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“Treatment Resistant Teens”: Making Therapy Work for Adolescents

January 11, 2023
By: Dr. Amanda Plokar, Clinical Psychologist

As a psychologist who often works with adolescents, I regularly hear from parents hoping to find a therapist for their teen who seems more irritable and withdrawn, is struggling in school or having difficulties with peers. Concerned, parents wish to provide their teen with resources to help navigate what can be a tumultuous developmental period marked by growth and change alongside strong emotions, pressures, and confusion. Cue the panicked phone calls. When I inquire whether their teen is aware they are reaching out to me, it is not uncommon for parents to be unsure or for teens to not know. Parents may reach out even after their teen has refused to talk to a therapist hoping they (or I) may change their mind. While parents may have the best of intentions in reaching out — their child may have a different perspective. Teens may be reluctant to seek or accept help for a range of reasons including fears of judgment, pride, feeling forced by an adult, prior negative experiences in therapy, disinterest, confusion about the process (etc.). By exploring and understanding these reasons, parents can then tailor how they respond to prevent mislabelling teens as treatment resistant. Below are a few pointers for parents to consider that can help make teens more receptive to getting help and sticking with it.

“I’m okay… but not really”: Destigmatizing therapy

A stigma toward mental illness and seeking help continues to exist. Teens may worry about what it means for them to seek mental health support. They may hold negative assumptions or stereotypes about talking to a therapist (e.g., a sign of weakness, needing “fixing” because they’re crazy, being forced to lay on a couch while a silent therapist furiously takes notes, etc.). Parents can normalize help-seeking while exploring their teen’s fears and concerns through one or several conversations. Therapy can be introduced as a tool that can be beneficial for everyone. Getting informed about what therapy is and isn’t together can provide reassurance and clarity. For instance, doing online research, calling a therapist and asking questions, or talking to trusted friends or family members who may have been in therapy to further break down fears and get perspective. Reflecting on our own thoughts about mental health and therapy will help ensure such conversations are rooted in care and compassion to prevent teens from feeling judged or threatened. Ultimately, how therapy is framed matters.  

“I don’t want help”: Therapy must be a voluntary process 

The choice of whether a youth accepts to get help is an important choice to honor by parents and professionals alike. Adolescents are not often self-referred (or self-motivated) in the same way as their adult counterparts. Therapy can be perceived as a punishment or threat imposed from above which only breeds defiance or flat-out refusal. Forcing a teen into therapy guarantees poor engagement, disinterest, and treatment failure. Timing and readiness are essential. Parents can seek to represent their teen’s ally by including them in the conversation about getting help, giving them choices, and empowering them by allowing them to make decisions about the process. In other words, parents can start the conversation ahead of time so their teen feels they have a say in the matter. Therapy needs to be a voluntary process for adolescents rather than one in which they are volunteered. Ideally, one in which they are interested in being an active participant. Otherwise, there is risk of doing more harm than good and prematurely shutting down a door which might be helpful to open later on.

“You just don’t get it”: Engaging teens in therapy

Finding the right therapist for your teen to connect with is one of the most important predictors of therapeutic engagement. While parents are often reassured by a therapist’s experience or credentials (understandably so!), teens are less concerned by such things. I am often met with blank stares or yawns when I inquire if they’re familiar with a certain therapy approach whereas genuine efforts at getting to know them are usually well received. Teens are more likely to engage in therapy when they feel their therapist is the right ‘fit’ for them. Authenticity, humility, transparency, candor, playfulness, humor, flexibility, and creativity are but a few elements that are more likely to engage an adolescent in therapy — without which even the most experienced therapist’s input will fall on deaf ears. Otherwise, they may express feelings of dread or boredom, and are more likely to “forget appointments” due to a lack of care, which can all be signs something isn’t working. Different teens have different needs, priorities, and preferences. Talk to your teen about what they feel might be helpful or important to them whether or not they’ve been in therapy before. Parents can work together with their teen to find a therapist who will meet them where they’re at and adjust to their needs — not the other way around. 

“Are you going to tell my parents?”: Balancing parental concerns with a need for space

Teens often worry that what they disclose during therapy will be shared with others which makes them less likely to open up. They need to feel like therapy represents a safe and confidential space in which they have control or such worries can contaminate the therapeutic process. In an effort to be helpful or supportive, parents may reach out to their teen’s therapist to provide information (e.g., bringing up issues they are sure their teen won’t bring up on their own, working on a specific goal) or ask their teen directly for updates. Such well-intentioned efforts risk compromising an adolescent’s engagement in the process as they may feel the watchful eye of their parents over their or their therapist’s shoulders, thus undermining their needs for privacy and autonomy. Parents can instead support their teen by exercising restraint. Providing teens with opportunities to take on responsibility and advocate for themselves — such as during therapy — can be empowering. They are then more likely to feel trusted by their parents which facilitates trust in return — both in their parents and themselves. In this sense, parents and families play an invaluable role in supporting their teen’s therapeutic goals by striking a balance between providing support and encouraging exploration and independence.


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Bolton Oetzel, K., & Scherer, D. G. (2003). Therapeutic engagement with adolescents in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 40(3), 215–225. https://doi.org/10.1037/0033-3204.40.3.215

Davidson, M. (2012). You have to have the relationship: A youth perspective on psychotherapy and the development of a therapeutic relationship [Doctoral dissertation, Simon Fraser University]. SFU Summit Research Repository. https://summit.sfu.ca/item/12536

Edgette, S. J. (2006). Adolescent therapy that really works: Helping kids who never asked for help in the first place. New York, NY: W. W. Norton & Company, Inc.


About the author

Amanda Plokar completed her doctorate in clinical psychology at the Université de Sherbrooke and is a psychologist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogs, podcast, follow @connectepsychology on Instagram or like us on Facebook.