Yale Professor Urges Researchers to Find Out What Makes Therapy for Children Work

There are 550 different therapeutic techniques for treating children with emotional problems, but a new book by a Yale psychologist says little is known about what works, why, and for whom.

Knowing what works is important because 10 percent of three-to-17-year-olds – or about seven million children – receive treatment for emotional or behavioral problems, said Psychology Professor Alan E. Kazdin, whose book, “Psychotherapy for Children and Adolescents,” will be published by Oxford University Press in November.

In the early 1960s, there were about 60 different types of psychotherapy. In the 1970s, the figure rose from 130 to more than 250 techniques. By the mid-1980s, there were over 400 techniques, Kazdin, director of the Yale Child Conduct Clinic, said in his book.

“The number of techniques continues to expand - sort of like a Big Bang theory of psychotherapy,” he said. “The difficulty is that the vast majority of these techniques have never been studied and we have no idea whether they help, hinder, or have no impact on the clinical problems to which they are applied. The questions should be posed by researchers to whom we look for answers that can’t be answered in the practice.”

He said little is known about how different techniques result in change because of the way treatment research is conceptualized. Also, the investigations are limited, and there is no blueprint or long range plan to answer questions about child treatment.

As the number of treatments has ballooned, so has the list of symptoms, maladaptive behaviors, target complaints, and dysfunction now recognized as clinical problems, Kazdin said. The most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, published in 1994, includes over 300 recognized diagnoses and disorders - up from 100 in 1952.

The problems range from learning disorders to depression and substance abuse problems. The approaches to treatment might be, for instance, psychoanalytic, behavioral, cognitive, experiential, existential/humanistic, or integrative-eclectic, to name only a handful.

Kazdin said evaluating the effects of the 550 techniques on each of the 300 disorders, including the comparison of treatments and evaluation with different types of children and families, would require several million studies.

His book proposes alternative studies, outlines the questions they will answer, and explains how the studies will yield answers for therapists. Kazdin’s studies would use a system of moderators and mediators.

A moderator is a variable that influences the relationship between two or more other variables - for example, how the effects of treatment “A” may differ for boys and girls. Other moderators might be the severity of the child’s problem or conditions in the family, such as parents with psychiatric problems of their own. “A goal of therapy research is to hypothesize and evaluate factors that moderate treatment effects, and, eventually, to understand why these factors serve as moderators,” Kazdin said.

A mediator is the means through which a variable operates or produces a particular outcome. For example, therapy may achieve its effects because of changes in cognitive processes (i.e. how cues from the environment or from others are coded, changes in specific beliefs and attributions). Changes also might result from learning processes, altering memories, or reducing physiological arousal associated with real or imagined events.

“When we do know how change takes place, we can say the particular process mediates treatment,” Kazdin said.

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