IPT Book Reviews

Title: Effects of Psychotherapy with Children and Adolescents  Positive Review Positive Review
Authors: John R. Weisz and Bahr Weiss
Publisher: Sage Publications, Inc. 1993

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Price: $15.50 (p)
 

Description:

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.
 

Discussion:

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 sample.

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.

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