Research

This section features two reviews of research relevant to the ACP, the first is Child and Adolescent Psychotherapy: A Systematic Review of Psychoanalytic Approaches, the second Process and Outcome Research in Child, Adolescent and Parent-Infant Psychotherapy: A Thematic Review.

Child and Adolescent Psychotherapy: A Systematic Review of Psychoanalytic Approaches

A systematic review of the research evidence for the effectiveness of psychoanalytic child and adolescent psychotherapy was published in May 2004 by the North Central London Strategic Health Authority which has a national advisory role to other authorities for child psychotherapy training and workforce development. The review was written by Dr Eilis Kennedy and the following is the executive summary.

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Executive Summary

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Aims

To review systematically the research evidence for the effectiveness of psychoanalytic child and adolescent psychotherapy.

Methods

Database searches were conducted in the following bibliographic databases: PsycInfo; Embase; Medline; Cinahl; Cochrane; British Education Index; ERIC; Care Data; Child Data; Assissa; Index to Scientific and Technical Proceedings; Campbell Collaboration. Searches were conducted over the entire lifespan of each resource and covered the period up to February 2004. Supplementary searching was undertaken, including: hand searching of relevant journals; relevant websites; book catalogues; citation searching; contacting key researchers. Studies were included or excluded according to pre-specified criteria. A descriptive (non-quantitative) data synthesis was undertaken i.e. key study characteristics were presented in the form of a tabular summary.

Results

Thirty seven study reports met the inclusion criteria. Some of these reports represented the same study at different time points. In all thirty two different studies were identified. The key characteristics of these studies were described and presented in tables. A critical appraisal was undertaken of each study report. Thirty studies were categorised according to a design hierarchy for studies of effectiveness (Centre for Reviews and Dissemination, 2001). Five completed randomised controlled trials, one ongoing randomised controlled trial and a protocol for a randomised controlled trial were identified and come into the highest category of evidence of effectiveness. i.e. Level 1. Evidence, (experimental studies). One ongoing and three completed quasi-randomised controlled trials are in the next highest category, Level 2. Evidence, (quasiexperimental studies). Seven completed and three ongoing studies fulfil the criteria for Level 3. Evidence, (controlled observational studies) and ten studies can be considered to provide Level 4. Evidence of effectiveness (observational studies without control groups).

Main Findings

Beneficial effects were shown on a broad range of outcome measures. Most studies used standardised psychiatric and psychological measures. In addition some incorporated measures of family functioning or psychoanalytic outcome. One study was notable in focusing exclusively on physical outcomes. e.g. height, height velocity and glycosylated haemoglobin levels. The positive impact of analytic treatment on these physical outcomes provides robust confirmation of clinical change. In addition treatment led to improvements in: social and educational adjustment, behaviour, symptoms, relationships, family functioning, as well as psychiatric and psychological disorder. Adverse effects were noted in two studies. A deterioration in family functioning at follow up was identified in one study where children were treated individually with child psychotherapy in the absence of any parallel parent work. Another ongoing study which looked at the adult outcome of treatment in childhood raised the possibility that children who received insufficient treatment in childhood may be worse off in terms of their attachment security compared with an untreated control group.

The vast majority of studies were undertaken in clinically referred samples rather than samples specifically recruited for research (there were only two exceptions to this). A range of diagnoses/problems was looked at. Many of the children/young people studied presented with high levels of clinical disturbance. When the study participants were less impaired they responded to briefer, less intensive interventions. Those with more severe levels of difficulty were less responsive to treatment and often required more intensive intervention, indeed for certain disorders intensive treatment seemed necessary in order to bring about substantial change.

A number of studies comparing treatments of different intensities showed greater benefits with intensive treatment particularly at long-term follow-up. Two studies suggest that younger children are more likely to improve with treatment. Parent or family work appears to be an important component of the treatment of younger children.

The proportion of randomised or quasi-randomised studies in this review is high (33.3%) and compares favourably with the percentage of experimental/quasi-experimental studies identified when the evidence base for treatments in child mental health in total is looked at (7.4%; Fonagy et al., 2002).

Conclusions

There is evidence to support the effectiveness of psychoanalytic psychotherapy for children/young people with a range of psychological disorders. Beneficial effects are shown with treatment on a variety of outcome measures and many studies showed that improvements were sustained or even enhanced at long-term follow-up.

Process and Outcome Research in Child, Adolescent and Parent-Infant Psychotherapy: A Thematic Review

This publication follows a previous systematic review (Kennedy, 2004) which focused on effectiveness studies in the field of child and adolescent psychotherapy. The aim of this second review is to look more broadly at other research, not captured in the previous work but nonetheless of relevance to those working psychotherapeutically with children. In order to give some focus to what is a wide area of research, we have set out to limit this review to three distinct areas:

•   Researching the process of psychoanalytic child psychotherapy
•   Child and adolescent psychotherapy research in a clinical setting
•   Parent-infant psychotherapy research

In addition to the three main sections, this publication includes a substantial glossary of many of the measures and assessment tools referred to in each of the sections of the review.

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