What Works with Children, Adolescents, and Adults?

A Review of Research on the Effectiveness of Psychotherapy

Alan Carr

• Publisher: Routledge
• Year: 2008
• eBook ISBN: 9781134054565
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

What Works with Children, Adolescents, and Adults? provides an up-to-date review of research on the effectiveness of psychotherapy and psychological interventions with children, adolescents, adults, people in later life, and people with intellectual and pervasive developmental disabilities.

Drawing on recent meta-analyses, systematic reviews, and key research studies in psychotherapy, this volume presents evidence for:

• the overall effectiveness and cost-effectiveness of psychotherapy
• the contribution of common factors to the outcome of successful psychotherapy
• the effectiveness of specific psychotherapy protocols for particular problems.

This comprehensive, user-friendly guide will inform clinical practice, service development and policy. It will be invaluable to psychotherapists, service managers, policymakers, and researchers.

What Works with Children, Adolescents, and Adults? offers a review of the evidence base for three Handbooks published by Routledge: The Handbook of Child and Adolescent Clinical Psychology (Carr, 2006), The Handbook of Adult Clinical Psychology (Carr & McNulty, 2006), and The Handbook of Intellectual Disability and Clinical Psychology Practice (O'Reilly, Carr, Walsh, & McEvoy, 2007).

Chapter 1
Psychotherapy, psychotherapy research, and translating science into practice

The central question addressed in this book is: In the field of psychotherapy, what works for children, adolescents, and adults? To answer this question, a wide-ranging review of scientific evidence concerning the effectiveness of psychotherapy is presented. The evidence reviewed shows, unequivocally, that psychotherapy and psychological interventions are effective in helping children, adolescents, adults, and people in later life, with a wide range of psychological difficulties. The review demonstrates that the evidence base for psychotherapy and psychological interventions is a large rigorous body of scientific work, which has clear implications for practice, policy and future research. The implications of the current psychotherapy evidence base for future research and policy is considered in Chapter 7. The main concern of this book, and a central theme of Chapters 2 to 6, is articulating the clinical practice implications of the results of research on psychotherapy and psychological interventions. As a preamble to addressing this central issue, some introductory comments will be offered in this chapter on psychotherapy, the process of conducting psychotherapy research, and ways in which research results can be used to inform practice. These comments are offered to answer such questions as: What is psychotherapy? What is psychotherapy research? How can the results of psychotherapy research be used to inform clinical practice?

This chapter opens with a cursory statement about the origins of psychotherapy and an outline of the psychodynamic, humanistic, cognitive behavioural, and systemic therapeutic traditions. A definition of psychotherapy follows. Then a hierarchy of types of evidence from the least to the most persuasive is presented. The hierarchy includes case studies, single group outcome studies, controlled group outcome studies, narrative literature reviews, and meta-analyses. In the remainder of this book, greatest weight will be given to meta-analyses and narrative reviews of controlled group outcome studies in presenting scientific evidence for the effectiveness of psychotherapy and psychological interventions. Finally, the chapter closes with a discussion of different approaches to translating scientific evidence into practice procedures; specific empirically supported treatments and general practice guidelines; and psychotherapy research programmes which focus on either common factors or specific techniques.

Origins of psychotherapy

Modern psychotherapy has a long past and a short history. Its origins date back thousands of years, but psychotherapy, as it is currently practised, is no more than a hundred years old. In the western world, the idea that skilled dialogue can alleviate distress may be traced to Socrates (469–399 BC) and the classical Greek philosophers. Sigmund Freud (1856–1939) in Austria, founder of psychoanalysis and the psychodynamic tradition, played a central role in the establishment of modern psychotherapy as a discipline and profession. Psychotherapy flourished first in North America and later in the UK, other parts of Europe and elsewhere. The humanistic, cognitive behavioural, and systemic psychotherapy traditions developed in the wake of the trail blazed by psychoanalysis and psychodynamic psychotherapy.

Psychotherapy traditions

There are over four hundred schools of psychotherapy and at least a dozen approaches that are widely practised in the English-speaking world (Corsini & Wedding, 2004). However, available research evidence – the central concern of this book – is usefully conceptualized as falling within the psychodynamic, humanistic, cognitive behavioural, and systemic psychotherapy traditions.

Psychodynamic psychotherapy

Psychodynamic (or psychoanalytic) psychotherapy is an approach to practice that has evolved from the seminal work of Sigmund Freud (Gabbard, 2004; Messer & Warren, 1998). Within this tradition, psychological disorders are assumed to arise from unresolved unconscious conflicts and the associated use of maladaptive (and unconscious) defence mechanisms. A defining feature of this approach is the use of free association and interpretation, particularly transference interpretation, to help clients become aware of how unconscious conflicts, motivations, emotions, memories, and defences underpin or maintain their current difficulties. Psychodynamic psychotherapists facilitate the working through of complex emotions arising from insights into unconscious material, and provide containment of clients’ problematic internal states in this process. Psychodynamic therapy helps clients resolve unconscious conflicts and find more adaptive solutions to the problems they currently face in their lives. Within the psychodynamic tradition, the twin goals of therapy are character change and symptom alleviation. Character change involves clients transforming their habitual ways of managing internal conflictual states and important relationships in their lives.

Humanistic psychotherapy

Humanistic psychotherapy is an overarching term for a tradition that includes a variety of therapy models, for example, Carl Rogers’ client-centred therapy, Fritz Perls’ gestalt therapy and various experiential therapies (Cain & Seeman, 2001). Within this tradition, it is assumed that avoidance or denial of current feelings, emotions, and desires, and deliberate or inadvertent failure to take responsibility for these aspects of experience prevent personal growth and give rise to psychological symptoms. A defining feature of humanistic psychotherapy is the use of the therapeutic relationship between client and therapist as a resource in promoting personal growth. Within this relationship, the therapist is warm, empathic, and emotionally congruent. A second defining feature of the humanistic tradition is facilitating personal growth by helping clients become more fully aware of, and to take responsibility for, their immediate feelings, emotions, and wishes, which may be outside normal awareness. Within the humanistic tradition, personal growth is the main goal of therapy. Resolving presenting problems is often secondary to this superordinate goal.

Cognitive behavioural therapy

Cognitive behavioural therapy includes approaches that fall within the broad traditions of learning theory and cognitive science (Clark & Fairburn, 1997). John Watson in the USA (1878–1958) was a founding figure of behaviour therapy and Aaron T. Beck was the founder of cognitive therapy. Within this tradition it is assumed that psychological problems are inadvertently learned and maintained by cognitive and behavioural social learning processes, and these learning processes often operate outside awareness. A defining feature of cognitive behavioural therapy is the use of highly specific treatment procedures (grounded in social learning theory and cognitive science) for specific problems, such as cognitive procedures to change depressive thinking patterns or exposure to feared stimuli to overcome anxiety. A strong collaborative therapeutic relationship between clients and therapists is required to implement these highly specific treatment procedures. Resolving presenting problems is the primary goal of cognitive behavioural therapy. However, this may entail developing skills which enhance general well-being and interpersonal adjustment.

Systemic therapy

Systemic therapy includes approaches that involve working directly with couples, parents, families, and social networks (Carr, 2006). In the USA, the Englishman, Gregory Bateson (1904–1980), while not a clinician himself, inspired the development of systemic therapy and the family therapy movement. Within the systemic tradition it is assumed that psyc...

Table of contents

• What Works with Children, Adolescents, and Adults?
• Contents
• List of figures
• List of tables
• Preface
• Chapter 1 Psychotherapy, psychotherapy research, and translating science into practice
• Chapter 2 The overall effectiveness and cost-effectiveness of psychotherapy
• Chapter 3 Common factors in psychotherapy
• Chapter 4 Effectiveness of psychotherapy and psychological interventions with specific problems in children, adolescents, and people with intellectual disabilities and pervasive developmental disorders
• Chapter 5 Effectiveness of psychotherapy and psychological interventions with specific problems in adulthood and later life
• Chapter 6 Additional elements in the psychotherapy evidence base
• Chapter 7 Conclusions
• Bibliography
• Index