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12 Weighing Evidence for Common and Specific Factors in Psychotherapy with Children
- Johns Hopkins University Press
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CHAPTER 12 Weighing Evidence for Common and Specific Factors in Psychotherapy with Children Natoshia Raishevich Cunningham, Ph.D., Thomas Ollendick, Ph.D., and Peter S. Jensen, M.D. Because they focus on the conquest of specific symptoms, cognitive and behavioral therapies may be more effective than evocative ones in heightening the sense of mastery and in generally increasing self-confidence. They teach patients to confront situations and inner feelings they have previously avoided, thereby opening up new opportunities for learning and growth. These therapies seem effective in treating depression , and for such specific symptoms as panic attacks, compulsions and phobias. —persuasion and healing, 1991, p. 240 Since publication of the first edition of Persuasion and Healing (1961), our understanding of the necessary ingredients of effective psychotherapy has grown substantially. In the main, the book’s key insights about the centrality of empathic, healing relationships, informed by keen appreciation and respect for patients’ cultural contexts, have withstood rigorous scrutiny. Arguably, these concepts apply even more strongly to child psychotherapies, in which effectiveness depends both on the therapist’s relationships with the child and the parents and on the therapist’s understanding of the cultural context of the child’s family. Though child and adolescent psychotherapy research has lagged behind “Now you talk like a reasonable child,” said Humpty Dumpty, looking very much pleased. “I meant by ‘impenetrability’ that we’ve had enough of that subject, and it would be just as well if you’d mention what you mean to do next, as I suppose you don’t mean to stop here all the rest of your life.” —Through the Looking Glass Common and Specific Factors in Psychotherapy with Children 239 studies in adults, the literature pertaining to the treatment of children’s mental disorders has grown exponentially in recent years (Wang et al. 2003). This surge of publications has been a mixed blessing. In many ways, the field resembles the entrepreneurial decades of the 1960s and 1970s, when adult therapies ranging from abreaction to Zen far outran careful research meant to develop or evaluate them. More than 90 percent of the more than 550 “psychotherapies” claimed as useful to treat childhood disorders have not been studied empirically (Kazdin 2000). The field of child psychotherapy cries out for rigorous studies of the efficacy and effectiveness of both common and novel treatments. About ten years before Persuasion and Healing, Eysenck (1952) asserted that psychotherapeutic practices were no more effective than the passage of time, a claim that Frank and others repeatedly refuted, citing evidence from numerous well-designed studies in adults. Nevertheless, early reviews of the child psychotherapy literature (Levitt 1957, 1963) supported Eysenck’s assertion and led many clinicians and researchers to question the efficacy of psychotherapy for both adults and children. Even in more recent years, Bickman and colleagues noted that a large, expensive attempt to provide optimal mental health services for children and adolescents was of no more benefit than usual care provided to a control group, combined with the passage of time—the so-called clocksetting cure (Bickman et al. 1995; Bickman, Noser, and Summerfelt 1999; Lambert and Bickman 2004). Notably, the early discouraging reviews stimulated valuable further studies of developmental psychopathology, diagnostic nomenclature, and assessment and treatment of children and adolescents. Researchers now typically focus on the ingredients of effective care, not just how it is organized or whether it is empathic and “family friendly.” Current research in child psychotherapy seeks to determine the conditions under which certain treatments are effective, moving past the older question of whether therapy is effective. This has led to an exponential increase in studies of treatment process and outcome, using more rigorous experimental designs (Durlak et al. 1995; Kazdin 2000). Four major meta-analyses examining the effects of child psychotherapy (Casey and Berman 1985; Weisz, Weiss, Alicke, and Klotz 1987; Weisz, Weiss, Han, et al. 1995) counter the findings of Lambert and Bickman, offering good evidence that certain forms of child psychotherapy are beneficial for children and their families . Specifically, the current research suggests that some of the psychotherapies for children may be superior to waiting-list and attention-placebo conditions , although exceptions abound (Jensen et al. 2005). [18.116.10.154] Project MUSE (2024-04-17 18:59 GMT) 240 Cunningham, Ollendick, and Jensen Merely demonstrating the efficacy of therapy in general or of one particular method against placebo leaves many questions unanswered. Persuasion and Healing was prescient in highlighting the difficult next step: differentiating among therapies and demonstrating that...