Several recent reports — including a December 2021 advisory from the U.S. Surgeon General and a joint statement issued in October 2021 by several major medical groups, including the American Academy of Pediatrics — have deemed the state of youth mental health in the United States either a crisis or emergency. Those reports cited high rates among young people of hospital visits due to mental health issues and suicide attempts. One in 10 American children ages 5 to 17 received counseling or therapy for mental health in 2019, according to the Centers for Disease Control and Prevention (CDC). And that data, the most recent available on the prevalence of youth utilizing mental health therapy, comes from before the start of the COVID-19 pandemic, which has undoubtedly contributed to a rise in mental health struggles for people of all ages, experts say. “The mental health crisis was there before the pandemic, but the pandemic really brought it to light,” says Jill Emanuele, PhD, a New York City–based clinical psychologist and vice president of clinical training at the Child Mind Institute, a national nonprofit dedicated to transforming the lives of children and families struggling with mental health and learning disorders. “Things are really problematic and troubling right now,” she says. Behind each of those children is a concerned parent or caregiver wanting to know if their child is getting the care and support they need, and what to do if they’re not. Here’s a guide to helping your child get the most out of therapy.
First, Determine if Your Kid’s Therapist Is a Good Fit
Part of helping your child get the care they need is determining whether they are seeing the right person to help them with their current challenges. “I always want people to remember that this is a relationship. Choosing a therapist is very much the same as choosing any other professional that you work with,” Dr. Emanuele says. You want the therapist to be someone you and your child are comfortable with. You can ask the therapist upfront about their training and approach to therapy, Emanuele says. It’s a positive sign if the therapist has experience helping children whose symptoms are similar to your child’s right now. Likewise, how the therapist answers your questions and addresses your concerns right off the bat can give you a sense of whether you’re in good hands, Emanuele adds. If your child struggles with multiple aspects of their mental health (which isn’t uncommon), their therapy plan should account for that, according to the Child Mind Institute. And if your child’s needs change over the course of starting therapy with one provider, it can be a good idea to reevaluate if your child’s therapist is still a good fit. “Key to ensuring good therapeutic outcomes in therapy are open and direct communication between parent or guardian, the therapist, and, most importantly, the child or adolescent,” says Patrice Harris, MD, MA, FAPA, psychiatrist who specializes in child and adolescent psychiatry and Everyday Health’s chief health and medical editor. “This should occur prior to seeking therapy and throughout the process.” And don’t forget to ask your child about their preferences, including when it comes to race and gender, Dr. Harris says. You might not find a provider who meets all of the preferences of your child who is in your area or network, but engaging your child in the conversation will help.
Getting Involved: Help Your Kid Show Up and Do the Work
Effective therapy requires consistency, and, as a parent, you have a significant role to play. You can help your child arrive at their virtual or in-person appointments on time, every time. Parents can physically help their children get through the office doors or logged on to telehealth says Alysha Thompson, PhD, a clinical psychologist and clinical director at the Psychiatry and Behavioral Medicine Unit at Seattle Children’s and assistant professor in the department of psychiatry and behavioral sciences at the University of Washington. If your child doesn’t want to go, taking time to hear and thoughtfully address their concerns can go a long way, according to the Child Mind Institute. And for therapy to be most effective, your child will likely need to work on their mental health outside of sessions, too. Many therapists also assign work between sessions. Ask your child about their therapy homework and look for ways to get it done. “A therapist doesn’t wave a magic wand and make everything better. It is a collaborative process between the therapist, the parent, and the child,” says Emanuele. That’s different from a pediatrician’s appointment, where the provider does most of the work, she points out. The appropriate level of parental involvement depends on the situation. For younger children, the level tends to be quite high; the therapist might spend more time talking with you than with your child in sessions, Dr. Thompson says. An approach called parent management training (in which parents learn skills to help manage their children’s behavior) has a lot of evidence to back it up; it requires parents to practice those strategies at home between sessions. And it may take time, Harris adds. “Some therapeutic goals may take time to achieve, and it often takes time for youth to develop a therapeutic alliance with their mental health professional.”
How to Tell if Your Kid Is Getting the Help They Need
Once therapy is underway, it’s normal to wonder whether it’s working. Use these strategies to check in and determine whether your child’s therapy is doing what it should:
Look for changes in your child’s behavior. If therapy is helping, you may notice your child begin to act differently. This could look like wanting to hang out with friends after a period of withdrawing or appearing to enjoy a favorite hobby after previously seeming disinterested. “Some people make slow and steady progress,” says Emanuele. “Most of the time, though, it’s a bumpy road where there are days when it’s better and days when it’s worse. But you’re overall looking for the upward trajectory.”Ask your child. Go straight to the source. Even if your child doesn’t respond right away, regularly asking them open-ended questions can help get them ready to share with you when they do feel ready to talk. Emanuele suggests asking questions like: How do you think therapy is going? What do you think is working? What do you think isn’t working? If your child has negative things to say, it’s not necessarily a sign to stop treatment. “Parents know their kids, so they’ll know if you can count on that statement right away or if it’s better to wait,” says Emanuele.Talk to your child’s therapist. “One of the things I see over and over and over again is parents are having doubts, and they’re not really sure what to do. And the only person they don’t talk to about it is the therapist — and that’s the person you need to talk to,” says Emanuele. Ask your child’s therapist questions like: How do you think my child is progressing? Do we need to try something different? “Therapists are trained to have those open, frank conversations about what’s going well, what’s not,” Thompson adds.
Remember, no hard and fast rule dictates the frequency of these conversations. You’ll likely have more check-ins earlier in the process and fewer as time passes, but it’s appropriate to check in anytime. If your child doesn’t think therapy is going well and you’re seeing them act in ways that concern you, including showing warning signs for suicide, that may be a sign your child’s needs aren’t being met in therapy, Thompson says.
7 Steps to Take if Your Child’s Therapy Doesn’t Seem to Be Helping
If your kid is seeing a therapist but still struggling, don’t give up hope. You can help your child in other ways, many of which are also useful if you’re stuck on a waitlist.
1. Educate Yourself About Mental Health
If you know your child’s mental health diagnosis or have an idea of what it might be, you can look for nonprofit organizations particular to that disorder. For example, if your child struggles with anxiety or depression, check out the Anxiety and Depression Association of America. You don’t have to have a diagnosis in mind to start learning about mental health. The National Alliance on Mental Illness (NAMI) offers a free, six-session online course called NAMI Basics OnDemand for parents and caregivers who want to support youth with mental health symptoms.
2. Cultivate Healthy Lifestyle Habits at Home
Healthy habits aren’t a substitute for mental health treatment, according to the Child Mind Institute, but they are a critical complement to mental healthcare. In particular, proper sleep should be a priority because many mental health disorders are linked with poor sleep, including depression, research shows.
3. Draw on Social and School Support
Emanuele and Thompson both encourage caregivers to lean on the power of their community. Your friends and family can offer general support and may have particular advice about therapists or organizations that have helped other children in your circle. It’s also key to loop in your child’s school, which can connect you to local resources.
4. Give It Time
When your child is suffering, it’s natural to want it to stop — yesterday. But mental health therapy doesn’t work like that. “Therapy is more a long game than a short game,” says Emanuele. A course of evidence-based therapy generally takes between 8 and 16 weeks, says Thompson. More complex and severe cases can take more time. If you feel like your child’s therapy isn’t working, it may be that it isn’t working yet.
5. Request a Second Opinion and Consider Switching Therapists
If you’re not sold on your child’s therapy, you can get a second opinion. Your current therapist may be able to provide a referral or loop in a colleague for a consultation. If you decide to stop working with a therapist, you shouldn’t just stop coming, adds Emanuele. Ending formally can provide closure and model healthy relationships for your child.
6. Consider More Intensive Therapy Options
If weekly or biweekly sessions aren’t helping with your child’s mental health issues, there are more intensive options. Families in this situation may want to consider a range of more intensive mental health services, including partial hospitalization programs (PHP), intensive outpatient programs (IOP), day treatment programs, and residential treatment programs, according to the PACER Center’s Inspiring Opportunities Project, a nonprofit funded by the U.S. Department of Education’s Office of Special Education Programs. What these programs look like varies by your location, your child’s age, and your child’s specific needs. Features of many of these programs include meeting multiple days per week for a combination of individual therapy, group therapy, skill building, and medication management. Research indicates higher levels of care, like PHPs, can provide lasting positive impact on children’s mental health without requiring more restrictive types of care (like full hospitalization). Ask your therapist about programs in your area or ask parents in your community what programs have worked for their children. You can also use the treatment locator from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), which includes some intensive mental health treatment options for children.
7. Get Help in a Crisis
Take it seriously if your child is in therapy but shows warning signs for suicide, like those the Society for the Prevention of Teen Suicide (PDF) describes. You can call the national 988 Suicide and Crisis Lifeline in a crisis. Or if you suspect your child needs urgent help, visit the ER. “If a parent is really concerned that their child is going to imminently harm themselves or has already harmed themselves, they should bring them to the ER,” urges Thompson. Hospital staff are there to keep your child safe and assist with the next steps.
