Psychotherapy is the treatment of adjustment problems or mental disorders in a trusting relationship. In child and adolescent psychotherapy, the relationship must be built with the youngster, which may take time—but also with the parent(s). If the young person feels safe in being open with the psychologist, he will more easily be open with his thoughts and feelings and the work can advance more quickly. The youngster’s adjustment will then hopefully ease the way to better relationships with others, including parents, peers, and teachers—if any of these have been problematic.

Parents and Psychotherapy for Their Children

Often it is difficult for parents to bring a child to psychotherapy because of feelings of guilt or of not being “good enough.” But, in fact, psychotherapy can be a wonderful gift for a child for a more productive and more fulfilling life. Some parents also feel conflicted about a child developing a more open relationship with a therapist than with themselves, but if they recall their own childhood, they will usually be able to remember times that they cared so much about the feelings of their own parents that they could not be totally open. Additionally, psychotherapy with youngsters can never replace parents, but it can supplement their work with their children and give neutral consultations. Some children from early on are more challenging, or they come into the world with problems which surprise parents (for example, Attention Deficit Hyperactivity Disorder or Trichotillomania). Parents often welcome help with these and other issues, which not only impact the child, but also the whole family.

Signs and Symptoms

Generally, parents or school personnel should first talk to the child before taking the child to a psychologist. Often, this will help resolve the issue, and if not, it still can yield valuable information. Sometimes, the child can tell what is needed to solve the problem. These are some of the signs that it might be helpful to seek help from a psychologist:

• Struggling in school or poor performance in school
• Worrying much of the time
• Behaviors that seem unusual or bizarre
• Opposition to reasonable authority figures
• Problems with attention or concentration
• Hyperactivity
• Problems separating from parent(s)
• Difficulty in peer relationships
• Changes in sleeping or eating
• Negative outlook or sadness
• Physical complaints without physical basis
• Sexual acting out or inappropriate sexual behavior
• Use of alcohol or drugs
• Distorted body image
• Body focused disorders, e.g,skin-picking and hair-pulling (see section on Trichotillomania)
• Threats to self or others
• Threats of running away
• Obsessions or compulsions (see section on OCD)

How Does the Psychologist Determine the Need for Psychotherapy?

The psychologist does a thorough intake, which takes at least one session and asks lots of questions and listens as you describe your experiences over the years with your child. These are the areas that are covered:

• Child’s history
• Child’s strengths and weaknesses
• Child’s activities and interests
• Current problems and goals for therapy
• School and educational problems
• Any traumas experienced (e.g., divorce or separation of parents, death of a pet, etc.)
• Any neglect experienced (e.g., caretakers suddenly unavailable, perhaps due to no fault of their own)
• Ability to connect with adults and peers
• Sibling issues and rivalry
• Ability to cooperate with treatment
• Interventions available and most efficacious
  • Play therapy
  • Talk therapy
  • Behavior therapy, e.g., “behavior mod,” and Exposure and Response Prevention
  • Consultations with school personnel

Uniqueness of Psychotherapy for Youngsters

Psychotherapy for children and for adolescents differs from treatment for adults in some important ways:

1. Talking alone, particularly to young children, will lose their shorter attention spans very easily.
2. The impact of adults on the lives of minors cannot be underestimated, and so caretakers and sometimes teachers must also be consulted in order for treatment to be effective. 
3. The issues themselves are often different.
4. For those younger than 12 years of age, fantasy can be utilized as part of play therapy or with drawing.
5. If behavior therapy is utilized (for example, behavior modification) it will be dependent on adults for reinforcers and consistency.
6. The history taking and consistency of treatment will depend on adults.