This book, edited by two of the most eminent psychotherapy clinician-researchers in the United States, describes psychotherapies for children and adolescents. The editors begin the book with a clear statement of their intentions. “The book presents psychotherapies for children and adolescents that have strong evidence on their behalf and illustrates the type of research needed to place treatment on a strong empirical footing” (p. 15). It succeeds admirably. The book is divided into three parts: one on foundations of research, one on programs of interventions and research and finally there will be the editors’ concluding chapter.
As with all edited books, it is not of uniform excellence. It does have chapters which are of remarkable erudition, compass and depth and others which are weaker. Those which fail to reach excellence tend to fall into detailed and jargon-filled descriptions of their own treatments. They seem to promote their own treatments, rather than discuss them in the context of scientific neutrality and open-minded questions. They often take up a territorial dismissal of psychodynamic versus behavioural treatments. The weaker chapters however, are the minority.
Many chapters were a delight to read. Certainly those chapters written by the editors when they described their own interventions for conduct disorders or depression and their introductory and concluding chapters were paradigms of clarity, breadth and vision. The introductory chapter puts psychotherapy and its study into historical and scientific context. Its definition of psychotherapy reflects the complexity of this field of interventions.
Two other chapters in the introductory section were also noteworthy. It has always seemed to me that developmental issues are at the heart of psychotherapies in child and adolescent psychiatry. Holmbeck et al describe the neglect of development in either the design and practice of psychotherapy or its evaluation. They make a number of useful corrective recommendations applicable to clinical or research work. Chorpita discusses the gaps between laboratory and community interventions when we think about effective interventions. The book is written to be of interest to policy makers and funders. For them, this chapter more than any other, is a must-read.
Hoagwood’s chapter on ethics which closes the first section, is competent but also points out a significant failing of this text: it is written almost completely (excepting one chapter) by authors from the United States. The ethics are often those that apply in the U.S.A., which has its own healthcare system, quite different than our own. It would have been interesting to read more from the international scene, not only about ethics but about programs of intervention and research.
A number of chapters in the section on Programs of Research provided excellent, dispassionate reviews of knowledge and exploration of questions implicit in interventions and their evaluation. Most described their interventions in ways that let the reader understand something about actually conducting the treatment. In the subsection on Internalizing Disorders, Kendal et al on Child-Focused Treatment of Anxiety, Weersing et al writing about Cognitive Therapy for Adolescent Depression, Weisz et al also writing about treatment of adolescent depression were best.
In the subsection on Externalizing Disorders, Kazdin’s chapter on treating youth with conduct disorders was a highlight, addressing the complexity of psychopathology and of psychotherapy, therapist training and supervision. He questioned the application of brief therapies for some clinical problems, an issue often overlooked in the rush to provide treatment or satisfy third-party funders.
Chapters on treatments of autism, eating disorders, obesity and enuresis and treatment in the American Hispanic community form a subsection on treatment of Other Disorders and Special Applications. Epstein’s chapter on obesity clearly illustrated how a program of research and the evolution of knowledge can lead to improved approaches to treatment. Houts’ chapter on enuresis engaged the debate between psychotherapy and medication, which is an important issue in our time.
Unfortunately, this review of interventions and research programs is entirely behavioural. Only Robin’s chapter on anorexia nervosa significantly referenced any psychodynamic treatment (and found it equally efficacious.). In their final chapter the editors wrote that little research had been done on helping therapists build therapeutic relationships. Relationships have been examined more closely in psychodynamic treatments. Unquestionably, research has been a greater priority in the behavioural schools. In psychodynamic circles, defence of beliefs has too often displaced respect for scientific method and the knowledge it can generate. This is much less the case now than it once was. Hopefully, the editors’ suggestion that work needs to be done on integrating therapies may lead to useful integrations not only of clinical interventions but also to the development of new knowledge and better interventions.
Overall, this was a very rewarding and useful book to read from both clinical and research perspectives.