While psychotherapy works, how it works remains unknown. Understanding the mechanisms of effective psychotherapy is an important goal because it may suggest ways to improve therapy outcomes and service delivery. The importance of this goal is heightened for young people because of their developmental vulnerability to mental health problems. Young people are affected by high rates of mental illnesses and can be difficult to engage in treatments and services. They also represent a critical subset of psychotherapy clients as they are neurologically and developmentally distinct from adults. Considering little literature exists exploring the characteristics of therapeutic change in young people, and with the current focus on youth mental health initiatives, it is timely to redress this. To date, the limited literature on adult therapeutic change has been assumed to apply to youth. This article highlights why this is a concern that potentially stymies efforts to improve therapeutic outcomes for youth. It is proposed that an independent stream of qualitative research into therapeutic change should be undertaken to explore young people's experiences. It is argued that by understanding therapeutic change as a developmentally sensitive construct, psychological treatments can be improved for both adults and young people.