Book Review
Psychotherapy 
Psychotherapy for Children and Adolescents: Evidence-Based Treatment and Case Examples John R Weisz. Cambridge (UK): Cambridge University Press; 2004. 528 p. US$35.00.
Reviewer
rating*: Excellent
Review by: Llewellyn W Joseph, MD
Toronto, Ontario
John Weisz is an experienced researcher and clinician in child and adolescent treatment. The purpose of his book is to evaluate the research on treatments tested and shown to work in children and adolescents with emotional and behavioural problems. He aims to correct a preceived deficit in the transmission of research findings to the clinical practice community, owing to of language differences as well as differences between the research and clinical conditions. The book is aimed at practitioners, researchers, training directors, parents, and administrators, offering a choice of treatment appropriate to their various roles.
The book is arranged in 6 sections labelled A to F. Section A is a 23-page introduction that provides a comprehensive background on child and adolescent therapy from its historical roots to studies of effectiveness and outcome. The last section (F), discusses the “Strengths, Limitations, and Future Directions of Evidence-Based Youth Psychotherapy.” The 4 intervening chapters deal with treatment studies of the following 4 major categories of disorders: fears and anxiety, depression, ADHD, and conduct problems and conduct disorder.
The introduction includes some important background information. For instance, findings from studies of clinically guided treatment in usual care tend to show it has no benefit, and studies of “the effects of integrating of usual care procedures into systems of care show little evidence of benefit” (p 15). Metaanalysis of controlled studies of structured therapies for children and youth show benefits comparable with adults in effect sizes and precision of effect as well as in duration of effect. There are, however, problems with metaanalyses, and hence, an increasing use of “focused review” by different professionals such as pediatricians and child psychiatrists.
For this review, the author uses the guidelines of the American Psychological Association’s Task Force of the Society of Clinical Psychology (1995), which rates therapies as well-established or probably efficacious according to the number and quality of supportive studies, the use of a manual, the specification of the sample, and the support by 2 or more investigators or research teams. Therapies that were well established and probably efficacious were further identified for the 4 broad symptom and diagnostic clusters: fears and anxieties, depression, ADHD, and conduct problems and disorders.
The studies reviewed in this book were selected from the 350 studies meeting methodological requirements for inclusion in the above-mentioned metaanlysis, meeting criteria of the Task Force as either well established or probably efficacious, and further meeting other criteria imposed by the author, such as addressing existing, compared with anticipated, psychological dysfunctio; treating a specific problem, compared with general harm or trauma; and focusing on primary behavioural and mental problems, compared with medical or physical problems.
The clinical focus of the book is emphasized by the introduction of 4 cases of young people, each with a problem matching one of the 4 diagnostic groups discussed in the separate sections. Each section starts with the presentation of the appropriate case, followed by a discussion of the available and commonly used treatments in clinical settings compared with the research. A discussion of the selected evidence-based treatments and treatment programs follows in the body of each section. The discussion is thorough, incorporating different perspectives.
Section B, “Four Classic Treatments for Fears,” opens with a summary of the clinical observations of the development of fears and the theory of the genesis of avoidant behaviour. The author describes how the 4 therapeutic techniques of modelling, systematic desensitization, exposure, and self-talk can be used to break into the fear–avoidance cycle.
For each treatment, a summary box provides key facts about the therapy, such as the population for which it was designed, the duration of treatment and session length, the theoretical orientation, treatment elements, the treatment classification (that is, well established or probably efficacious), and treatment resources. The discussion of each treatment closes by returning to the patient and discussing the process and progress of therapy. Each section closes with a critical appraisal of the studies of the particular therapies, noting the research challenges involved and the value and limitations of these therapies in the clinical arena.
The last section appraises the body of research as a whole and identifies issues requiring research attention, such as treatments for a broader array of disorders and the understanding of change processes.
The book is well referenced (31 pages), thorough in its discussion, and readable. Its main selling point is the inclusion of clinical segments where the procedures and the progress of therapy are demonstrated and discussed. Use of the clinical case enhances the discussion of the clinical application and increases appreciation of the use of these therapies in the real world, thus increasing the likelihood of their adoption. Summary tables and boxes make it easy to locate core information.
It was disappointing that some disorders, which would be more usefully discussed separately, were lumped together. For example, although they may be different levels of problems with different pathological and prognostic implications, conduct disorders and conduct problems were grouped together. With respect to depression, it is also not clear why studies of interpersonal psychotherapy were excluded, particularly since its processes are readily adaptable clinically.
I finished the book more willing to faithfully use treatments that I previously only incorporated into an eclectic amalgam of treatment strategies and techniques. It is worth every penny.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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