dd won't co-operate in therapy

[dogpeoplearebetter]

Hi all,
So my DD (almost 14) will not co-operate in therapy whatsoever. She is in therapy for a myriad of issues such as low self esteem, phobias, poor social skills and serious mental illness/mental instability but we've been through several therapists and none have really clicked with her. She doesn't feel comfortable telling most of them anything at all, because she fears they may tell us (her parents) about the issues she confides in them as well as a few other reasons I won't really go into now. She hates herself and creates personas of other people, she has imaginary friends that she talks to, but i think she's comfortable in her sadness because she just will not do anything the therapist tells her to do or take any of the improvements they suggest to her. She just thinks it will be fixed if she sits there and does nothing and doesn't co-operate. Therapy is expensive and I figure, what's the point if she isn't doing anything? AIBU to want to stop paying for therapy if she keeps this charade up/doesn't work on herself at all?!
Thanks

@biscuitsandbooks Autism, add and ocd are the only official ones. She talks to herself alot though.

Something that strikes me from your comments OP is that you (quite unconsciously) present her as a problem to be resolved. This is quite understandable but not helpful, because any sort of battle of wills, even on an unconscious level, will be doomed to fail because she knows you can’t make her speak. Not speaking gives her agency and control. Rather than “she must get better and therapy must fix her issues”, perhaps you need to reframe it to yourself and to her as “this is a space for you to explore your psyche and to learn about yourself”? It’s exploratory, not with any “goal” in mind besides a better understanding of herself.

As a PP has said, not all communication is verbal, and there are therapists and therapists. You don’t say what sort of “therapist” your DD is seeing. I would find a psychoanalyst rather than a psychologist or CBT practitioner. A psychoanalyst will be quite prepared to sit in complete silence for as long as necessary (in fact, traditionally the psychoanalyst doesn’t speak unless/until the patient does). The space is as important or more important than the therapist themselves.

@ButThisIsMyHappyFace I've made that clear to her, these are just my thoughts. She is seeing a regular talking therapist. She's also pretty self aware, so I don't know if that would make a difference to the type of therapy that would be beneficial.

Honestly I found both therapy and medication awful for different reasons. With therapy it felt like I was reliving all the bad things that had happened to me without any kind of progress/moving on. I had awful side effects from medication.

In the end I realised I had to change my life dramatically to deal with the root issues. Everything else was either masking them or not helping. However I have friends and their method of coping is through a hobby - things like art. Perhaps something that your DC really enjoys or something special to look forward to regularly until out of the downward spiral could help? Also things that don't necessarily get suggested a lot, like being warm all the time (heating, baths, etc.). Made a huge difference to my depression and made it a lot easier to do things like get out of bed.

People often believe therapy is always helpful or good for everybody in some way. But the research shows us this simply isn't the case. About a third of people who attend will find it very helpful, about a third will find it somewhat helpful but not completely. And about a third of people will find it not helpful or even actively unhelpful (will make them feel worse or make their situation worse).

There is also the importance of "right time, right place, right person". Is it the right time in a person's life to engage or do they have other stuff going on they need to prioritise. Are they in the right place mentally to engage, for your DD it doesn't sound like it because she doesn't seem want it or believe it is going to help. Right person is about the relationship between the therapist and person attending. Again the research tells us that the therapeutic relationship is the biggest factor that influences whether therapy works out well, regardless of the model or techniques used. It doesn't sound like she has built a good enough relationship with any of her therapists and seeing them for a year should have been much more than enough time to do that.

From what you've said I don't think therapy is right for your daughter now. It may be in future but she might need to do other stuff first. Some people find support groups or interest groups that have nothing to do with MH helpful because they can find connection and purpose without focusing on all the upsetting stuff that can come up in therapy. Learning a new skill or accomplishing something is great for building self esteem and confidence. Could she go down these routes rather than standard talking therapy. Sometimes improving your life and how you feel about your life is better achieved by going out and living it, rather than sitting in a room and talking about it.

Does the therapist believe that the therapy is beneficial? If you don’t know then definitely ask.

A regular talking therapist?
What is their training?
Have they trained to work with children and young people?

I can call myself a regular talking therapist. I have no training in mental health.

A person who has done a weekend course online can call themselves a therapist

A person who has trained for 6 years, and has had ten years of personal therapy, and has monthly supervision from an experienced peer, and has a 500 hours of clinical experience can call themselves a therapist.

A trained therapist might be trained to deliver CBT or psychotherapy or mindfulness or some other modality. Different trainings work better or worse for different people with different problems. CBT is great for helping a person with a phobia for example, but won't touch the sides on a person with a more complex presentation.

Equally a person who wants only techniques to distract themself might find CBT really useful. But a person who wants to understand the why, wouldn't connect with the therapy at all.

These type of therapies might be more helpful @dogpeoplearebetter. Many teenagers struggle with talking therapies for a number of reasons.

Something like Art or Equine therapy is more successful for teens who struggle to verbalise their pain to an adult.

Try a different type of therapy? Horses? Dogs? I even saw surfing therapy in Dunbar.

How does equine/eco/etc therapy work? I'm intrigued!

A Different form of therapy like equine therapy might work better.

My daughter is adopted and got some therapy when she was 18. She wouldn't have engaged when she was younger. The therapist explained to me that it would take her a year to trust him and start opening up, and he was right. She had therapy for 3 years and it helped her enormously but it wasn't a panacea for all her problems. Growing up, getting a job, a boyfriend, we're all important too.

The therapist we used offered all sorts of ways to engage. They could build something together, create music tapes, do art, play with figures on a sand tray, make video stories.... talk therapy isn't for everyone.

Is she at school? If so, can school access counselling specifically for teens? School may also have various resources such as a Nurture Hub. It’s a less formal approach within a familiar setting.

https://www.muirfieldridingtherapy.org.uk/

https://www.waveproject.co.uk/project-locations/scotland/

https://www.nhsinform.scot/scotlands-service-directory/health-and-wellbeing-services/44c234724b7444ccab7006980c2066cb%201

Maybe she would be better doing something therpeutic rather than therapy. Art therapy or even just an art class that you do together, horse riding, a swim etc. She doesn't sound like she is ready to talk so naybe stop for now.

Talking therapies have not worked at all for my neurodivergent young person - they were never able to trust the therapist or open up to them despite being highly articulate.

Non-verbal modalities, especially art therapy, have helped instead as it enables them to express big, scary, sad, and traumatic things without having to find the words to explain.

With trauma, they say that the person regresses emotionally to half their age, which is why therapies that don't involve talking are often better for young people. My young person is 13, but when triggered by trauma is like a much younger child - art therapy provides the sensory resources, space, and expressive opportunities to be emotionally more like a 6 or 7yr old.

Talking therapies need an ability to be able to understand what your feeling, reflect on it, and work out how to make changes. This is hard enough for many neurotypical young people as their brains are still developing those skill, but even harder when you're neurodivergent - rigid thinking, wobbly empathy, difficulties understanding body sensations and emotional sensations, etc, all present huge barriers to talking therapies.

An appointment with an interoception trained Occupational Therapist might be worth considering. Ideally, someone trained in Kelly Mahler's Interoception Curriculum who can lay the groundwork before deeper emotional therapy can take place. Then, it could be an idea to look for a specialist therapist who uses non-verbal modalities and has specific experience in working with neurodivergent trauma and EMDR.

Can I ask why you know so much about these sessions and know she isn’t talking if everything is confidential

That to me would signal that I couldn’t trust a therapist

My guess is she's not maybe ready to engage in it properly (which is hard and involves emotional labour and can make you feel worse initially).

I would try linking her in with a youth worker who can use a different approach that might be less intense but still be there for support and guidance.

Could these be neuropsychiatric symptoms. Has she has a blood test? Lymes, PANDAS etc

That's quite a heafty range of diagnosis, have any of her therapists got expertise in any of these.

I think you need to be realistic about what can be achieved. She will never be fixed, she will always be autistic with ADD. What she needs is to learn to understand herself and learn strategies to help her cope with life. What support does she get at school? How does she manage there?

@helpfulperson All her previous + current therapist(s) have had experience in all these areas. She’s okay at school but can’t properly function sometimes, the SEND is shit so there’s really minimal support

That's exactly what I was thinking.

Only when you have no clue what's going on in the sessions and whether they are working or not, or whether your daughter is speaking or not, will they start working....

I am rather concerned with how you talk about your daughter.

She sounds extremely troubled and she does not seem to trust people.

And you are dismissing this by blaming her for 'keeping the charade' and not working on herself. ...

I also think there is a wider back story here.

You need to stop blaming your daughter and push for more than just therapy.

The imaginary friends and multiple personas could mean a wider personality disorder and she needs proper psychiatric evaluation, not just sitting down with a therapist. She might need medication too.

'Pushing for her to have hope' is just meaningless drive frankly.

Your daughter needs proper intervention and support.

I don't know about Eco therapy but Art and Equine therapy works on feelings rather than thoughts to be vocalised and (in your DD's mind) judged.

For most teenagers, sitting across the room from an adult in order to "talk" is daunting and scary. Their experience of such settings has usually been negative. Art, equine and other therapies take the pressure off.