Policy Statement on Psychotherapy as a Core Competence of Child and Adolescent Psychiatrists


Psychotherapy is and must remain a core competence in the practice of and training in child and adolescent psychiatry. Evidence supports the efficacy of psychotherapy* as monotherapy or adjunctively for multiple disorders in youth, including depressive disorders, anxiety disorders, trauma-related disorders, obsessive-compulsive and related disorders, disruptive-behavior disorders, emerging personality disorders, eating disorders, and substance use disorders. Competence in psychotherapeutic approaches ensures child and adolescent psychiatrists have a framework to approach and formulate a holistic understanding of the patient and family, increasing patient engagement, and individualizing treatments, including psychopharmacology. Child and adolescent psychiatrists must integrate psychotherapeutic, biological and psychosocial interventions, and by the nature of their training, inextricably combine the skills, knowledge, and mind set of the physician and psychotherapist. The ability to consistently incorporate evidence-based psychotherapeutic principles and techniques with expert knowledge of development, biology, physiology, pathology, medicine, and psychopharmacology distinguishes child and adolescent psychiatrists from other health professionals. It is imperative that teaching competence in psychotherapy, including brief and long-term individual therapy, family therapy, psychodynamic psychotherapy, and cognitive-behavioral therapy, remain a core requirement in training programs. 

Despite the increase in evidence supporting psychotherapy and continued training requirements, there remains significant variability in the role of psychotherapy in child psychiatry training programs, including supervision. This can include inadequate didactic education, insufficient time allotted for psychotherapy, and sparse psychotherapy supervision. Existing models and recommendations that purport maintaining the central role of psychotherapy in child and adolescent psychiatry training have recommended several options, including but not limited to:

  • Teaching psychotherapy as an evidence-based intervention
  • Adopting or developing models of psychotherapy didactic curricula
  • Structuring training goals for measuring competence in psychotherapies
  • Ensuring adequate time and faculty expertise for trainees to receive psychotherapy supervision
  • Allotting for sufficient time for child psychiatry trainees to practice psychotherapy
  • Assuring flexibility for programs in meeting direct supervision requirements for billing to allow more trainees to provide psychotherapy.  

Common barriers include inadequate public and commercial insurance reimbursement rates for psychotherapy delivered by child and adolescent psychiatrists, often resulting in providers not accepting insurance. Adverse outcomes include restriction to access and timeliness of medically necessary services, particularly for disadvantaged populations.

To ensure that psychotherapy remains a core competency of child and adolescent psychiatrists, the American Academy of Child and Adolescent Psychiatry recommends that:

The American Academy of Child and Adolescent Psychiatry endorses psychotherapy as a core skill of central importance to the practice and training of child and adolescent psychiatry.

* Psychotherapy refers broadly to the many evidence-based schools of psychotherapy, including but not limited to psychodynamic/psychoanalytic psychotherapies, cognitive-behavioral therapies, interpersonal therapy, dialectical-behavior therapy, relational psychotherapy, family therapies, group therapies, and use of play.


The American Academy of Child and Adolescent Psychiatry promotes the healthy development of children, adolescents, and families through advocacy, education, and research. Child and adolescent psychiatrists are the leading physician authority on children’s mental health.

Approved by Council April 2024