Having a Child or Teen in Therapy: What Happens Next?
Deciding if therapy is needed for your child or teenager is complex, and arriving at the conclusion may be unique for each family. Some families openly discuss mental health, perhaps it was valued and common during your upbringing; for others, it may be that therapy was not accessible or normalized. You might have already tried several ways to support your child or teenager, or you may still be unsure of what they are experiencing.
Whatever brought you and your family to therapy, you may still have questions about how you can support your young person. You may wonder how involved you need to be, if you should be asking what happened during the session, or if there is anything you need to be doing. There is no single answer that fits all families. This post will help you consider what you can do.
Young People Come to Therapy for Many Reasons
Many children and teens come to therapy because they are struggling to manage and regulate anxiety, sadness, grief, or other strong emotions. Other young people are in therapy because they are having a difficult time paying attention, organizing, or experiencing other behavioral difficulties, such as initiating and completing tasks. Also, life is filled with uncertainty and pain, and so your child or teen may be struggling to adjust to, accept, understand, or deal with traumatic or stressful events. Learning to socialize can be difficult, as well as building and maintaining relationships with family, friends, teachers, and other people. On top of that, young people are dynamic, and they may be experiencing biological shifts, struggling with puberty, identity, independence, and other body changes.
Children and teens are more than one diagnosis or one challenge. They may have interrelated difficulties, and there are strengths we can build on strengths despite the struggles they face.
Children and Teens Do Not Live in a Bubble
As a clinician who considers more than the individual, and who looks at how a person interacts with the systems around them, I think it is important to remember that young people do not live in bubbles. They navigate various systems and socialize inside multiple relationships and settings. Your child or teen is affected by more than what happens in the therapy room or at home. Their relationships, home life, school experiences, culture, community, access to resources, and events happening in the larger world can all influence how they feel and respond.
Have there been any recent changes, losses, conflicts, or transitions they have experienced or witnessed? Does the environment understand and support your child or teenager? What strengths, relationships, and resources are currently available to them? Are there any unfair expectations, policies, or treatment adding to the problem?
Remember that perspective is everything. Some of the answers to these questions might be different for you than for your child or teen.
Sometimes the Environment Needs to Change
It is important to understand the context in which we live, as reading the reality can help empower you and your family. Sometimes young people are struggling because there is a mismatch between their needs and the environment. School practices, discrimination, financial stress, language barriers, limited resources, inaccessible services, or unfair policies can affect a person's wellbeing, even if it was previous generations who experienced these challenges.
Therapy can help young people develop coping and communication skills, but those will not erase or replace the changes that are needed in their environment. They are not solely responsible for advocating and addressing systemic problems.
Therapy can be a step to help children, teens, and caregivers ask questions, communicate their needs, request support, and speak up when something is unfair. When we step away from looking at individuals as the only source of problems, that in itself can be therapeutic.
Supporting Yourself Is Part of Supporting Your Young Person
Throughout the therapy process, you may be feeling worried, helpless, frustrated, guilty, or unsure whether you are responding the "right" way. These reactions are common and understandable. Caregivers are part of a young person's life, and while you are not solely responsible or to blame for their challenges, it could be helpful to reflect on what you may need as well.
I have worked with various caregivers who say they feel like they need therapy themselves or they were in therapy before. Some juggle various tasks, manage multiple stressors, and work through their own histories, and they find little left for themselves.
Consider Your Own Needs
You might consider if you would benefit from the following: Your own individual, couples, or family therapy; A caregiver support group; Religious, cultural, or community support; Employee assistance benefits; Help with childcare, meals, or household responsibilities; More rest, or time away from work; Learning more about what your child or teen is experiencing.
Taking care of yourself is part of parenting, and it is also something your young person sees you do. Caring for yourself helps you remain patient, emotionally available, and better able to respond during difficult moments.
Practical Strategies to Support Your Child or Teen in Therapy
Understand Your Role: Your participation in your child's or teen's therapy will depend on their age, abilities and limitations, and developmental level. Younger children may benefit from more direct involvement, such as you being included in sessions or collaborating on reinforcing strategies and skills. Older children, eleven and up, may benefit from greater privacy and independence as they grow. Ask their therapist what caregiver involvement will look like and how you can support the treatment plan.
Be Honest About Communication With the Therapist: Many caregivers share information with me as the therapist, and it is an important and helpful part of the process. What strengthens this relationship is asking your child or teen whether they prefer information shared by email, phone call, or a private caregiver meeting, rather than in the waiting room or therapy room while they are present. Although some children or teenagers say they are okay with it, asking their preference ahead of time really supports their developing autonomy and privacy.
Respect Their Privacy: Speaking of privacy, knowing every detail from every session is usually not helpful. What is more powerful is letting them know that you are available if they want to talk. All young people have their preferences, so it is okay if they share immediately, take their time and only share highlights, or feel more comfortable asking their therapist to share updates with you directly. Know that your therapist is required by law to share safety concerns, such as risk of suicide or of harm to others, and any physical or emotional abuse. We are transparent about that process with your young person, which supports continuity of care and makes it more likely that the experience leads to more openness in the future.
Model Skills: Your children and teenagers may be learning new skills, so consider practicing them too. Children and teens often learn as much from what caregivers model as from what you tell them. Consider practicing some of the skills, such as labeling your emotions and engaging in positive self-talk: "Ugh, that was so frustrating, let me cool down before I move on to my next task." Pausing: "Hmm, let me check in with myself before I make this decision." Or apologizing: "I was defensive and realized I might not have responded in the best way. I am sorry, you didn't deserve that. Would you be willing to try explaining that again to me when you are ready?" Practicing and doing what we expect from them can be a very powerful strategy to help young people.
Offer Age-Appropriate Choices: Life itself can be stressful. Being able to decide what happens in your life is especially important for children and teens. It could be very helpful to offer them opportunities to lead. You can try letting your young person choose a family activity, selecting between two options, deciding when they are ready to talk, being part of their disciplinary action, or helping plan part of an outing. This helps build various skills, lets them take ownership of their life, and reduces the need to seek control in maladaptive or inappropriate ways.
Lead With Curiosity: Most children and teens will say that they feel their caregivers give them too many lectures or too much advice. As children grow, it may help to ask questions before offering advice. Connect before correcting is a helpful phrase to remember this strategy. Helpful questions may include: "Do you want me to listen, help, or give you some space?" "What parts were the hardest for you?" "What do you wish I understood?" "Would you like to talk now or later?"
For younger children, six and under, depending on the behavior or circumstance, it may be more helpful to act gently but firmly act. For example, remove items that they know they should not be using, instead of repeating rules and asking why they are doing what they are doing. Younger children are working on controlling their behaviors and emotions and tend to be more impulsive in their actions.
For older children, between the ages of seven and twelve, you can practice reducing lecturing or advising for rules or norms that have been discussed extensively, and instead provide them with options or continue with your established consequences. For example: "You lost TV time today. What can you do better next time? Is something going on that you want to talk about?" It could be that they want more of something, that they do not think the rule is fair, or that they have had a bad day and are engaging in a coping strategy.
For teenagers, asking questions is most helpful, as it builds trust and gives you an opportunity to see what they have learned and how they feel or are thinking about a situation. It also helps them recognize what to expect from you as they start to develop their own identities.
Pay Attention to Their Response: It is equally important to notice how your young person is responding to your reactions and behaviors. Your intention does not automatically produce the impact you are hoping for. Notice if they shut down, open up, or repeat similar phrases such as "I don't know," "sure," "whatever you want," or "I don't care." A young person's reaction does not automatically mean you have done something "wrong." It may show that they need more time, less pressure, or a different approach.
Ask for Feedback and Practice Repair: This is one of the most useful things you can do for your child or teenager. While this is a skill that many of us are still practicing, it is pivotal in building and maintaining relationships. Defensiveness, overwhelm (whether it be anger, sadness, or guilt), and shutting down are all part of socializing. Other times we may share unhelpful or hurtful comments or opinions. It is important that when these reactions occur, you recognize them and return to the conversation. Expect that you will hurt your young person in some way, and be ready to make amends.
Invite Coping Skills Without Demanding Them: Because your young person is practicing skills, sometimes it may feel frustrating that they are not practicing them consistently, or when they "need" to be. There are some alternatives for reinforcing new skills. Instead of "Why aren't you doing what your therapist says", try "Would one of your coping tools help right now?" or "Do you want help thinking about what might make this manageable?". Depending on your child's or teen's personality, symptoms, developmental level, and age, they may need a more direct approach, such as sitting with them and saying, "I thought you might need more company, is this okay?" or "I am giving you some space and will be back to check on you." During moments of intensity, it is difficult to think, so gently implementing a coping skill can be helpful too.
Notice Effort and Small Changes: Sometimes you may notice stark changes in your young person's growth; other times the changes may be slower and smaller. Either way, noticing them and being specific can help sustain their efforts. While general praise feels good, specific praise can be more effective. Here are some examples of ways you can be specific: "I noticed that you took a break before responding"; "You told me what you needed even when it was difficult. Thank you, that was helpful"; "You made a mistake and kept trying." Some teenagers may be uncomfortable with praise, but it still makes a difference.
Make Room for Difficult Feelings: Children's and teenagers' lives are always changing, and some days are harder than others. Additionally, if your young person is currently processing heavy memories or experiences, symptoms could potentially worsen before they get better. This process is common in therapy. Your teen or child may sometimes feel tired, emotional, anxious, or irritable after discussing something difficult. This is part of building tolerance. Offering calm support, instead of trying to make the feeling disappear, can be helpful. However, if the change is intense, continues, interferes with daily life, or raises safety concerns, it is something you should share with their therapist.
Do Not Use Therapy as a Threat or Punishment: Therapists have different roles than caregivers, teachers, principals, and even school counselors. Depending on your young person's therapist's style and theoretical orientation, they may not even expect your child to "behave" during the session. So it is important to avoid statements such as: "I'm going to tell your therapist what you did"; "Are you better yet?"; "You have to do what your therapist says". Try statements such as: "That might be something important to share in therapy." "How are you feeling, since starting therapy?" "What is something helpful you learned or realized in therapy this week?".
When It Might Be Necessary to Contact the Therapist: There are moments when you should definitely contact your child's or teen's therapist. Here is a list of some of the most common reasons: A major lasting change in behavior; Intense or increasing sadness, anxiety, anger, or withdrawal; Difficulty sleeping, eating, attending school, or completing daily activities; Statements or behavior related to self-harm, suicide, or harming others; Changes that seem out of character for them; Questions about how to respond to home or school situations. Remember that temporary discomfort will arise, but worsening symptoms are not automatically signs of progress.
This Is a Long Road
Remember that this is a process. You will not do this perfectly. What matters most is fostering curiosity, consistency, openness, and repair. Therapy works best when caregivers and therapists collaborate while respecting the young person's voice. Owning your own humanness and modeling care, concern, and connection gives your young person something many of them need and deserve.
If you would like to explore this further, read about Dr. Kimberly Smoots or Request a Session.
Real Talk Clinical Psychology is a clinic in Houston, Texas. Our clinicians are in-network with Aetna, Blue Cross Blue Shield, Cigna, UHC/Optum, Tricare, Curative, and Oscar.
