Shifting the paradigm towards positive mental health for children, parents and young people
Revisiting research: Making it meaningful
This book asserts that there is a need for an urgent paradigm shift in how we conduct research into time-limited psychotherapy. This is not solely a concern of child psychotherapists, but also of the larger professional group of mental health practitioners. As mentioned earlier, the British Psychological Society presented a challenge to the authors of the DSM (V) (American Psychiatric Association, 2013), criticising the predominant ‘medicalisation’ disease model of distress in both children and adults. As part of creating a paradigm shift, we must be clear about who the beneficiaries are of research that follows a symptom-based medicalised model that exclusively utilises the randomised controlled trial. We need to ask questions about whether the ‘evidence’ thereby derived, is ultimately in the best interests of children and young people.
The role of professionals themselves is an important part of this inquiry. In research carried out to ascertain how professionals construct the mental health problems of children, parents and families (Schmidt Neven, 2008), it was striking to discover a professional as victim discourse that ran like a leitmotif through all the interviews with the professionals. Whilst the professional as victim discourse was understandably strong in those professional groups with the least amount of discretion in managing their caseloads, and their day-today work, it was particularly evident in one of the most powerful groups interviewed, namely the psychiatrists. They perceived themselves as the victims not only of the demands of the organisations they worked for, but also of the broader constituency of opinionshaping journals, particularly in the United States. This was given as the major justification for example, for taking a narrow research focus that favoured the randomised controlled trial. The psychiatrists also perceived themselves as the victims of a community that forced them into over-diagnosis and prescription, and as such, they perceived themselves additionally as being at the mercy of society’s demands and expectations.
This kind of self-referential discourse and the maintenance of the status quo is intrinsic to many professional groups. However, it is particularly disturbing where professionals have responsibility for the mental health and wellbeing of children and young people. We may question therefore whether we can reconcile conducting research to justify professional relevance, with promoting findings that have relevance for our patients.