Children and adolescents are the most accurate informants of their own thoughts, feelings, moods, and perceptual experiences. External behavior problems are often identified by others, yet children’s internal experiences may be largely unknown. Children often can describe their feelings in a particular situation but cannot execute therapeutic changes without an advocate’s help. Thus, child psychotherapists function as advocates for their child patients in interactions with schools, legal agencies, and community organizations. Child psychotherapists may be called on to make recommendations that affect various aspects of children’s lives.

Treatment reflects an understanding of children’s developmental levels and shows cultural sensitivity toward families and environments in which children live. Most children do not seek psychiatric treatment; rather, they are taken to psychotherapists because of a disturbance noted by a family member, a schoolteacher, or a pediatrician. Children often believe that they are being taken for treatment because of their misbehavior or as a punishment for wrongdoing.

Group formats have been demonstrated to be useful in randomized clinical trials using cognitive behavioral techniques to treat childhood anxiety disorders. Groups have been used for a wide range of clinical situations, including anger management for aggressive adolescents, social skills improvement, survivors of childhood sexual abuse and other traumatic events such as the trauma of the September 11, 2001, World Trade Center tragedy, adolescents with social phobia and obsessive-compulsive disorder (OCD), children with psychotic disorders, interventions for adolescents with substance abuse, and children and adolescents with learning disorders. Group therapy can be done with children of all ages using developmentally appropriate formats. Group therapy can be structured to address a variety of communication skills, including issues of interpersonal competence, peer relationships, and social skill. Group psychotherapy can be modified to suit groups of children of various ages and can focus on behavioral, educational, and social skills and psychodynamic issues. The mode in which the group functions depends on children’s developmental levels, intelligence, and problems to be addressed. In behaviorally and cognitive behavioral groups, the group leader is a directive, active participant who facilitates prosocial interactions and desired behaviors.

Students should study the questions and answers below for a useful review of these treatments.