpatient therapy (meeting daily for part of the day) or an inpatient stay might be needed before your child is ready to “step down” to weekly therapy sessions.
It might be hard to think about adding more therapy when things are already not working: it means more time, more money, and more effort. While a higher level of care isn’t the right answer for every child, it can make a world of difference for kids who really need it.
Therapist is Not the Right Fit
Sometimes, it’s just not a good match. Maybe the style of therapy your counselor offers doesn’t work for your kid: a child who’s reluctant to attend therapy might not do well in an approach that requires a lot of self-motivation, for example. Or, maybe you’re feeling a lack of clarity about what the treatment plan is, and you can’t seem to get on the same page. If your child’s diagnosis or needs have changed over time, they may need a form of help your therapist no longer specializes in.
It’s also possible that your personalities just don’t mesh well: just like you’re not going to be friends with every person you meet, you’re not going to hit it off with every therapist you meet, either. Simply not feeling comfortable with your therapist—even if they’re a nice person—can be reason enough to make a change.
If you’re just not vibing with your child’s therapist, there are a few things you can do:
As awkward as it may seem, you can still bring this up to your therapist, as long as you don’t have any big ethical concerns about their behavior. They may sense that it’s a poor fit, too!
Try to get specific about what you need out of therapy that you’re not getting now. Would your child respond better to a therapist who is more animated and engaging? Do you need someone who specializes in a specific diagnosis, or does more parenting work?
Ask yourself whether a difference in culture or background might be part of the problem. It may or may not be, but sometimes finding a therapist who shares your racial or cultural heritage can help.
Search for therapists who meet your new criteria. You can even ask your current therapist for referrals, if you’d like!
Just like doctors have no problem with patients seeking a second opinion, most therapists genuinely just want our clients to feel better, whether that happens with us or someone else. I’m always happy when a family is able to find someone who is exactly the right fit for their situation.
Should You Switch to Another Therapist?
It’s always within your rights to switch to a new therapist, and sometimes that’s exactly what you’ll need to do if your current therapy plan isn’t working. If you’ve tried talking with your therapist and things still aren’t working out, it’s perfectly okay to transition your child to a new counselor. There are so many different styles of therapy out there that you might not find the right match on your very first try.
Just like you wouldn’t fire an employee over a minor offense, I don’t recommend leaving therapy the first time something goes wrong. In fact, you should expect that things will go wrong sometimes! Your therapist won’t always get it right. They may interpret something in a way that doesn’t sit right with you. Or, they may have a policy you don’t agree with, like charging a cancellation fee.
Minor missteps and frustrations can be worked through, and will often make your relationship with your therapist stronger. If you left therapy every time something like this happened, you’d be repeatedly starting from the begining and it would be hard to make any meaningful progress. On the other hand, unethical behavior—things like making racist or sexist comments, not protecting your private information, or saying something inappropriate in session—should never be tolerated. Get out of the situation immediately if this happens to you, and consider filing a complaint with your therapist’s board.
Most of the time, there won’t be a big, dramatic reason for ending therapy: it’ll just turn out not to be a good fit. In these situations, I strongly recommend being upfront with your therapist about what’s going on. Scheduling a final “goodbye” session for your child gives them a sense of closure before moving on.
Take Care of Yourself As a Parent
Your child’s therapy process isn’t going to look like anyone else’s, so resist the temptation to compare your child or family to others. You can’t help your child through therapy if you’re completely burned out! Photo by Albert Rafael via Pexels.
It’s easy to feel burned out when therapy isn’t working for your kid. Here you are, contributing all this time, money, and emotional energy in the hopes that things will get better…and then they don’t. You might blame yourself, worry that your child’s problem is unfixable, or start to question whether therapy will ever work.
We all know the adage about the oxygen mask in the airplane: there’s no use in bending over backwards to find help for your child if you’re feeling utterly fried by the whole process, and have no time to take care of yourself. Do whatever you need to do to prioritize your own mental health during this stressful time, even if it feels a little selfish.
Your kid’s process is not going to look like any other kid’s process: they’re a unique individual. There’s no reason to beat yourself up if so-and-so’s kid had a miraculous transformation in 3 sessions of therapy and your family is still struggling 6 weeks in. Just like kids hit their developmental milestones at their own pace, you and your child will figure this out on your own timeline, too.
When you’re really feeling stuck, it can be easy to overlook the small, everyday ways that things are getting better. It sometimes helps to refocus on those small victories. Did your child encounter a triggering situation today, but not melt down? Were they able to articulate their feelings to you this week? Have some aspects of your problem gotten better, even if other parts have stayed the same? This is all growth and progress to be celebrated.
Be patient, hang in there, and don’t neglect these little wins while you figure out how to get unstuck.
Begin Child Counseling in Charlotte, NC or Online
Finding a therapist who is the right fit for your child can make therapy more effective. If you’re looking for someone who specializes in tween anxiety and OCD, I’m available to work with children throughout NY, NC, and FL. Photo by Victoria Rain via Pexels.
If you’re still looking for the right fit for therapy for your child, I might be able to help! I can see kids in person at my Davidson, North Carolina office, or online anywhere in North Carolina, Florida, or New York.
I mainly work with tweens (rougly ages 8-13) who are struggling wtih anxiety due to OCD, difficult life circumstances, or just by virtue of having an anxious temperament. We’ll work together using practical, skills-based therapy along with a healthy portion of fun and play to learn new ways to deal with difficulties in life. I’m trained in three research-based forms of therapy: CBT (great for anxiety), TF-CBT (designed for trauma), and ERP (for OCD). I’m also a drama and play therapist, so we won’t just be learning dry skills from a book, but we won’t be playing Uno all day either :-).
If you think your child could benefit from this approach, feel free to reach out! You can also join my mailing list to get my free coping skills guide, as well as monthly information on how to help kids and tweens navigate life with anxiety.
