It's mostly an unwillingness with inability to cooperate while going through the motions for him. We use state aid for his appointments so therapy for him is less an outlet and more check ins while making sure his meds are going well. They can make time if he's going through a particularly rough spot but it's normally me noticing while everyone else pretends everything is fine.
He's had a few different therapists with at least one decent one. Unfortunately he doesn't like what he hears back from them since he's VERY sheltered due to alienating himself from his peers despite me telling him some of those people are trying to offer olive branches or be friends. He suffers from being a weird kid and not understanding that he needs to lower his standards a bit too.
He has a very poor understanding of how easy he has for his home life since he was an only child for 13 years of it. He's loved and he knows it. But he also goes through big mood swings that are exacerbated with mom. When she's in a bad mood, he immediately becomes defiant. They feed off each other and it quickly becomes a negative feedback loop. They have short fuses with each other which results in him breaking his courtesy rules and mom making it worse by calling him out bluntly with little tact.
Would more therapy help or from someone different? Maybe a bit. He is very much one of the has a great month or few weeks then one bad couple days just ruins it all due to the executive dysfunction and the teenage need to pour gasoline on a fire out of spite lol.