Dear Therapist:

My son (19) hasn't been productive for a long time. He has been in therapy for two years and it hasn't really made much of a difference. He gave me permission to speak to his therapist who basically agreed that he hasn't made much progress and that the most important thing for him is to be productive but he just isn't moving forward. The therapist himself said he considered stopping with him but is hesitant to do so if my son doesn't want to stop. Basically, he says he discussed it with him but he has a policy of not sending someone away against their will. That is good and fine for him, but this seems to be a waste of time and money and may just be enabling my son and not pushing him to make the next move. I am seriously considering telling my son I will no longer pay for therapy and that will pretty much end it because he doesn't have money of his own. Do you think that this is appropriate and can be the right move or do we never push someone out of therapy even if it's not going anywhere? 

Response:

You seem frustrated by the situation, which is entirely understandable. We all want our children to follow a path that includes happiness, productivity, and generally “moving on in life.” When their paths diverge from this, it can be difficult to simply sit back and allow things to percolate. In fact, there are times when this approach may be indicated. At other times, maintaining the status quo may contribute to problematic patterns.

Your mention a few issues. Your primary concern appears to be your son’s long-term lack of productivity. I don’t know exactly what you mean by “productive.” Nor do I know for how long he hasn’t been productive. If, for a few years your son has not been in school, has not had a job, has no social life, and spends most of his time in bed, this could be indicative of a depressive or anxiety disorder, or related to other disorders. If, since graduating from high school last year, he hasn’t really firmed up plans for his future, but has a job and spends time with friends, this is a completely different situation.

Since your son has been in therapy for two years but you haven’t mentioned any specifics, I am assuming that his situation falls somewhere in the middle. I don’t know what the goals are in therapy, but there certainly should be goals that are clearly delineated. The degree to which these goals are being reached should be periodically assessed, and your son and his therapist should have a clear sense of his progress. Not every therapist is the right fit for every client. This person may or may not be the right therapist for your son.

I understand the notion of not terminating with a client against their will. This can cause clients to feel alienated from both that particular therapist and from the therapy process in general. However, a discussion of goals and progress can help to clarify some of the vagueness that seems to be bothering you. Perhaps your son does have a clear sense of his goals and progress. If not, it is the therapist’s job to help him explore these.

I don’t know how far your son’s permission to discuss the case extends. If he consents, one option is to meet with the therapist and your son together. In this forum, you could air your concerns, and ascertain the existence and nature of goals and progress made. If progress is not being made (or possibly even if some progress is being made), the three (four?) of you could address the reason that you son wants to continue with his therapy. What does he believe he is accomplishing? Is there something that he appreciates about the therapy process? About this particular therapist? If your son can articulate goals and progress, or even less perceptible benefits, this may help to set your mind at ease. This could also be a springboard for discussion of a change in the direction of the therapeutic process, or of a switch in therapists.

Although the most important apparent, concrete goal may be increased productivity, there are underlying reasons for your son’s lack thereof. These can range from “laziness” to anxiety to low self-esteem. Although concrete goals are important, their achievement is often thwarted by disregarding of—and therefore lack of work on—the underlying issues that are causing the problems in the first place.

We have always made use of catchphrases in many areas of life. Buzzwords relating to mental health have become the norm rather than the exception. Some familiar cliches include “I’m traumatized,” “Stop gaslighting me,” and “I had a panic attack.” Some clinical terms that are constantly being overused are anxiety, depression, OCD, ADHD…and enabling. While these terms may have their place, they are often used in ways that are not productive. In fact, they can contribute to—or even cause—the problem that they refer to.

Enabling is a real thing. The term was popularized with reference to alcohol and drug use, but is used to describe the way in which people support negative behaviors in others. The negative behavior to which you seem to be referring is your son’s unproductiveness. You seem to be suggesting that your son’s therapy sessions are in some way supporting his lack of productivity.

In the past, I have written and discussed the possible negative aspects of long-term therapy. Though it can certainly be necessary in some cases, there are times when such long lasting therapeutic relationships can become a crutch on which a client can learn to become dependent. Once again, this is a concern that could be addressed in a joint session with the therapist and your son. Hopefully your son is mature enough, insightful enough, and motivated enough to thoughtfully approach the concerns that are discussed.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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