If your child may be in immediate danger, call 911 or go to the nearest ER. To reach a trained counselor at any hour, call or text 988 (988 Suicide & Crisis Lifeline).
Part of our guide: A Parent’s Guide to Child and Teen Mental Health
Choose family therapy when the problem is closely tied to patterns at home or when parents are central to making change happen. Choose individual therapy when your child needs private space or focused skill work, such as for a specific fear or for depression in an older teen. Many children end up with some of each, and the first plan can change.
Research does not crown one winner. The better fit depends on the problem, your child's age and how safe and workable family sessions are right now. An evaluation can help you decide.
What each option involves
Psychotherapy for young people can involve an individual child, a group, a family or multiple families. AACAP notes that playing, drawing, building and pretending, as well as talking, are ways children express feelings and work through problems.
Individual therapy
Your child meets alone with a therapist, usually with some parent contact. The therapist might teach skills, work through thoughts and feelings, or use a structured approach such as cognitive behavioral therapy. For younger children, see this guide to play therapy.
Family therapy
AACAP says family therapy focuses on helping the family function in more positive and constructive ways. Sessions can include the child, parents, siblings and grandparents. This site's family therapy page notes that not every session requires every family member, and that sometimes working with parents first is most effective.
Parent-focused options
A third path gets overlooked. In some treatments, parents get most of the coaching, and the child may attend little or not at all. NIMH lists support and training for parents among treatment options. A related option, Parent-Child Interaction Therapy, works with parents and children and uses real-time coaching to help with behavior problems or connection.
How the two compare
| Question | Leans family or parent-focused | Leans individual |
|---|---|---|
| Child's age | Younger children, who rely on adults to change routines | Older children and teens who want private space |
| Main problem | Repeated conflict, behavior struggles, major family change | A specific fear, trauma memories, inner distress |
| Who keeps it going | The pattern involves several people | Mostly happens inside your child or outside the home |
| Child's willingness | Refuses therapy, but parents will come | Won't speak openly with parents in the room |
| Safety at home | Everyone can speak without fear | Fear, coercion or violence means joint sessions may have to wait |
This table is a starting point for conversation with a clinician. It is not a rule. It reflects common reasoning in child therapy, and the research below is narrower.
What the research says for common problems
Teen depression
A 2022 systematic review found that family therapy was not superior to other psychotherapies for depressive disorder in adolescents, with low certainty in the evidence. Either format may be reasonable, so your teen's preference and the therapist's fit deserve weight.
Suicidal thoughts
The same review found significantly better outcomes on suicidal ideation with family therapy than with comparison psychotherapies, with moderate certainty. The authors called it premature to conclude that it beats treatment as usual and asked for larger, higher-quality studies. Any teen with suicidal thoughts needs prompt evaluation and a safety plan first. This guide covers warning signs and what to do.
Childhood anxiety
In a randomized trial of 124 children ages 7 to 14, a parent-only program called SPACE was found noninferior to individual CBT for anxiety disorders. The trial was not limited to children who refuse therapy, but it suggests that working with parents alone may be an option when a child will not attend. It is one trial, and two of its authors report royalties from book publishers, so ask what is available and appropriate for your child.
Anorexia in teens
Parents are commonly involved here. A Cochrane review found limited, low-quality evidence that family therapy may be more effective than treatment as usual in the short term, with most of those studies done in adolescents and youth. It could not say whether family therapy beats other psychological treatments. Eating disorders can be medically serious, so a medical assessment matters too. See eating disorder treatment for teens.
ADHD in young children
For children under 6, CDC says the AAP advises behavior therapy first, before trying medication, and the most effective type is parent training in behavior management.
OCD
Treatment for childhood OCD centers on CBT with exposure and response prevention, and family work is often important because relatives can get drawn into rituals. See signs of OCD in children.
Five questions to help you decide
- Where does the problem show up most? If it appears mainly at home or around family conflict, family work may be a good place to start. If it appears everywhere, or mainly inside your child, individual work may come first.
- Who would need to change for things to improve? If the honest answer includes adults or siblings, family or parent sessions can make the change easier to sustain. This article on how family dynamics affect a child's mental health explains why this usually isn't about blame.
- Will your child talk with you in the room? Many teens need some private time. Others open up more when parents are present.
- Is it safe for everyone to be honest? The family therapy page notes that ongoing fear, coercive control or violence at home make safety and stabilization the priority. Tell the clinician privately if this applies.
- Can your family attend regularly? If scheduling several people is hard, ask about a mix: individual sessions for your child with regular parent meetings.
You often do not need to choose just one
AACAP notes that a combination of different approaches may be helpful at times. Common combinations include individual therapy with regular parent sessions, or family therapy added once a teen has stabilized. Separated parents may benefit from co-parenting work, described in this piece on therapy for co-parenting conflicts.
Therapy may also work alongside medication when a clinician recommends it. See therapy vs medication for children and teens.
What to ask before starting
AACAP and NIMH suggest asking questions like these:
- Why is this kind of therapy being recommended?
- Will you be meeting with just my child or with the entire family?
- What results can we expect, and how long will it take?
- How will we be informed about progress, and how can we help?
- How will progress be evaluated?
- What stays private between you and my teen? See teen therapy and confidentiality.
How to tell whether the format is working
NIMH says effective child psychotherapy often involves parents, includes skills practiced between sessions, and tracks progress over time. Those three things are useful to look for in any format. Whichever you choose, you should be able to answer a few simple questions after a reasonable stretch of sessions:
- Does your child have at least some trust in the therapist?
- Do you know what the goals are, and how you can help at home?
- Has anything changed at home or school, even in a small way?
- Does the therapist check progress and adjust the plan when it stalls?
If things are not improving after a fair trial, ask whether to adjust the format. A change in plan is a normal part of care. If you are ready to explore options, see family therapy, individual therapy or the child and adolescent page.
FAQs
What if my teen refuses family therapy?
Ask whether parent-only sessions or individual sessions could be a first step. Pressure rarely helps, and starting somewhere can make later joint sessions easier. This guide on talking to your child about therapy may help.
Does recommending family therapy mean we caused the problem?
No. The focus is on helping the family function better, and a child's difficulties usually have many causes. Family sessions can give everyone more tools.
Will my child's therapist tell me what they say in individual sessions?
Practices and laws vary, and it depends on age and safety. Ask at the start how privacy and parent updates will work.
Can one therapist do both?
Sometimes, though some therapists prefer to keep roles separate. Ask how they handle it and why.
