Take our Do I Need Therapy?

Find a therapist near me

Labels in childhood may shape identity and future behaviour patterns.

Parent-focused interventions can reduce childhood difficulties effectively.

Changing family interactions often changes the child’s emotional responses.

When children present with behavioural, emotional, or relational difficulties, the response of adults is never neutral. The way professionals, parents, schools, and wider systems define the problem shapes not only the intervention itself, but also the child’s developing identity. Childhood is not a fixed psychological state; it is an evolving developmental process. Labels applied during this period can become powerful organising principles that influence how adults interpret behaviour and how children come to understand themselves (Link & Phelan, 2001).

Within strategic and systemic psychotherapy, an alternative model has emerged that seeks to reduce unnecessary pathologisation while maximising effective change: indirect therapy. Rather than positioning the child as the direct recipient of treatment, the therapist works primarily through parents or caregivers, who become the principal agents of intervention. This approach has been explored within the brief strategic tradition by authors such as Giorgio Nardone and other systemic clinicians (Nardone & Portelli, 2005; Portelli, Papantuono, & Gibson, 2016).

Indirect therapy is grounded in pragmatic, ethical, and developmental reasoning. It recognises that children exist within relational systems and that modifying those systems can often produce change more effectively and less intrusively than direct therapeutic intervention with the child.

Defining Indirect Therapy

Indirect therapy refers to interventions in which the individual presenting the difficulty is not the direct recipient of therapy. In childhood cases, this usually means working with parents or caregivers, who implement structured strategies within the child’s everyday environment. Parents are positioned as collaborators or co-therapists and are guided in changing interactional patterns that maintain the difficulty.

This differs significantly from many traditional child psychotherapy approaches that emphasise direct therapeutic engagement through emotional processing, play therapy, cognitive work, or diagnostic assessment. Indirect therapy instead rests on a systemic understanding of behaviour. From this perspective, problems are not viewed as isolated traits existing solely within the child. Behaviour emerges within patterns of interaction. As theorists such as Paul Watzlawick argued, attempted solutions can paradoxically become the mechanisms that maintain the problem (Watzlawick, Weakland, & Fisch, 1974). When relational patterns change, the child’s behaviour frequently changes as well.

Importantly, this principle is supported across multiple therapeutic traditions. Behavioural parent training programmes and parent management interventions........

© Psychology Today