This chapter discusses some of the more obvious choices therapists make in providing professional services to children, as well as reviews other decisions that therapists don’t learn in graduate school but often encounter in reality. It delves into the pragmatics of providing child psychotherapy with considerations for therapists who are in the trenches every day. In developmentally grounded child psychotherapy, the therapist is exploring the child’s symptoms within a developmental framework while gathering data to assist with diagnosis, treatment planning, and psychotherapy. Parents are important sources about the child’s symptoms and treatment goals and may also participate in the child’s psychotherapy. The therapist may need to teach the parent about using behavioral management skills with the child. Referring a parent to parenting classes can reinforce the parent’s feelings of importance and create a therapeutic alliance with the therapist.