Children in psychodynamic psychotherapy: changes in global functioning

Abstract

This study was part of the Erica Process and Outcome Study. The aim was to investigate if children's global functioning improves after psychodynamic psychotherapy. Variables that may predict changes in global functioning were examined both statistically and qualitatively, for example, the child's age and gender; diagnosis and comorbidity; treatment variables. The sample consisted of 33 children (five to 10 years of age) who participated in psychodynamic psychotherapy with parallel work with parents. Twenty-nine children had at least one DSM-IV diagnosis, and 15 children had comorbid conditions. At the start of psychotherapy, the most frequent diagnoses were attention disorder and disruptive behaviour. Child psychotherapists rated the children's global functioning using CGAS and HCAM. Large effect sizes were obtained (d = 1.80 and d = 1.98). However, no statistical correlations were found between global functioning and the selected variables. In order to illuminate the complex connection between process and outcome the study was complemented with in-depth case studies where data were taken from questionnaires, completed by the child therapists every third month. Two child therapies were selected: one in which the therapist rated a large change and one in which a small change was rated (CGAS). The analysis showed that important individual change, for example, attainment of formulated goals, was not always reflected in the change rated using the CGAS. Findings suggest that psychodynamic child psychotherapy can be beneficial. However, further research is needed to identify factors that contribute to change in children's global functioning.

Keywords:

• CGAS
• psychotherapy process
• case study
• outcome
• treatment goals
• intersubjectivity
• EPOS

Notes

1. The 14 HCAM subscales are: 1. Ability to look after own body needs. 2. Ability to learn and work. 3. Ability to tolerate frustration and control impulses. 4. Relationship with parents. 5. Relationship with siblings. 6. Relationship with peers outside the family. 7. Relationship with adults outside the family. 8. Development of confidence and self-esteem. 9. Ability to cope with very stressful events. 10. General mood, and variability of mood. 11. Sexual development. 12. Play, hobbies and interests. 13. Sense of moral responsibility. 14. Physical health resilient, not affected by emotional state.