Treatment Resistant Teens

Sometimes teens just don’t want to engage in therapy.

This can be frustrating for parents — especially when you believe counseling would be useful or it is being required by some external mandate, such as school or the legal system. However, with many teens the more you push, the more they’re going to resist.

It is developmentally appropriate for teens to question, rebel against, and ultimately reject the plans of authority figures. This is true for all adolescents. With some teens, though, we see distorted versions of these normal developmental tasks, like we’re looking into a fun-house mirror. In these cases, the problem isn’t that they’re attempting to establish autonomy and develop identity. The problem is that they’re doing so in ineffective ways.

It can be easy to label these teens oppositional, defiant, or out of control. In my experience, though, they’re stuck. What they’re doing isn’t working, but they don’t know what else to try.

Stuck teens usually know they’re stuck. They might not admit it to you, but they know their choices aren’t effective. They know they’re making things worse. They know something needs to change. But, since they don’t know what else to try, they continue the ineffective behaviors. Every time these behaviors are repeated, they become more internalized, more inevitable, more hard-wired. Stuckness becomes the defining stories of their lives.

Facilitating change with stuck teens requires meeting them where they’re at and helping them find their own motivators. It requires that we believe they’re capable of making better decisions and then help them make more thoughtful choices. It requires that we help them discover a new story.

If you’re the parent or caregiver of a resistant teen, please know that you’re not alone. Please also know it won’t help to threaten, bribe, or nag them about counseling. Therapy isn’t punishment — at least it shouldn’t be. More importantly, therapy as punishment will absolutely not be effective.

If your teen is reluctant about counseling, I suggest you be direct and clear about why you believe counseling is appropriate. If your teen is willing, invite them to participate in finding and choosing their new therapist.

Teens can have all sorts of misconceptions about therapy. As a result, getting them to that first appointment is often the hardest part. If you can do that — without threatening, bribing, or nagging — chances are good those misconceptions will be dispelled.

When teen guys state they don’t want to attend counseling it may be they believe doing so means they’re weak, damaged, or not adequately self-sufficient. In my experience, this is especially true with teen guys who are depressed or have trauma histories.

Also, if the teen guy is oppositional at all and a parent wants him to attend counseling, doing so — or not — could be more about autonomy than anything else. In other words, he doesn’t want to attend because you said he should. Nobody wins this stand-off.

So what do you do instead? I suggest you present counseling as an expectation, while avoiding any argument, debate, or negotiation on the matter. When parents take this approach, teen guys can blame you for having to go. That lets them off the hook, since they don’t have to admit they need or want help.

In my experience, these “forced” guys often end up being amazingly well engaged in the counseling process.