- Email: [email protected]
Child psychotherapy: Developing and identifying effective treatments
263
Book Reviews
really learn these concepts, and would be an excellent basis for a course. We have determined to make it required reading for our interns. JEFFREY
M. BRANDSMA
Medical College of Georgia
Child Psychotherapy: Developing and Identifying Effective A. E. Kazdin. Elmsford, New York: Pergamon, 1988. 161 pp.
Treatments.
By
In the opening pages of his book Kazdin presents data indicating that up to 10 million children in the United States suffer from some form of behavioral or emotional dysfunction requiring mental health services. Statistics on the prevalence of emotional disturbance are not surprising to most professionals working with children; results of the Joint Commission on Mental Health in Children have been available since 1969. However, the reader is somewhat startled to learn that in the most recent edition of the foremost text on psychotherapy research (Garfield & Bergin, 1986) the editors excluded a chapter on child psychotherapy because so little research and progress had been accomplished since the previous edition in 1978. In his book, Child Psychotherapy: Developing and Identzfying Effective i?eatments, Kazdin attempts to identify issues, problems and attitudes that have impeded progress in child psychotherapy research and provides a blueprint of methodological requirements and research models with a goal towards accelerating progress in this area. Because his focus is on clarifying issues, problems and methodological requirements, Kazdin does not use this book to provide an exhaustive survey of all the psychotherapeutic interventions that have been used with children (although he does provide a table of over 200 therapy approaches that are used). Nor does he provide an encyclopedic review of all the studies that have been done on child therapy. Critical reviews of the child therapy research literature are available from other sources. Proponents of the various theoretical approaches may be disappointed that he does not promulgate a particular theoretical perspective nor does he draw conclusions about which approaches are most effective for child problems. Kazdin’s goal is broader than these questions and his focus is on stimulating and accelerating research progress. To this end he selects from the available literature studies that illustrate some of the problems as well as exemplars of wellconceptualized and -designed models of research. At the end of this process he provides an outline of conceptual and methodological issues that must be considered in designing and evaluating child psychotherapy research. The outline will be extremely useful to both experienced researchers as well as students and other beginners in that it brings together in one source the many issues that need to be grappled with in designing and carrying out psychotherapy research. Kazdin’s important contribution arises from his broad grasp of these issues and his ability to bring them together in extremely well-organized form for the reader. The first chapter of the book defines the nature of the problem (i.e., the slow pace and limited progress to date in the field of child psychotherapy research) and some of the historical obstacles to advancement. Among the latter include the unavailability until relatively recently of an adequate nosological system for childhood disorders; developmental considerations that make control questions in
264
Book Reviews
child psychotherapy research particularly difficult; the fact that psychotherapeutic work with children often involves multiple points of impact (i.e., intervention with parents and/or teachers as well as therapy with the child); among others. Many of these problems have neither obvious nor ideal solutions, but raising them as issues alerts the potential researcher to the questions to which he must give thought in the context of the particular project at hand. The third chapter provides an overview of the current state of research on the effectiveness of child psychotherapy. As mentioned earlier, Kazdin does not attempt to provide an encyclopedic review of all the studies that have been done. He does review the reviews however, particularly two recent reviews using metaanalysis to quantify the effectiveness of therapy across studies. In this chapter, Kazdin provides a useful discussion of the strengths and some of the limitations of meta-analysis, particularly the limits imposed by such a small pool of available studies to include in these analyses. A general conclusion can be drawn that psychotherapy is more effective than no treatment, on the average, in improving children. However, because of the nature of the literature very few of the more compelling questions on the effectiveness of child psychotherapy can be addressed, supporting the need for much more research effort. In the fourth chapter, Kazdin reviews selected individual studies as well as programs of research which serve as exemplars in the field of child psychotherapy. None is perfect but they do demonstrate an attempt on the part of the respective investigators to address some of the methodological issues that have plagued the field and impeded progress. The preponderance of work reviewed in this chapter is on aggressive and antisocial child populations, perhaps reflecting Kazdin’s own immersion in this particular area. Much of this chapter is repeated from other of Kazdin’s works (Kazdin, 1987a,b). N evertheless, the principles that are exemplilied in these programs of study are generally applicable to the broader domain of child psychotherapy research, and Kazdin certainly cannot be faulted for drawing upon an area with which he is intimately familiar to illustrate his points. The final three chapters of the book are the ones within which Kazdin most powerfully accomplishes his purpose, for it is in these chapters that he reviews in detail the methodological and substantive issues that must be considered in designing and carrying out a psychotherapy research project, as well as innovative models that need to be adopted in order to expand the knowledge base. Again, much of this information is available in other Kazdin works (Kazdin, 1986, 1987a,b). However, in these chapters he expands and amplifies his previous discussions to provide a very thorough view of patient, treatment, therapist and assessment issues that emerge in psychotherapy investigations. The final chapter provides an outline of these issues that could serve as a checklist for the potential investigator designing a research project. Kazdin acknowledges that none of these issues represents new or novel information, as they have been discussed in various sources in the adult literature. However, it is extremely helpful to have this information assembled in one source and directed to a child-focused audience SO that child psychotherapy researchers do not have to reinvent the wheel in their attempts to accelerate progress in the field. In addition, Kazdin casts these methodological issues in the context of children as patients and subjects with the unique perspective that such consideration brings. In summary, this is a book that should well serve the purpose of stimulating and accelerating the sluggish progress to date in child psychotherapy research. Stu-
265
Book Reviews
dents and instructors of child psychotherapy and psychotherapy research will find it to be an extremely valuable instructional text. However seasoned researchers will also find it extremely helpful in stimulating their planning processes as they approach research projects. Careful consideration of the issues that Kazdin so lucidly raises in this book must occur if child psychotherapy research is to address the most sophisticated questions of what treatments work, with what kinds of children and under what circumstances. REFERENCES Garfield, S. L., & Bergin, A. E. (Eds.), (1986). Handbook ofpsychotherapy and behaviorchange: An empirical analysis (3rd ed.). New York: John Wiley & Sons. Kazdin, A. E. (1986). Comparative outcome studies of psychotherapy: Methodological issues and strategies.Jownal of Consulting and Clintial Psychology, 54, 95-105. Kazdin, A. E. (1987a). Treatment of antisocial behavior in children: Current status and future directions. PsychologicalBulletin, 102, 187-203. Kazdin, A. E. (1987b). Conduct disorders in childhood and adolescence. Newbury Park, CA: Sage.
KAREN
C. WELLS
Children’s Hospital National Medical Center, George Wmhington University School of Medicine
Treating Child Sex Offenders and Victims: A Practical Guide. By Anna Salter (Ed.), 1988. 344 pp. $29.95 ($14.95 softcover).
C.
This practical guide for treating sex offenders and victims is a very important contribution to a field that has long been neglected. The book is well-written, informative, and carefully organized into four sections. The first section presents epidemiological research on the prevalence of child sexual abuse and provides an excellent discussion of the psychiatric and psychological conceptualizations developed to explain the occurrence of sexual abuse. This discussion is particularly powerful as it documents the changes in conceptualizations and attitudes toward the victim, offender, and non-offending parents from the early part of this century to the present. This historical account should be considered mandatory reading for all individuals working with sex offenders and victims, as it underscores the strides that have been made as well as the biases that persist with respect to psychiatric, legal, and societal reactions to sex offenders and victims. The second section outlines the philosophy and structure of the treatment programs to be described. Here, the author clearly and concisely provides the principles upon which the treatment programs are based, and she appropriately urges that these premises must be accepted by therapists and clients alike in order for treatment to be effective. In addition, guidelines are provided for developing and implementing a comprehensive treatment center including practical suggestions for building a treatment team, gaining community support and obtaining funding. The third section outlines strategies for assessing and treating sex offenders. The author’s discussion of the differences in treating sex offenders who are often under court order as opposed to voluntary, motivated patients is excellent. In addition, the issue of offender denial is addressed in detail. The author also offers
Book Reviews
really learn these concepts, and would be an excellent basis for a course. We have determined to make it required reading for our interns. JEFFREY
M. BRANDSMA
Medical College of Georgia
Child Psychotherapy: Developing and Identifying Effective A. E. Kazdin. Elmsford, New York: Pergamon, 1988. 161 pp.
Treatments.
By
In the opening pages of his book Kazdin presents data indicating that up to 10 million children in the United States suffer from some form of behavioral or emotional dysfunction requiring mental health services. Statistics on the prevalence of emotional disturbance are not surprising to most professionals working with children; results of the Joint Commission on Mental Health in Children have been available since 1969. However, the reader is somewhat startled to learn that in the most recent edition of the foremost text on psychotherapy research (Garfield & Bergin, 1986) the editors excluded a chapter on child psychotherapy because so little research and progress had been accomplished since the previous edition in 1978. In his book, Child Psychotherapy: Developing and Identzfying Effective i?eatments, Kazdin attempts to identify issues, problems and attitudes that have impeded progress in child psychotherapy research and provides a blueprint of methodological requirements and research models with a goal towards accelerating progress in this area. Because his focus is on clarifying issues, problems and methodological requirements, Kazdin does not use this book to provide an exhaustive survey of all the psychotherapeutic interventions that have been used with children (although he does provide a table of over 200 therapy approaches that are used). Nor does he provide an encyclopedic review of all the studies that have been done on child therapy. Critical reviews of the child therapy research literature are available from other sources. Proponents of the various theoretical approaches may be disappointed that he does not promulgate a particular theoretical perspective nor does he draw conclusions about which approaches are most effective for child problems. Kazdin’s goal is broader than these questions and his focus is on stimulating and accelerating research progress. To this end he selects from the available literature studies that illustrate some of the problems as well as exemplars of wellconceptualized and -designed models of research. At the end of this process he provides an outline of conceptual and methodological issues that must be considered in designing and evaluating child psychotherapy research. The outline will be extremely useful to both experienced researchers as well as students and other beginners in that it brings together in one source the many issues that need to be grappled with in designing and carrying out psychotherapy research. Kazdin’s important contribution arises from his broad grasp of these issues and his ability to bring them together in extremely well-organized form for the reader. The first chapter of the book defines the nature of the problem (i.e., the slow pace and limited progress to date in the field of child psychotherapy research) and some of the historical obstacles to advancement. Among the latter include the unavailability until relatively recently of an adequate nosological system for childhood disorders; developmental considerations that make control questions in
264
Book Reviews
child psychotherapy research particularly difficult; the fact that psychotherapeutic work with children often involves multiple points of impact (i.e., intervention with parents and/or teachers as well as therapy with the child); among others. Many of these problems have neither obvious nor ideal solutions, but raising them as issues alerts the potential researcher to the questions to which he must give thought in the context of the particular project at hand. The third chapter provides an overview of the current state of research on the effectiveness of child psychotherapy. As mentioned earlier, Kazdin does not attempt to provide an encyclopedic review of all the studies that have been done. He does review the reviews however, particularly two recent reviews using metaanalysis to quantify the effectiveness of therapy across studies. In this chapter, Kazdin provides a useful discussion of the strengths and some of the limitations of meta-analysis, particularly the limits imposed by such a small pool of available studies to include in these analyses. A general conclusion can be drawn that psychotherapy is more effective than no treatment, on the average, in improving children. However, because of the nature of the literature very few of the more compelling questions on the effectiveness of child psychotherapy can be addressed, supporting the need for much more research effort. In the fourth chapter, Kazdin reviews selected individual studies as well as programs of research which serve as exemplars in the field of child psychotherapy. None is perfect but they do demonstrate an attempt on the part of the respective investigators to address some of the methodological issues that have plagued the field and impeded progress. The preponderance of work reviewed in this chapter is on aggressive and antisocial child populations, perhaps reflecting Kazdin’s own immersion in this particular area. Much of this chapter is repeated from other of Kazdin’s works (Kazdin, 1987a,b). N evertheless, the principles that are exemplilied in these programs of study are generally applicable to the broader domain of child psychotherapy research, and Kazdin certainly cannot be faulted for drawing upon an area with which he is intimately familiar to illustrate his points. The final three chapters of the book are the ones within which Kazdin most powerfully accomplishes his purpose, for it is in these chapters that he reviews in detail the methodological and substantive issues that must be considered in designing and carrying out a psychotherapy research project, as well as innovative models that need to be adopted in order to expand the knowledge base. Again, much of this information is available in other Kazdin works (Kazdin, 1986, 1987a,b). However, in these chapters he expands and amplifies his previous discussions to provide a very thorough view of patient, treatment, therapist and assessment issues that emerge in psychotherapy investigations. The final chapter provides an outline of these issues that could serve as a checklist for the potential investigator designing a research project. Kazdin acknowledges that none of these issues represents new or novel information, as they have been discussed in various sources in the adult literature. However, it is extremely helpful to have this information assembled in one source and directed to a child-focused audience SO that child psychotherapy researchers do not have to reinvent the wheel in their attempts to accelerate progress in the field. In addition, Kazdin casts these methodological issues in the context of children as patients and subjects with the unique perspective that such consideration brings. In summary, this is a book that should well serve the purpose of stimulating and accelerating the sluggish progress to date in child psychotherapy research. Stu-
265
Book Reviews
dents and instructors of child psychotherapy and psychotherapy research will find it to be an extremely valuable instructional text. However seasoned researchers will also find it extremely helpful in stimulating their planning processes as they approach research projects. Careful consideration of the issues that Kazdin so lucidly raises in this book must occur if child psychotherapy research is to address the most sophisticated questions of what treatments work, with what kinds of children and under what circumstances. REFERENCES Garfield, S. L., & Bergin, A. E. (Eds.), (1986). Handbook ofpsychotherapy and behaviorchange: An empirical analysis (3rd ed.). New York: John Wiley & Sons. Kazdin, A. E. (1986). Comparative outcome studies of psychotherapy: Methodological issues and strategies.Jownal of Consulting and Clintial Psychology, 54, 95-105. Kazdin, A. E. (1987a). Treatment of antisocial behavior in children: Current status and future directions. PsychologicalBulletin, 102, 187-203. Kazdin, A. E. (1987b). Conduct disorders in childhood and adolescence. Newbury Park, CA: Sage.
KAREN
C. WELLS
Children’s Hospital National Medical Center, George Wmhington University School of Medicine
Treating Child Sex Offenders and Victims: A Practical Guide. By Anna Salter (Ed.), 1988. 344 pp. $29.95 ($14.95 softcover).
C.
This practical guide for treating sex offenders and victims is a very important contribution to a field that has long been neglected. The book is well-written, informative, and carefully organized into four sections. The first section presents epidemiological research on the prevalence of child sexual abuse and provides an excellent discussion of the psychiatric and psychological conceptualizations developed to explain the occurrence of sexual abuse. This discussion is particularly powerful as it documents the changes in conceptualizations and attitudes toward the victim, offender, and non-offending parents from the early part of this century to the present. This historical account should be considered mandatory reading for all individuals working with sex offenders and victims, as it underscores the strides that have been made as well as the biases that persist with respect to psychiatric, legal, and societal reactions to sex offenders and victims. The second section outlines the philosophy and structure of the treatment programs to be described. Here, the author clearly and concisely provides the principles upon which the treatment programs are based, and she appropriately urges that these premises must be accepted by therapists and clients alike in order for treatment to be effective. In addition, guidelines are provided for developing and implementing a comprehensive treatment center including practical suggestions for building a treatment team, gaining community support and obtaining funding. The third section outlines strategies for assessing and treating sex offenders. The author’s discussion of the differences in treating sex offenders who are often under court order as opposed to voluntary, motivated patients is excellent. In addition, the issue of offender denial is addressed in detail. The author also offers