The Single Most Important Factor Determining the Success of Child and Adolescent Therapy

In this article, I will offer clinical observations and reflections on a basic question of child therapy. When we work with children, adolescents, and families, what makes change possible? Psychotherapy with children and adolescents is a multi-dimensional process, and therapy helps children in many ways. Based on my experience as a therapist and supervisor over several decades, I have come to believe that one therapeutic attitude is more important than any other. I will present the thesis that the most important factor determining the success of child and adolescent psychotherapy, a common factor present in different clinical models, is the therapist’s ability to find what is positive in the midst of what is problematic in a child’s life and family relationships. Finding what is positive helps engage children in treatment, expands our clinical inquiry, improves family relationships, and offers children realistic hope. For many children and teens, finding what is positive helps set in motion an expanding cycle of increased engagement, confidence, and parental support. When families are stuck in repetitive, angry, and hurtful interactions, finding what is positive often shows us a way forward.