A critical assessment of research and outcome studies of time-limited psychodynamic psychotherapy with children and young people
This chapter will address some of the contemporary developments with respect to research and outcome studies in time-limited psychodynamic psychotherapy with children and young people. Several key studies are discussed including ‘manualised’ models of time-limited psychotherapy. The challenges of fulfilling the requirements of the randomised controlled trial will be addressed, and will be followed by a critical assessment of the method and meaning of contemporary research particularly for children, parents and young people.
Psychodynamic psychotherapy particularly with respect to child and adolescent psychotherapy has come late to the area of researching its findings and creating a sense of transparency about what works for whom. It is difficult to avoid the observation that much of the current research now taking place appears to have an underlying agenda of needing to prove professional relevancy within a cost-cutting health and welfare government environment. The impact this may have on what is researched and how this research is carried out is discussed in more detail below. Nevertheless, the increasing attention to time- limited psychotherapy with children and adolescents in many of these research projects points to a recognition of the potential efficacy of short-term psychotherapeutic work.
Midgley and Kennedy (2011) who have been at the forefront of much of the current research into the efficacy of psychodynamic psychotherapy for children and young people, carried out an extensive review in which they identified 34 separate studies including nine randomised controlled trials that indicated the effectiveness of psychodynamic psychotherapy. Interestingly, of the nine randomised controlled trial studies at Level 1 of the design hierarchy for research methodology, four of these referred to time-limited psychotherapy (Trowell et al., 2003; Trowell et al., 2007; Trowell et al., 2009; Trowell et al., 2010).
Meta-analyses have yielded further useful information with respect to the efficacy of time-limited psychotherapy with children and adolescents. Abbass et al. (2013) conducted a meta-analysis of 11 controlled outcome studies specifically to evaluate the effectiveness of short-term psychodynamic psychotherapy for children and adolescents who presented with a wide range of common mental disorders. The 11 studies included a total of 655 patients who received 40 or fewer sessions. The review suggested that time-limited psychotherapy was effective for a range of disorders and that these gains were noticeable in follow-up. However, given the heterogeneity of the sample the authors urge some caution in interpreting the results.
Midgley and Kennedy make the important point that we need to keep in mind that ‘“hierarchy of evidence” does not necessarily reflect the quality of the study’.
Midgley (2009) has also separately addressed the vexed issue of how the randomised controlled trial forces the researcher to control for so many variables in order to make the research methodology sound, and that there is thus a risk of making the research as a whole less meaningful. In this respect he raises the question of how one assesses what kind of information counts.