General Principles for Psychotherapeutic Interventions in Children and Adolescents

Childhood and adolescent psychiatric disorders often go unrecognized in our country, despite this subpopulation constituting one of the largest segments of the whole population. Proper assessment and management of different psychiatric disorders at this age are of paramount importance, which will ultimately impact the course and outcome of the particular condition at later age.[1] Although medicines/drugs are required to treat many of these disorders, psychotherapeutic interventions remain a preferred choice for clinicians as well as for parents and family members. Assessing children and adolescents throws up multiple challenges to a treating physician. First, a child/adolescent may disagree with the parents or the doctor regarding the need for consultation or would not have come for the consultation in the first place. Second, the child/adolescent could have come for an entirely different problem, whereas the main problem remains unnoticed by the caregivers.[2] Moreover, children may report their symptoms but may not provide other details, such as duration and chronology of their symptoms. They may also hide the problem if it depicts them in a bad light or are embarrassing for them. Therefore, a clinician should gather information from multiple sources, i.e., the child, parents, teachers, and other caregivers. An elaborate history-taking by an astute clinician helps in proper case formulation and embarking upon a psychotherapeutic procedure.[2] There can be discrepancies in the report; nevertheless, multi-source information minimizes error in diagnosis and management. Psychotherapy is a form of psychiatric treatment that involves therapeutic conversations and interactions between a therapist and a child or family. It can help children and families understand and resolve problems, modify behavior, and make positive changes in their lives. The term “psychotherapy” usually includes supportive, re-educative, and psychoanalytic forms of psychotherapy. All can be used to treat child and adolescent psychiatric disorders depending on the kind of problem we encounter in clinical practice. Various forms of psychotherapy that are used in the treatment of child and adolescent psychiatric disorders include acceptance and commitment therapy, cognitive behavioral therapy (CBT), dialectical behavior therapy, family therapy, group therapy, Interpersonal Therapy (IPT), mentalization-based therapy, parent–child interaction therapy, play therapy, and psychodynamic psychotherapy. Before we embark on a psychotherapeutic engagement with a child or adolescent, we must be very sure regarding the nature of the problem at hand and what exactly we need to address or which behavior we want to modify. Parents also at times come up with unusual demands which are not keeping with the changing social milieu or in direct conflict with changing times (e.g., demanding a bar on the use of mobile phones completely for a 15-year-old adolescent). This guideline outlines the special considerations that a clinician/counselor needs to make while doing psychotherapeutic interventions in children and adolescents. This guideline attempts to cover the important areas in this topic with focus on certain clinical conditions. However, this guideline is far from exhaustive and modifications may be necessary according to the clinical condition at hand. For purpose of this guideline, the term “child”/“children” will be used in references to children and adolescents. The term “child” and “adolescent” will be used for all children between 0 and 12 years of age and between 13 and 18 years of age, respectively.[2]