She’s 13 years old now. I first started seeing her when she was a bouncy, saucy, and distractible 7 year-old who was able to depict movement in her intricate drawings.

Yesterday, I saw her for the 53rd time since 2009. Most of those visits occurred in 2009. That is a typical treatment pattern, initially intense, followed by sporadic booster sessions. Adolescence changes treatment relationships, often from parenting-focused to an individual focus.

Unfortunately, not all kids are good candidates for individual therapy. There are certain prerequisites. I could go on and on. However, I won’t because the most important of these is that the kid needs to want to be there. This is not just practically important but legally important. In the state of Washington, children aged 13 or older have the right to consent to mental health services. Inherent in the right to consent is the right to say, “No, I don’t want to do this.”

Thirteen-year-old’s often do not want to go to psychotherapy. This particular girl had complained on two previous occasions. However, due to parental scheduling the visits were MONTHS apart. It’s important to give kids a chance to get used to seeing me again. But yesterday, she was still coming in with the attitude, “What’s the point of this?”

Yesterday, I spelled it out. I noted that when she was younger, she was enthusiastic about seeing me. I noted that currently, this was not the case. I reassured her that this was not a criticism, just an observation, and that I cared about her no matter what. I also explained her rights, now that she is a teen.

After two sessions of tight-lipped stone walling, she started talking. I knew I had used the skills called for by the situation, but I was surprised, nonetheless. I had mentioned the importance of having goals. She replied, “I can’t make a goal.” I said, “What would you like to be different in your life?”

“Nothing that I can change.”

“What would you like different about your life, without censoring your wishes?”

At this point, tears welled in her eyes. In all of the years that I have known her, I have never seen her cry.

“I wish that I never had ADHD.”

“I know. It’s incredibly hard to have something in your life that you can’t change. I imagine that people have told you that your life is about having tons of choices. But that isn’t true. You have choices about some things. Other things are completely out of your control. I am really sad that you have ADHD. I wish I could take it away from you, but I can’t. I can, however, help you feel better about having it. It is not an elimination of the problem but I can offer you the chance to have some peace with this. I can help you feel less hopeless about your future.”

Thus began a short but productive discussion. Maybe a step toward peace. Maybe the next step will take place during the next meeting. Maybe not. Growth often occurs in fits and starts.

It is so hard to have shitty unfair things in our lives. People die. People get sick. People suffer. People we love. Some of those people may even be ourselves.

I am sorry.

I imagine that people have told you than you have control over all of the events that have led to suffering.

That is not fair.

But nonetheless, there are opportunities for choice, for helpfulness, and for peace.