What is the effectiveness of child psychotherapy; does it work under real-world conditions? Surprisingly little research has been directed to answer this question. Lee, Horvath, and Hunsley (2013) found only 20 studies examining the effectiveness of psychotherapy for children and adolescents under real-world conditions. With respect to anxiety and depression, 80% of youths participating in behavioral, cognitive, or interpersonal therapy for anxiety or depression completed treatment. Furthermore, 65% of youths responded to treatment; after completion, their functioning was similar to youths without these mental health problems. With respect to conduct problems, 81% of families who participated in behavior therapy completed treatment. On average, 69% of youths who received therapy had better outcomes than youths who did not receive treatment. Outcomes varied considerably, however, with some studies showing large improvements in behavior and others showing no symptom reduction.
Altogether, these findings suggest that child psychotherapy is effective under real-world conditions. It is noteworthy, however, that all of the studies showing the effectiveness of therapy examined treatments that had previously been shown to be efficacious under optimal conditions. As long as clinicians rely on evidence-based treatments in their practice, they can be reasonably confident that they will help their clients (Weisz et al., 2013).
Review
Meta-analysis shows a medium overall effect size for child and adolescent psychotherapy (ES = .46). Youths who receive therapy have approximately one-half standard deviation better functioning than youths who do not receive therapy.
The dodo verdict describes the tendency for all psychotherapies to be equally efficacious. Although the dodo verdict applies to adult psychotherapy, some data suggest that behavioral and cognitive therapies may be more efficacious than other therapies for children.
Efficacy refers to the effects of therapy under ideal conditions; effectiveness refers to the effects of therapy under real-world conditions. Most research indicates that child therapy is both efficacious and effective.
Key Terms
Academic achievement:TKnowledge and skills that children learn through formal and information educational experiences; typically reflects reading, math, and written languageAffect:TA child’s short-term emotional expression; assessed by observationBehavior therapy:TA system of psychotherapy that focuses on children’s overt actions; tries to change behavior by altering environmental contingencies that either elicit the behavior or maintain it over timeCognitive therapy:TA system of psychotherapy that focuses on children’s thoughts; identifies and challenges cognitive biases or distortions that contribute to maladaptive actions or emotionsCommon factors:TFeatures shared by all forms of effective psychotherapy, including a supportive relationship, a plausible explanation for the person’s problem, and a method for alleviating that problemConstruct validity:TThe degree to which test scores assess the construct of interest; usually supported by strong correlations with similar constructs (convergent validity) and weak correlations with dissimilar constructs (discriminant validity)Content validity:TThe degree to which test items are relevant to the construct of interest; usually supported by asking experts to rate each itemCriterion-related validity:TThe degree to which test scores can be used to infer a probable standing on some external variable of interest; usually supported when test scores are associated with outcomes at the same point in time (concurrent validity) or in the future (predictive validity)Cultural formulation interview:TAn interview used to gather information about families’ racial, ethnic, and cultural identities and how these identities affect their current problems, strengths, and preferences for treatmentCulturally adapted treatment:TModifying evidence-based psychotherapy to fit families’ social–cultural context and valuesDiagnostic interview:TThe most common assessment technique in which the clinician collects data regarding the child and family’s presenting problem, history, and current functioningDodo verdict:TA term used to describe the finding that no single system of psychotherapy works best under all circumstancesEffectiveness:TThe effects of therapy under real-world conditions (e.g., therapists using a wide range of treatment approaches, clients with comorbid problems)Efficacy:TThe effects of therapy under optimal conditions (e.g., well-trained and closely supervised therapists, carefully selected clients with single problems)Family systems therapy:TA system of psychotherapy that views the entire family as the “client”; improvement in one member’s behavior will necessarily change all members of the familyFunctional analysis of behavior:TAn assessment technique in which the clinician attempts to identify the antecedent events that elicit a behavior and the environmental consequences that maintain it over timeInsight:TDuring a mental status exam, the degree to which the child recognizes that he might have a psychological problemIntelligence:TA broad construct related to people’s abilities to adapt to their environments, to solve problems, and to learn and use information accurately and efficientlyInterpersonal therapy:TA system of psychotherapy that focuses on the quality of children’s relationships with others and helps them cope with changes to these relationships over timeIntersectionality:TA term used to describe the way a person’s social–cultural factors and/or identities interact to either promote or hinder their developmentJudgment:TDuring a mental status exam, the child’s ability to consider the consequences of behavior before actingMental status exam:TA brief assessment of the child’s current functioning in three broad areas: (1) appearance and actions, (2) emotion, and (3) cognitionMood:TA child’s long-term emotional disposition; usually assessed by self-reportMulti-informant assessment:TThe process of gathering data from several different people (e.g., parents, teachers, child) to obtain an estimate of children’s functioning across settingsMultimethod assessment:TThe process of gathering data in a number of different ways (e.g., self-report, observation, testing) to obtain a more complete picture of children’s functioningNorm-referenced tests:TTests that yield scores that quantify the degree to which a child’s performance on the test deviates from the scores of his or her peersNormal distribution:TA bell-shaped distribution of scores in which most children earn scores near the mean and fewer earn scores at the extremesOrientation:TDuring a mental status exam, the child’s awareness of person, place, and timePersonality:TA person’s relatively stable pattern of thoughts, feelings, and overt actionsPresenting problem:TThe family’s primary reason(s) for seeking helpPsychodynamic therapy:TA system of psychotherapy that focuses on unconscious thoughts and feelings that affect children’s functioning; often attends to transference—that is, the client’s attitude and pattern of responding to the therapistPsychological assessment:TThe process of gathering data about children and families in order to reach valid conclusions about their current functioning and future well-beingPsychosocial history:TA portion of the diagnostic interview in which the clinician gathers information about the child’s developmental, educational, medical, and psychological pastPsychotherapy:TA professional relationship between at least two people with the goal of alleviating distress or impairment, and promoting growth and adaptation; this goal is usually achieved by altering the client’s thoughts, feelings, or actionsRapport:TAn aspect of the therapeutic relationship in which the client believes that the therapist understands his or her feelings and is willing to participate in the initial phase of treatmentReliability:TThe consistency of scores generated by a psychological test; includes test–retest, inter-rater, and internal consistency typesStandardization:TA property of evidence-based tests; indicates that tests are administered, scored, and interpreted in the same way to all examineesStructured