Most Kids Don’t Need Therapy. They Need Healthy and Supportive Families

When I was in college, one of my best friends used to playfully adopt a rather unusual alter-ego. We called her “the cognitive distortion fairy.” Whenever one of us was caught up in rumination—obsessing over the awkward, incredibly embarrassing thing we’d done or said—she would, with the air of a benevolent fairy godmother, bop us on the head and pronounce the magic words. “That,” she would say, “is all-or-nothing thinking” (or “catastrophizing,” or whichever unhelpful thought pattern we were currently trapped in). Somehow, naming our distorted thinking really did help us snap out of it and move on with our lives.

Contrast that with the dynamic described in Abigail Shrier’s new book, Bad Therapy: Why the Kids Aren’t Growing Up. When my friend went to therapy (circa 2007), she was taught how to keep her emotions from ruling her life. Then she shared the techniques she had learned with her friends, teaching us to become more resilient, too. 

According to Shrier, that’s not the kind of therapy most kids today are getting. Instead of teaching kids to overcome their negative emotions and face their fears, she reports, parents, teachers, school counselors, therapists, and doctors are accommodating those fears and challenges, creating a feedback loop that makes kids more anxious and depressed. 

Shrier begins by devoting three chapters to the concept of “iatrogenesis,” “the phenomenon of a physician harming a patient in the course of treatment.” Specifically, she argues that “unnecessary mental health treatments”—in the form not only of actual therapy but also of “social emotional learning” and “trauma-informed” pedagogy in schools—have done more harm than good. In fact, she suggests, “bad therapy” is a major driver of the soaring levels of anxiety, depression, and suicidality among teens. When your teen struggles, she concludes, the last thing you should do is bring her to therapy. Instead, you should tell her to buck up and “shake it off.”

In his recent review here at IFS, Dr. Leonard Sax harshly critiques Shrier. Dr. Sax writes from the perspective of a practicing clinician, with an ethical and legal responsibility to provide the best possible care. As he argues, determining who is actually in crisis—who might go so far as to end their own lives—is much harder than Shrier seems to think. He worries that the book is “likely to confuse and mislead parents whose kids really need professional help.”

I write from the perspective of a parent who has indeed sought professional mental health help—for myself and my kids—and is glad to have done so. Accordingly, I started reading the book with a defensive mindset. Learning about and applying therapeutic frameworks like cognitive behavioral therapy, acceptance and commitment therapy, and internal family systems has been so helpful to me. They’ve deeply informed the way I parent. In a sort of DIY exposure therapy, for example, I’ve encouraged my kids to overcome anxiety by facing their fears—from germs and dirt during the COVID lockdowns, to the loud lunchroom at school and the highest slides at the waterpark—which has made them braver and more self-confident, more able to embrace life and meet its challenges head on. We’ve also sought support from the school counselor, a practice Shrier sees as deeply dangerous. 

Yet, as I read on, I kept finding Shrier responding to my objections, soon after they formed in my mind. Yes, some of her rhetoric is over the top, and I do think her criticisms of fellow parents sometimes lack both nuance and charity. In her discussion of gentle parenting, for example, she seems to overlook the maintenance of strong, adult-instituted boundaries that is the cornerstone of many parenting gurus’ advice. Personally, the encouragement that parental authority is what makes kids feel safe—paired with advice on helping kids name their emotions, a practice Shrier decries—was what kept me coming back to Janet Lansbury’s podcast, Unruffled, when my first two kids were toddlers. Knowing that kids need boundaries helped me hold the line in the face of tantrums and tears.

Still, despite its flaws, I do think her book can be helpful for parents. Shrier’s general approach to parenting—which encourages parents to stop overthinking everything, enjoy their quirky kids, and let them encounter the world, with all its risks—is a positive and empowering one. Her closing chapter contains some beautiful, deeply moving reflections on the vocation of parenthood. Along the way, she offers some important insights about how our hyper-individualistic culture has severed kids from the larger communities and social structures that once gave them not only a sense of belonging, but also a sense of identity that was unchosen, not self-created. She writes:

[A]sk a kid: “How are you feeling today?” as our schools now do on a routine basis, and you tear kids from that social fabric. You ask them to conceive of themselves as free radicals, hurtling through the universe without a tether. This sort of contemplation is inherently destabilizing. It may even be indistinguishable from unhappiness itself.     

To put it another way, if parents make happiness the ultimate goal, neither they nor their children will achieve it. 

Although the book is framed as a tirade against therapy, as Dr. Sax points out, it does distinguish between helpful and unhelpful therapeutic practices. Shrier specifically praises exposure therapy, “CBT’s escalating method of encouraging patients to confront things that make them uncomfortable,” noting that it “is among the few therapies with an evidentiary track record of benefits.” Yet, she reports, “School psychologists and counselors so often do the opposite: solidify a child’s worry through affirmation and accommodation.” Shrier calls out other practices parents might encounter (particularly in public schools), such as “trauma-informed” teaching and lurid mental health surveys. She devotes a whole chapter to describing the 10 steps of “bad therapy,” which may help parents spot red flags early on—if, of course, they aren’t dissuaded from seeking professional help in the first place.

The problem, as Dr. Sax notes, is that sometimes kids do experience serious mental illness. Sometimes, kids and parents need good therapy. Shrier knows this, but she doesn’t emphasize it. She consistently measures “bad therapy” against the implicit alternative, consulting psychiatric and psychological experts whose advice she clearly considers to be sound. But she doesn’t tell parents how to find evidence-based therapy or psychiatric treatment from providers who will help their kids, not harm them. 

For that, I would suggest a different book: From Survive to Thrive, by Dr. Margaret Chisholm, who is Director of the Paul McHugh Program for Human Flourishing and Professor of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine. There, Dr. Chisholm offers a framework that integrates sound psychiatric practice with a holistic vision of human flourishing, which necessarily takes place within larger community networks, such as families and churches. When paired with strong religious beliefs that lend transcendent meaning to the inescapable reality of human suffering, sound psychological frameworks can improve our self-knowledge and our parenting. And for those who do need professional help, Johns Hopkins now offers an online directory of clinicians who have been trained in the University’s signature “Perspectives Approach.”

For most parents, though, Shrier is right: we should resist the urge to pathologize our children, to allow “experts to corrode our relationship with our children,” and “downgrade how we see our daughters and sons.” As she explains,

For thousands of years, until the therapeutic turn in parenting, societies took it for granted that parents’ primary job was to transmit their values to their children…. Once parents decided the goal of child-rearing was emotional wellness, they effectively conceded that the actual authorities were therapists.

Yet, as she also notes, it is “a remarkably sturdy research finding” that “kids are happiest when raised in a loving environment that holds their behavior to high standards, expects them to contribute meaningfully to the household, and is willing to punish when behavior falls short.” 

In other words, most kids probably don’t need therapy. But they certainly do need you.  

Serena Sigillito is a writer and the editor of Fairer Disputations. Her work has appeared in outlets like Newsweek, America, National Review, Verily, First Things, and The American Conservative.