Is therapy a waste/just medicate?

[Anonymous]

My young teen began therapy this spring and has been to about 10 sessions and I’m not seeing the benefit at all. My child is clearly neurodivergent, we can’t afford to get a neuropsych testing, but we want to see a reduction in the daily severe anxiety and occasional school refusal that occurs. School is overwhelming at times and they have some friends but there are also some bullies. School officials have zero control (or maybe it’s zero inclination to control) the bad behavior of some of the kids toward others. Any advice for neurodivergent-aware therapists or experienced parents who’ve been through this?

[Anonymous]

From what you have shared here, it does sound like a psychiatrist might recommend medication. It doesn't mean "just medicate" it means therapy just won't be enough or may not work without medication. Fwiw I think I may be neurodivergent, have suffered from anxiety and depression throughout my life, and I started a low dose of an SSRI at age 40. My only regret is not starting it sooner.

[Anonymous]

medication is the only thing that really ever helped my kid.

[Anonymous]

Medication worked for us. Therapy did not.

[Anonymous]

In many, or some cases, it is all part of the solution. Our ASD child had many types of therapy and providers. Small group. Individual. He is also on medication, which is trial and error. We worked with a board certified child and adolescent psychiatrist who is experienced in psychopharmacology. While you might luck out, in our experience it is not as simple as "just medicate." Maturity helps too.

[Anonymous]

Both. Without the medication, therapy/EF training couldn't get through to my kid. Knowing what you should do/how to behave is one thing; being physically able to do so with your brain is another. The medication helps them be able to act on they they are learning in therapy.

[Anonymous]

Therapy is a very broad area. As is neurodivergence. It's not clear from your post what your kid's main issues are.

A good therapist will be able to work with a client to come up with clear goals. For some kids, talk therapy is great but others benefit from modalities like DBT, CBT (often tough with ASD/PDA types IIRC). Others thrive with more obscure things like equine therapy. If you feel it's not effective, it might be time to revisit the goals and see if your therapist's skill set matches your child's needs

It couldn't hurt to see a psychiatrist and talk about the issues. They can prescribe medication if they think it may help. Keep in mind that medication is not a destination but a journey. Often the first ones tried are not what patients stick with for various reasons.

[Anonymous]

I’m no expert but it seems to be therapy won’t work if the patient is not onboard. And most people with anxiety really don’t want to talk about it. That was my DD. Therapy gave her anxiety. She didn’t have bullies but I can’t imagine a scenario where she’d talk about school relationships with a therapist in any meaningful way. I think it will be good when she’s older, maybe in her 20s, and initiates it herself because she’s up to talking about her anxiety.

[Anonymous]

Anonymous wrote:Both. Without the medication, therapy/EF training couldn't get through to my kid. Knowing what you should do/how to behave is one thing; being physically able to do so with your brain is another. The medication helps them be able to act on they they are learning in therapy.

This. Ideally you'd have both. But therapy only works with the person's buy in, so if you have to do only meds until they are ready for therapy, then so be it.

[Anonymous]

OP here—Really appreciate all these responses. Thank you, and I welcome any others who want to share. My child has very strong social anxiety and sometimes has selective mutism episodes at inopportune times, is sometimes seen as “different,” or “too quiet,” especially if you spend a lot of time with them and their masking becomes too tiring. They have a special interest which not many people are interested in, as well.

[Anonymous]

Medication+ about 4 months therapy worked for ours. Therapy was helpful for adjusting to accepting and loving a ND identity, discussing how meds changed things, lingering behavior issues. However not at all sub for meds

[Anonymous]

I have 3 kids, all with anxiety. Two are medicated and in therapy, one only in therapy - therapy is to address anxiety.

My oldest has gone in and out of therapy as needed (same therapist for 2 years, switched for this past year). They go in to work on CBT when something happens and they get stuck. A recent medication adjustment made a huge difference, but it wouldn’t work without the therapy. Therapy is very goal-oriented, and once the goal is achieved, DC wants to stop seeing their therapist.

My middle has had the same therapist for 3 years, does CBT, and is much, much better but still pretty anxious. Also medicated. I sometimes wonder if they will just spend their whole lives being anxious, but they are learning to cope. The skills the therapist has built are something DC uses daily, and the meds made DC to be calm enough to use their skills (before meds DC had panic attacks, which was awful).

Youngest DC has been able to manage anxiety only with therapy. I see them stopping therapy in the near future.

All kids do CBT, all have been amazing at working to use it in their daily lives. All that being said, the meds are life changing for my kids - very thankful we are able to have access to both.

[Anonymous]

You need to have a good therapist, which is hard to find, a person willing to participate and the need to be a good fit. We had many therapists for DS over the years with trying different meds. All had to be changed for different reasons. Some were terrible and had a negative affect on him, some moved, some had schedule conflicts. Ultimately we stopped therapy around 15 when he didn’t want to go anymore.

BUT he’s 18 now and every now and then lectures us on things he thinks we are doing wrong and brings up something he says he learned in therapy. So maybe it wasn’t all a waste.

[Anonymous]

^ the last “therapist” was really a psychiatrist for med management for him. That was helpful. He stopped going when he stopped the meds. If you start medication, you need someone to manage it who is knowledgeable on all of the effects.

[Anonymous]

I agree that you often need to medicate for therapy to help. You also need to be sure you’re with the right therapist. DS is on his fifth therapist and she’s finally someone he clicks with and trusts. I thought he’d do better with a male therapist, but I think there was a need to put on some bravado and not let his guard down with the males, whereas he can be vulnerable with the female.