Evidence of Effectiveness

Growing Evidence for the Effectiveness of Child and Adolescent Psychotherapy

...there is now enough research evidence to claim that psychodynamic therapy is an evidence-based treatment with effect sizes similar to or superior to those reported for other psychotherapies…it is encouraging that the benefits of psychodynamic therapy not only endure after therapy ends, but increase with time. This suggests that insights gained during psychodynamic therapy may equip patients with psychological skills that grow stronger with use. (Harvard Medical School, 2010)

Several reviews over the past few years have provided useful summaries of research on the effectiveness of child and adolescent psychotherapy.

Kennedy (2004) carried out an independent Systematic Review of research into the effectiveness of psychoanalytic psychotherapy for children and young people, while Kennedy and Midgley (2007) conducted a Thematic Review. These have recently been updated by Midgley and Kennedy (2011) - see below.

The Systematic Review found that child psychotherapy was effective in treating children and young people with:

depression
anxiety and behaviour disorders
personality disorders
learning difficulties
eating disorders
developmental issues

It was also found to be effective in helping sexually abused girls, those who have suffered early emotional deprivation, and children with poorly controlled diabetes to manage their emotional responses to their illness. Significantly, the review found that improvements were sustained or even enhanced in the long-term, with adults who had been treated as children or adolescents still feeling the benefits of psychodynamic psychotherapy many years later. This finding, which has been labelled the ‘sleeper effect’ , was clearly demonstrated in a randomised control trial of severely depressed young people. In the study, 30 sessions of child psychotherapy plus parent work were shown to be highly effective. This led to child psychotherapy being recommended in the NICE Guidelines on childhood depression, as part of a stepped-care approach.

Thematic review of process and outcome research in child, adolescent and parent-infant psychotherapy

Kennedy and Midgley (2007) completed a thematic review examining process and outcome research in child, adolescent and parent-infant psychotherapy. This highlighted that child psychotherapists are widely engaged in research into the process of psychotherapy which has helped monitor and improve clinical practice and aided the development of client-focused services.

The research reflects three important types of questions

how does child psychotherapy work;

for whom does it work - which children and young people benefit with what kind of problems, and for how long do they need treatment; and

how psychotherapy can contribute to early intervention with parents and infants, to improve sensitivity of parenting and attachment security.

These findings, along with a wide variety of state-of-the-art research contributions, form the basis of Child Psychotherapy and Research: New Approaches, Emerging Findings (Midgley, N. et al. 2009).

Critical review of the evidence base

Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base
Nick Midgley & Eilis Kennedy (2011)

Abstract: For many years psychoanalytic and psychodynamic therapies have been considered to lack a credible evidence-base and have consistently failed to appear in lists of ‘empirically supported treatments’. This study systematically reviews the research evaluating the efficacy and effectiveness of psychodynamic psychotherapy for children and young people. The researchers identified 34 separate studies that met criteria for inclusion, including nine randomised controlled trials. While many of the studies reported are limited by sample size and lack of control groups, the review indicates that there is increasing evidence to suggest the effectiveness of psychoanalytic psychotherapy for children and adolescents. The article aims to provide as complete a picture as possible of the existing evidence base, thereby enabling more refined questions to be asked regarding the nature of the current evidence and gaps requiring further exploration.

A copy of the full article can be downloaded from this page.

Researchers gather evidence that psychotherapy works - and keeps on working

An article in the February 2010 edition of Scientific American outlines new research which shows the movement to establish an evidence base for psychodynamic therapy has taken a huge step forward. Written by Raymond Levy and Stuart Ablon, the article "Talk Therapy: Off the Couch and into the Lab", reports the strongest evidence yet that psychodynamic psychotherapy works and keeps working long after the sessions stop.

Read the full article here: Scientific American

The research the article refers to is "The Efficacy of Psychodynamic Psychotherapy", Jonathan Shedler (2010) which is available on his website below. It is a very good paper and contains a useful summary of the distinctive features of psychodynamic technique.

Jonathan Shedler Website

Major new NHS-funded Randomised Controlled Trial (RCT)

Child Psychotherapists based in several areas including Manchester and the Wirral will be contributing to a major Randomised Controlled Trial of treatments of adolescent depression over the next three to five years.

The NHS has funded this very large study to compare the outcome of Treatment as Usual (psychiatric management and support and medication as necessary), Short-Term Psychoanalytic Psychotherapy (STPP) with parallel parent support, and Cognitive Behavioural Therapy (CBT). The STPP arm of the trial will be delivered by Child and Adolescent Psychotherapists. It is anticipated that the findings with have a major impact on the further development of NICE guidelines for children and young people with depression. The research aspects of the trial are being led by Professors Ian Goodyer, Cambridge University, Peter Fonagy, University College London and Jonathan Hill, University of Manchester.