Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base

Abstract

For many years psychoanalytic and psychodynamic therapies have been considered to lack a credible evidence-base and have consistently failed to appear in lists of ‘empirically supported treatments’. This study systematically reviews the research evaluating the efficacy and effectiveness of psychodynamic psychotherapy for children and young people. The researchers identified 34 separate studies that met criteria for inclusion, including nine randomised controlled trials. While many of the studies reported are limited by sample size and lack of control groups, the review indicates that there is increasing evidence to suggest the effectiveness of psychoanalytic psychotherapy for children and adolescents. The article aims to provide as complete a picture as possible of the existing evidence base, thereby enabling more refined questions to be asked regarding the nature of the current evidence and gaps requiring further exploration.

Keywords:

• child and adolescent psychotherapy
• evidence-based practice
• effectiveness
• efficacy
• outcome studies
• psychodynamic psychotherapy

Notes

1. For the purposes of this article, the term ‘psychodynamic’ will be used as an umbrella term to cover all therapies that describe themselves as psychoanalytic or psychodynamic. Whilst psychodynamic child and adolescent psychotherapy is the specific focus of this review, the term ‘child psychotherapy’ can be used more broadly to cover all psychotherapeutic interventions with children, whatever actual model of intervention is used. There have been a substantial number of reviews and meta-analyses of ‘child psychotherapy’ research more broadly (for an overview see Fonagy et al., 2002; Weisz and Kazdin, 2010), but until now there have been very few systematic reviews of the outcome literature in the field of psychodynamic psychotherapy for children and adolescents more specifically.

2. The ‘effect size’ of a treatment is a descriptive statistic that conveys the estimated magnitude of a relationship, e.g. between the delivery of a treatment and a particular outcome. An effect size of 0.2 is typically considered to be ‘small’; 0.5 ‘medium’ and anything over 0.8 as ‘large’.

3. Cognitive analytic therapy is described as a time-limited, integrative psychotherapy which ‘arose from a theoretical and practical integration of psychoanalytic object relations and cognitive psychology’ (Chanen et al., 2008: 479). The primary author of the study confirmed that he considered it as a ‘psychodynamic treatment’ (Chanen, personal communication, 3 April 2011), and as such, it met the criteria to be included in this review.

4. These criteria include: a group-comparison design with random assignment; well-documented treatment procedures; uniform therapist training and evidence of adherence; clinical samples; multi-method outcome assessment; tests of clinical significance; functional outcomes in addition to symptoms; and assessment of long-term outcome.