State of Mind

Just How Helpful Is Childhood Therapy?

Grown-ups who saw therapists as kids talk about how they remember their experiences.

A Rorschach test that looks like a teddy bear.
Photo illustration by Slate

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I didn’t have therapy as a kid, but sometimes I wonder if I should have. I had a happy childhood, but I was one of those anxious kids—I was terrified of flash photography, fireworks, and cats, among other things. (I stand by that last one as 100 percent rational.) As an adult, it’s easy to forget that childhood, though devoid of heavy responsibilities, often isn’t easy, and many kids need extra help and support. Mental health disorders are the most common diseases of childhood, afflicting some 17 million youth. According to the National Survey of Children’s Health, nearly one in 10 kids received treatment or counseling from a mental health professional in 2017.

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But just how helpful is childhood therapy, and what kinds of factors shape its usefulness?  I talked with seven adults who underwent therapy as children and dug into the research literature to find out. As you might guess, child therapy is a bit of a mixed bag. Its effects depend on many things, including why children are there and what they are experiencing.

There’s one major difference between child and adult therapy: Kids often aren’t there by choice. They may have no interest in changing their behavior or their beliefs, and they may also resent the therapy or the therapist. Eric—I’ll refer to most sources by their first names to protect their privacy—started therapy at the age of 12 for exhibiting problems with authority. (Among other things, he once told his science teacher to “go fuck himself.”) Now 47, he tells me he considered his psychiatrist “weak and feckless.” He recalls, “It was just one more grown-up trying to say something to me.” Research involving both kids and adults suggests that when a client and therapist do not have a strong “therapeutic alliance”—when they don’t have empathy, congruence and positive regard for each other—therapy just isn’t going to succeed.

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When an adult is the impetus for a kid to go into therapy—as is so often the case—that adult’s relationships with both the child and the therapist can also shape how things go. Adults are often the ones communicating with the therapist about the child’s problems, and they may not be reliable narrators. They’re often the ones setting treatment goals, too, since they’re footing the bill. Their relationship with the child may affect progress as well. Cheryl recalls that when she went to therapy as a child, she knew she couldn’t talk to her therapist about the real cause of her depression: Her father was sexually abusing her. “My family wanted me to go to therapy, but I also knew it wasn’t OK to talk about what went on,” she says. If a child doesn’t feel she can open up to her therapist, she won’t get very far—and if a child is in a toxic environment she can’t escape from, therapy isn’t going to solve her problems, either.

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If kids welcome therapy, trust their therapists, and are no longer experiencing trauma, however, the experience can be positive. Keri was sexually and physically abused by a babysitter’s son over the course of a year, and when her parents found out, they sent her to an immersive therapeutic preschool, where she had individual therapy sessions throughout the day. At the time, she didn’t realize what the school was, but she’s confident the experience helped her heal. “What I remember is constantly being asked ‘How does that make you feel? How did that make you feel?’ and being asked to understand what it was I was feeling in a given moment, and what other people’s interactions meant to me,” she says. “I think they wanted to re-train us into not being victims, to understand that what we feel matters.”

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Sometimes, too, therapy’s benefits can be shaped more by external than internal factors. When Josh, who is now 38 but went into therapy as a child to treat his anxiety, told his therapist about the ways his brothers teased him, his therapist told his mother about the situation. His mom promptly told his brothers to ease up, lest they screw their little brother up for life—and they did.

Other adults who underwent therapy as kids don’t have strong feelings about the experience either way. After Slate staffer Ruth Graham’s parents separated when she was 8, she saw a therapist, with whom she did art projects and talked about her feelings. “I found it uncomfortable,” she says, but “it was at least a space to think about that stuff every week, and so that was good.” Matt was sent to a psychologist because of his sharp temper, and although he enjoyed talking with his therapist, he thinks the experience benefited his mother more than him. “I think it helped my mom to know that my behavior wasn’t unusual and that this was something to work on, rather than a symptom of a more serious problem or evidence that she had failed as a parent,” he told me.

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Clearly, then, child therapy can have varying outcomes—but if you average its effects, research suggests that overall, it does help. According to a 2017 meta-analysis of 447 studies, kids who undergo therapy fare better than 46 percent of similar kids who don’t. It’s most helpful for anxiety (particularly cognitive-behavioral therapy, which involves teaching kids to recognize and change counterproductive thinking habits) and is much less useful for treating depression, conduct problems, and ADHD. Chris, an old friend of mine who saw a therapist because he was disruptive at school, felt annoyed by the fact that his therapists always tried to tie his behavior back to family issues—when really, he says, he was just was bored at school and had ADHD, which wasn’t diagnosed until he was much older. (Chris’ name has been changed.) As for how the effects of child therapy compare with those of adult therapy, it’s hard to say: No studies have directly compared the two. But research suggests that, as with child therapy, adult therapy can ease symptoms of anxiety, and that it can also help with depression.

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Everyone I interviewed for this article underwent therapy decades ago, so I also couldn’t help but wonder: Has it gotten more beneficial since? In a 2019 paper, researchers at Harvard University and other institutions analyzed results from 453 clinical trials conducted over the course of 53 years, controlling for improvements in study design that may have occurred over time. They found that child therapy is working about as well as it used to for treating anxiety, but that there has been a downward trend in how well it works for depression and conduct problems. Although no one knows why therapy for these conditions may have gotten less effective over time, one possibility is that kids are being bombarded with more stress than they used to: Increased school pressures and the advent of social media, among other things, could be making childhood more challenging, and therapy may not be able to keep up. As the authors of the 2019 paper wrote, “social and technological change are continually altering and expanding the range of ways young people may experience anxiety, depression, ADHD, and conduct problems, generating a need for corresponding change in interventions, but at a pace treatment developers may find difficult to match.” Still, as the mother of two somewhat anxious kids (because of course they are), my take is that if your child is struggling and you’ve got the means, therapy may be worth trying. Yes, that sounds a bit wishy-washy—but as is so often the case with therapy, whether it’s necessary, and whether it works, varies wildly depending on your family and your child. The key? Find someone your child can trust.

State of Mind is a partnership of Slate and Arizona State University that offers a practical look at our mental health system—and how to make it better.

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