Psychotherapy, Child and Adolescent Psychiatry
Review by Allan Frankland, MD, Nasreen Roberts, MD, FRCPC
This book is from the Cambridge Child and Adolescent Psychiatry series
that has given us other interesting titles, such as The Depressed Child
and Adolescent (recently reviewed in this journal ).
As the preface states, the aims of this text are ambitious. Foremost among
these is to provide a comprehensive overview of psychotherapy for children,
adolescents, and their families. Other areas include diagnostic assessment,
choice of treatment techniques, and indications and contraindications for
the various psychotherapies. Professor Remschmidt states categorically
that modern psychotherapy should proceed according to a pluralistic concept
that allows for an indication-informed and disorder-specific approach.
From the outset, he reassures readers with his objective, inclusive view—a
view in stark contrast to the polarized, dichotomous views prevalent in
psychotherapy texts of 30, or even 20, years ago.
The book is presented in 4 parts. Part 1 establishes the basic framework
by addressing the principles of psychotherapy. The first chapter offers
a precise definition of psychotherapy and discusses choice of psychotherapy
modality and setting, adapting to the patient’s developmental stage, outcome
evaluation, and limitations. The chapter on treatment planning is enhanced
by tables and algorithms that facilitate and set up lucid paradigms. The
author stresses the need for ongoing appraisal and review. The chapter
on research reviews some of the metaanalytic studies from Europe and North
America that reveal behavioural therapy, cognitive-behavioural therapy,
and short-term focused psychotherapy to be consistently superior to traditional
long-term psychotherapy in treating various child and adolescent disorders.
The author also describes his own research and provides readers with information
on recommended treatment modalities. There are interesting differences
between European and North American practice; these are evident from the
tables outlining forms of psychotherapy and types of medications used to
treat outpatients. A chapter on quality assurance candidly discusses the
gaps in this area and the need to address these, with suggestions for future
work. In North America, we appear to be somewhat further ahead in the area
of quality assurance, perhaps owing to our Canadian health system and the
managed care system in the US. Measures such as admission and discharge
symptom checklists, outcome measures, and satisfaction questionnaires are
an integral part of most Canadian child and adolescent psychiatric programs.
Part 2 covers psychotherapeutic methods and settings. The author discusses
all the major psychotherapy modalities in an organized and concise overview.
Included are chapters on interpersonal psychotherapy for adolescents, play
therapy, psychodrama, family therapy, and parent training, among others.
Several vignettes are used thoughtfully to illustrate the various techniques.
Many (but not all) of the chapters include a discussion of indications
and contraindications to the particular psychotherapy style. Several chapters
use tables to illustrate the various phases of therapy. At the end of each
chapter, the author includes available evidence supporting the use of each
particular psychotherapeutic modality.
At almost 300 pages, Part 3 is the book’s largest section. It comprises
17 chapters examining the use of psychotherapy in each of the various psychiatric
disorders affecting children and adolescents. Each chapter gives a brief
description of the key features of the disorder, including a short discussion
of etiology, epidemiology, and pharmacotherapy. The principle modes of
psychotherapeutic treatment are described in greater detail and are illustrated
with summary charts and vignettes. These vignettes often highlight systemic
differences between the European and North American conceptualization and
delivery of mental health care. For example, inpatient admissions lasting
several months do not appear to be unusual in the centres in Germany noted
in the text. It is significant that this book is based on European practice
and thus refers primarily to the ICD-10 classification system. Therefore,
there is no distinct section devoted to attention-deficit hyperactivity
disorder (ADHD). Rather, it seems to be addressed in a chapter entitled
“Hyperkinetic Disorders,” a term rarely used on this continent.
The final and shortest section contains chapters devoted to inpatient psychotherapy,
day treatment, and home therapy. Interestingly, the author recommends inpatient
stays of 2 to 3 years for rehabilitation of serious mental illnesses, including
schizophrenia, eating disorders, psychosomatic disorders, and “neurotic
disorders.” The chapter on day treatment offers several useful outlines
of this treatment paradigm. The final chapter is devoted to home therapy
and includes indications, contraindications, and evaluation of this treatment
mode rarely seen this side of the Atlantic.
This volume was originally published 5 years ago in Germany. The current,
clearly written, English translation was published last year. Because it
was written 5 years ago, however, this edition does not capture numerous
significant advances in an ever-growing body of literature on psychopharmacology,
quality assurance, and outcome research. For example, in 1997, the American
Academy of Child and Adolescent Psychiatry began publishing practice parameters
for various disorders in this population. Some of these parameters are
referenced, but many are not reflected in this edition. That said, although
there are several excellent volumes on psychopharmacology in children and
adolescents, texts focusing on the psychotherapeutic aspect have been somewhat
neglected. This volume is thus a welcome addition to that body of literature.
With regard to production, although the writing style is clear and concise,
there are a surprising number of typographical errors. The text is somewhat
expensive, but it is nonetheless a valuable reference in the library of
any child psychiatrist.
1. Chan J, Roberts N. The depressed child and adolescent [book review].
Can J Psychiatry 2002;47:274–5.
Rating Scale/ Échelle dévaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé