Reader question #121: How do I convince my partner that his daughter needs therapy?

39 thoughts on “Reader question #121: How do I convince my partner that his daughter needs therapy?”

1. I wonder if, on some level, LW’s partner feels LW is being a hypocrite and evil stepmother: “why do you want to put my kid in therapy and not yours?” I don’t know how to respond to that, unfortunately, though LW’s son may well have his own issues with his parents’ divorce and if he can benefit from therapy — and they can swing it financially — it can’t hurt.

   1. Oh my god, that’s a great, great, great point. You cannot tell me that little brother does not have feelings about all this stuff, including big sister’s behavioral problems – I mean, who the hell is she scratching up besides herself, anyway?

      It’s possible that the sister is the identified patient in the sense that she is the one who cannot conform/keep a lid on her feelings and who is most openly acting out what’s going on.

      1. Especially if the son is being identified as “the good kid” or “the low-maintenance kid,” I’d be concerned about the possibility that he’s having problems but hiding them — even if you think he’s not picking up on that expectation. I know I made my own anxiety problems worse as a teenager by internalizing the message that I was supposed to be “an easy kid to raise” and trying to hide them, and my mom was actually making a deliberate effort not to put that expectation on me.

   2. I second this something like a thousand percent.

      My reaction to a lot of issues was to shut down emotionally – go quiet. Unsurprisingly, this looked to adults like I was “just fine”. (My parents would, separately and together, occasionally express bewilderment that when they asked me how things were at school I’d say “oh fine” when in fact as they sometimes found out via third parties, I was miserable, being bullied, and many of my teachers thought of me as a dull well-behaved little girl who found it hard to cope with class work.) My mum had a thing against therapy because she felt that if strangers were being called on to talk to her children that meant she had Failed – but my younger sister, who had much noiser and more active ways of indicating that she was Upset, got more intervention than I did (not necessarily more helpful intervention).

      It can’t hurt for both kids to go talk to a therapist, and both of them are old enough to understand that even if they’re seeing the same therapist, that person will not share information with anyone else, including their own stepsibling.

      1. My first reaction to this is NO. they are NOT old enough to understand that.

         Upon reflection, they are probably old enough to understand it if the therapist expressly states that they do not share the information. I do not believe I was told that this was the case, and was not inclined to trust other peoples’ motives at that age. I was sure that the therapist was telling (my mother in this case) everything I said. I doubt they are experienced enough to figure out that the discussions are confidential unless this aspect is explicitly discussed.

         Also they may not want the therapist to tell their parents either even if the parents are not in therapy, and may need reassurance about that. I don’t know about kids in general, but I think it can’t hurt for the therapist to reassure them that things are confidential and explain exactly when and why things might not be (standard immediate danger to self or others)

         1. I don’t remember if our family therapist told me that our discussions were confidential or not, but even if he did, I sure as hell didn’t believe him.

2. I wonder about the “psychosomatic illnesses” bit–both as an armchair diagnosis and as a possible way to convince the reluctant partner. “I’ve noticed that lately Daughter has been sick a lot, and she seems to be acting out a lot too [list incidents]–it seems like she’s very stressed out. Let’s check with her pediatrician and see if he thinks counseling would be a good move.” Or something along those lines. But I also want to say (and I’m sure you know this, so forgive me if it’s overly simple): some kids just get sick a lot. I know I did, and I’m sure some of it was related to family stress, but much of it was living in a house with kids of different ages (also a stepfamily) bringing home different infections all the time. Either way, I *experienced* it as physical illness, and I would have been really upset if one of my parents had thought it was psychological. As an adult, I understand more of what that implies, but as a kid, I would have heard that as “you’re faking it.”

   1. Heck, stress can make you feel sick! To a kid it’s the same thing as feeling “real” sick.

3. She might also spin it as family therapy, ie for the whole family to adjust to being a new family. It’s very common to have minor communication issues when combining families and everyone can benefit from more communication skills. Then, in the family therapy, the therapist can recognize and recommend individual counseling for the daughter. I’m guessing here that the therapist will meet with everyone in the family one on one and a good therapist will recognize the issues with the daughter from that meeting alone.

4. When I was in junior high, my mother kept threatening to send me to see the school psychologist because she had no idea how to deal with me. If I could go back in time, I would volunteer to have gone. Being a tween is complicated all by itself. Having a therapist to help be feeling detective and possibly have a safe place to express anger without fear of shame or grounding? That would have been so helpful — even just the figuring out how to express anger in a healthy way part.

   1. The Feelings Detective! Phrase of the day. 🙂

5. Family therapy when there’s a “his,” a “hers,” and an “ours” child is a great idea and might take them over the anti-therapy hump and allow a professional to assess of one or both of the kids could benefit from additional talk time. Most children of divorce could benefit from a neutral third party to talk to, and even moreso children of a messy divorce.

   But convincing an anti-therapy parent to embrace therapy can be difficult. An initial consult might be free, and that would be a good step.

6. LW, thank you for asking for help to broach this matter and don’t give up trying to get help. And please, consider getting help for the whole family, not just her.

   My youngest sister is a foster child. She was basically dropped off at my parent’s home by her grandfather at the age of 2 and left there. It was probably the best thing that could have happened to her; but she has behavioural issues – fetal alcohol syndrome and difficulty to bonding. She would take things and hide them in her room (stockpiling) and in fits of rage would destroy other people’s things. And very similarly to your step-daughter desperately craving attention. And bad attention is better than no attention at all.

   She was “the problem” so she was sent to counselling from a very early age – but the rest of the family wasn’t. Unfortunately, my mother being very Christian, she was sent to a Christian counselor. In my opinion, the woman should have had her license revoked – if she ever had one. Telling a troubled kid with neurological issues that they will go to hell if they are not good and not actually you know, providing therapy was disasterous. She learned all the right answers and just did everything she could to get out of therapy.

   She’s actually a good kid by most measures but also scared, stressed, frustrated, and fighting with mom constantly. The other kids at home ignore her, fight with her, or blame her for everything that goes wrong (as does mom, although she won’t admit it). I have backup plans for her to come live with me if necessary but I’m far away and little sis wants to stay with her friends and the only family she has. She tried to commit suicide a few weeks ago and the immediate reaction of the household was that “it wasn’t real, it was just for attention” and sent her off to the same crappy counselor again. Who tells her that if she succeeds in committing suicide she’ll go to hell.

   tl;dr: When one person in the family is hurting – everyone ends up hurting. You don’t have to go to therapy as a family (group sessions), but if you can afford it, everyone should go. Not just the kids.

7. Check out:
   http://www.rainbows.org/

   This group provides peer support groups for children dealing with death or divorce.

8. My parents did their absolute best, but like everyone, their parents had f*cked them up in ways they may still not fully understand. And they passed some on to me. I got sick often as a kid, too, and only now can see the pattern of how I would hold in all the stress and worry until my little body’s only way of letting it out was to blow up my tonsils so I could sleep a few days and have no one expect anything more of me. My parents did counseling for a bit, and I got taken to one session, but good grief, what kid is going to tell on her parents in front of them and some adult she’s never met before on the first visit? I wish I had had the chance, as like Capt’n Awkward says, you can learn all those skills, how to express needs in a healthy way, how to identify your feelings and express them, all of it. And what you learn wrong as a child is very hard to unlearn and relearn properly as an adult.

   I agree with the others who’ve said to approach this from the angle of family therapy first- being a family is hard, period, and blending them can only add factors of difficulty. And being a kid is hard, and you cannot talk to your parents about everything. That would be weird. Having a trusted adult who isn’t family is great when you’re a kid, especially an adult who listens to you and helps you figure out how to be comfortable in your own skin.

   1. Oh oh, totally forgot- use the “She’s a girl, they’re different,” trump card if you must. Do any single fathers look forward to discussing periods and bras? Not likely. And as a step-mother, this may be awkward for LW too. There will be feelings! And yelling! And doors slamming! Puberty should come with free coupons for therapy. Get in there now and you may be able to avoid all that. Not entirely, but at least she’ll use her words and not just shout “I f*cking hate you!” in front of all the school faculty like one of my friend’s daughters did recently.

      1. Spinning off this, another good point is to say that you really want to help her sort these things out while she’s still in elementary school, before she gets hit with hormones and body image issues and middle school social crap.

9. I think it’s also ok to say that sometimes, kids are anxious and troubled for unspecified reasons that have nothing to do with how they are raised. My childhood was great — solid parents, no end of amazing pets, brothers who picked on me JUST enough to thicken my skin — and yet I was an anxious, sensitive kid who benefited from counselling I did in third grade and again in seventh grade (and my own fears ranged from “What if suddenly all my friends start hating me” to “what if I wake up and everyone I love died overnight in a tornado?”). It had nothing to do with environment and everything to do with brain chemistry. My oldest brother is the same way. Sometimes, anxiety is just anxiety.

   Also, I agree with the poster above who said to check with her primary physician, as well. That strikes me as good diplomacy for both the stepdaughter and the new husband. And checking with teachers its a great idea — I’ve worked in education and with teachers who spend six to eight hours with kids. That’s a lot of time for observation. Plus, just because teachers haven’t approached you doesn’t mean they haven’t observed something. They are required in some districts to document weeks to months of behavior before taking the next step. If you and your husband approach them first, however, you might be able to take action sooner.

   Either way, good luck to the LW. This is a tricky one.

10. I’m really uncomfortable with “approaching this” from the “angle” of family therapy. When children are experiencing difficulties within the family, the parents who shunt the kid off into therapy to get fixed are kidding themselves. They also need methods to help parent the kid that is having problems. Family therapy can not be an “angle” here, it is a must for all parties who are interested in having a functional family unit, full stop.

    I apologize to the LW for what is a harsh truth here, but often the parent that fingers the kid who is in need of therapy is a major player in the problem. The theory of the “identified patient” is very important here, in that “the person who gets diagnosed is part of a wider network of extremely disturbed and disturbing patterns of communication” but becomes the scapegoat for the family’s problems because they are having completely functional, sane reactions to fucked up problems: a really messy divorce, a distant father, an absent mother, an anxious step-mother, conflict and insecurity within a mixed family, being told she’s having the “wrong” reactions to all this instability. The father needs methods to overcome his emotional distance. The step-mother needs methods to alleviate her anxiety. The mother — she’s out of your hands. Clean up your own side of the street and let her succeed or fail on her own merits.

    But LW and Husband — you both came from what sound like abusive households. It sounds like you want to do the right thing, so do it. You all need therapy to keep from re-enacting the dysfunction your parents handed you on to your own children. This isn’t a angle to exploit to manipulate anyone else into therapy for a mental tune-up; this is your life. Do what your own parents didn’t know how to do and make sure your children have sane, stable, plugged-in parents who hold their children’s emotional and physical safety paramount. Period.

    1. And frankly, if Husband decides he doesn’t need therapy, then the rest of you go and keep going. His pride can be his downfall, but LW, please don’t let his be the downfall of the children too. If he’s a good man, he’ll figure out that his participation is worthwhile.

    2. I want to tell you first off that your comment has really made my hackles go up. Your tone is unhelpful and condescending and as someone who has been the abused child I don’t appreciate it. You make a lot of assumptions about the care of that child, and about the LW. From what it sounds like LW is doing the best she possibly can with a very crappy situation to take care of that child. No one said take family therapy as an angle. They said that family therapy would identify the problem areas and work to solve them. No family therapist worth their salt is going to tell a family unit yes yes you are absolutely right child is solely responsible for all of the issues, if that’s not the case. Sometimes though, it really is the case and your comments are extremely off base in pretending to understand their individual dynamics. Furthermore, your assumption that LW is an abuse victim when she never says that is going to put her hackles up and make her less likely to want to listen to any advice given.

       1. Abuse victims come in all shades. I am one too, and I don’t mince words when it comes to child abuse and neglect. Sorry that hurts your feelings. Not hurting your feelings does not save this child from whatever pain she is going through.

          The LW details her own family dysfunction and says that her husband comes from an abusive family as well. And so it is. We can strategize indefinitely on how to convince/manipulate/triangulate circumstances so this girl’s father will agree that she needs therapy. LW may be doing the best she can with what she knows at the moment. However. Once a child’s self-destruction has been identified, to not act on it is emotional neglect.

          LW wanted advice. This is my advice as a caregiver, a parent, an abuse survivor, and a trained child advocate. Take it or leave it.

          No family therapist worth their salt is going to tell a family unit yes yes you are absolutely right child is solely responsible for all of the issues, if that’s not the case. Sometimes though, it really is the case

          Based on what LW is describing, the husband here sounds like an excellent candidate for CBT. I have yet to see a case where, thanks to the caregiver and caregivee dynamics, that a child who is in *need* of therapy has a caregiver who is not. Caregivers who are interested in helping their children more often than not need the kind of coaching that a therapist will provide. I have yet to see a case where a parent who thinks their child needs therapy but they do not have been correct. More often, they are the problem. More often, they’re quite happy naming a scapegoat for the family dysfunction or denying that dysfunction exists at all.

11. I’m feeling a strong reaction to all of this. I’m not sure I have any actual useful advice, but my emotional state upon reading this was extreme enough I thought it was worth paying attention to and writing down a few things.

    I identify with your husband re: the “insecure with a strong need for approval & praise” business. I have that same stuff.

    I would strongly suggest you find a way to make your request to your husband about your needs and not about his daughter’s unmet needs. She’s taking up too much of your time and attention and you need support.

    If I were in a blended family and my wife came to me and said “your daughter needs therapy” I really doubt it would matter much what words she used – I’d push her away. And if your husband is anything like me I bet he’s REALLY, REALLY good at pushing people away. Like Jordan is really good at dribbling, or like a nine year old is good at being short.

    On the other hand when my wife comes to me and says “I’m drowning – I need these specific things from you” it makes me feel powerful and needed and desired. It’s a whole different thing than if she’s telling me what to do with my own life.

    The other thing that’s super-useful when dealing with your partner is to explain clearly and honestly exactly WHAT it is about your own childhood that is making the current situation so hard for you. If your husband sees your “child self” as you’re discussing this with you. he’ll feel empathy for you in a way that he won’t otherwise. Tell him when you see his daughter struggling you can’t help but reach out to her because it makes you feel nine again. Tell him what that feels like. Tell him you can’t do it alone.

    It’s a difficult and treacherous thing you’re doing but it feels like you’re approaching it from a place of love and honesty, so I’m cheering you on and I think your chances are good. Good luck.

12. When I was 13 and my parents caught me shoplifting, they “punished me” with therapy. Amusingly enough, it WAS a punishment, since the therapist was quite far from any public transit options (walking 1-2 miles was a lot to me at this time!) so I hitchhiked to get there. Yeah. Oh, but I went! Because I actually was a good kid and a people-pleaser.

    And then she said, “Hmm, let’s talk to your whole family! It seems like most of the problems that need to be addressed are familial.” So my mother and father came in one time, and she told them I was a good kid but that she saw some communication issues between me and my parents that she thought we should work on. And we shut it DOWN. Never went again!

    I didn’t have behavioral problems! Sometimes I made a mistake, or lied about making a mistake to get out of trouble, as kids do. And that was the first and only time I had shoplifted, and I had stolen a pair of earrings because I was just beginning to learn that we were poor and oh yeah, THAT’s why I get bullied at school! and anyway, I could maybe have benefiting from therapy, until the unfortunate family session, when I realized my parents had no interest in fixing problems in our family- they just wanted to fix ME. And I was not broken!

    1. Been down that familiar route. As soon as a therapist broached the idea that maybe JUST MAYBE my parents and sister perhaps had a role to play in my depression and emotional problems as a teenager, treatment was stopped cold until my mother could shop around for yet another councellor who might tell her what she wanted to hear (ie, that it was all my fault and she was the Perfect Martyr Who Deserved So Much Better from her ungrateful child).

       I still have all those mental scars.

       1. *hugs*!

13. This sounds like a complex and difficult situation. It is clear that the LW has good intentions to get some help for a suffering little girl. A few ideas for you, Stepmom:

    1) Go yourself or with your husband to a child psychologist, just for a consultation. You don’t have to “convince” him of more than that. And if you can’t convince him, go yourself. Pick a “cognitive-behavioral” psychologist since they tend to be more practical and solution focused (and more supported by research).

    2) Know this: A lot of child therapy can be done by meetings with the parent(s) and psychologist alone. I agree that it’s better that the child also have someone to talk to (if needed). But if that’s not about to happen, that’s okay. Did you know that many reputable treatments for child behavior problems are parent group therapy, or parent only sessions? Ask about a “parent training” model.

    2) Ask your hubby for support in dealing with this. He seems to take more of a basic approach to parenting but you sound like you need help. Maybe he can manage more practical things, while you pick up some of the emotional slack.

    3) Have a meeting with the 9-year old’s teacher. Maybe there are school factors at play. At the same time, ask about counseling options through the school. Still consider parent training, even if she is seeing a counsellor.

    4) Buy this book “How to raise an emotionally intelligent child” By John Gottman. You can just buy it and read it even if you can’t do any therapy and you can’t convince anyone of anything. This may help. It’s not an expensive book.

    5) Remember that healing this child may take a long, long, LONG, time. And you can’t fix the co-parenting problem between her dad and mom. That is a whole other issue. But you can figure out: a) how to fine tune your own parenting approach- even if she does not respond, maybe the other two kids will benefit from your work in this area, and maybe you will feel more confident in dealing with her b) how to reduce your own stress, and work better with your husband so you are not feeling so overwhelmed.

    Good luck!

14. Don’t say “she needs therapy,” say “she’s hurting.”

    1. That’s exactly right, thank you.

15. There is a ton of great advice here already, particularly regarding how this little girl is most likely acting out the legit stress she feels within her new family constellation. Family therapy sounds like it might indeed be the best route if Husband would agree to that. Proud as he may be of his success as a single parent – and I’m sure he is an awesome Dad! – this new family thing is tough to adjust to, and probably not just for his daughter. Perhaps family therapy would help you two get on the same page re: the type of parenting your children will need in the future.

    I just wanted to add my voice to the posters who are saying, “if only someone would’ve been paying such close attention to me…” Depending on the type of scratching she’s doing, LW, google skin picking and trichtillomania. I started in with skin picking at about her age due to stress and an inability to express anger properly [the parts of Black Swan where Natalie Portman starts picking away at her hands are basically an exaggerated artistic rendering of my habits] and it has been HARD AS HELL breaking down those entrenched coping strategies. I struggle with it 15 years later.

    Maybe helping her Dad realize just how commonplace those types of self-harm are, and the fact that they are often NOT childish habits that just automatically disappear, would help convince him to pay serious attention to it right now.

    1. This is a bit of an aside, but OMG I had no idea that what I do (picking at my face) actually has a name. So thank you.

       With that being said, yes, it’s a big deal. I have scars because of the picking and scratching, which only seems to make things worse. I think k is right in suggesting that the self-harm may be enough on its own to convince your husband.

       1. oh jeebus. I didn’t know it had a name either or that any form of research on this sort of compulsive behaviour had been done, it’s always just been ‘normal’ for me. Sorry for the derail but this is a cartoon lightbulb moment for me too, so thanks k and i hear ya CorissaM

16. Hello, LW here!
    First of all, dear Captain, thank you so much for answering!
    Your script and the counterarguments seem like a really good starting point to prepare myself for The Talk.
    Also, I will start right now to make a list of the various behaviours & their triggers. Not only as an argument for my partner, but also for the potential therapist.

    Also, a big thank you to the commenters for taking such empathetic interest.
    I’m quite overwhelmed with all these responses and advice.

    Since I love talking about myself, here are some clarifications for the various comments:

    – He is not my husband, but my partner. Some commenters used this expression and I don’t really like it.

    – Yes, both my partner and me had abusive childhoods, but in a very different way. He was beaten and neglected and ran away as a 13-year-old. He’s come a long way since then & always analyses and reflects his parenting so he won’t become like his own parents.
    I was emotionally abused by my father, but mostly had a close & healthy relationship to my mother. I had a lot of therapy, starting when I was 15, and “the big issues” are definitely resolved.

    – The problem does absolutely not lie in the current living situation. The stepdaughter was difficult before I met her father. I remember, when we first started dating, she had this phase of refusing school. She would go, but just sit on her place and doodle and ignore the teacher. She doesn’t do that anymore. So it actually got better already!

    – We have weekly talks with the teacher at school. Don’t get me started on the long list of issues. And the guilt-tripping! According to the teacher, everything’s my fault!

    – This may sound deluded, but my own son is quite healthy. I am not divorced, his father and me broke up before the birth. But the two of us were never alone, we have an astoundingly big support group consisting of my mom, my stepdad, my sisters, the paternal grandparents etc… He is one lucky boy, being loved and cherished by everyone, and I hope he will never find out how much I had/have to work my ass off so he would not feel neglected, ever. When the stepdaughter acts up, my son is not invisible – I talk to him about what happened afterwards & how it makes him feel. I try to spend as much quality time as possible alone with him.
    (Interestingly, the children seldom fight. They surprised us by becoming close friends. Which is awesome!)

    – Concerning the scratching: the girl only scratches herself, she shows no aggressions (except verbally) towards others. She has neurodermatitis, so there’s an “official” explanation – or rather, excuse… Cause it usually goes like this: we fight, she gets sent to her room, she starts scratching herself until she bleeds and then plays with the blood and tries to keep it flowing and then shows us. This is not her neurodermatitis.

    – I live in Germany. The health care system here is quite different (yay for free health insurance!). When I said: “the girl needs therapy”, a family therapy was implied – I didn’t even know there was any other form for children this young. The root of the problem lies in the relationship of and to the parents; you can’t fix that from just one side, everyone has to be involved.

    I’m sorry if my letter sounded like I view my stepdaughter as some kind of freak who terrorizes our peaceful family. Most of the time, we get along great. And whenever she does act out, my first reaction is a strong urge to shoot the mother, not the child.

    I hope I covered all the bases now, sorry if it got too long.
    And again, thanks for all your interest & helpful suggestions!

    1. Hi Libelle!

       I’m from Germany as well and would like to throw the following suggestions into the ring (in addition to the great advice already given!).

       1. You could try contacting the Jugendamt (German child services) for support. They offer “Familienhelfer/-beratung” (family help, family assistance) and/or could give you addresses of child psychologists or family therapists.

       2. There are psychologists specialised for children that age (“Kinder- und Jugendpsychologen” -> psychologists for children and adolescents). You could either ask your child’s doctor, the Jugendamt, your health insurance provider or search on the website of the your local “Kassenärztliche Vereinigung”* (Association of Statutory Health Insurance Physicians) for licensed therapists in your area.

       *(For example, you can google “Kassenärztliche Vereinigung Bayern” if you live in Bavaria and conduct a search for psychologists near you who a) are specialised for children and b) whose fees are paid for by your health insurance. (Not all psychologists/therapists are paid for by the health insurers)).

       Best of luck to you!

    2. sorry about the “husband” thing. i actually noticed that after i posted my comment but there was no way to go back and change it.

17. Hi, I just wanted to add an experience here. My youngest brother had a lot of behavioural and learning difficulties so the decision was made to see a psychologist. Best thing ever. We all went, both to family sessions and one on one. Our communication as a family drastically improved and we are still feeling the benefits ten years on, plus my little brother learned just how much we love him.

18. I want to hug letter writer. You are awesome and not an evil stepmother.

19. I’m a bit late here, but I wanted to add a thought, since I listened to a pair of Chinese-Canadian therapists talking about working in the Chinese community in Canada, where there’s a huge resistance towards therapy. They were discussing approaches they would use to explain therapy (especially “soft” talk therapy vs. CBT) to parents who didn’t want to think their kid was “crazy”.

    One they translated for me that I thought was really insightful was, “Children so often want to please their parents and make them happy. Some children care for their parents so much they’re afraid to admit they’re unhappy or they want anything, because it will seem like they’re criticizing their parents for not being good enough. They’re too young to understand their family would do anything to see them happy and successful, but parents don’t always know everything and can’t always guess what each specific child needs. If the child talks to a counsellor who is very clear about how confidentiality works, they can speak freely without judgment, and the counsellor can help them find ways to communicate their needs to their family.”

20. I’m even later…I’d say, “I see x, y, and z that have me very concerned that SD needs more help than we can give her. I’m not a professional or an expert on kids; I could be wrong. Let’s take her to talk to someone who DOES know about this stuff and they can tell us if this is totally normal for nine-year-olds or if a little extra help now would be the best things for her.”

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