What to Do When Your Teen Refuses Therapy
When your teen refuses therapy, it is important to remember that their refusal might be due to other underlying causes.
It is normal to think your teen is being defiant or maybe even trying to hurt you. However, more often, your teen has fears about therapy that they don’t want to talk about and they want to have some control over what happens in their lives, especially when they already feel overwhelmed or confused.
It’s also important to give them time to navigate how they feel about going to therapy, and to not jump to trying to force them into anything against their will. When a teen is willing and engaged in getting mental health and substance use treatment, they recover more quickly, and that recovery lasts much longer than if they are coerced into getting care.
What are the most common reasons teens say no?
Common reasons teens say no include, but aren’t limited to:
- Stigma: Many teens worry about being labeled as having a mental illness or being seen as less than or broken by friends or family members.
- Privacy concerns: A major concern among teens is the fear that what they say in therapy sessions will be shared with parents, authorities, or others involved in their care.
- Hopelessness: A teen experiencing depression may genuinely believe that mental health treatment won’t make a difference for them.
- Fear of change: Even if their unhealthy patterns are harming them, they can feel familiar. Change can feel intimidating.
- Loss of control: Adolescents crave independence and sense of control. Being told that they have to do something, like see a mental health professional, can feel like a loss of autonomy.
To avoid therapy, your teen might say things like:
- “I hate you.”
- “I’m fine. I don’t need therapy.”
- “Therapy is stupid. I’m not talking to a stranger about this.”
- “I don’t want to talk about it. I’m not going to say anything if you make me go.”
At what age can teens refuse treatment?
Different states have different rules and laws about when teens can refuse treatment or consent to their own treatment without their parents.
Generally, older teens around age 16 have the ability to seek treatment and consent to care without their parents. However, these laws vary significantly by state.
If you are unsure, consult a clinician or medical provider to understand the laws in your state.
It’s important to understand that even if you can force your child to go to treatment, you can’t make them participate. For example, you can’t force them to talk in a group session or talk to their therapist.
Knowing your options can ensure you’re acting ethically. Instead of forcing a teen to do something against their will, working with them to understand why they don’t want to go, or giving them agency and choice, typically works better.
Why pushing harder can backfire, and what to do instead
It is perfectly natural to want to push your child harder when they resist help.
However, keep in mind that doing so can backfire and damage trust, making them dig in harder.
A teen who feels forced might:
- Shut down all communication
- Avoid or refuse to participate in therapy sessions
- Develop resentment towards you or their care team
- Lose trust in any therapeutic relationships they’ve developed, as well as the therapeutic process
Instead of pressuring your teen, focus on collaborating and building connections with them.
How to Talk to a Struggling Teen About Treatment
1. Provide validation and curiosity about what they are going through
It is normal to have a lot you want to say to your teen. As their parents, you want to see them get help.
However, it is essential to start by listening. Instead of jumping in with solutions immediately, show genuine curiosity about their experience.
You can try phrases or open-ended questions, such as:
- I’d like to understand what you’re going through.
- What has been hardest for you lately?
- I’m here for you and ready to listen if you’d like to talk about what’s going on.
- I’m curious about what your experience at school has been lately.
2. Avoid labels or threats of punishment
While absolute phrases like “always” and “never” are often too extreme in mental health, it is crucial never to frame therapy as a consequence.
It is also crucial to avoid making your child feel labeled, or like they are a problem that you are trying to get rid of.
For example, avoid phrases like:
- If you don’t go to therapy, you’re grounded
- You are too difficult, and we need a therapist to help with your attitude
- You are so frustrating, I need someone else to handle this
- You need to go to therapy, or else I’m taking your phone away for a day
3. Talk to them about treatment during calm moments
Timing matters. Avoid bringing up the idea of therapy during an argument or when emotions are running high.
Choose a neutral moment to talk, like a quiet evening at home. If feelings escalate, be prepared to let the conversation go and move on to a more neutral topic.
Sometimes a car ride is a good place to talk. However, be aware that your teen may feel trapped in the car. So again, be ready to drop the conversation if they push back.
4. Give them a say in their treatment
Part of adolescence is developing a sense of self and teens crave autonomy and control as they define who they are as a person.
This is also why age specific care is crucial. Sandstone’s teen residential treatment and teen therapy programs understand the needs of teens and we meet them where they are. We understand that teens aren’t just younger adults or older kids. They are working through their own developmental process.
As a parent or caregiver, work to empower your teen with choices and let them drive the process as much as possible, with your guidance.
For example, consider letting your teen have a say in:
- Choosing which therapist they see
- Deciding between in-person and virtual sessions
- Exploring different types of care, like group therapy, family therapy, or outpatient programs
Many therapists and programs offer consults with a provider to see if it is the right fit. Consider letting your teen schedule their own consultation to see how they feel about the provider, their treatment plan, and to give them a chance to ask any questions they may have.
At Sandstone, we welcome teens asking questions about their options and our admissions representatives are happy to provide more information to your teen about our programs. Call us at 888-850-1890.
Or, access the online chat in the lower right-hand corner of any of our webpages during business hours to chat with an online receptionist. They’ll connect you with an admissions member.
Your teen may want your support in asking questions about their care, or they may want to do this privately. Respecting their privacy and space, as long as they are being safe and not an immediate risk to themselves or others, is often helpful.
What to Do If Your Teen Still Refuses to Go to Treatment
1. Focus on the basics
If your teen isn’t ready to say yes to treatment, you can still help them build a healthy foundation to begin feeling better at home. This includes focusing on things such as:
- Sleep routines and sleep hygiene
- Regular meals
- Reduced screen time
- Daily structure
Of course, there is nuance here, and you know your teen the best. For example, regular meals may look like a sit-down family meal. Or, if that’s too high-pressure for your teen, it can look like setting out meals and including some of their favorite foods.
A teen who is experiencing depression or other mental health conditions may struggle to eat a full, nutritious meal. Alternatively, they may use food to cope and binge. It is important to make sure that your teen has options, but avoid making any comments on their food choices that might make them feel embarrassed, ashamed, or like they are a burden to your family.
Many teens use screen time to cope with difficult experiences. Screens and social media can give them a chance to connect with their friends, but it can also become an unhealthy way to manage difficult emotions because of low-quality, addictive, or “brain rot” content.
Not all screen time is created equal, and it is important to make decisions that are specific to your teenager.
For example, online video games with friends might be a place where they can build their social life, so you might choose to allow them to play video games with friends from school as a way to feel better. Instead, you may choose to limit how long they can doomscroll on their phone by turning off the internet at bedtime. This can also help them get enough sleep.
While all of the basics are important, teens who are experiencing mental health challenges, such as ADHD, OCD, depression, anxiety, or any other conditions, need a stabilizing, expert environment in order to find a healthier way to live. They may lack the energy or clarity to make big decisions about care right now, which is why both your support and boundaries are important to guide them to get the help they need.
2. Schedule time with a professional
Even if your teen refuses to go to a therapist, you can:
- Schedule time with a therapist for yourself
- Consult with a clinician or psychiatrist specializing in adolescent medicine for advice
- Join a support group for parents
- Explore mental health services that focus on all family members, such as family therapy
You can also consider scheduling an appointment for your teen and letting them know it’s their choice how much they choose to participate. Sometimes, once your teen is alone with the clinician, they may start to feel more comfortable with the idea.
However, it is important to present this as a choice and not force your child into a room with a provider. Also, allow them space to go with the provider independently unless they ask you to come with.
If you need support and are not sure where to start, Sandstone offers a free virtual support group for parents of teens and young adults who experience addiction or mental health challenges.
3. Create “yes-sized” options
Instead of framing therapy as a long-term commitment, consider breaking it down to a smaller, “yes-sized” option.
For example, you might suggest:
- A short walk and talk with the clinician
- A single, introductory session with the option to not go back if it doesn’t go well
- Trying one face-to-face conversation virtually, at a reasonable location of their choosing
Small steps may help teens feel more willing to explore treatment over time, while helping them take responsibility for their health at a pace that isn’t too overwhelming.
4. Set boundaries for their safety
If your teen is engaging in self-harm, experiencing suicidal thoughts, or is involved in substance use or has a substance use disorder, safety needs to come first.
Things around the home you might do include:
- Removing harmful items
- Increasing supervision (e.g., limiting closed doors just to bathrooms)
- Limiting risky behaviors by setting curfews and setting clear boundaries around phone use
However, if your teen is struggling, you may need help beyond these limits. Additionally, setting firm boundaries can escalate some situations.
If you believe your teen is an imminent risk to themselves or others, call 911 or head to a mental health crisis center or emergency department for help.
Understanding the Laws of Teen Treatment
Is it legal to force my teen to go to therapy?
Yes and no. In most cases, you can’t physically force your teen to go to therapy.
However, if you are concerned that your teen is an imminent risk to themselves or others and you seek help, a licensed professional may place a mental health hold on them.
These holds go by different names in different states. However, they are generally for a few days, to stabilize the individual and develop a plan of care.
When someone is on a mental health hold, they are usually transferred to inpatient psychiatric care at a crisis stabilization unit or inpatient psychiatric unit at a hospital.
Is it the same in every state?
No. Laws around forcing a teen into treatment differ widely from state to state.
Additionally, some states grant teens greater autonomy, while others place greater emphasis on parental authority.
Reach out to clinicians or providers in your area for accurate information specific to where you live.
What is “voluntary admission”?
Voluntary admission most commonly refers to a client who does not require a mental health hold but recognizes that they need help and consents to inpatient treatment, usually at a crisis stabilization unit.
However, it can also refer to a client voluntarily entering any type of treatment program, such as an outpatient program, a partial hospitalization program (PHP), or residential treatment.
What is a “court’s evaluation”?
A court’s evaluation is a process where a judge can order someone to undergo an assessment by a licensed mental health professional.
Reasons this might be ordered include assessing someone’s risk level to themselves or others. It can also be used to evaluate competency for trial if the individual is a suspect in a crime.
Signs that Your Teen Needs Urgent Treatment
Seek immediate help if your teen shows:
- Active suicidal thoughts, especially if they have a plan and access to that plan
- Engagement in self-harm
- Severe withdrawal or inability to function
- Psychosis or extreme behavioral changes
- Dangerous substance abuse, such as an overdose, near overdose, or heavy drinking
What is a “crisis evaluation”, and how can I use it?
A crisis evaluation is where trained professionals conduct a mental health crisis evaluation to assess immediate risk.
They can occur in hospitals, crisis centers, or through emergency services. If a mental health professional considers your teen a safety risk to themselves or others, then they might be placed on a mental health hold.
What do I do if my teen is showing signs of self-harm or suicidal thoughts?
If your teen is showing signs of self-harm or suicidal thoughts:
- Call the 988 Lifeline or 911
- Take your teen to the nearest ER or mental health crisis center
- Request a crisis assessment
Many teens will show different signs that they may be struggling with self-harm or suicidal thoughts, so it is crucial to keep a close eye on any sudden changes in behavior and reach out for help immediately.
I’m scared about my teen’s future. What do I do?
First, take a breath. You are actively researching and reading through ways to help your teen and taking meaningful action.
Supporting an adolescent or teen can feel overwhelming. Progress may happen slowly.
Things you can do include:
- Learn about teen mental health
- Seek therapy for yourself
- Consider parent coaching to learn about ways to approach your teen and work with them
- Explore evidence-based approaches such as cognitive behavioral therapy (CBT), both for your teen and for you, to learn to improve your response to them
- Work towards a supportive home environment that prioritizes rest and nutritious food
- Connect with school counselors and mental health providers, even if your teen is hesitant to connect with them at this point
- Consider joining a parental support group
- Reach out to emergency services (988 Lifeline or call 911) if there is an immediate concern
Even if your teen refuses to engage in the process, your support and effort matter.
