Child Psychotherapy

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This is a review published in a British journal a while back, speaking to the question of efficacy in child psychotherapy – and ultimately, therapeutic change.  

Weisz, J.R. & Kazdin, A.E. (Eds.). (2010). Evidence-Based Psychotherapies for Children and Adolescents. Second Edition. New York and London: Guilford Press. 

 Conversations about the efficacy of child psychotherapy frequently, if not always, return to the question of the ‘mechanisms of change’ inherent in the process.  How does child psychotherapy change the individual’s behavior?  Why does this particular therapy work, and another therapy does not? How is the effectiveness of a therapy – in the real world experience of therapists – to be measured, taking into account the developmental factors of age, maturity, language ability, environmental factors, and the child’s capacity to form a relationship with the therapist. One must further consider the training and education of the therapist, as well as the therapist’s personality with all its proclivities, the therapist’s theoretical orientation and consequent preferences, along with the impact of those preferences on the clinical approach.  The challenges of understanding this process and of the persistent questions raised for the clinician as well as for the researcher continue to perplex, and to aid or hinder the determination of what we measure.

In the context of these challenges, funding sources continue to ask for the evidence – and the current volume under review attempts to shed further light on these questions, the methods, and the results of a considerable body of research – research carried out in varied settings and different methods.  The aim is not only to highlight the evident progress in researching evidence- based psychotherapies, but also to help researchers in their efforts at developing treatment programs and determining paths of further research. 

The book begins by examining the foundations of child and adolescent psychotherapy research by first setting the context – the historical perspectives, ethical issues in the research of children and adolescent treatment, offering a sound look at the developmental issues that need to be accounted for in both practice and research.  This section is followed by looking more particularly at the discrete problems or disorders and the treatments utilized for those disorders, e.g., antisocial disorders, autism, children with attention deficit or hyperactivity disorders, anorexia and substance abuse.  Interestingly, the editors have included several unique treatment approaches (and the research on those approaches), such as the Oregon Model of parent management training, and cognitive-behavioral models for treating several recalcitrant disorders, as well as the use of narrative therapies.    

In the third section of the book, the editors provide examples that illustrate the difficulties and the attempts at implementing treatment in several settings with different populations.  That is, how might clinicians make use of the ‘science’ in measurement of evidence-based psychotherapies, so strenuously investigated now by the researchers – namely, the ‘science to service’ issue.  How are the challenges to be addressed within the contexts of children in poverty, of cultural differences in the populations of children needing psychotherapeutic help, of the need for more critical programs of parent intervention? 

The editors emphasize their perspective in the final chapter on the need for clinicians to attend to the research on what some skeptics (in the clinical world) may refer to as “manual-guided treatments,” – those treatments having a prescriptive nature – and the consequent questions about the relevancy of the research to their particular clinical settings and populations.  It is noted that clinicians engaged in the ‘actual practice in mental health service settings’ do indeed need to recognize the usefulness of the research – in order to build the types of treatment and a base of evidence that will support their continued clinical work. 

The thread that runs through the book however, remains that of the challenges created in our attempts to tease out the mechanisms of change as a result of our psychotherapeutic work.  Perhaps the clinicians and the researchers in this field need to keep Rilke’s comment in mind:  “…for at bottom, and just in the deepest and most important things, we are unutterably alone, and for one person to be able to advise or even help another, a lot must happen, a lot must go well, a whole constellation of things must come right in order once to succeed.” 

 Rilke, R.M. (1934) Letters To A Young Poet. New York and London: W.W. Norton & Co. 

 Rudy Oldeschulte        roldeschulte@gmail.com

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