This dissertation uses a modified systematic literature review to look at working with parents and carers within child and adolescent psychotherapy, and to consider this tasks relationship to therapeutic outcomes for children and adolescents. The topic is important because psychotherapy with children and adolescents inevitably involves additional relationships. The literature indicates the way this undertaking has been regarded has varied through the history of psychodynamic child and adolescent psychotherapy. Numerous writers reflect on the ongoing neglect and absence of systematic thinking in relation to the task of work with parents and carers. This lack of attention is understood to have been influenced by the traditional model of child and adolescent psychotherapy where the source of the child or adolescent’s distress or difficulty was regarded as being primarily intrapsychic. What is now known regarding the current and active nature of the child or adolescent’s relationship with the parent or carer, and the power and persistence of the parent-child bond has resulted in an acknowledgement of the need for a more equitable balance of focus between internal and external factors. In acknowledging that the external can no longer be seen as peripheral there are compelling clinical reasons to work with parents and carers. This undertaking should not be seen as dependant on the therapist’s orientation or interest. The significant scope of possibilities for work with parents and carers within child and adolescent psychotherapy is explored; however there is a lack of data relating to the clinical effectiveness of these approaches. The future need is for systematic thinking, and the development of practice guidelines for this clinical task.