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Systemic family therapy has a coherent and relevant place in child and adolescent psychiatry, in association with the developmental needs of children and their parents. Its effectiveness, moreover, has been highlighted by numerous research studies. This article looks at the fundamental principles of this therapeutic approach, both in terms of the specific aspects of the setting and the theoretical options that guide the therapists’ actions: collaboration with families, absence of aetiological presuppositions, circular causality, inclusion and participation, dynamic balance, developmental perspective and teamwork.