I'm A Therapist. We Need To Be Honest About Whether Therapy Works For Children

"There is often a mismatch between what therapy requires and what children are developmentally able to do."

We often hear the phrase: you can lead a horse to water, but you cannot make it drink. It’s a useful way to think about therapy.

Therapy has enormous value. I believe in it both personally and professionally. It can offer insight, structure, and a safe space to explore difficult feelings, their origins, and what might be possible in the future. I say that as someone who has spent years training and working as a psychotherapist, and as someone who has also sat in the therapy room myself.

But something has been bothering me for some time now.

Therapy asks a great deal of the person in front of us. It asks them to take what is explored in a 50-minute session and carry it into the complexity of everyday life.

To notice thoughts in real time, reflect on feelings, and apply strategies when emotions are already running high. This relies on metacognition – the ability to think about one’s own thinking, to pause, reflect, and respond rather than react.

That is demanding for many adults. And even more so for children. Sometimes extremely hard.

In recent years, therapy – or long waiting lists for therapy – has become a default response to children experiencing anxiety, ADHD, ASD (autism), and emotional regulation difficulties. Yet many families reach the same point after weeks or months of sessions: why is nothing changing?

The answer is rarely that therapy “works” or “doesn’t work”. It is that there is often a mismatch between what therapy requires and what children are developmentally able to do.

Children live in the moment – therapy often asks them to step out of that........

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