Finding the Right Therapy for Children

Cognitive behavioral therapy works for treating anxiety and depression.

Mother and daughter looking out window

Cognitive behavioral therapy can help children struggling with mental illnesses such as anxiety disorders, obsessive-compulsive disorders, and depression. But finding good CBT can be really tough, particularly since some child psychologists say they do CBT but don't really. It's a precise art.

Unlike talk therapy, cognitive behavioral therapy focuses on teaching the patient practical skills. A depressed person might get out of the house and do something enjoyable or learn to replace "I'm no good" thoughts typical of depression with "I'm pretty good at this." An anxious patient, for example, learns step by step to manage tasks that the illness has made difficult or impossible and practices those skills until they become comfortable. "One of the main vehicles in cognitive behavioral therapy for treatment of anxiety is teaching the patient how to confront what they're afraid of," says Anne Marie Albano, coeditor of a study in the online New England Journal of Medicine that showed that CBT is as good as antidepressants for treating anxiety in children and that CBT and antidepressants combined are even better. "We call this exposure."

A therapist practicing exposure with a child suffering from separation anxiety disorder would send the parents out of the office, then help the child practice staying calm. (This separation anxiety is not the "I want Mommy" kind common in toddlers but anxiety so overwhelming that it might send children running away from school in an effort to find the parent.) Over time, the child would be given new challenges—to go across the street to buy a soda by herself, say, or sit in a room alone and do homework for 15 minutes. "We will create the separations in a step-by-step way and help the kids endure these separations for a greater level of time," says Albano, psychologist at Columbia University Medical Center and the New York State Psychiatric Institute.

There's not much downside to CBT, but it does take at least 12 weeks of therapy, and most families stick with it for nine months to a year. The big plus is that CBT can make drugs unnecessary, and studies have shown that its benefits against depression persist for seven to 10 years. (It's also being investigated as a potential treatment for schizophrenia.)

If you'd like to check out CBT for treating mood disorders (it's proven to work for adults, too), a good first step is the Association for Behavioral and Cognitive Therapies. The group's website not only explains how good CBT will work but can help you find cognitive behavioral therapists in your area. The National Alliance on Mental Illness has a good primer on CBT and is a terrific resource for finding people in your state who have tracked down local treatment. A third choice: the Society of Clinical Child and Adolescent Psychology's site on evidence based treatments.

One easy test to find out if the therapist does real CBT? Albano says ask: "Do you know how to do exposure?" A good therapist will practice with the child, not just tell the parents to try exposure at home. This is a case when you really want to go with the pros.