||Effects of Psychotherapy with Children and Adolescents
||John R. Weisz and Bahr Weiss
||Sage Publications, Inc. © 1993
Sage Publications, Inc.
2455 Teller Rd.
Newbury Park, CA 91320
Price: $15.50 (p)
This is Volume 27 in Sage's series on Developmental Clinical Psychology and
Psychiatry edited by Alan Kazdin. The book has 118 pages including
references and an index. There are five short chapters followed by a
summary chapter. In Chapter 1 the field of child psychotherapy is surveyed
and described. The purpose of the book is set forth and the method of
meta-analysis is sketched out. In the analysis of the studies reviewed,
meta-analysis requires the calculation of effect size, a method of getting some
comparative understanding of the stability and meaning of the observed
differences. Chapter 2 sums up the meta-analytic research on those
children who stay in therapy and those who drop out. Chapters 3 and 4
report the meta-analytic data on the effects of child psychotherapy.
Chapter 3 deals with the general meta-analysis of controlled experimental
studies and Chapter 4 presents specially focused meta-analyses. Chapter 5
reports the meta-analytic study of research done on the effects of psychotherapy
in a clinical setting. Chapter 6 sums up the conclusions the authors reach
on the basis of the review of the meta-analytic studies cited.
This short book should be carefully read and its message thoroughly
internalized by every professional who is involved in any way in either
deciding about therapy for a child, vending or providing therapy for
children, evaluating therapy for children, and imposing therapy on
children. Its message is simple and straightforward, although the
authors do not explicitly state it this way:
Most of what is done to children under the label of therapy is
ineffective and has no demonstrated efficacy or utility. Furthermore, it
may be harmful.
The most startling finding is that overall the therapy provided in clinics
and agencies throughout the country does not do any good. Children in
therapy in the real world show no differences from children with no therapy.
There is no method of therapy that demonstrates any utility in the clinic
In the studies involving therapy provided as part of a research program or a
specific study, behavioral methods are the only ones that demonstrate an
acceptable effect size and can be said to show efficacy and utility. This
is a consistent and replicated finding in the several meta-analytic studies
reviewed. Psychodynamic, insight-oriented and feeling-expressive, and play
therapy do not show a positive effect.
When it comes to therapy provided to children where there is an allegation of
sexual abuse, we reported in 1988 that in a sample of 405 children every one was
given psychodynamic, insight-oriented therapy (Wakefield & Underwager, 1988).
Since then we have seen the treatment records of hundreds of additional children
being treated for sexual abuse. Many of them were probably not actually
abused, but the most striking observation continues to be that almost every
child, no matter what age they are or what their specific experience may have
been, is given psychodynamic, insight-oriented therapy.
When there is an allegation of sexual abuse, long before there is an
adjudication, children are routinely put into a kind of therapy that does not do
any good for anybody, much less a victim of sexual abuse. Given the nature
of the feelings elicited and the behaviors presented, there is a risk of
iatrogenic harm to the child, abused or not.
This book should be the basis for every guardian ad litem and every counsel
for a child and every defense counsel for parents falsely accused to file
motions requiring any therapy given to children to be behavioral and cognitive,
not psychodynamic or insight-oriented or feeling-expressive. Any judge who
ignores the findings of the research on child psychotherapy across fifty years
and orders a child into the kind of therapy currently vended as child sexual
abuse therapy may be damaging the child.
A mental health professional who continues to vend and provide psychodynamic
insight-oriented therapy for children where there is an allegation of sexual
abuse in the face of the data summarized in this book may be guilty of
negligence and malpractice.
Reviewed by Ralph Underwager, Institute for Psychological
Therapies, Northfield, Minnesota.