Why do Kids Need Therapy?

Many kids have mental health disorders, which can make it difficult to be happy, succeed in school, get along with other people, and accomplish their goals. Before the COVID-19 pandemic, about one in every six kids in the United States had a mental health disorder [1]. Now, even more kids have problems with feeling anxious, depressed, or acting out than before the pandemic [2]. In the United States, about half of kids with mental health disorders do not get the treatment they need from mental health professionals [1].

Does Good Therapy Help?

Luckily, lots of research studies have proven that good therapy can help kids with mental health disorders. But what counts as “good therapy”? Research studies combining the results of hundreds of other studies show that some therapies are particularly good at improving kids’ mental health quickly. Cognitive behavioral therapy (CBT) has the most research showing it is a therapy that is likely to work [3]. CBT focuses on giving kids the skills they need to get better by changing thoughts and behaviors that can make their problems worse. Other therapies have also been scientifically proven to be effective, like interpersonal therapy and behavioral parent training, which you can learn more about by visiting the websites at the end of the article.

How Do I Know if I am Getting Good Therapy?

Because we all have different needs, what counts as “good therapy” might look different from person to person. But there are common signs to look out for that can help a person know if they are getting good therapy (Figure 1).

Green Flags

Green flags mean you are likely getting good mental health treatment that should make you feel better. Here are some of the main green flags:

- Therapist tells you about your treatment plan: at the start of therapy, a therapist should provide a plan for what kinds of things you will do in therapy and how long you will need to be in therapy. The plan will depend on the specific problems you are dealing with, how often you see the therapist, how long the sessions are, and if there are other hard things happening in your life. Generally, you will need at least a few months of weekly therapy to start to feel better and have less symptoms, but therapy does not usually last longer than a year. Most importantly, your therapist should be open to changing the plan if therapy is not working.

- Therapist talks about research studies: if your therapist talks to you about research studies and treatments that work, like CBT, this is a green flag that your therapist is giving you treatment that will likely make you feel better. This could mean telling you things like the types of skills likely to be helpful for you, the name of the treatment they plan to use, and how likely it is you will feel better at the end. The more your therapist talks to you about why they are doing something and references the research studying it, the more confident you can be that you are getting treatment that is likely to work.

- Therapist asks what you like and do not like about therapy: not everyone likes the same things, and that applies to mental health therapy, too. It is important that your therapist asks you how you are liking therapy. This means they ask you what is working well for you, so they can do more of it. And it also means asking what is boring or not helping you, so they can do less of it. Good therapists will change to be more helpful for you.

- Therapist asks about your culture and values: every person has their own culture and different things they value. Some examples of values or preferences in therapy are if you prefer to speak a certain language, who else you want to be involved in therapy, holidays and traditions that are important to you, or religions that are important to you. Research studies with thousands of kids and teens show that the more your therapist tries to understand your culture, values, and preferences, the more likely you are to enjoy therapy and feel better.

- Therapist asks you questions to understand how you are doing: to make sure therapy is working, a therapist might ask you to fill out questionnaires rating how much you are experiencing certain symptoms. It is extra helpful if therapists repeat the same questions a few times over the course of therapy, to see how your answers change. If your answers show you are getting better, then it means the treatment is helping. If your answers show you are not getting better yet, then you and the therapist can decide what to change about therapy to make it work to help you feel better.

- Therapist talks to your caregivers: research studies with thousands of families show that when therapists work with kids’ caregivers (adults who take care of the kids) at least a little bit, it helps kids feel even better than therapy without the therapist talking to caregivers at all. If a therapist asks what you are comfortable sharing with your caregiver, that is a sign that you are getting good therapy. If a therapist asks your caregivers to try new things to help you feel better, this is another sign that you are getting good therapy.

Red Flags

Red Flags mean you ae likely receiving poor therapy that is less likely to make you feel better. Here are some important red flags:

- Sounds too good to be true: imagine you are meeting your therapist for the first time and they are really excited to tell you about a new and improved “cure-all” therapy that has been a “magic fix” for all of the kids they have seen. If you think what your therapist is describing is too good to be true, you are probably right. The truth is that getting better can take time and involves hard work. It is also important for your therapist to put in the time to make sure your therapy is fixing whatever problem is bothering you the most.

- Therapist says it will take years to get better: it might be a problem if your therapist says you will need to be in therapy for a very long time. Therapies that are scientifically proven for kids tend to be short term and, except for treatment for autism spectrum disorder, typically last less than a year [3]. Research shows that there may be a point when staying in therapy longer might not make people feel better.

- Therapists talk about themselves a lot: when it comes to a therapist’s style, it is important to listen to your gut. If it feels like your therapist talks a lot about themselves, that might be a sign that they are not spending enough time focused on helping with your problems. Your therapist’s job is to put you first and ask questions about how they can best support you in achieving your goals.

- Not seeing the therapist regularly: to make the most of therapy, you should meet with your therapist regularly. Weekly meetings are most common, but they might see you more often depending on the types of problems you are working on. But if a therapist decides from the beginning that you should meet less than weekly or they cancel your meetings often, it may be less likely that therapy will help you feel better.

- Therapist hurts your feelings: if your therapist says something hurtful, insults part of your identity or culture, or tells someone else something private that is not for the purpose of protecting your safety, this is a red flag that this therapist is not likely to help you feel better—even if the therapist does these things by accident.

More Information about Finding Good Therapy

Now that you know some green and red flags to look for in mental health therapy, you know how to be an advocate for yourself.

If you are already in mental health therapy and worried that the therapy you are getting might not be good, you or your parent/caregiver can ask the therapist questions to try and understand if the therapist is a good fit for what you want in therapy (Figure 2). It is a good idea to ask these questions before starting with a new therapist, if possible. Here are some examples of questions you or your caregiver could ask: What kinds of things will we do in therapy together? How will we know if therapy is working or not? What did research studies show would help kids like me in therapy?

If you are trying to find good mental health therapy, the websites below can help you learn more. Some will help you find names of therapists, but it is up to you to ask good questions like the ones in Figure 2, to help you learn about each therapist and make a decision that is right for you. Remember, some therapists are qualified to offer treatments that have been scientifically proven to work, like CBT, but some are not.

- American Psychology Association—Psychologist Locator

- Association for Behavioral and Cognitive Therapies (ABCT)

- Psychology Today

Here are a few other trusted sources for mental health information:

- Help Your Keiki

- Child Mind Institute

- National Alliance on Mental Illness

- Effective Child Therapy

- Substance Abuse and Mental Health Services Administration

It is normal for kids to go through hard times with their mental health, and there is a lot of hope it will get better with support from your loved ones and mental health professionals.

Glossary

Mental Health Disorder: ↑ A medical condition that involves changes in the way you think, act, or feel that causes pain and makes it hard to do your best with other people, at home, and at school.

Therapy: ↑ A type of mental health treatment that teaches kids how to handle their emotions and change the way they act to have the happiest life and reach their goals.

Cognitive Behavioral Therapy (CBT): ↑ A type of research-proven therapy that focuses on connections between the way you think, feel, and act, and teaches kids skills to manage their emotions and behaviors.

Autism Spectrum Disorder (ASD): ↑ A pattern of differences, which include things like differences in an individual’s social communication skills, having a few things you are very interested in for a long time, and moving your body in the same way over and over often.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

AI Tool Statement

The author(s) declare that no Gen AI was used in the creation of this manuscript.

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