There is a growing evidence base of outcomes in clinical controlled trials of psychoanalytic child and adolescent psychoanalytic psychotherapy.
There are four systematic meta-analytic studies by Abbas et al. (2013), Barlow et al. (2016), Palmer et al (2012) and Midgley et al. (2017). The majority of these studies were undertaken in clinically referred samples rather than samples recruited for research, involving children with a range of diagnoses or problems and involving trained psychotherapists. These findings from practice based evidence are likely to have greater relevance to the ‘real world’ setting.
Midgley et al’s (2017)1 systematic review found that many of the children included in studies had high levels of clinical disturbance, and most trials made use of a broad range of outcome measures, including standardized psychiatric and psychological measures. Most studies were of children presenting with a range of difficulties, rather than one specific diagnostic group, although some also focused specifically on particular diagnostic categories. Psychoanalytic child and adolescent psychoanalytic psychotherapy is recommended as a treatment in NICE guidance for depression in children and young people and in NICE/SCIE guidance as a therapeutic intervention after abuse and neglect.
Child and Adolescent Psychotherapy in NICE and SCIE Guidance
Depression in Children and Young People
NICE recommends psychodynamic psychotherapy in its guidance on management of depression in children and young people2:
- For 5 – 11 year olds psychodynamic psychotherapy is recommended (1.6.4) as one of the options for first line treatment for those with severe to moderate depression.
- For 12 – 18 year olds it recommends psychodynamic psychotherapy as an option to consider (1.6.6) if individual CBT would not meet the clinical needs of those with moderate to severe depression or is unsuitable for their circumstances.
- In addition the guidance recommends psychodynamic psychotherapy (approximately 30 weekly sessions) for depression unresponsive to combined treatment (1.6.13).
CYP with moderate to severe depression, and co-morbid depression and anxiety, are likely to make up a significant proportion of the additional 345,000 to be seen under the LTP and therefore psychodynamic psychotherapy should be made available in all CAMHS and considered as an option for all 5 to 18 years olds with moderate to severe depression.
CAPTs undertook the work in the trials that have led to the inclusion of psychodynamic psychotherapy in the NICE guideline and are best placed to offer treatment for these groups of patients. This work is included as a core competency in their training.
Abuse and Neglect
NICE/SCIE guidelines3 on therapeutic interventions after abuse and neglect recommend individual psychoanalytic psychotherapy as an intervention after sexual abuse for girls aged 6-14.
It also recommends providing separate sessions for non-abusing parents or carers to help them support their child’s attendance and address issues in the family. Concurrent work with parents is a key aspect of the CAPPT approach.
1. Nick Midgley, Sally O’Keeffe, Lorna French & Eilis Kennedy (2017) Psychodynamic psychotherapy for children and adolescents: an updated narrative review of the evidence base, Journal of Child Psychotherapy, 43:3, 307-329, DOI: 10.1080/0075417X.2017.1323945
2. NICE (2019) NICE guideline [NG134] Depression in children and young people: identification and management, available at: https://www.nice.org.uk/guidance/ng134/chapter/Recommendations
3. NICE/SCIE (2018) Therapeutic Interventions After Abuse and Neglect, accessed at: https://www.nice.org.uk/about/nice-communities/social-care/quick-guides-...