Child and Adolescent Therapy

Child and adolescent therapy is a set of methods designed for a developing mind. For younger children, play is the natural language: in play therapy, puppets, drawing, stories and sand let a child show what they cannot say. Attachment-based approaches focus on the child's relationship with the parent, because that security is the base of a child's calm.

For older children and teens, cognitive behavioural therapy (CBT) is among the most common methods: the young person learns to notice thoughts, feelings and behaviour, face fears step by step and practise problem solving and calming skills. At every age parents are part of the work. Sometimes the biggest change comes from parent guidance, sessions where parents learn how to respond to their child's behaviour.

Therapy usually starts with one or two assessment sessions with the parents: the child's developmental story, when the problem began, how it shows up at home and at school, and what has been tried. The therapist then meets the child or teen to get to know them and build a safe relationship. Together, clear and measurable goals are set.

With teenagers, sessions are mostly individual and privacy matters a lot. From the start the therapist agrees with the teen and parents what stays confidential and when parents must be told, for example if there is a serious risk to the young person's safety. With younger children much of the work happens with parents, with occasional joint sessions.

Imagine a twelve-year-old girl who moved to Germany with her family two years ago. Every morning before school she gets stomach aches and begs to stay home. In session the therapist talks with her about school, friends and missing Iran, and uses a "worry thermometer" to rate her fear in different situations. It turns out her biggest fear is speaking German in class and being laughed at.

Together they build a small ladder: first a one-word answer to the teacher, then asking a classmate a question. For the last ten minutes her mother joins, to learn how to encourage her warmly and calmly instead of letting her stay home. The next week they review the steps.

Child and adolescent therapy is used for many concerns: anxiety, separation fears and school refusal, teenage low mood and depression, anger and challenging behaviour, sleep problems, grief, parental divorce, bullying, heavy phone use and adjustment after migration. For ADHD or autism, parent guidance and skills work can be part of the plan, usually alongside specialist assessment.

Research shows CBT is a well-supported treatment for anxiety and depression in children and teens, and parent training programmes have strong evidence for behaviour problems in younger children. The evidence for play therapy is promising but more mixed. No method is guaranteed, and results also depend on family involvement and regular sessions.

For a specific problem such as one anxiety, CBT courses often run about 8 to 16 sessions. Parent guidance programmes usually last a few weeks to a few months. More complex situations, where several factors meet, such as grief and migration at once, may need longer. Sessions for younger children are shorter, sometimes 25 to 30 minutes, while teen sessions are usually 45 to 50 minutes.

To be honest: online therapy usually works well for teenagers, who are comfortable on screen and often find it easier to talk from home. For children under about seven, online work mostly happens through parent sessions, and direct sessions with the child are shorter and play-based. A parent should be nearby to help if the child gets tired or restless, with simple materials such as paper, crayons and a toy at hand.

Children of immigrant families are often bilingual: they may talk about feelings in Farsi and about school in the local language. A therapist who knows both worlds can mediate cultural gaps between parents and child, for example about independence, friendships or freedom, without judgement. For children, consent from a parent or legal guardian is required, and the child's or teen's own view is heard and respected.

Online therapy does not replace in-person assessment in every case. If you are concerned about developmental delay, autism or ADHD, a specialist in-person assessment where you live, and sometimes a paediatrician, is needed. Suicidal thoughts, self-harm, a severe eating disorder or any sign of abuse require local services to be involved straight away. Online sessions are not an emergency service; in immediate danger, call your local emergency number.

When the difficulty lies mostly in relationships across the whole family, family therapy may suit better, and working with the school or school counsellor is often an important part of the solution.