Roughly one in five U.S. children ages 3 to 17 has a diagnosed mental, emotional, or behavioral condition, yet fewer than half receive treatment from a qualified clinician. Child and adolescent therapists fill that gap. These licensed professionals treat clients under 18 and their families for issues including anxiety, trauma, ADHD, family disruption, and school refusal.

The marriage and family therapy pathway is especially well suited to this work because MFT training centers on relational and family systems, the very context in which most childhood problems develop and persist. Earning LMFT licensure typically requires a master's degree, 2,000 to 4,000 supervised clinical hours depending on the state, and a passing score on a national exam. Specialization in child and adolescent work is then built through deliberate practicum placement, caseload focus, and, for many clinicians, a post-licensure credential such as the Registered Play Therapist designation.

Steps to Become a Child & Adolescent Therapist

Becoming a child and adolescent therapist follows the same general licensure pathway as any marriage and family therapist, but the specialization is built through deliberate choices at every stage. From selecting the right practicum sites to pursuing post-licensure credentials, each step should point toward work with young clients and their families. Expect a total timeline of roughly 7 to 9 years from the start of your bachelor's degree to independent licensure.

Degree and Coursework Requirements for Child Therapy

A master's degree is the standard entry point for anyone who wants to specialize in child and adolescent therapy. Two main program types lead to clinical licensure, and the accreditation body behind each one determines which license you pursue and which states recognize your training.

Choosing the Right Program and Accreditation

Programs accredited by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) prepare graduates for LMFT licensure. Their curriculum centers on systemic and relational practice, making them a natural fit for clinicians who plan to treat children within the context of the family unit. COAMFTE programs require a minimum of 500 direct client contact hours, of which at least 200 must involve relational or family work.¹

Programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP), specifically in the Clinical Mental Health Counseling track, lead to LPC or LMHC licensure instead. CACREP programs require at least 60 semester credit hours and a combined 700 clock hours of practicum and internship, including 280 hours of direct client service.¹ Some states accept either credential for child therapy work; others favor one over the other. For a detailed breakdown of how these two licenses compare, see our LMFT vs LPC guide. Research your state's requirements before enrolling, and use the online MFT degrees page as a searchable starting point for COAMFTE-accredited options.

Coursework That Builds Child Therapy Competence

Regardless of which accreditation path you follow, look for programs that offer coursework in the areas most relevant to working with young clients:

• Play therapy: Teaches clinicians to use play as a developmentally appropriate modality for children who cannot yet articulate complex emotions verbally.
• Child and adolescent development: Covers cognitive, emotional, and social milestones so therapists can distinguish typical behavior from clinical concerns.
• Family systems theory: Provides the framework for understanding how a child's symptoms relate to dynamics within the larger family structure.
• Trauma-informed care: Equips students to recognize and treat adverse childhood experiences, attachment disruptions, and abuse-related presentations.
• Psychopathology across the lifespan: Ensures familiarity with diagnostic criteria as they manifest differently in children, adolescents, and adults.

Some programs bundle these courses into a formal child and adolescent concentration. Others offer them as electives that students can weave into a more general degree plan.

Practicum and Internship Settings for Child Specialization

Clinical fieldwork is where your child therapy identity takes shape. Seek placements in settings that guarantee consistent exposure to younger populations:

• School-based clinics, where you work alongside educators and school counselors to address behavioral and emotional concerns in real time.
• Pediatric behavioral health units within hospitals or medical systems.
• Community mental health centers that serve children and families on Medicaid or sliding-scale fee structures.
• Residential treatment facilities for youth with severe emotional or behavioral challenges.

These placements let you accumulate the supervised hours your state licensing board will require while building a clinical skill set specific to children and adolescents.

Online vs. Campus Programs

Both online and campus-based MFT or counseling programs can lead to full licensure. Online formats offer scheduling flexibility that appeals to working adults and career changers. However, practicum and internship hours must still be completed face to face with actual clients, including child and adolescent populations. If you choose an online program, confirm that the school assists with placement coordination in your area, or be prepared to arrange local clinical sites on your own. The quality of your fieldwork matters as much as the degree itself when your goal is a specialized caseload.

Questions to Ask Yourself

Supervised Clinical Hours for Child Therapists by State

Every state sets its own supervised clinical hour requirements for LMFT licensure, and the totals vary more than most prospective therapists expect. If you plan to specialize in child and adolescent therapy, understanding these requirements early lets you map out a realistic timeline and seek practicum placements that give you meaningful exposure to younger clients. For a broader overview of the licensing process, see our guide to becoming an MFT.

How Hour Requirements Differ Across States

Most states require between 2,000 and 4,000 total supervised clinical hours before you can sit for the licensing exam. Within that total, a portion must consist of direct client contact, meaning face-to-face therapeutic work rather than case notes, treatment planning, or administrative tasks. A few examples illustrate the range:

• California: 3,000 total hours, with at least 1,750 in direct client contact.
• Texas: 3,000 total hours, including 1,500 hours of direct clinical services.
• New York: 1,500 hours of supervised clinical experience following the master's degree.
• Florida: 1,500 hours of postgraduate supervised experience.
• Illinois: No separate postdegree hour mandate beyond the practicum embedded in the degree program, though applicants must complete 200 hours of direct client contact in practicum.
• Colorado: 2,000 hours of postdegree supervised practice.
• Washington: 3,000 hours of postgraduate supervised experience, with at least 1,000 in direct client contact.
• Georgia: 2,000 hours of supervised experience.
• Virginia: 4,000 hours (among the highest in the nation), with 2,000 in direct client contact.

No state currently mandates a fixed number of hours that must involve children or adolescents specifically. The child therapy focus is built through the practicum sites and caseloads you choose, not through a regulatory carve-out.

Where to Find Authoritative Information

State licensing board websites are the definitive source. The California Board of Behavioral Sciences, for instance, publishes a detailed breakdown of hour categories, supervision ratios, and acceptable practice settings. The Association of Marital and Family Therapy Regulatory Boards (AMFTRB) also maintains a state licensing comparison tool that lets you review requirements side by side.

Keep in mind that the Bureau of Labor Statistics provides useful occupational data on job outlook and median wages across states, but it does not cover licensure hour specifics. Use it to compare demand, not to plan your supervision timeline.

Tips for Verifying Requirements

Online summaries from professional associations like AAMFT or state-level MFT chapters can be helpful starting points, but they may lag behind legislative changes. If anything seems unclear or outdated, contact the licensing board directly by phone or email. Board staff can confirm current hour totals, direct contact minimums, supervision ratios, and whether telehealth hours count toward your total. Requirements do change, and a five-minute call can prevent months of wasted effort.

Finally, when selecting practicum or postgraduate employment sites, look for settings that serve children and families, such as school-based clinics, pediatric behavioral health centers, or community mental health agencies. These placements let you accumulate hours that are both licensure-eligible and directly relevant to the specialty you want to build. Understanding the difference between AMFT and LMFT designations can also help you navigate the supervised-practice stage more confidently.

Licensing Exams Mapped to Child Therapy Roles

The exam you sit for depends on the license you pursue, and the license you pursue shapes the scope of your child therapy practice. Understanding which test maps to which credential will keep you on track and prevent costly detours.

LMFT: The MFT National Examination

If you are pursuing the Licensed Marriage and Family Therapist credential, most states require the MFT National Examination administered by the Association of Marital and Family Therapy Regulatory Boards (AMFTRB). This exam tests knowledge across the lifespan, including family systems theory, child development, and relational dynamics that are central to working with young clients. While it does not contain a standalone "child therapy" section, its emphasis on systemic assessment and family-centered intervention aligns closely with child and adolescent work. For a full breakdown of the steps leading up to this exam, see our guide to becoming an MFT. Exam details, registration windows, and candidate handbooks are available at AMFTRB.org.

LPC: The NCE and NCMHCE

Licensed Professional Counselors typically pass either the National Counselor Examination (NCE) or the National Clinical Mental Health Counseling Examination (NCMHCE), both offered through the National Board for Certified Counselors (NBCC). The NCMHCE uses clinical simulations that can include child and adolescent scenarios, making it particularly relevant if you plan to specialize in younger populations. State boards vary on which of the two exams they accept, so check your state licensing board website before registering. Current content outlines and pass-rate data are posted at NBCC.org.

Psychologist: The EPPP

Licensed psychologists take the Examination for Professional Practice in Psychology (EPPP), governed by the Association of State and Provincial Psychology Boards (ASPPB). This exam covers developmental psychology, child psychopathology, and evidence-based assessment, though it spans all age groups. Doctoral-level training is required to sit for the EPPP, which is one key distinction explored in our comparison of LMFT vs psychologist credentials. Pass rates and jurisdiction-specific rules are maintained at ASPPB.org.

Navigating State Variations

Regulations differ significantly from state to state. Some jurisdictions require supplemental jurisprudence exams, and a handful specify additional child-related content areas or endorsements. The most reliable approach is to:

• Visit your state licensing board's website for the exact exam(s) required and any child therapy endorsements.
• Review the Bureau of Labor Statistics Occupational Outlook Handbook at BLS.gov for a broad overview of licensing requirements by role.
• Contact your graduate program's advising office, which often maintains updated exam-mapping guides and study resources tailored to your credential path.

Starting this research early, ideally during your first year of graduate study, gives you time to align coursework, practicum placements, and supervised hours with the license and exam that best support your child therapy career.

Child Therapist vs. Child Psychologist: Key Differences

Both child therapists and child psychologists help young clients navigate emotional and behavioral challenges, but the two roles differ in education, scope of practice, and earning potential. Understanding these differences will help you choose the path that best fits your goals and timeline.

Education and Training

A child therapist holding an LMFT or LPC credential typically completes a master's degree, which takes roughly two to three years of full-time study. A child psychologist earns a doctorate (PhD or PsyD), a commitment that usually spans five to seven years including a dissertation or doctoral project.¹ Both paths require supervised clinical experience after graduation, though the hour requirements differ. Master's-level clinicians generally complete between 2,000 and 4,000 supervised hours depending on their state, while doctoral-level psychologists typically log 1,500 to 2,000 supervised hours (some of which overlap with their doctoral training).²

Scope of Practice

Child therapists and child psychologists share the ability to diagnose mental health conditions and provide psychotherapy.³ The key distinction lies in psychological testing. Licensed psychologists are trained and authorized to administer standardized assessments such as IQ tests, neuropsychological batteries, and psycho-educational evaluations. Master's-level therapists generally cannot conduct these evaluations. Neither role includes prescribing authority in most states, though a small number of jurisdictions grant limited prescriptive privileges to psychologists who complete additional training.

Salary Comparison

The added years of doctoral education translate into higher median earnings. According to 2024 Bureau of Labor Statistics data, marriage and family therapists and similar master's-level counselors earned a median annual wage in the range of $63,000 to $64,000. Clinical psychologists, by contrast, reported a median in the range of $100,000 to $110,000. Those figures reflect all specialties within each occupation, not exclusively child-focused practitioners, but they offer a reliable benchmark. For a deeper breakdown by state and setting, see our guide to marriage and family therapist salary.

Which Path Should You Choose?

If your primary interest is providing therapy to children and families, and you want to enter the workforce sooner, the master's-level route to LMFT licensure is the more efficient choice. If you are drawn to psychological testing, research, or academic roles, the doctoral track is worth the longer investment. Many professionals start with a master's degree, build a child therapy caseload, and later decide whether additional credentials are warranted.

• Time to independent practice: Roughly 4 to 6 years for a child therapist; 7 to 10 years for a child psychologist.
• Testing and assessment: Only licensed psychologists administer formal psychological evaluations.
• Diagnosis and therapy: Both professionals diagnose and treat children.
• Median pay range (2024): $63,000 to $64,000 for master's-level therapists; $100,000 to $110,000 for psychologists.

Specialty Certifications and Credentials for Child Therapists

There is no separate "child therapy license" in any U.S. state. Your LMFT (or equivalent clinical license) is the foundation, and child specialization is layered on top through focused caseload experience, continuing education, and optional credentials that signal expertise to employers, referral sources, and families. Below are the most recognized options.

Registered Play Therapist (RPT)

The Registered Play Therapist credential, awarded by the Association for Play Therapy, is the gold standard for clinicians who use play-based modalities with children.¹ Eligibility requirements include:

• Graduate degree: A master's or doctoral degree in a mental health field.
• Licensure: A current, active clinical mental health license such as the LMFT.
• Play therapy instruction: At least 150 hours of specialized play therapy education, plus 75 contact hours in related coursework.
• Supervised experience: A minimum of 350 hours of direct play therapy practice under the supervision of an RPT-S (Registered Play Therapist-Supervisor), including at least 35 hours of play therapy supervision and five observed sessions.
• Application fee: $140, with a $60 annual renewal.
• Continuing education: 24 hours per renewal cycle, of which 22 must be in play therapy and 2 in cultural diversity.

For LMFTs who already work with young children, the RPT is a natural complement to your license and can open doors in school-based, hospital, and community agency settings.

Certified Clinical Trauma Professional (CCTP)

The Certified Clinical Trauma Professional credential, offered by the International Association of Trauma Professionals, is especially relevant for therapists treating childhood trauma and adverse childhood experiences (ACEs). The CCTP requires completion of an approved training program, a current clinical license, and documentation of trauma-focused clinical work. Because trauma exposure is one of the most common presenting concerns in child therapy, this credential helps demonstrate competence in evidence-based trauma interventions to both employers and insurance panels. You can learn more about the broader pathway in our guide on how to become a trauma therapist.

AMHCA Child and Adolescent Counseling Specialty

The American Mental Health Counselors Association offers a Child and Adolescent Counseling specialty credential. Eligibility typically requires AMHCA membership, a clinical license, documented experience working with minors, and completion of specialty-specific continuing education. While this credential is more common among licensed professional counselors, LMFTs who also hold counseling credentials may qualify and benefit from the additional recognition.

Building Competence Through CEU Pathways

Even without pursuing a formal credential, you can deepen child therapy expertise through continuing education in targeted modalities. Training in EMDR adapted for children, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and Parent-Child Interaction Therapy (PCIT) each carries strong research support and is widely recognized by clinical supervisors and hiring managers. Many of these trainings count toward your state's CEU requirements for LMFT renewal, so they serve double duty: maintaining your license while sharpening the skills that define your niche.

The bottom line is that credentials like the RPT or CCTP are valuable differentiators, but they are not gatekeepers. Consistent, supervised work with children and adolescents, paired with intentional continuing education, is the most reliable path to becoming a sought-after child therapist.

Where Child & Adolescent Therapists Work

Child and adolescent therapists practice in a wide range of settings, each presenting a distinct mix of clients, presenting issues, and therapeutic approaches. Understanding these environments can help you decide where your skills and interests align best.

Private Practice (Solo or Group)

Private practice offers the most autonomy over caseload, schedule, and clinical focus. Solo and group practices that specialize in children and teens commonly treat anxiety, depression, ADHD, adjustment disorders, and family conflict. Therapists in this setting frequently use play therapy, cognitive behavioral therapy adapted for youth, and family therapy. Because private practice relies on referrals and insurance panels, building a reputation for child-focused work takes time, but the earning potential and flexibility make it a popular long-term goal.

Schools and School-Based Health Centers

School-based therapists are embedded where children spend most of their day. They address anxiety, behavioral disruptions, social skills deficits, bullying, and learning-related stress. Sessions are often shorter, and collaboration with teachers, counselors, and parents is constant. Expressive therapies such as art therapy and play therapy are especially useful here because they meet younger children at their developmental level. The school setting also offers natural opportunities to work with the family system, not just the individual student.

Community Mental Health Agencies

Community agencies serve families who might not otherwise access care, including those on Medicaid or without insurance. Caseloads tend to be high and clinically diverse, covering trauma, substance use in the family, grief, and behavioral disorders. Therapists in these agencies often use Trauma-Focused CBT (TF-CBT), family therapy, and evidence-based group interventions. This is an excellent training ground early in a career.

Hospitals and Pediatric Medical Settings

Hospital-based child therapists work in pediatric units, emergency psychiatric departments, and outpatient behavioral health clinics. They treat children coping with chronic illness, medical trauma, self-harm, and acute psychiatric crises. EMDR and CBT are common modalities, and collaboration with pediatricians and psychiatrists is routine.

Residential Treatment Centers for Youth

Residential facilities serve adolescents with severe behavioral disorders, substance use, complex trauma, or co-occurring diagnoses that require around-the-clock clinical support. Therapists here combine individual sessions with family therapy, milieu therapy, and structured group work. The intensity of the setting demands strong crisis-intervention skills.

A Common Thread: The Family System

Across every setting, effective child therapy rarely involves the child alone. Parents, siblings, and caregivers are integral to treatment, whether through formal family sessions or parent coaching. This systemic perspective is where a marriage and family therapy background becomes a natural advantage: MFTs are trained from day one to see the child within the context of relationships and family dynamics. To learn more about what this training involves, review the guide to becoming an MFT.

For a closer look at roles and open positions in these settings, explore our MFT career paths resource.

Child & Adolescent Therapist Salary and Job Outlook

Most child and adolescent therapists are classified under two Bureau of Labor Statistics categories: Marriage and Family Therapists and Substance Abuse, Behavioral Disorder, and Mental Health Counselors. The approximate 2024 figures below show national salary percentiles alongside projected job growth for the 2024 to 2034 decade. Both occupations are growing faster than average, and child-specialized therapists who build a private practice caseload often earn above the median. For a deeper look at MFT compensation across all specialties, visit the full salary breakdown on marriagefamilytherapist.org.

Salary by Metro Area for MFTs and Mental Health Counselors

Where you practice matters. The table below compares median annual pay for marriage and family therapists and mental health counselors across the highest-paying and largest metro areas. Keep in mind that metros with the steepest salaries, particularly in coastal California and the greater New York area, also carry significantly higher living costs. A premium paycheck in San Jose or San Francisco may not stretch as far as a slightly lower salary in a metro like Nashville or Pittsburgh.

Frequently Asked Questions About Becoming a Child Therapist

Prospective child and adolescent therapists often share similar questions about education, licensing, and career development. Below are straightforward answers to the most common ones, with pointers to resources on marriagefamilytherapist.org that can help you plan each step.

How long does it take to become a child and adolescent therapist?

Plan on roughly six to eight years after earning a bachelor's degree. A master's program typically takes two to three years, followed by one to two years (sometimes longer) of post-graduate supervised clinical experience before you qualify for licensure. Building a child therapy specialization through additional training or certification may add several months. Visit the state pages under /how-to-become/ for timelines specific to your location.

Can you become a child therapist with an MFT degree?

Yes. A master's in marriage and family therapy is one of the most common pathways into child and adolescent work. MFT programs emphasize family systems theory, which is especially relevant when treating younger clients whose challenges are closely tied to family dynamics. After earning your LMFT, you can narrow your caseload and pursue specialty credentials that focus on children.

What is the difference between a child therapist and a child psychologist?

A child therapist typically holds a master's degree and a clinical license such as the LMFT or LPC, providing talk therapy, play therapy, and family interventions. A child psychologist holds a doctorate (Ph.D. or Psy.D.) and can administer psychological testing and formal diagnostic assessments. Both treat children, but psychologists undergo significantly more years of training and can perform evaluations that master's-level clinicians generally cannot.

How many supervised hours do you need to become a licensed child therapist?

Supervised hour requirements are set by each state's licensing board and vary widely, from roughly 1,500 to 4,000 hours for LMFT candidates. There is no separate hour total for a child therapy specialization; however, seeking placements focused on children during your supervised experience is the best way to build competency. Check the /how-to-become/ state pages for your state's exact requirements.

What certifications should a child and adolescent therapist get?

The Registered Play Therapist (RPT) credential from the Association for Play Therapy is the most recognized specialty certification for clinicians who work with children. Other valuable options include the Certified Clinical Trauma Professional (CCTP) designation for those treating childhood trauma, and the National Board for Certified Counselors (NBCC) specialty certifications. These credentials signal advanced competence to employers and families.

Can you specialize in child therapy through an online MFT program?

Many accredited online MFT programs offer electives or concentrations in child and adolescent therapy. Coursework can be completed remotely, but practicum and internship hours must be completed in person at an approved clinical site. Look for programs that help you arrange placements in schools, pediatric clinics, or child welfare agencies so you graduate with direct experience in this population.

Do child therapists need a doctorate?

No. A master's degree and a clinical license (LMFT, LPC, or LCSW) are sufficient to practice independently as a child therapist in every state. A doctorate is required only if you want to perform psychological testing, pursue certain academic or research positions, or use the title 'psychologist.' Most child and adolescent therapists build successful careers at the master's level.