Does psychotherapy help some students? An overview of psychotherapy outcome research

Professional School Counseling, June, 2006 by Kelly C. Eder, Susan C. Whiston

This article provides a brief overview of the outcome research on psychotherapy with children and adolescents. Outcome research indicates that psychotherapy can be effective with both children and adolescents, with meta-analyses indicating that youth who participated in this type of intervention tended to score on the outcome measures half of a standard deviation or more above those who did not receive any intervention. Little is known about the process of psychotherapy with children, but there are some indications that the therapeutic relationship is important. Moreover, there is some research that supports the assumption that certain types of treatment are most helpful with specific clinical issues.

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In the ASCA National Model[R] proposed by the American School Counselor Association (2005a), school counselors have the responsibility for promoting the academic, career, and personal/social development of all students. This includes students who are experiencing difficulties and those who may meet diagnostic criteria for a psychiatric disorder. Furthermore, policy initiatives at national and state levels, such as the No Child Left Behind Act of 2001 (2002), are requiring that all children succeed academically; however, this may be difficult for children who are experiencing emotional problems. The number of students experiencing difficulties does not appear to be trivial. For example, the National Institute of Child Health and Human Development (2005) recently reported that an estimated 2.7 million children are noted by their parents to suffer from noticeable or severe emotional or behavioral problems that may interfere with their family life, their ability to learn, and their abilities to make friends.

Kazdin and Johnson (1994) noted that prevalence studies indicate that between 17% and 22% of youth under 18 years of age suffer developmental, emotional, or behavioral problems. Costello et al. (1996) had similar findings that 20.3% of children between the ages of 9 and 13 met the criteria for mental disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000). This is also consistent with Doll's (1996) findings that a typical school can expect to find between 18% and 22% of students with diagnosable psychiatric disorders, most frequently anxiety disorders, conduct disorder, oppositional defiant disorder, and attention deficit disorder. In secondary school populations, Doll also found that depression and suicidal behaviors were prevalent.

Schools and, subsequently, school counselors may be in a strategic position to provide services to children and adolescents in need. The child or adolescent's relations to peers, problem behaviors, prosocial functioning, and academic performance can be observed and assessed within the school. This allows professionals in the school to identify when an intervention is needed and to evaluate whether an intervention is having an impact (Kazdin & Johnson, 1994). Additionally, the school setting has a broader reach as nearly all children are required to attend school. Thus, schools have direct access to nearly all children and adolescents and have the potential to reach more children than clinic settings where parents must seek out and take the child or adolescent for treatment. Thus, by default, schools become the only avenue for some students to receive the mental health services they need (Hoagwood & Erwin, 1997).

The intent of this article is to review the research related to psychotherapy with children and adolescents to determine if these types of services or interventions are helpful to students who are experiencing moderate to severe emotional or behavioral difficulties. In addition, this article is designed to review psychotherapy research with the goal of informing school counselors about aspects of psychotherapy that may assist them in either referring students for appropriate treatment or providing services within a school setting.

OVERALL EFFECTIVENESS OF CHILD AND ADOLESCENT PSYCHOTHERAPY

In considering the needs of students with emotional, behavioral, and developmental disorders, the first issue is what can be done to assist these students. For many of these students, it does appear that psychotherapy can be quite effective and helpful. In meta-analytic studies, researchers seek to statistically combine results from different studies in order to analyze across studies the effectiveness of certain interventions. For each study, an effect size is typically calculated by subtracting the mean of the control group from the mean of the treatment group and dividing by the pooled standard deviation, which results in a numerical index of whether the individuals receiving the intervention did better or worse on the outcome measure than those who did not receive the intervention during the time of the study. These effect sizes then are combined and often weighted related to sample size and error variance, which produces an overall effect size for the intervention.