The Modern Teen

Inside the mind of the American teen

A Scary Truth About Psychotherapy With Youth

Effective vs. ineffective treatment: do you know which is which?

There is something important you need to know about psychological treatment for children and adolescents:  some of it could be a complete waste of time!  However, some treatment is excellent, based on scientific principles, and has strong data to suggest that it could work well, and work quickly to help your child feel a whole lot better.

Can you imagine bringing your child to a medical doctor with a bacterial infection, being prescribed an unfamiliar treatment for weeks, seeing no progress, and then learning that a friend's child with a similar diagnosis had greatly reduced symptoms rather quickly by taking a well-known antibiotic?

Why didn't my child's doctor know about this antibiotic?
Why did my child have to suffer needlessly when a well-established treatment was available?

It would be frustrating to spend so much time, money, and effort hoping for a treatment to work, all the while not realizing that another treatment approach was available!

Unfortunately, due to a long history of our society's stigma regarding psychological symptoms and treatment, this is exactly what happens to literally thousands of children every day.  It is an extremely tragic issue.

Now in 2011, we have come a long way.  The stigma of mental illness has abated considerably.  People now know that suffering from psychological symptoms is as common and as debilitating as suffering from a bacterial infection, or many other medical illnesses.  People also know that it is crucial to get treatment.  No one would let their child suffer from pneumonia; no one should let their child suffer from depression, anxiety, ADHD, or so many other possible diagnoses.  Like medical illnesses, psychological symptoms also can lead to problems in related domains of functioning (e.g., academic achievement), physical health, and even death.  Treatment is essential.

But due to decades of stigma, the public does not know as much about psychology as they do about medicine.  If your child has a physical illness, you likely look online (e.g., WebMD) to learn about possible causes, talk with friends, discuss treatment options with colleagues and neighbors, get second opinions from multiple health care providers, etc.

This doesn't happen with psychological illness and treatment, unfortunately.  Most folks have trouble finding a therapist for their child, are unsure what treatment options are available, and often do not question the type of treatment that their child receives.

But they should.

Some psychological treatments are based on years of scientific evidence, demonstrating why youth experience symptoms, what types of treatments work, for whom, and how, and the best way to administer this treatment.  Cognitive-behavioral therapies are an excellent example of a treatment approach that are known to work for many different types of disorders.  Research is available to understand when therapy should be combined with medications, when it shouldn't, and what the long-term implications are of the type of "combination therapy" (note: most research suggests that meds + therapy are far superior than either one alone).

However, other therapies are untested, based on old-fashioned theories of psychology (e.g., some over 100 years old!), and can even do harm.  Clinicians may have a good "hunch" that their therapeutic approach is effective, but data have clearly demonstrated that these "hunches" or clinicians' judgments rarely hold up to scientific rigor.

There are also some wacky therapeutic approaches that just seem peculiar (e.g., "rebirthing therapy").  Someone out there has tried it and felt that it worked, so they may insist that it is a good approach to reducing symptoms.  But the public should accept no substitute for scientifically-based, rigorously tested, psychological treatment.  You wouldn't take a new medication or attempt a radical sounding medical procedure just because a few people "think" it worked for them.  Why hold psychological treatment to any different standard?

Why aren't psychological treatments "regulated" the same way medications are?
Isn't there a national group that can ensure that all psychologists have the most updated, safe information available for treating children and adolescents?

Unfortunately, like many issues involving national policy, this is a complicated and politicized issue.  Efforts are underway, but it likely will take many, many years until such regulation is in place.  If the public demanded it, it would likely happen much faster.  But again, the stigma of psychological treatment has kept any public groundswell on this issue to a quiet whisper.

A few professional associations have been very committed to this issue, however.  They have used their own limited funds to start a grassroots campaign to educate the public about scientifically-based treatment.  The product of their work so far is available as a free service online at:

You can help!  Please visit this site and offer feedback on how it can be made more helpful to educate the public.  If every parent knew about their options for the psychological treatment of their child, and demanded clearer options, better regulation, and more information, then literally thousands of children could be helped to feel a whole lot better.


Mitch Prinstein, Ph.D., is a Distinguished Term Professor and the Director of Clinical Psychology at the University of North Carolina at Chapel Hill. He writes about clinical adolescent psychology.


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