The research-practitioner relationship for child and adolescent psychotherapists

Like all professionals working within the NHS, child psychotherapists are under pressure to demonstrate effective outcomes and to enrich the evidence base of the discipline. How are practicing child psychotherapists to respond to the research agenda?
In this talk I will, firstly, outline some different ways of conceiving the relationship between scientific research and practice for mental health professionals in general and, secondly, outline some issues that apply particularly strongly for child psychotherapists. These include the need to practice psychotherapy free from the ‘pressure of memory and desire’, the recognition that therapeutic effects involve creative processes that may fall outside the range of prediction, and the fact that the population of children receiving child psychotherapy is relatively small, highly disturbed and marked by complexity. This diversity can make for small sample sizes, increasing the difficulty of using traditional scientific methods. On the other hand, single case studies or qualitative approaches may suffer the problem of limited generalisability
I will address possibilities for getting round some of these problems, using multisite problems to increase sample sizes, for example, and the kinds of generalisability that may be possible from qualitative studies.
Finally I will focus on a piece of research of my own which aims to evaluate the effectiveness of child psychotherapy from the points of view of parents/carers, child psychotherapists and their child patients. The approach involves parents/ carers and child psychotherapists putting forward specific ‘hopes and expectations’ for child psychotherapy treatment to be evaluated after an agreed period of treatment. These hopes and expectations are based on what the psychotherapist finds and feeds back to the parents after the psychotherapy assessment that routinely precedes a child’s starting psychotherapy. The approach also provides a framework in which the practicing child psychotherapists can monitor the validity of their initial formulations of a particular patient’s underlying difficulties and the effectiveness of subtle variations in psychotherapeutic technique
In this presentation I will describe work with one boy who, while eventually doing well in child psychotherapy, at first did not develop as I hoped and expected. I show how the evaluation framework enabled me to monitor the child’s progress, modify the original formulation and adjust technique, with consequent developments in the child’s progress. In this way the research endeavour contributed to developments in my own clinical practice.
References
Anderson, J. (2003) The mythic significance of risk-taking, dangerous behaviour Journal of Child Psychotherapy 29, 1. 75-91
Baruch, G. (2001) The routine evaluation of mental health outcome at a community-based psychotherapy centre for young people. In G. Baruch (ed.) Community-Based Psychotherapy with Young People. Evidence and innovation in Practice. London: Jessica Kingsley
Bion, W. (1972) Attention and Interpretation London: Heinemann
Desmarais, S. (2007) Hard science, thin air and unexpected guests: A pluralistic model of and conjecture in child psychotherapy research. Journal of Child Psychotherapy, 33 (3), 203-307
Dreher, A.U. (2000) Foundations for conceptual research in psychoanalysis. London: Karnac
Midgley, N. (2004) Sailing between Scylla and Charybdis: Incorporating qualitative approaches into child psychotherapy research. Journal of Child Psychotherapy, 30 (1) 89-111
Midgley,N., Anderson, J., Grainger, E., Nesic-Vuckovic, T., and Urwin, C. (in press) Child Psychotherapy and Research: New Approaches and Emergent Findings. London: Routledge
Urwin, C. (2007) Revisiting ‘What works for whom?’ A qualitative framework for evaluating clinical effectiveness in child psychotherapy. Journal of Child Psychotherapy, 33 (2) 134-160