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

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 moment

Children are still learning how to identify and express emotions. They are developing the ability to link cause and effect, to reflect on behaviour, and to pause before reacting. They live in the moment, whereas therapy often asks them to step out of the moment, reflect on it, and apply that understanding later.

This is not resistance. It is development.

Even approaches such as cognitive behavioural therapy (CBT), which can be highly effective, rely on a child being able to notice, question, and shift their own thinking patterns. These are not simple skills – they are still under construction for many young people, and continue developing well into adolescence and early adulthood.

Short-term interventions can add another layer of difficulty. A child may be introduced to helpful ideas or strategies, but then expected to carry and apply them independently in real-life moments. For many children – particularly those with ADHD and autism – that is where the process breaks down.

And so we are left with an important question: are we sometimes placing too much emphasis on the therapy room itself?

When a child is struggling, it is easy for the narrative to centre on what is “wrong” within them. But in many cases, the difficulty sits in the interaction between the child and their environment. A busy classroom. A rushed morning routine. Sensory overload. Expectations that do not match how a child processes the world.

These are not background details, they are that person’s world.

So, rather than asking how to fix the child, we might begin to ask how to better support the environment around them – and how therapeutic ideas might be applied not just in sessions, but in everyday life.

This is where caregivers become central. And it can feel like an uncomfortable shift. Many parents are already stretched beyond capacity, and the idea that they hold so much influence can feel like added pressure. But it is also where the greatest opportunity lies.

Caregivers are present in the moments that matter most: the school run, the transition home, the moments of overwhelm, the recovery after distress. The ordinary, repeated experiences where emotional patterns are shaped and reshaped.

No 50-minute session can replicate that. What children often need is not just insight. They need practice. And not occasional practice, but supported, repeated, calm practice.

One way to understand this is through a “seed planting” approach.

In therapy, a child may be introduced to a strategy – perhaps breathing techniques, emotional labelling, or identifying what is within their control. But understanding a strategy is only the beginning.

For it to become useful, it must be revisited and practised in calm, safe moments. This is when the brain is most able to encode and store new learning. Over time, repetition builds pathways that make those strategies more accessible when stress rises.

Without this, expecting a child to use a strategy in the middle of distress is often unrealistic.

A simple analogy may help. Imagine standing in a large field and being asked to find your way to a specific point. The grass is long, the path unclear, and obstacles are hidden. It feels overwhelming.

Now imagine that same field, but this time a path has been cut through the grass. There are signposts along the way. A map has been drawn. Hazards have been identified and managed.

The destination is the same, but the experience is entirely different. Preparation changes what is possible.

Children need that preparation – not once, not in crisis, but over time, through repetition and relationship. These pathways are not built in a single session. They are built in daily life.

This is where the conversation around therapy becomes more nuanced.

We need to reimagine the role of therapy

It is not that therapy does not work (for areas such as attachment and relational trauma, it can be profoundly important, and I have seen this firsthand in my work in school settings), it is that therapy alone is often not enough.

For many children, particularly those who are neurodivergent, meaningful change happens when therapeutic ideas are woven into everyday life – when they are supported consistently, adapted to developmental stage, and held by the adults who are present day in, day out.

In that sense, the most effective support often happens outside the therapy room.

The challenge is not to abandon therapy, but to reimagine its role. To see it as one part of a wider system of support. And to recognise that the people best placed to bring that system to life are already there: caregivers.

For families navigating neurodiversity, anxiety, and emotional regulation difficulties, this shift can be powerful. It moves the focus away from whether a child is “failing” to engage with therapy, and towards how we can better support them to learn in a way that fits their development, their environment, and their needs.

This is why my practice has changed. I rarely see children directly in clinic now. Instead, I work with parents – equipping them with therapeutic tools that can be planted, practised, and nurtured over time. Tools that help them provide daily scaffolding in both calm and challenging moments.

Because children are not failing to use the tools they are given. More often, they are still learning how.

Psychotherapist Gee Eltringham is the founder of the parental care platform for ADHD families, twigged.