Working with children who resist therapy can feel like one of the biggest challenges in mental health care. These are the kids who refuse to talk, avoid sessions, or become defiant when asked to engage. For parents and clinicians alike, the resistance can be frustrating and sometimes heartbreaking. But psychologists and therapists say that therapy-resistant children are not beyond help. With the right mix of patience, creativity and persistence, it’s possible to break down those walls and help even the most reluctant children move forward.

Psychologist Jay Anderson has seen it many times before. Over more than a decade of working with children, she can count only a handful of cases where therapy has failed completely. Most children, she explains, are not unhelpable — they simply haven’t yet been offered the approach that clicks for them. “I’ve seen hundreds of children in therapy, and I can only think of a couple who didn’t respond at all,” she says. Children may push back, but once trust is built and they are given a way to express themselves that feels safe, things begin to change.

One example Anderson recalls is a child with severe anxiety who had withdrawn from almost all aspects of life. The family, believing they were protecting their child, kept them home from school and excused them from outings. “The child was fine in their opinion, as there were no tantrums when the child was allowed to avoid circumstances or situations that increased the anxiety.” But really, avoidance was ruling their life.

Resistance comes in many forms. Some children refuse to talk, convinced that nothing will ever help. Others disengage quietly, turning their body language into a wall of silence. There are those who come angrily, lashing out at the very idea of therapy. And sometimes, as Anderson explains, children are so entrenched in hopelessness, particularly in cases of depression, that they genuinely believe no intervention could possibly work. These children may require more intensive interventions through specialist services.

But Anderson stresses that these situations are rare. The majority of children, even those who resist strongly at first, will eventually engage when therapy meets them on their level. “Even children who are aggressive or don't want to attend will connect with a therapist who is listening and non-judgmental,” says Andersen.

This is where creative and play-based therapies help. While adults often work best with traditional talk therapy, children usually need another outlet. Art, music, sand-play, drama and movement can all open up pathways to expression that words alone cannot. Children may not be able to explain what they feel. But give them paints or clay or a story to act out, and suddenly their inner world starts to show itself. Therapy becomes less threatening and more natural.


Occupational therapist Deb Hopper at Life Skills 4 Kids also works with children who resist therapy, especially those with anxiety. She points out that many of these children are not being oppositional at all: their bodies are simply overwhelmed. “They’re often stuck in a stress response,” she explains. “Their amygdala and limbic system are on high alert and overload, and their frontal cortex is unable to reason and think through strategies.”

For Hopper, the first step is always to calm the body. That might mean deep pressure through massage, rolling a therapy ball over a child, or placing a weighted object on their lap. Sometimes it’s done through playful activities that feel fun rather than clinical. “When we calm the body, the limbic system is calmed, and the frontal cortex can come back online, and we can support them to get a strategy together,” says Hopper.

From there, therapy can gradually move into breaking down challenges into smaller steps. Social stories, sensory stories, and task analysis are some of the tools Hopper uses to help children see problems as more manageable. These stories not only reinforce calming strategies but also build confidence that a big, scary task can be tackled one step at a time. “When the child is calm, the second step involves helping them to break down the task through task analysis into smaller sub-steps, a top-down or cognitive approach.”

Throughout this process, it’s vital to develop a trusting relationship between the therapist and the child and to use a combination of sensory or cognitive and relationship strategies to support their self-regulation and willingness to participate in play-based activities, explained Ms Hopper.

What’s changed in recent years is the way therapy is delivered. Since the pandemic, telehealth has become a normal part of mental health care for children. At first, many clinicians worried that online sessions wouldn’t work for younger clients, but therapists have found creative ways to engage. Online drawing tools, interactive games, and even showing pets or toys on screen can create a connection. For some children, especially those with social anxiety, being in their own home during therapy reduces stress and allows them to participate more fully.

Another important shift has been the wider adoption of trauma-informed practice. Many children who resist therapy are not simply being difficult; they may be protecting themselves from re-experiencing trauma or from feeling vulnerable. By recognising this, therapists can respond with patience and compassion rather than frustration.

Despite the progress, the work can still feel slow. Parents often worry when sessions don’t seem to “work” immediately. But clinicians emphasise that progress with therapy-resistant children is measured in small wins: a moment of eye contact, a shared laugh, the willingness to come back next week.

Even when a child resists, it doesn’t mean therapy has failed. Resistance is often a sign that the child needs a different approach, a slower pace, or more safety in the relationship. With creativity, persistence and compassion, therapists can help children break through barriers and find new ways to thrive.