Psychotherapy
Psychotherapy
Effective youth psychotherapy is evidence-based, developmentally adapted, and measurement-based. Know first-line modalities: behavioral parent training for disruptive behavior in young children; exposure-based CBT for anxiety and OCD; CBT for depression; IPT-A and DBT-A for adolescent mood/emotion dysregulation; TF-CBT for trauma; family-based treatment for eating disorders; and social skills/parent-mediated interventions for ASD. Common factors-alliance, expectancy, collaboration-matter, but they do not replace disorder-specific mechanisms such as exposure, reinforcement, or cognitive restructuring. Consent, assent, confidentiality, and its limits must be explained. Parent involvement is often essential, especially for children, but adolescent autonomy needs balancing.
Traps: choosing supportive therapy for OCD or anxiety when exposure is indicated; applying adult CBT language to a young child; ignoring family accommodation; and failing to monitor outcomes. Questions may ask what to do first-usually psychoeducation and evidence-based therapy matched to the disorder, not polypharmacy.
Worked example/rule of thumb: A 7-year-old with OCD and family accommodation should receive ERP with caregiver involvement, not reassurance-based counseling. Rule: match the modality to the disorder and developmental stage; measure symptoms and function regularly.
Family and Systems Interventions
Family and systems interventions
Family and systems thinking examines circular patterns, boundaries, hierarchies, triangulation, and the child's symptom as embedded in relationships and contexts. Understand models: structural (boundaries, hierarchy), strategic/systemic (feedback loops), and family-based treatment for anorexia, which empowers parents to refeed. Psychoeducation, parent training, communication skills, and home-school collaboration are core. Cultural humility and family accommodation are key: accommodation maintains anxiety/OCD, and parental criticism or inconsistency can maintain disruptive behavior. Assess for abuse, neglect, intimate partner violence, and basic needs; mandated reporting may override confidentiality.
Traps: blaming parents for neurodevelopmental disorders; missing safety issues while focusing on "dynamics"; ignoring school and community systems; and failing to address family accommodation. Confidentiality in family work is complex-state who is the patient, what will be shared, and how secrets are handled.
Worked example/rule of thumb: An adolescent with anorexia and frightened parents: family-based treatment is first-line, with parents supported to manage refeeding, rather than individual therapy alone. Rule: identify the maintaining system-family, school, peers-and intervene there while safeguarding the child.
Consultation
Consultation
Consultation differs from treatment: the consultant advises the consultee (pediatric team, school, agency) while the primary team retains responsibility. Core competencies include role clarity, consent/assent, confidentiality, cultural humility, interdisciplinary communication, and systems awareness. In medical settings, consultation-liaison psychiatry triages safety, delirium, capacity, and disposition. In schools, recommendations should be functional and educational (accommodations, supports) rather than prescribing medication; know IDEA/504 processes. Consultation may be client-centered or consultee-centered, so clarify the question, expectations, and follow-up. Ethical traps: "curbside" advice without consent, disclosing private information, taking over care, boundary blurring, and giving recommendations outside one's expertise. Document the question, findings, formulation, and actionable recommendations.
Worked example/rule of thumb: A school asks a consultant to recommend a specific medication. The consultant should clarify consent, address functional needs, and offer classroom accommodations and referral to a treating clinician. Rule: consultative recommendations should be consented, role-appropriate, and functional-not a prescription by proxy.