As a child psychologist specializing in anxiety and behavioral problems, I frequently work with children who have either previously seen therapists or are currently in therapy that isn’t yielding effective results. Through discussions with their parents, I have identified several common factors that contribute to ineffective therapy for children. These mistakes can make the difference between a successful course of treatment and one that is ineffective—or even potentially harmful.

Fix My Kid

Parents often see their child struggling with something and understandably want to relieve that suffering. For example, “Dovid gets so angry and throws tantrums,” or “Dena gets so anxious that she curls into a ball.” Because the suffering is visible in the child, it’s natural to assume the solution lies within the child. However, the 50 minutes a child spends with their therapist each week is just a tiny fraction of their time. Expecting a child to use breathing techniques when their sister breaks their train tracks instead of exploding is the exception, not the norm.

Effective therapy for children works from the outside in. It focuses on understanding how the child’s environment might be sustaining their distress or behavioral patterns and addresses those factors first. Instead of merely updating parents, therapists should actively collaborate with parents and teachers (when relevant) as therapeutic partners. These adults, who are with the child throughout the week, can implement strategies and create the supportive environment needed to make a meaningful difference.

Encourage Rumination

Some therapists, often with the best of intentions, encourage children to increase their awareness of “negative emotions,” discuss these feelings and explore why they occurred. While this can be useful for gathering assessment data, therapy may inadvertently turn into a venting session. This approach can make children more sensitive to and impacted by their emotions, potentially amplifying their distress. Additionally, when a child is socialized—explicitly or implicitly—to strive for “positive emotions,” they may develop less tolerance for feelings of anxiety or other forms of discomfort. This limitation can hinder their ability to cope effectively. Instead, helping a child focus outward on the task at hand fosters resilience, builds self-efficacy and ultimately enhances emotional well-being.

Diffuse Goals and No Timeline

Therapy for children should address a specific, identifiable problem using evidence-based treatments, with measurable desired outcomes and a projected timeline. This process should be guided by a working case conceptualization that theorizes how environmental, psychological or behavioral factors are maintaining the problem. While certain circumstances may extend the timeline, it’s important to troubleshoot the conceptualization if progress stalls.

The notion that a child should always turn to a therapist for their problems can unintentionally undermine their relationship with their parents, effectively outsourcing an important bonding experience. Parents should clarify that, in some cases, the parent may need professional support to better help their child. However, children should understand that their parents are their primary source of comfort and support, and they can turn to them for help with any challenges they face.

Affirmation Is Not Therapy

I wish it weren’t necessary to write the following, but unfortunately, here we are. A child therapist must understand that a child or adolescent’s identity is naturally in flux, and simply affirming a declared identity is not inherently therapeutic. Parents should exercise great care when selecting a therapist for their child, especially given the growing influence of certain ideological trends within the mental health field. This is particularly crucial for children and adolescents experiencing distress or confusion about their gender.

Therapists influenced by these ideologies risk solidifying an evolving identity prematurely, even encouraging irreversible medical interventions. Recognizing these risks, many European countries have reconsidered this approach. Instead, they advocate for thoughtful, exploratory psychotherapy that seeks to understand and address underlying challenges contributing to a child’s distress or confusion.

This issue has led some parents to lose trust in the mental health field altogether, which is a tragic loss for families who genuinely need therapeutic support. Thoughtful, evidence-based therapy that prioritizes exploration over affirmation is essential for helping children and adolescents navigate their developmental journeys safely and effectively.

In short, not every child needs therapy, and not every problem a child faces can be resolved through therapy. When there is an identifiable psychological issue, success is more likely when working with a therapist who specializes in that issue, collaborates closely with parents and schools (when relevant), and employs a goal-oriented, time-limited, developmentally appropriate and evidence-based approach.

Finding a skilled child therapist can be challenging, but selecting one who understands and applies these principles can make all the difference in helping your child thrive.

Dr. Elliot Kaminetzky is the founder and clinical director of The Center for Child Behavioral Health, childbehavioralhealth.com.