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Research Summaries

There is a growing body of outcome research from the UK and abroad demonstrating the efficacy of child and adolescent psychotherapy. Below you will find summaries of some of that research.

  • NHS-funded Randomised Controlled Trial (RCT) of treatments of adolescent depression (2009 – present)

Child psychotherapists based in North London, East Anglia, Manchester and the Wirral are 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 registered with the ACP. Manuals to describe the treatment approach to young people and to parents have been written by senior child psychotherapists.

Almost 600 young people, aged between 11 and 17 and suffering from moderate to severe depression, will be seen during the course of the study. The treatments will last about 28 weeks and it is anticipated that the findings will have a major impact on the further development of NICE guidelines, which currently indicate that there is preliminary evidence to suggest that STPP is an effective treatment for children and young people suffering from depression. It is recognised that other problems often accompany these levels of depression.

The research aspects of the trial are led by Professors Ian Goodyer, Cambridge University, Peter Fonagy, University College London and Jonathan Hill, University of Manchester. The clinical work will be located in NHS Child and Adolescent Mental Health Services (CAMHS). Staff from the Tavistock & Portman NHS Foundation Trust, the Anna Freud Centre, from Cambridge and the North West have worked together closely to bring this important initiative into being.

A systematic review of the evidence base for child and adolescent psychotherapy carried out in May 2004 by Eilis Kennedy, consultant child and adolescent psychiatrist, and published by the North Central London Strategic Health Authority identified 32 distinct research studies including six randomised controlled trials, four quasi-randomised trials and ten controlled observational studies.

Kennedy noted that “a vast majority of studies were undertaken in clinically referred samples rather than samples recruited for research”, involving children with a range of diagnoses or problems and involving trained psychotherapists. This would indicate that the findings are likely to have relevance to the ‘real world’ setting.

The systematic review suggested that many of the children studied had high levels of clinical disturbance, and most of the studies made use of a broad range of outcome measures, including standardised psychiatric and psychological measures. Most studies were of children presenting with a range of difficulties, rather than one specific diagnostic group, although some studies also focused more specifically on particular diagnostic categories. Unusually, many of the studies (20) included a long-term follow-up, ranging from one-and-a-half to 40 years.

Description: Following on from the Systematic Review, above, the Thematic Review looked more broadly at other research not captured in the previous work but nonetheless of relevance to those working psychotherapeutically with children. Edited by Eilis Kennedy, consultant child and adolescent psychiatrist and Nick Midgley, child and adolescent psychotherapist and member of the ACP. Published in March 2007 by the North Central London Strategic Health Authority.

Findings: The review was limited to three distinct areas which can be categorised into three broad questions: How does child psychotherapy work; Who does it work for; and How can it contribute to early intervention with parents and infants. It reports on research with neglected and maltreated children and young people, treatment of young adults with personality disorder and those at risk of suicide, children and young people with emotional or ‘internalising’ disorders, children with physical illnesses, children with autism and children with learning difficulties. It also reports on long-term follow up and the so-called ‘sleeper effect’ of child and adolescent psychotherapy.

Conclusions: This form of research, which looks at the process of psychotherapy to find out why and how change takes place, demonstrates the willingness of child and adolescent psychotherapists to engage with research and to open their clinical practice to scrutiny. Child psychotherapy has already made important contributions to developing this form of research and is potentially in a good position to develop process outcome research because it has a strong theoretical base from which to develop models of therapeutic change.

  • Childhood depression: a place for psychotherapy. An outcome study comparing individual psychodynamic psychotherapy and family therapy (2007) [ABSTRACT in European Child and Adolescent Psychiatry]

Authors: Judith Trowell et al.

Description: A randomised control trial was conducted with 72 patients aged 9 to 15 years to examine the use of individual psychodynamic psychotherapy and family therapy as treatments for moderate and severe depression in children in young people. Published January 2007.

Findings: Significant reductions in disorder rates were seen for both individual therapy and family therapy. A total of 74.3% of cases were no longer clinically depressed following individual therapy, and 75.7% of cases were no longer clinical depressed following family therapy. The changes in both treatment groups were persistent and there was ongoing improvement. At follow-up six months after treatment had ended, 100% of cases in the individual therapy group and 81% of cases in the family therapy group were no longer clinically depressed.

Conclusions: This study provides evidence supporting the use of focused forms of both individual psychodynamic therapy and family therapy for moderate to severe depression in children and young adolescents.

  • Psychotherapy for sexually abused girls: psychopathological outcome findings and patterns of change (2002) [ABSTRACT in British Journal of Psychiatry]

Authors: Judith Trowell et al.

Description: A multi-centre psychotherapy outcome study which recruited 71 sexually abused girls aged 6-14 years who were randomly assigned to focused individual psychotherapy (up to 30 sessions) or psychoeducational group therapy (up to 18 sessions). Changes over the course of the study were monitored to compare the relative efficacy of focused individual or group therapy and to monitor psychiatric symptoms for persistence or change. Published 2002.

Findings: Both treatment groups showed a substantial reduction in psychopathological symptoms and an improvement in functioning, but with no evident difference between individual and group therapy. However, individual therapy led to a greater improvement in manifestations of post-traumatic stress disorder (PTSD).

Conclusions: The beneficial effects on PTSD support the use of individual therapy. However, the small sample size and lack of a control group limit conclusions about changes attributable to treatment.