When a child is struggling, “therapy” can mean very different things. Some kinds put the child in a room with a therapist each week. Others work mostly with parents. Some are backed by decades of trials; others by much less. Here’s a plain-language guide to the main types, and how to tell which fits.
1. Behavioral parent training
What it is: Therapy for the child that happens mainly through parents. Also called parent management training or parent behavior therapy. The therapist works with you on specific changes: more positive attention, clear instructions, rewards tied to specific behaviors, calm and consistent consequences, and steady routines. You practice in session and use it at home. The child joins some sessions, more as they get older.
The evidence: For defiance, aggression and meltdowns in children 12 and under, parent behavior therapy is the best-established treatment there is (Kaminski & Claussen, 2017). The American Academy of Pediatrics recommends it as the first treatment for preschoolers with ADHD (Wolraich et al., 2019).
Best for: Tantrums, defiance and power struggles, bedtime and sleep problems, attention and impulsivity, and young children generally.
2. Parent-based treatment for anxiety
What it is: A close cousin of the above, aimed at worry and fear. Parents learn to respond to an anxious child with confidence that the child can cope, and to step back gradually from the reassurance and workarounds that keep anxiety in charge.
The evidence: In a randomized trial of children 7 to 14 with anxiety disorders, a parent-only treatment of this kind did as well as cognitive behavioral therapy with the child (Lebowitz et al., 2020).
Best for: Anxious children, especially those who won’t or can’t engage in therapy themselves.
3. Cognitive behavioral therapy (CBT)
What it is: Therapy with the child that looks at how emotions, thoughts and behavior affect each other, and builds practical skills: noticing and naming feelings, calming the body, facing feared situations in small steps, and solving problems. With children, parents are usually involved too.
Best for: Anxiety, low mood, and older children who can reflect on their own feelings and practice skills between sessions.
4. Family therapy
What it is: Therapy that treats the family as the unit, since a child’s difficulties are shaped by what happens around them. Sessions may include the whole family, some members, or only the parents.
Best for: Divorce and two-home transitions, conflict that involves several family members, and situations where parents disagree on how to respond. Behavioral parent training is one form of family therapy focused on the child.
5. Play therapy
What it is: Therapy with the child that uses play as the main way of communicating, since young children often can’t put feelings into words. Approaches vary a great deal, from child-led play to more structured, skill-focused play.
Best for: Young children working through a hard experience, where building a relationship with a therapist is part of the goal. For behavior problems in young children, the research supports working through parents more strongly.
6. Art therapy
What it is: Therapy that uses drawing, painting and other creative work as a way to express and process feelings, guided by a trained art therapist.
Best for: Children who find talking hard, and as a complement to other treatment.
How to choose
A few questions help narrow it down:
- How old is your child? The younger the child, the more the research favors working through parents. Under 5, almost all of the work is with parents.
- What’s the main problem? Behavior, sleep and attention problems respond best to behavioral approaches. Anxiety responds to parent-based or child CBT approaches.
- Will your child engage? If not, parent-based treatment can still help a lot, because it doesn’t depend on the child taking part.
- Is it backed by research for this problem? It’s fair to ask any therapist what the evidence is for what they’re proposing.
Where Alpine Family Therapy fits
Child therapy at Alpine Family Therapy is behavioral parent training for children from toddlers to 13: mostly sessions with parents, with your child joining as their age and needs call for. See the problems families bring us, or send us a message to talk it through.