These Researchers Are My Heroes and Inspiration
Scott Miller and Barry Duncan at
http://www.talkingcure.comTreatment that Harms . . .(
More and more, adolescents are being referred to treatment. A popular approach is to put these young people into treatment settings with peers (e.g., group therapy, guided group interaction, boot camp, etc.). (CEDU CEDU CEDU max)
These approaches are not only politically but also economically popular--simply put, fewer therapists ((therapists?
)max)are required.
The data say, however, that these approaches not only do not work but actually increase the problematic behavior they are intended to solve.
Researchers Dishion, McCord, and Poulin (1999) reviewed the exiting literature and found that such peer-group oriented interventions inadvertently reinforce the problem behavior--in particular among young, high-risk youth.
Dishion, T.J., McCord, J., and Poulin, F. (1999). When interventions harm. American Psychologist, 54(9), 755-764.
Here you'll find archived reviews of research on children and adolescents.
Adolescents, Depression, and Therapy: The evidence so far . . .
Well, what do you do with depressed kids? In spite of an absolute lack of evidence of safety and efficacy, the pharmaceutical industry says, "medicate them." (Hi Ulrich) Therapists, of course, say, "treat them." And yet, the data on psychotherapy are not so compelling either. In this study, researchers compared ,(Cognitive Behavioral Therapy) CBT, systematic behavioral family therapy, and unstructured supportive therapy. The results showed that 60% of those receiving CBT recovered compared to 29% for family therapy and 36% for supportive therapy.
While the results initially seem to make a compelling argument for CBT nearly a third of those in the study had a recurrence within 4 months despite receiving booster sessions.
The conclusion: since other studies show that 90% of adolescents spontaneously recover from depression within 1 to 2 years, there is little evidence that therapy of any kind helps.
(Interesting that a two year EG program falls within the range of natural recovery and taked credit for the natural recovery)(Max 2004)
Birmaher, B. et al. (2000). Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder. Archives of General Psychiatry, 57, 29-36.
Are number of sessions related to amount of change in successful psychotherapy with children? (Tine In Boarding schools) (max)
This is an important study--one that confirms findings from other studies on therapy with kids. As should be well known to most clinicians, researchers have long established that a logrythmic relationship exists between the number of sessions of therapy and the percentage of improvement. This finding is referred to in the adult treatment literature as the "Dose-Effect" relationship. The finding is critical as it allows clinicians to determine whether a client is responding to treatment as they should when it is successful and thereby allow for modifications in the treatment or therapeutic relationship when it is not. It has also been used by managed care companies to suggest that long term therapeutic relationships should be ended in the absence of meaningful change in the early stages of treatment.
This firmly established clinical finding leads to the question, "Does it apply to work with kids." And the answer thus far is, "absolutely not!" There could be many reasons for this finding, not the least of which is that the treatees themselves--that is, children--are not the ones who determine whether to start, continue or end treatment services thus obliterating any connection between amount of change and duration of treatment.
(too bad CEDU isn't time limited and voluntary then it might work) $$$$$$$ get the picture? - max 2004)
Salzer, M.S., Bickman, L., & Lambert, W. (1999). Dose-effect relationship in children's psychotherapy services. Journal of Consulting and Clinical Psychology, 67(2), 228-238.
Does anything work with Kids?
A Review of the Research on Therapy with Kids
Every years literally thousands of children are taken to therapy by caregivers or mandated into treatment by teachers and school officials. But what does the data say? Well, researchers Weisz et al. (1992) reviewed the literature on the treatment of children and found controlled outcome studies have shown consistent evidence of the benefit of therapy for children and adolescents. However, research focused on more representative treatment (that is, done in clinics) shows much more modest effects--in fact,
most studies in clinics have found no significant effects! This is a big problem in research--the difference between efficacy studies (those done in laboratory settings) and effectiveness studies (those done in real life clinical settings).
This is also the reason why The Institute For the Study of Therapuetic Change (ISTC) recommends that clinicians have a method in place for the routine and systematic monitoring of the outcome of their clinical work. (This is why I (max) use the Client Directed Outcome Informed Measures of the above ISTC)(max)
Weisz, J.R. et al. (1992). The lab versus the clinic: Effects of child and adolescent psychotherapy. American Psychologist, 47(12), 1578-1585.
Social Phobia in Kids: Something that Does Work
Researchers Beidel and Turner have developed and now assessed the efficacy of an approach for "shy" kids called, "Social Effectiveness Training." Building on the principles of intervention known to work with adolescents, these researchers spent less time exploring why kids were shy and medicating them and more time on helping them develop skills to handle social situations competently. After just 12 weeks of participation in the program two-thirds of the kids were no longer shy or frightened in social situations--a number which increased to 75% at six month follow-up. An innovative aspect of the program was the pairing of the kids in the program with other children for public social activities!
Beidel, Deborah C.; Turner, Samuel M.; Taylor-Ferreira, Jill C. Behavior Modification. (1999 Oct) Vol 23(4) 630-646.
What Causes Schizophrenia?
Schizophrenia is the enigma and Achilles' heal of the mental health profession. Though awareness of the problem has been around for hundreds of years, the field is yet to come up with a convincing etiological theory. Many have been advanced: from family dynamics to disturbed dopamine to morphological differences in the brain. Now researchers have aimed their sites on an uncommonly simple and common cause: childhood infections. Not prenatal infections as was once thought, but common infections transmitted by siblings during childhood. The research fits with other findings which show in increase incidence of the destructive disorder in larger families with 2 years or less between siblings.
Westergaard, T. (November, 1999). Archives of General Psychiatry, 56, 993-8.
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Last modified: July 03, 2001
