Table Of ContentWhat Works with Children,
Adolescents, and Adults?
What Works with Children, Adolescents, and Adults? provides an up-to-date
review of research on the effectiveness of psychotherapy and psychological
interventions with children, adolescents, adults, people in later life, and
people with intellectual and pervasive developmental disabilities.
Drawing on recent meta-analyses, systematic reviews and key research
studies in psychotherapy, this volume presents evidence for:
(cid:127) the overall effectiveness and cost-effectiveness of psychotherapy
(cid:127) the contribution of common factors to the outcome of successful
psychotherapy
(cid:127) the effectiveness of specific psychotherapy protocols for particular
problems.
This comprehensive, user-friendly guide will inform clinical practice, service
development and policy. It will be invaluable to psychotherapists, service
managers, policymakers, and researchers.
Alan Carr is Professor and Director of Clinical Psychology at University
College Dublin, and Consultant Psychologist and Family Therapist at the
Clanwilliam Institute Dublin.
What Works with Children, Adolescents, and Adults? offers a review of the
evidence base for three handbooks published by Routledge: The Handbook
of Child and Adolescent Clinical Psychology (Carr, 2006), The Handbook of
Adult Clinical Psychology (Carr & McNulty, 2006), and The Handbook of
Intellectual Disability and Clinical Psychology Practice (O’Reilly, Carr, Walsh,
& McEvoy, 2007).
‘“What Works” is an outstanding achievement. Professor Carr has effectively
translated psychotherapy research findings into principles for clinical practice and
public policy. This wide-ranging review is the first to examine treatment outcomes in
children, adolescents, adults, the aged, and populations with special needs, providing
conclusions with wisdom and reason. Must reading for students and professionals.’
Professor Michael Lambert
Department of Psychology
Brigham Young University, USA
‘In recent years there has been increasing demand to move towards a clinical practice
that is informed by sound research evidence and inevitably this has meant that there
has also been a huge increase in the number of publications telling us what the
research evidence actually says. To have a useful impact in such a crowded field is not
easy but I have little doubt that “What Works with Children, Adolescents, and Adults”
will be one of the books that people will really value reading. As in his previous
publications Alan Carr draws on his impressive knowledge of the field and his ability
to provide a very accessible and readable text. This is a book that will be useful both
for the novice to this area providing a good overview and explanation of basic
concepts as well as for the more expert reader for whom it will provide an excellent
resource of up-to-date research evidence. An excellent book which I highly
recommend.’
Ivan Eisler
Reader in Family Psychology and Family Therapy
Kings College, Institute of Psychiatry, London
This book offers a unique and comprehensive up-to-date review of the research into
the effectiveness of psychotherapy and psychological interventions with children,
adolescents, adults, people in later life, and people with intellectual and pervasive
developmental disabilities. Thanks to Alan Carr who has done an admirable job.
The book presents a helpful guide to mental health professionals who aim to provide
evidence based interventions. I highly recommend this book as a valuable source of
information for students, clinicians and researchers in clinical psychology and
psychiatry.
Professor Anegen Trillingsgaard
Department of Psychology
University of Aarhus, Denmark
What Works with Children,
Adolescents, and Adults?
A review of research on the
effectiveness of psychotherapy
Alan Carr
First published 2009 by Routledge
27 Church Road, Hove, East Sussex BN3 2FA
Simultaneously published in the USA and Canada
by Routledge
270 Madison Avenue, New York NY 10016
Routledge is an imprint of the Taylor & Francis Group,
an Informa business
This edition published in the Taylor & Francis e-Library, 2008.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s
collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
© 2009 Alan Carr
Paperback cover design by Sandra Heath
All rights reserved. No part of this book may be reprinted or
reproduced or utilized in any form or by any electronic,
mechanical, or other means, now known or hereafter
invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in
writing from the publishers.
This publication has been produced with paper manufactured to
strict environmental standards and with pulp derived from
sustainable forests.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Carr, Alan, Dr.
What works with children, adolescents, and adults?: a review of
research on the effectiveness of psychotherapy / Alan Carr.
p.; cm.
Includes bibliographical references and index.
ISBN 978-0-415-45290-8 (hardback) – ISBN 978-0-415-45291-5 (pbk.)
1. Evidence-based psychiatry. 2. Psychotherapy–Evaluation. I. Title.
[DNLM: 1. Psychotherapy–methods–Review. WM 420 C311w 2008]
RC455.2.E94C37 2008
616.89′14–dc22 2008005410
ISBN 0-203-88976-2 Master e-book ISBN
ISBN: 978–0–415–45290–8 (hbk)
ISBN: 978–0–415–45291–5 (pbk)
Contents
List of figures vi
List of tables vii
Preface viii
1 Psychotherapy, psychotherapy research, and translating
science into practice 1
2 The overall effectiveness and cost-effectiveness
of psychotherapy 29
3 Common factors in psychotherapy 49
4 Effectiveness of psychotherapy and psychological
interventions with specific problems in children,
adolescents, and people with intellectual disabilities
and pervasive developmental disorders 68
5 Effectiveness of psychotherapy and psychological
interventions with specific problems in adulthood
and later life 148
6 Additional elements in the psychotherapy evidence-base 268
7 Conclusions 282
Bibliography 302
Index 374
List of figures
1.1 Hierarchy of evidence 9
1.2 Improvement in mean symptom scores on the Beck
Depression Inventory for adults with chronic depression
receiving couples therapy or antidepressants before
treatment, one year after treatment, and two years after
treatment 11
1.3 Improvement rates at six years follow-up for adolescents
with anorexia who received family or individual therapy 12
1.4 Graph of results of multiple baseline across cases in a
psychotherapy outcome study 14
1.5 Graphic representation of an effect size of 1 15
2.1 Mean effect sizes from meta-analyses of psychotherapy and
medical and surgical procedures 40
2.2 Mean effect sizes from meta-analyses of psychotherapy with
adults and children, and therapy from different traditions 44
3.1 The effects of psychotherapy compared with placebo control
groups 50
3.2 Factors that affect the outcome of psychotherapy 51
3.3 Psychotherapy dose–effect relationship 55
List of tables
1.1 Interpretation of effect sizes 16
1.2 Translating scientific evidence into clinical practice 20
1.3 Sources for evidence-based clinical practice guidelines 26
2.1 Summary of results of broad meta-analyses 45
3.1 Results of dose–response studies 56
3.2 Therapy, client, and therapist factors that affect positive
psychotherapy outcome 66
7.1 Problems in childhood and adolescence for which
psychotherapy and psychological interventions are effective 286
7.2 Problems in adulthood for which psychotherapy and
psychological interventions are effective 287
Preface
‘Brother, the greatest of all virtues is curiosity and the end of all desire is
wisdom.’
‘I might observe, not in order to combat your views but merely to continue
an interesting conversation, that wisdom may not be the end of everything.
Goodness and kindliness are, perhaps, beyond wisdom.’
James Stephens, The Crock of Gold (1912, pp. 11–12, Dublin:
Gill & Macmillan)
This book provides an up-to-date review of research on the effectiveness of
psychotherapy with children, adolescents, adults, people in later life, and
people with intellectual and pervasive developmental disabilities. It has been
written to inform clinical practice, policy concerning mental health service
development, and psychotherapy research. It is my intention in this book to
show that, when it comes to psychotherapy, both of the attributes valued by
James Stephens’s philosophers, in the quotation from The Crock of Gold
which opens this Preface, are essential. Wisdom, drawn from a careful con-
sideration of scientific evidence is important, but so too are goodness and
kindliness, in the form of empathic, collaborative clinical practice.
What Works with Children, Adolescents, and Adults? provides a review of
the evidence base for our three handbooks of clinical psychology: The Hand-
book of Child and Adolescent Clinical Psychology (Carr, 2006), The Handbook
of Adult Clinical Psychology (Carr & McNulty, 2006), and The Handbook of
Intellectual Disability and Clinical Psychology Practice (O’Reilly et al., 2007).
I was inspired to write this book following the success of my previous
volume What Works with Children and Adolescents? A Critical Review of
Psychological Interventions with Children, Adolescents and their Families,
published by Routledge in 2000. I received a great deal of positive feedback
from readers on this book, and many suggestions about how to improve
it. In a nutshell, these included covering research on the effectiveness of
psychotherapy with adults and older adults, as well as research that focused
on children and adolescents; covering research on common factors in
Preface ix
psychotherapy, as well as research on the effectiveness of specific psycho-
therapy protocols for specific problems; adopting a style that is less ‘stat-
istical’, focusing more on authoritative narrative and quantitative reviews,
and less on individual studies, with a strong focus on the clinical ‘take-home
message’ about what works. The upshot of this feedback was to write a new
book (not a second edition of What Works with Children and Adolescents?).
This book has the following structure. In Chapter 1, a definition of psycho-
therapy is given and an outline of some of the more influential psychotherapy
traditions. The way types of research evidence which support the effectiveness
of psychotherapy may be organized into a hierarchy from the least to the
most persuasive is also presented. The chapter closes with a discussion of
various approaches that have been taken to translating evidence for the
effectiveness of psychotherapy into procedures for routine clinical practice.
Chapter 2 reviews results from major meta-analyses of child and adult psy-
chotherapy trials which evaluate the overall effectiveness of psychotherapy
with a range of problems. It also focuses on results of meta-analyses of
the overall effectiveness of psychotherapy conducted within the context of
four major psychotherapy traditions: psychodynamic, cognitive behavioural,
humanistic, and systemic. In Chapter 3, empirical evidence for the role of
factors common to all effective approaches to psychotherapy is considered.
In Chapter 4, the focus is on evidence for the effectiveness of specific psycho-
therapy protocols and psychological interventions for children and adoles-
cents with specific types of problems. The effectiveness of psychological
interventions for people with intellectual disabilities and pervasive develop-
mental disorders is also considered. Chapter 5 addresses the effectiveness of
psychotherapy with adults and people in later life with specific types of prob-
lems. In Chapter 6 the effectiveness of additional interventions not con-
sidered elsewhere in the book is discussed. In Chapter 7, conclusions on
evidence for the effectiveness of psychotherapy are drawn, and the implica-
tions of these for clinical practice, policy and future research are considered.
Acknowledgements
While I was working on an early draft of this book, the Irish Council for
Psychotherapy (ICP) commissioned me to write a report on the effectiveness
of psychotherapy. The ICP is the umbrella organization that incorporates
professional associations for major psychotherapy associations in Ireland,
including those representing psychoanalytic, systemic, humanistic, cognitive
behavioural and constructivist traditions. I took time out from writing this
book to complete the ICP report. While this book and the ICP report are
distinctly different documents, the broad arguments in both are similar. I
received much helpful feedback on early drafts of the report from colleagues
within the ICP, for which I am extremely grateful. Both the report and this
book have, no doubt, profited from this feedback.
Description:What Works with Children, Adolescents, and Adults? provides an up-to-date review of research on the effectiveness of psychotherapy and psychological interventions with children, adolescents, adults, people in later life, and people with intellectual and pervasive developmental disabilities. Drawing
