What To Do If Your Child Refuses To Attend Treatment

If your child is experiencing a psychiatric emergency and refuses to go for help, see section 7 of this handbook.

 If your child is experiencing mild-moderate emotional difficulties (sadness, anxiety, shyness, social or academic difficulties) but can still meet his/her responsibilities, and refuses to attend treatment, do not try to force him/her to attend. Your best strategy is to be patient, continue providing love and understanding and repeatedly educate your child about the treatment process and its potential benefits. If you maintain your supportive position and your child becomes uncomfortable enough with how he/she feels, there is a good chance that he/she will eventually volunteer to participate in treatment. If your child does not take you up on your offer, then perhaps he/she does not feel as badly as you might think or is deriving some type of benefit from their emotional upset. In the latter case it might be helpful to discuss that possibility with your child.

If your child is involved in destructive and/or illegal behaviors (including substance abuse) and refuses to enter or participate in treatment, you may need to consider taking a “tough love” approach in motivating him/her to do so. Tough love is a parenting philosophy that stresses the accountability of the child to behave in a healthy and responsible way and the accountability of the parent to provide consistent and appropriate punishment for destructive behaviors. The way it works is, when your child is involved in destructive and/or illegal behaviors, you consequence (punish) him/her by imposing logical consequences and/or by allowing natural consequences to occur. Logical consequences are punishments that have a logical link to the behavior that is being disciplined. Logical consequences can include punishments as severe as reporting your child to the police, withholding non-essential support (materials and privileges outside of those necessary for survival – allowances, car, TV or computer in room, rides to friends’ houses) and/or making alternative living arrangements for your child. Natural consequences are punishments imposed by society (school suspension, police arrest, etc.). In addition to punishing destructive behaviors, you simultaneously provide logical rewards and encouragement for your child to enter treatment.

In taking a tough love approach, ideally you want to communicate with your child in a non-emotional, assertive yet loving and respectful way. The goal of your communication style is to keep the focus on your child’s behavior and not to get drawn into an argument that shifts the focus to you, your parent-child relationship or past unresolved conflicts.

With tough love, as with any disciplinary approach, you need to be patient. There is rarely any one consequence administered at any one time that is going to make the difference. You will only impact on your child by being consistent with your approach over an extended period of time. The following are examples of a tough love response to a child involved in ongoing destructive and/or illegal behaviors.

• Child is being verbally abusive towards you, breaking curfew and refusing to follow house rules. You say: “You are being verbally abusive toward me…you have come home late the past two nights…you have stopped doing school work…at this time you will not receive your allowance and I will not drive you over to your friend’s house…you can receive those privileges back when you are able to talk to me about what is going on and improve your attitude and behaviors…”
• Child gets arrested for drinking and driving. Your response is to not hire an attorney to get him/her out of trouble. You explain to your child that if he is going to break the law he has to be prepared to pay the price for it. You allow your child to experience whatever “natural” consequences result from his/her behavior.
• You find drugs in your child’s room and confront him/her with it. Child gets angry, pushes you and runs out of the house. Your response is to call the police, report your child for drug possession and assault.
• Child is misbehaving in all of the above ways, you want the child to enter treatment. Your response is to follow through with all of the predetermined consequences. Say to your child, “I don’t want things to be this way…if you continue to behave the way you are I will have to continue to hold you accountable…if you go for treatment and show me that you are trying to work at it, we can wipe the slate clean…you can have back all of the privileges you once had…what do you want to do?”
• Child continues to be involved in unhealthy, destructive or illegal behaviors and refuses to enter or participate in treatment despite all of the consequences that have been imposed. You continue to set and follow through with consequences that match the severity of your child destructive and/or illegal behavior.
• One severe consequence is to make alternative living arrangements for your child. You say to your child: “Things continue to get worse…this is not good for either of us…perhaps it would be better if you lived with someone else…here are your options…go to treatment for help in changing your behaviors or plan on living somewhere else by the end of next month.”
• Another serious consequence is to work with the police and court system in generating a court order for treatment against your child. To find out more about how to obtain a court order, read Section 8 of this handbook. When reading Section 8, please be aware that the court order is explained in the context of seeking inpatient treatment, but, that it can be used to force a child into any one of the various levels of care (individual outpatient, intensive outpatient, inpatient, etc.)

What makes the tough love approach difficult to institute is that it goes against most parents’ natural instinct to protect their child from perceived harm and to avoid the interpersonal pressure inherent in saying no or imposing a consequence. Generally speaking, in some ways it is easier to yell, argue, nag or try to guilt our children into compliance than it is to hold them accountable and impose a consequence that often initially escalates their agitation and anger. Ultimately however, research and my own clinical experience suggest that children (particularly those with behavioral difficulties) learn and are more influenced by our actions in response to their behavior than by our words or emotions. With this principle in mind we move from trying to convince them to change, to giving them leadership and good reasons (logical and natural consequences) to change. For additional information and support in implementing a tough love approach with your child, contact the tough love support program at (800) 333-1069 or visitwww.toughlove.org.