CAMHS appointment - lack of engagement

[Sinequa]

We’ve had serious issue with our DD. Finally got an appointment with CAMHS. Was impressed by the centre and the practitioner but disheartened by DD’s apparent failure to engage (during the part of the session which I also attended). She simply either agreed with what was put to her or said ‘I don’t know’. I appreciate that it’s confusing and difficult for kids to be there but I expected that she might say more. For anyone with more experience, is that seeming lack of engagement fairly standard and are they listening despite it? Thanks.

Thats frustrating. However you were only in part of the session and without you there the therapist maybe had a better response. Will you get a chance to talk with them?

I got the impression that she said more but there wasn’t really an opportunity to ask about it and I wondered if it might be deliberate to ensure trust is built. We are early on in the planned therapy process but I really want to make progress if we can as her behaviour is adversely affecting the life of the whole family. I know there’s probably no easy or quick fix but…

Lack of ability to engage, ironically, is a big reason many young people need CAMHS, then they get signed off for not engaging!
There needs to be a radical overhaul of how CAMHS supports hard to reach children.

At least she turned up! That was more than we managed with our son, after working hard to get the apointment.
I would think that any decent practitioner would anticipate the high possibility of someone being hesitant about engaging, and would try hard to work with them to get past that hesitation. It is entirely natural that a person (especially a young person) would take time to get the measure of the service and decide whether and how to fully participate.

On the other hand, if, after a reasonable effort, CAMHS do find that she simply doesn't want to participate, they will call a halt. They were very clear with us that they could only work with someone who was to some degree willing and active. Theywould likely leave it open to resurrect things in the future if her preferences changed.

It's pretty normal that there will be limited engagement initially. You'd be surprised what the clinician can pick up verbally and non verbally. Hopefully if they are offered sessions they will be able to build trust and rapport.

I think that our CAMHS team did persist a bit - trying to speak with our son over the phone, for example, when he chose not to attend.

Sorry to hear OP.
How old is your daughter?
From my experience, it takes them a while to communicate and articulate how they feel.
Is your DD open to receiving help?
If she is, then just persevere..she will get used to it. Also, a good therapist will know how to get her to open up.
If possible, discuss with DD about possible things she could speak to the therapist about.

We’ve been through this with DD. I found talking to her a lot outside of appointments so I knew how she was feeling and then prepping her before hand about things to cover off. She struggled to speak without me there so I would introduce a topic and then the nurse would ask her questions to find out more. I spoke less as time went on and she felt more comfortable to open up.

Suggesting topics to discuss is a good idea, thanks. DD is nearly 13. Her school is currently closed to her year group because of an issue with the building so she’s living in a very unstructured way at the moment which isn’t helping. It’s frustrating as we thought we were finally getting somewhere.

My 15yo DD refused to engage over a CAMHS assessment video call so they didn't take her on. She wouldn't engage with the lovely private counsellor either. I cancelled after 4 weeks.
I can't get her to talk to me either. It's heartbreaking knowing she feels so awful and won't open up.

Especially if the issues are related to family she won't open up while you are there.

It's really hard but she needs to be able to talk to them without you knowing the content. Even if you haven't done anything 'wrong" or that you could have predicted would be a problem family relationships are at the bottom of many of the problems. And the kicker is that even if you know what the problems are it isn't always in your gift to solve.

I really feel for you OP. It is so hard if the response is 'I don't know.' That is pretty much all DS says in his appointments. Luckily for us CAMHS are persevering at present (I think they see the need despite the seeming lack of engagement). They can and do pick up quite a lot from non verbal cues too e.g. facial expressions, body language, fidgeting and nervous energy. DS's CAMHS appointment would be so much simpler if more than I don't know was said but if DS opened up about anything we likely wouldn't have got to the point of needing CAMHS. A quick thought, if school are aware of the need for CAMHS it may be good to involve them somehow so that CAMHS can see how much their input is needed despite the 'I don't know' response.

This !

We need more professional Psychologists. I saw one at 17 and he didn't need me to engage much, he made me think, and then see things differently. Most of the CAMHS are just counsellors.

I attended CAMHS at about 14/15. Was desperate to get some help and really wanted to engage but for my first session my parents sat in with me (I'd agreed to this). It was until I was actually in the session and wasn't able to answer questions that I realised I didn't feel comfortable in front of my parents. My counsellor asked my parents to leave and the dams broke. So possibly worth sitting out from now on?

Also it's worth noting that even as an adult I've needed time to warm up to therapists. It's a big thing to trust them and be comfortable opening up so I wouldn't worry if it's just been one session

A teenager would open up more without you there.

I can't imagine one of my parents sitting in and I went to a lot of therapy from 16 onward.

The clinician spent 30 mins with her alone and we had 30 mins together. She must have said something when I wasn’t there. I understand all the reasons why she might not want to speak in front of me. I’m just so desperate for her to feel better. Without school to attend and the reduced amount of social contact, she seems so withdrawn. The school closure couldn’t have been worse timed.

All I can say is push for another counsellor if she doesn't seem to make any progress.

It's difficult.

With CAHMS, DD was only offered a group lesson but it was clearly that none of the 3 girls wanted to interact with the therapist. It was better when DD was on her own once.
That was based on what DD told us, she was alone during these sessions.

Parallell we managed to get hold of a private therapist. Outside of two initial meeting with all of us to dig into background issues, DD was on her own for with her for all but 10 minutes and in these 10 minutes she didn't really say a lot but the therapist recalled what they discussed and what she asked DD/us all to do the following week.

There was the odd time DD felt anxious and asked us to be there for the whole session and after a while she would interact, so I think it's a matter of not talking in front of parents.

We had huge sucess in the 15 months of therapy. DD's therapist told us from the beginning that her discussions are confidential but she normally encourage her patients to talk to the parents. She would only say something if she feels there is a safeguarding issue. DD had suicidal thoughts and self-harmed so her therapist said she needed to say something if she felt an immediate danger.

Thanks for all your helpful replies. We are early days so I will probably have to wait and see. We tried private counselling but she refused to attend. DD has recently befriended some girls whose home lives are really very different from her own. There seems to be some odd ‘kudos’ attached to being under CAMHS which I find slightly discomfiting but perhaps she genuinely feels that they ‘get her’. I don’t know. It’s all so outwith my experience that I just don’t know what is going on.

I’m a mental health nurse. In terms of the “kudos” from being under CAMHS, this can be really tricky. To some extent, adolescence as a whole is often quite difficult for everyone and there can be a certain “glamorisation” of mental illness amongst young people. They can see it as acknowledging pain/darkness/“realness” and the young person under CAMHS can be perceived as more “interesting”. It is also pretty common for young people who are experiencing emotional problems to attract/be attracted to other young people going through similar things. In some ways this should be encouraged as the young people can support each other, but there also needs to be some caution as a) “social contagion” and glamorisation plus active encouragement from others in the group can lead to the spread of maladaptive coping mechanisms such as self harm in the group and b) there is sometimes also glamorisation of “trauma”. This is particularly problematic if a young person has had a “stable” upbringing due to the lack of perceived “reasons” for the emotional problems. This may lead to “over focusing” on potential explanations and so worsen family relationships/ lead to the young person rejecting treatment that doesn’t focus on this, such as CBT or medication. (Of course, this doesn’t apply to “serious” trauma-and what serious means is different for different people. However, and especially with the internet/social groups being what they are, there can be a temptation to “overplay” trauma. Bizarrely, and somewhat problematically, trauma is currently “fashionable” which is leading to difficulties for everyone).
These are just my musings and I do hope they make sense and help a little.

@JennieTheZebra
Thank you! Your words make perfect sense to me.
I am seeing this in my DD.
She finds solace being under Camhs...though her camhs therapist isnt the best and is only there to open other doors into the service for DD.
she has recently made friends with someone else who has mental health issues and they are really becoming close as they understand each other.
I am hoping the relationship is symbiotic and it provides comfort to both of them.

My 14 year old daughter is under CAMHs. Had third appointment but she can't engage /open up and answers I don't know or makes no eye content and shrugs shoulders. She has anxiety and has EBSA. CAmhs now say they can't help and suggest a parent led approach with us parents now on a waiting list to attend such sessions. So frustrated that the therapist seems unable to find a different approach to get my daughter to open up. The system is broken and after a 18 month wait for CAmhs are now being discarded ! So frustrated and left not knowing where to go now .