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Is Child Psychotherapy Effective? is child psychotherapy effective for children and young people? a summary of the research The Child Psychotherapy Trust is dedicated to improving the lives of emotionally damaged children by increasing their access to effective child and adolescent psychotherapy services contents introduction Acknowledgements Developing appropriate and effective mental health services for children is one of the most important 1 Introduction 1challenges facing health authorities and primary 2 The outcome of child and adolescent care groups. However, the lack of systematic psychotherapy research about interventions for children and young 3 Factors affecting the outcome of therapy people means that there is little evidence about which interventions are effective. The strategic 4 What needs to be done review of psychotherapy undertaken for the 5 References Department of Health (1996) points out that the 6 Bibliography lack of evidence does not mean that interventions are not effective, just that we need to undertake 7 Publications from the Child research to find out if they are. Psychotherapy Trust Child psychotherapists work with mental health teams in assessing children and providing support and consultation to other professionals working with children. In addition they provide treatment for children with severe problems, where other interventions have failed to help them. The contribution that child psychotherapy services can make to mental health is outlined in With children in mind: how child psychotherapy contributes to mental health services for children and young people produced by the Child Psychotherapy Trust. Meta-analysis of outcome studies of all types of child psychotherapy, including psychoanalytic, have shown that psychotherapeutic treatments for children are associated with significant improvements (Weisz et al, 1987). Overall children and young people who have received psycho- therapy show more trust, confidence, age- appropriate behaviour and a greater awareness and concern for other people than those who have not received treatment. We also know some of the circumstances that may lead to effective psychotherapy: ᭤ Younger children are likely to show larger acknowledgements changes than older ones and are more likely to be Is child and adolescent psychotherapy effective? is part well at the end of treatment. of the project, Putting Child Psychotherapy on the ᭤ Young people may make greatest improvement in Map, which is supported by the Department of Health. the first six months of treatment. Longer treatment may be required for entrenched The Child Psychotherapy Trust would like to thank the personality problems and social difficulties. many people who contributed and commented on this ᭤ Older children and young people who refer report, in particular Christine Hogg who drafted the themselves to services have better outcomes than document for the Child Psychotherapy Trust, and the those referred by others. following people who contributed to it: Christopher ᭤ Longer treatment is generally associated with Beedell, Eve Grainger, David Hadley, Jill Hodges, Eva good outcome for children Holmes, Mary Holt, Margaret Hughes, Margaret Hurst, ᭤ Intensive treatment (that is the number of Charlotte Jarvis, Trudy Klauber, Dr Sebastian Kraemer, treatment sessions a week) is important for Dr Zarrina Kurtz, Dr Andrew McCulloch, Eileen Orford, certain conditions (generalised anxiety, depression Rita Ozolins, Louise Pankhurst, Dr Mary Target. or mixed emotional and disruptive disorder). In addition the child or young person may continue 2 to improve after psychotherapy finishes. childhood. These include anxiety and depression This paper looks at the research that is available on where the distress is kept inside rather than the outcomes of psychoanalytic child expressed in disruptive behaviour. psychotherapy and the evidence for its ᭤ A retrospective study was carried out of 763 effectiveness.1 Some of the key studies are children and adolescents, who had attended the summarised in the bibliography. Anna Freud Centre over a 40 year period. 299 of these children had emotional disorders. Over 85% of the children with anxiety and depressive disorders no longer suffered any diagnosable emotional disorder after an average of two years treatment (Target and Fonagy, 1994). ᭤ Heinicke and Ramsey-Klee (1986) looked at the outcome whether psychoanalytic psychotherapy helped children aged seven to ten with reading difficulties related to emotional disturbance. of child Children were divided into three groups in which 2 the frequency of treatment sessions were set at psychotherapy either one or four times per week for two years, or once a week in the first year following by four Mental health services need to offer a range of times a week in the second. All treatments led to options for children and families, since different gains in self esteem, adaptation and the capacity interventions and services are helpful, depending on for relationships. Gains were significantly greater the individual circumstances of children and their and better sustained for groups treated four times families. Child psychotherapy, using psychoanalytic per week for one or both years. approaches, is among services that should be Young people aged 12 to 25, who attended a available in all areas for children and young people community-based psychoanalytic psychotherapy and their families who may benefit from it. Child service showed improvement, in particular those psychotherapists work with individual children, with who had social problems or were anxious and families and with groups as well as providing depressed. After one year of treatment a large support and advice to other professionals. majority of young people’s scores for emotional Severe childhood disorders seldom get better (that is internalising) problems and overall spontaneously and many disorders are associated problems had significantly improved. with poor adjustment in adolescent and adult life. Improvements in disruptive behaviour (or Brief assessment with feedback to parents can be externalising problems) were less marked because effective in helping families with younger children to according to self report assessments at intake, understand their problems better and encourage young people reported fewer of these problems. them to deal with them (Smyrnios and Kirkby, 1993). The outcome was assessed by the young people themselves, the therapist and a ‘significant other’, Children seen by child psychotherapists have more such as a parent or friend (Baruch, 1995; Baruch complex and long established problems and many of et al, 1998a). them have already failed to respond to other forms ᭤ A study of eight adolescents in hospital with of treatment (Beedell and Payne, 1987). Children obsessive-compulsive disorders, who had who receive psychotherapy continue to improve refused to co-operate with behavioural after the therapy ends (Wright et al, 1976). treatment, found that they accepted psychoanalytic psychotherapy and improved emotional disorders (Apter et al, 1984). Emotional (or internalising) disorders constitute just under half of psychological disturbance in disruptive behaviour disorders Children and young people with disruptive 1 For an overview of prevalence and effective treatment behavioural disorders (that is externalising see: disorders) show improvements with psychoanalytic Target, M. and Fonagy, P. (1996) ‘The psychological psychotherapy, though they are more likely to drop treatment of child and adolescent psychiatric disorders’, in Roth, A. and Fonagy, P. (eds.), What Works for out of treatment and the improvement is not so Whom? A critical review of psychotherapy research. marked as for internalising (that is emotional) Guilford Press. disorders. Weisz, J. R., Weiss, B., Alicke, N. D. and Klotz, M. L. ᭤ In the retrospective study of clients of the Anna (1987) ‘Effectiveness of psychotherapy with children Freud Centre, 93 children with disruptive and adolescents: a meta-analysis for clinicians’. Journal behavioural disorders, who had continued in of Consulting and Clinical Psychology, 55: 542-549. 3 therapy for at least a year, were followed up. By accelerated growth and substantial increase in the end of treatment 69% no longer warranted predicted adult height. any diagnosis (Target and Fonagy, 1994). ᭤ About 10% of babies are estimated to cry ᭤ In the treatment of children with Attention excessively. This can undermine the parents’ Deficit Hyperactivity Disorder (ADHD) research confidence and impair the relationship of the has shown there to be a substantial and long parent and child in the long term, if early help is term improvement with ‘multi-modal’ therapy of not offered. A child psychotherapist undertook a at least two years duration (including the retrospective analysis of 45 of her own cases of provision of intense individual psychotherapy, as excessive infant crying and parental difficulties. compared to brief treatment or stimulant Sometimes a few sessions were effective. What medication on its own). Treatment of at least two proved to be the important factor in successful years showed greater improvement on a variety therapy was that it was structured around the of relevant measures of adjustment and child’s needs, based on shared observation of the behaviour (Satterfield et al, 1981). A nine year infant (Acquarone, 1992). These findings were follow-up showed that 30% of the boys on supported by two case studies which stimulant medication alone had at least two demonstrated that the most
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