How Do I Tell Her She Needs Help?

Q: I Have been in a relationship with a woman for 5 years and have an 18-year-old step-daughter who I think could really benefit from some therapy. Every time I bring this up to her, she gets really offended and has a meltdown. How can I suggest some counseling without her losing it on me?

He: As a teen-aged female, your step-daughter’s job description is to make you think that she needs therapy. Emotional outbursts, pushing back against authority and finding her identity are all going to test you. Your job as a step-dad is to just be solid, consistent and supportive. Push too hard and you’ll get the “You’re not my Dad! You’ll never be my Dad” type of response. Her mother, on the other hand, has a very tricky job description: she needs to be the one who makes suggestions to her daughter, such as the need for therapy, while still demonstrating that you are both in a position of caring about her and her welfare. You might want to stand-down about this and let her mother take the lead. If she is unable to convince your step-daughter to seek therapy, it’s probably not the end of the world. As Jen suggests below, there are many people who would benefit from therapy that do not ever receive it. As an 18-year-old, there are a lot of things that will change in her life shortly that could make the situation better. Moving out may be one of them. Be patient.

She: Unfortunately, you can’t force anyone to go to therapy. Even if you did force her (i.e. make it a condition on living in your house, spending money, being able to use the car, etc), you can’t make her really participate in therapy. She would not be the only one to go to therapy and fake it, until the therapist gives her a clean bill of health. That being said, I think that most people could benefit from a year (or more) therapy. Spending time opening up to someone that is impartial, and whose feedback you respect, can help gain insight and become a healthier, happier adult. Therapy can help to understand how your past affects your current thinking and behavior, how you are in relationships, self-esteem, goal setting, etc.

That being said, it sounds like either the way you are saying this to your daughter or the timing is making her feel like the suggestion is an insult rather than something that is coming from your heart and from a place of love. I would suggest that you and your wife sit down with her and let her know that you love her and just want her to be happy, then gently lay out the reasons why you think she should benefit from therapy. A great way to deal with resistance to treatment is to ask her to just give it a try for a pre-determined amount of time. Agree on a time frame that she will commit to (2-3 months of weekly session), at which time, if she doesn’t feel like she is getting any benefit, she is free to stop going and you will agree to not mention it again. She may be motivated by just getting you to shut up.

Another idea is to suggest family therapy. Although you were not specific, I’m sensing from her response to your therapy suggestion that there is some family tension. This might be a good way to get the ball rolling, either for you, or for all of you.

For most, the hardest part of the therapy process is finding a therapist, making an appointment, and going to the first session. I know she’s eighteen, but any way to make this process easier for her will increase the likelihood that she will agree to go.


Dr. Jen Semmes and Andy Wilson have been (mostly) happily married for eleven years (currently happily). They are the owners of Coastal Counseling therapy center in Carlsbad, California. Jen holds a license in clinical social work and a doctorate in psychology, and is a therapist at Coastal Counseling. Andy just tries to hold it together.

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