Review of Child Psychotherapy and Research: New Approaches, Emerging Findings, Nick Midgley, et. al. (Eds) (2009). Routledge, Taylor and Francis Group. London and New York. (Published in Bulletin of the Association of Child Psychotherapists, Issue No. 212, July 2010.)
Particularly good compilation of essays on the research in child psychotherapy, addressing the skepticism about effectiveness of our work – and applicable to the whole range of child and adolescent work. The primary editor is with the Anna Freud Centre in London.
The challenge has been laid down – by policy makers, funders, and the ‘scientific’ community – to measure and to quantify and qualify the effectiveness of child psychotherapy. Skepticism has been expressed about the benefits of child psychotherapy, despite its rather obviously good results for many children, adolescents, and families; those benefits being attested to each day from the consulting rooms of therapists. Understanding – and explaining that understanding of the mechanisms of change and the processes leading to that change – have been attempted since early on in Freud’s writings. This is noted by Nick Midgley and his colleagues in this excellent collection of papers. One of the goals of this volume is the delineation of the research methods or approaches to determining the effectiveness of child psychotherapy. An equally important goal is that of examining the developmental processes that allow a child or adolescent to come to the needed change; what promotes resilience and adaptability in children? What furthers our knowledge of how children and adolescents experience, and in turn deal with, adversity or psychological disorder? How do these qualities of resilience or adaptability augment the process of therapeutic change?
The challenge may seem daunting, given that coincident with our search for more applicable methodologies for research, we must also contend with the complex developmental processes occurring in a child – and that this knowledge base is being expanded each day by new research into the physical and mental spheres of the child. Complicating the picture even further is that the authors’ contributions in this volume utilize different theoretical frameworks to explain their findings – often contrasting or conflicting perspectives.
The editors embrace this challenge with a collection of papers designed to offer us a full spectrum that examines what child psychotherapy research is, how it is studied, how the effectiveness of child psychotherapy may be evaluated, and how interdisciplinary research affords us the best opportunity for creating connections – connections that will be relevant to clinical endeavors. A “pluralistic and pragmatic approach” is stated as the ‘spirit’ of this book – and this is certainly what this book offers us – and it does so in a marvelously spirited fashion with accessible chapters from a wide variety of clinical and theoretical perspectives.
Critical evaluation of our understanding of these processes of change in psychotherapy provides us with our greatest challenge in child psychotherapy. This requirement is well described in the first chapter by Peter Fonagy. He posits that our quest to “persuade policymakers and funders” with “evidence” for our work, and its methodology, will only result from further research into systematizing our knowledge of mental processes and integrating our work with the ever-developing science of mind. Michael Rustin echoes Montaigne’s question: Que sais-je? What do child psychotherapists know? Rustin states that we know quite a lot – that our clinical work has evolved as a result of our research into mental processes of the child and of psychotherapy. He writes that this research promises the further elaboration of meaningful clinical and systematic application of developing models of theory and methodology. Historical influences on our current clinical and research work is persuasively described. At the same time, Rustin acknowledges the complexity of understanding individual people, suggesting that there may be no “code book” to which we as child psychotherapists can turn. Rather, a ‘branching tree’ of classifications may be best visualized, the branches of which have resulted from our continued cross-fertilization in research and clinical efforts with different populations of children, be they within the autistic spectrum, the depressed or anxious children, deprived or abused children, or in parent-infant disturbances. Thus, the conversation and debate about research methodology will continue to be explored on several fronts.
The first two chapters set the stage upon which the process of child psychotherapy can be studied and effectively measured within different actual work settings, and in which the clinical relevance may be utilized by other child psychotherapists. The psychotherapeutic process is elucidated in descriptions of research projects with children in temporary foster care, in the collection and organization of child psychotherapy data, utilizing unique methodologies such as the Child Psychotherapy Q Set (CPQ) to examine the process of interaction between child and therapist. Diabetic children and the importance of developing insight for diabetic control is yet another illustration of the projects undertaken, as are the outcome studies that examine how we conceptualize the change process in child work.
The next section of this volume details the evaluation of the existing outcome studies. The long term consequences, as well as the evaluative techniques that can be incorporated into our daily practice are described. Illustrations are given of working with adopted children and those in foster care, childhood depression, and the long-term follow–up study of children (now adults) that received psychoanalytic treatment when young. A fascinating framework for evaluation is described using the Hopes and Expectation Treatment Approach (HETA) – this approach examining the “interrelationships between understanding psychopathology, developmental level, and appropriate intervention,” with a view to improving practice.
The final section focuses on the collaboration of unique perspectives in looking at the issue of effectiveness in child psychotherapy: studies of the complexity of the therapeutic encounter with autistic children, clinical understanding of risk and dangerous behaviour in children, attachment in maltreated children, and the linkage to be drawn from social neuroscience research into the theory of therapeutic action.
As will be evident to readers, there is food palatable for every appetite in this collection. Clinicians and researches will gain insight into different methodologies and practical approaches to the challenges presented. This is a work that was carefully and diligently brought together by the editors – and well worth the effort in study.