They come into my office and they stonewall me.

You know who I mean. You know what I mean. The teenager who sits in the chair, grumpy. Refusing to engage. Like, “You dragged me here and I am here, but don't even think I am going to do anything else in here.”

Yep. And the spouses—usually the husband—who acts the same way.

And that's when they actually come into the therapy room.

What about all those children, teens, and adults who don't even get into the room to begin with?

And this is the question: Is there ever a way for therapy to be effective if a person is forced to go?

YES.

That's my answer. Absolutely yes. But only if that reluctant client actually enters my office door. It's only then that we have a chance.

So let's talk about this.

Why do you want someone in therapy? Why doesn't that person want to come?

If you are a parent, you may have a number of reasons. Your child is behaving inappropriately, in a religious, ethical, moral, or social setting. At home, at school, in camp, in shul, on the block. Any kind of behavior. Disrespect. Fighting. Acting out in dress (or pants).

Or, your child seems unhappy. You don't know why. You do know why but you don't know what to do about it. Maybe your child had been doing well until now (or so you thought) but with life transitions such as seminary decisions, dating, finding a job, a new marriage, suddenly she is not transitioning into these new roles easily.

Maybe you are noticing depression. Anxiety.

And you suggest therapy to your child, and your child absolutely, positively refuses. “There is nothing wrong with me!” he declares.

This scenario can be applied to a spouse. To an aging parent. To a friend. To anyone.

At this point, there is nothing a therapist can do.

No, I will not agree to pretend that I am a coach or a mentor, or any other word you want me to use to present myself to your child so he should not feel stigmatized by going to a therapist. No, I will not call your child to convince her to come see me for just one session. No, I will not come to your home to talk to your child. No, I will not agree to talk to him on the phone just one time.

I will emphathize with you, but the parameters of my practice is that the client must come to me. It is only in case of severe physical limitations, or even severe mental illness, would a therapist make a home visit in the context of therapy as we are talking about here. Otherwise, the parent needs to somehow bring the client into the room.

And what if the parent or spouse or friend cannot do that?

If a parent cannot exert that kind of parental authority to bring a child into therapy, then I would strongly advise the parent to enter therapy himself. That may be sufficient to alleviate the problem itself.

In therapy, there is the concept of the identified patient.

There is the concept of the weak link. I will tell you what I mean. It's when the family is experiencing stress. Financial. Marital. Illness. And there's one kid that is making problems. Everyone else is doing fine. But him? He's making everyone crazy. As if we don't have enough on our heads without his acting out. Let's get him to the therapist.

It may be helpful. If he comes. But if he doesn't, the parent can come instead. It would actually be better if the parent(s) come. Because the whole chain is feeling the stress. All the links of the chain are getting weighed down. But it's one little link, that is somehow bearing the brunt of the weight that suddenly snaps. But if you take the weight of the link, the link would not need to break. It can do what links all over do. Be part of a chain.

That's when the child is really the identified patient in a system that is carrying too much weight. Let the parent come to therapy to lift the weight, and the child, even without therapy, will improve significantly.

But what if the child truly is the only one suffering? Maybe because her personality is delicate, shy, or her academic abilities are weak, causing her suffering in school, insecure with her peers and older successful sister? Her parents are concerned, wonderful, there are no unusual stressors at home or school. It's really only this sensitive child. Who has a tendency towards anxiety. Has been burned by a very bad experience with a teacher the previous year. It's a married child in a difficult marriage or situation that nobody could have anticipated? What then?

Let the parent go to the therapy if the child refuses. Learn tools to communicate and support the child. Maybe it is the parent that is suffering more than the child. Let the parent learn to let go. To live with discomfort. With things that may not go the way she wishes. Her desires for her beloved child. And usually, the change in the parent will effect change in the child.

But if the parent or spouse brings the client into therapy, (figuratively sometimes) kicking and screaming, or sullen and withdrawn, or frightened and silent, or even cheerful and blasé, it becomes the therapist's problem to engage the child in the process. The parents have done their job and now the therapist can do hers. (With the parents' cooperation and input depending on the child's age, of course.)

And what I need to do as the therapist is a few things. Create a therapeutic alliance with the client. Create a motivation to make the client want to return to therapy, to engage in therapy. Assess the problem. And I need to know that I have only one chance.

And sometimes, each time they come, I have only one more chance. Until I don't, because that client has finally seen the value of therapy, even if they won't admit it. Their attendance is evidence enough. That can take one session. Or fifty.

And sometimes I fail.

But when I don't, that force has been a good force in the life of the client and the family.

NOTE: THIS ARTICLE WAS ORIGINALLY PUBLISHED IN BINAH MAGAZINE

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