Psychotherapy for Children and Adolescents: Directions for Research and Practice

319 Pages·2000·17.31 MB·English

by  Alan E. Kazdin

Psychotherapy
for Children
and Adolescents
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Psychotherapy
for Children and Adolescents
DIRECTIONS FOR
RESEARCH AND PRACTICE
ALAN E. KAZDIN
New York Oxford
Oxford University Press
2000
Oxford University Press
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Copyright © 2000 by Oxford University Press, Inc.
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All rights reserved. No part of this publication may be reproduced,
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Library of Congress Cataloging-in-Publication Data
Kazdin, Alan E.
Psychotherapy for children and adolescents : directions for
research and practice / Alan E. Kazdin.
p. cm.
Includes bibliographical references and indexes.
ISBN 0-19-512618-1
1. Child psychotherapy—Research—Methodology. 2. Adolescent
psychotherapy—Research—Methodology. I. Title.
RJ504.K373 2000
618.92'8914—dc21 99-17112
9 8 7 6 5 4 3 21
Printed in the United States of America
on acid-free paper
To Bundle and Vugie—Ineffable sources of joy
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Preface
Psychotherapy piques our interest in part because of the scope of problems it
addresses. Psychotherapy is used for psychiatric disorders and mental illnesses,
including schizophrenia, depression, alcohol abuse, to mention only a few. In
addition, in everyday life, many stresses, strains, and traumas (e.g., experience
of loss, problems of identity and meaning, and relationship issues) can be aided
by psychotherapy. Although they are ordinary in the sense of being universal
and commonplace, their impact can be extraordinary. Of course, psychother-
apy is not just for "psychological" problems. Mental health is inextricably re-
lated to physical health. For example, fat consumption and lack of exercise pre-
dict heart disease, but so does depression. Moreover, psychotherapy can have
significant impact on physical health, including length of survival among ter-
minally ill patients. Although therapy is not a panacea, the scope of its appli-
cation and beneficial effects is broad.
We are also interested in the seeming mystery of therapeutic change. How
does therapy help? How does it work? We hear stories from therapists and
friends about significant changes or personal transformations produced by ther-
apy. Of course, personal transformations are fascinating whether effected by
age, religion, or psychotherapy. Psychological research can inform us about ba-
sic processes of change. Such information can be put to use beyond the con-
fines of therapy to aid in understanding development, interpersonal relation-
ships, and other processes in which change is involved (e.g., teaching and
training).
The problems for which psychotherapy can be helpful can emerge at any
point over the life span. But the social, emotional, and behavioral problems in
childhood raise special issues and special frustrations. Parents are often placed
in a demanding, frustrating, and demoralizing position in coping daily with a
seriously disturbed child. Yet, parents must mobilize efforts and resources to
obtain the necessary help and to follow through with treatment that may make
further demands. Psychotherapy is not the only solution to address the difficul-
ties that children, adolescents, and their families experience, but it is one to
which they can and do often turn.
Children and adolescents experience many types of social, emotional, and
behavioral problems. Moreover, a large proportion of children and adolescents
viii PREFACE
in everyday life are significantly impaired. The task of providing interventions,
over the range of disorders and number of children and adolescents in need, is
overwhelming. The mental health professions have been actively addressing
the task in many ways. There are hundreds of different types of therapies and
well over a thousand controlled outcome studies of then- impact. Thus, much
has been done to develop effective treatments.
Psychotherapy is the topic of this book. My focus is on what we do and do
not know about its effects. The book examines the current status and future di-
rections of psychotherapy research. I have two central theses. First, there are
major limitations in contemporary research and its conclusions about the ef-
fects of psychotherapy. Limitations can always be identified in any area of
study, so this thesis is not new or even necessarily important. Second, progress
(or at least significant progress) in treating disorders of children and adolescents
is unlikely to result from current psychotherapy research. Current research ig-
nores central issues important both in the short and long term for providing ef-
fective interventions. I address the central theses by focusing on three ques-
tions: (1) What do we wish to know about therapy and its effects? (2) What do
we already know? (3) What needs to be accomplished to fill in the gap between
what we wish to know and what we already know?
The book covers the current status of knowledge, current limitations, needed
knowledge about therapy, and a model for future research. The model is de-
signed to chart a course that assures systematic progress in the accumulation of
research. I make suggestions to redirect the questions, methods, and foci of both
research and clinical practice. Research goals are to understand therapy and its
effects and to advance the knowledge base so that clinical work has a strong
empirical footing. The goal of clinical practice is the care of the individual client
or patient. Both research and practice can be mobilized to fill the knowledge
gaps. The book discusses the present but aims squarely at future progress.
The mental health professions are not at a loss for more books on psy-
chotherapy. There are several genres of psychotherapy books, including those
that propose and promote a particular treatment, those that serve as compendia
to review research on many treatments as applied to many problems, and those
that instruct one how to do some form of treatment (e.g., treatment manuals,
self-help books). These are all valuable no doubt, but this book has a different
purpose, namely, to guide future research and to accelerate or ensure progress.
The overall goal is to influence psychotherapy research. What is now re-
garded as "state-of-the-art," "cutting-edge," and "groundbreaking" (insert your
favorite such term here) psychotherapy research simply will not lead us to un-
derstand how therapy works and what to do to make it more effective. The task
of this book is to reconcile the present knowledge with the goals of therapy and
to connect them with an explicit plan or course that plots future work.
I am pleased to acknowledge several sources of support provided during the
writing of this book. I am grateful for the support for research on child and ado-
lescent psychotherapy from the Leon Lowenstein Foundation, the William T.
Grant Foundation, and the National Institute of Mental Health. Yale University
PREFACE ix
is a very supportive environment and has provided colleagues—faculty and
students—who have greatly influenced my thinking. My current work is con-
ducted at the Yale Child Conduct Clinic, a clinical service for children and fam-
ilies. I am grateful for the work and collaboration of the staff at the clinic, where
we daily confront the many problems toward which therapy research is di-
rected. At the same time, clinical work has also taught us about the many prob-
lems and issues that research has eschewed.
The book is about the strengths and limits of therapy research. To that end,
research design and methodology are pertinent topics, especially so in one of
the chapters. A brief appendix on the topic of methodology has been provided
to convey key concepts for the interested reader. Dr. Irving Quickie graciously
agreed to serve as a guest author and to prepare a "quick" overview and brush-
up course. I am grateful for his contribution. Several individuals, but especially
Susan Breton and Tricia Zawacki, contributed to the appendix that identifies
treatments currently in use. Their work is described and gratefully acknowl-
edged further in that section. Finally, Michelle Kazdin assisted with the content
and editing; I am grateful for her contribution and participation.
New Haven, Connecticut A. E. K.
April 1999