Does My Child Actually Need Therapy?

It is the question parents ask me most often, usually in a slightly apologetic voice, usually after describing something they have been carrying alone for months. Does my child actually need therapy — or am I overreacting?

The question that matters is function

Distress on its own is not a diagnosis. Children are allowed to be sad, furious, frightened and unreasonable; those states are part of growing up. What clinicians look at is whether the distress is interfering with the ordinary machinery of a life: sleeping, eating, going to school, seeing friends, doing things they used to enjoy.

Signs that warrant a conversation now

• Any talk of not wanting to be here, self-harm, or hurting themselves — always, immediately, regardless of duration.
• School refusal that has lasted more than two weeks.
• Loss of interest in everything, not just one thing.
• Eating changes: restriction, secrecy, rigid rules, or distress around meals.
• Panic attacks, or avoidance that is spreading from one situation to many.
• A significant change following a specific event — a loss, a separation, an accident, a frightening experience.
• Distress that is invisible at school and enormous at home, sustained over months.

And the times I say wait

Not everything difficult is clinical. A child who is miserable for a fortnight after a friendship ends is grieving, not unwell. A child who is dysregulated in the six weeks after a house move is adjusting. A tired teenager in exam season is a tired teenager.

In these situations the most useful things are unglamorous: earlier bedtimes, predictable meals, less pressure, more time with you, and a parent who is not visibly frightened. Therapy offered too early can accidentally teach a child that ordinary hard feelings require a specialist.

What to do while you wait

1. 01
   Stabilise sleep first

   Nothing else responds well until sleep does. Consistent times, screens out of the bedroom, light in the morning.

2. 02
   Protect one daily connection point

   Ten unhurried minutes with no agenda. This is a clinical intervention, not a nicety.

3. 03
   Reduce demands temporarily

   Drop the optional commitments. Recovery needs capacity.

4. 04
   Keep a simple log

   Dates, triggers, duration. Any clinician will thank you, and patterns often show up on paper before they show up in conversation.

How to raise it with your child