Background: Child psychiatry has enjoyed a long tradition of using brief psychotherapy with children, but research on its efficacy and effectiveness in the setting of routine clinical care is remarkably sparse; the aim of this study was to evaluate the efficacy of an original model of brief psychodynamic psychotherapy (BPP) for children with emotional disorders in a clinical outpatient setting. Methods: A sample of 30 subjects (6.3–10.9 years old) was divided into an experimental BPP group and a control group. Each subject was evaluated at the beginning, after 6 months and at an 18-months follow-up. Outcome measures were Children’s Global Assessment Scale and Child Behavior Check-List. Statistical and clinical significance of change were evaluated. Results: At the first evaluation, the experimental group showed a better improvement in global functioning; at follow-up, the two groups improved to a comparable degree, but only the mean of the experimental group moved to a functional range. The experimental group showed a significant reduction in total behavioral problems and externalizing problems at the follow-up. Conclusions: The better improvement of the experimental group in two outcome measures suggests that BPP is efficient in emotional disorders. The hypothesis that BPP introduces changes at long term (sleeper effects) is suggested. The improvement in global functioning of the two groups is discussed in relation to specific characteristics of emotional disorders. Finally, limitations of the study are discussed and in particular the bias introduced by lack of randomization.

1.
Weiss B: Routine monitoring of the effectiveness of child psychotherapy. J Child Psychol Psychiatry 1998;39:943–950.
2.
Streiner DS: Thinking small: Research designs appropriate for clinical practice. Can J Psychiatry 1998;43:737–741.
3.
Wells JE, Bushnell JA, Hornblow AR, Joice PR, Oakley-Browne MA: Christchurch psychiatric epidemiology study: Methodology and lifetime prevalence for specific psychiatric disorders. Aust N Z J Psychiatry 1989;23:315–326.
4.
Finney JW, Riley AW, Cataldo MF: Psychology in primary health care: Effects of brief targeted therapy on children’s medical care utilization. Pediatr Psychol 1990;16:447–461.
5.
Kamlet MS, Wade M, Kupfer DJ, Frank E: Cost-utility analysis of maintenance treatment for recurrent depression: A theoretical framework and numerical illustration; in Frank RG, Manning WG (eds): Economics and Mental Health. Baltimore, Johns Hopkins University Press, 1992, pp 267–291.
6.
Casey RG, Berman JS: The outcome of psychotherapy with children. Psychol Bull 1985;98:388–400.
7.
Weisz JR, Han SS, Granger DA, Weiss B, Morton T: Effects of Psychotherapy with children and adolescents revisited: A meta-analysis of treatment outcome studies. Psychol Bull 1995;117:450–468.
8.
Weisz JR, Weiss B, Alicke MD, Klotz ML: Effectiveness of psychotherapy with children and adolescents: A meta-analysis for clinicians. J Consult Clin Psychol 1987;55:542–549.
9.
Kazdin A, Bass D, Ayers WA, Rodgers A: Empirical and clinical focus on child and adolescent psychotherapy research. J Consult Clin Psychol 1990;58:729–740.
10.
Fonagy P: Evaluating the effectiveness of interventions in child psychiatry. Can J Psychiatry 1997;42:584- 594.
11.
Jensen P, Hoagwood K, Petti T: Outcome of mental health care for children and adolescents. II. Literature and application of a comprehensive model. Am Acad Child Adolesc Psychiatry 1996;35:1064–1077.
12.
Pearsall D: Psychotherapy outcome research in child psychiatric disorders. Can J Psychiatry 1997;42:595–601.
13.
Orlinsky DE, Grawe K, Parks BK: Process and outcome in psychotherapy; in Bergin AE, Garfield SL (eds): Handbook of Psychotherapy and Behavior Change. New York, Wiley, 1994, pp 270–278.
14.
Marks I: Is a paradigm shift occurring in brief psychological treatments? Psychother Psychosom 1999;68:169–170.
15.
Roth A, Fonagy P: What Works for Whom? A Critical Review of Psychotherapy Research. New York, Guilford Press, 1996.
16.
Smyrnios KS, Kirkby RJ: Long-term comparison of brief versus unlimited psychodynamic treatments with children and their parents. J Consult Clin Psychol 1993;61:1020–1027.
17.
Leventhal T, Weinberger G: Evaluation of a large scale brief therapy program for children. Am J Orthopsychiatry 1975;45:119–133.
18.
Rosenthal AJ, Levine S: Brief Psychotherapy with children: Process of therapy. Am J Psychiatry 1971;128:141–146.
19.
Levenson A, Butler SF, Beitman BD: Concise Guide to Brief Dynamic Psychotherapy. Washington, American Psychiatric Press, 1997.
20.
Andrade AR, Lambert W, Bickman L: Dose effect in child psychotherapy: Outcomes associated with negligible treatment. Am Acad Child Adolesc Psychiatry 2000;39:161–168.
21.
Hoagwood K: Commentary: The dose effect in children’s mental health services. Am Acad Child Adolesc Psychiatry 2000;39:172–175.
22.
Petti TA: Commentary: More outcomes studies are needed. Am Acad Child Adolesc Psychiatry 2000;39:169–171.
23.
Target M, Fonagy P: Efficacy of psychoanalysis for children with emotional disorders. J Am Acad Child Adolesc Psychiatry 1994;33:361–371.
24.
Sigal JJ, Paris J, Kardos M, Zimmerman G, Buonvino M: Evaluation of some criteria used to select patients for brief psychodynamic therapy. Psychother Psychosom 1999;68:4:193–198.
25.
Kazdin AE: Methodology, design, and evaluation in psychotherapy research; in Bergin AE, Garfield SL (eds): Handbook of Psychotherapy and Behavior Change. New York, Wiley, 1994, pp 19–71.
26.
Rutter M, Tizard J, Whitmore K: Education, Health and Behavior. New York, Krieger, 1970.
27.
Costello EJ: Developments in child psychiatric epidemiology. J Am Acad Child Adolesc Psychiatry 1989;28:836–841.
28.
Kashani JH, Orvaschel A: A community study of anxiety in children and adolescents. Am J Psychiatry 1990;147:313–318.
29.
Bernstein GA, Borchardt CM: Anxiety disorders of childhood and adolescence: A critical review. J Am Acad Child Adolesc Psychiatry 1991;30:43–50.
30.
Kazdin AE: Treatment of Antisocial Behavior in Children and Adolescents. Homewood, Dorsey Press, 1985.
31.
Fonagy P: Prevention, the appropriate target of infant psychotherapy. Infant Mental Health J 1998;19:124–150.
32.
Kazdin AE: Childhood depression. J Child Psychol Psychiatry 1990;31:121–160.
33.
Achenbach TM: Manual for the Child Behavior Checklist/4–18 and 1991 Profile. Burlington, University of Vermont, 1991.
34.
Kazdin AE: Research Design in Clinical Psychology. Boston, Allyn and Bacon, 1998.
35.
World Health Organization: The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, WHO, 1992.
36.
Gilliéron E: Les psychothérapies brèves. Paris, Puf, 1990.
37.
Malan D: A Study of Brief Psychotherapy. London, Tavistock Publications, 1963.
38.
Strupp HH, Binder J: Psychotherapy in a New Key: A Guide to Time Limited Dynamic Psychotherapy. New York, Basic Books, 1984.
39.
Cramer B: Inteventions thérapeutiques brèves avec parents et enfants. Psychiatr enfant 1974;XVII:53–117.
40.
Cramer B, Palacio Espasa F: La pratique des psychothérapies mères-bébés. Paris, PUF, 1993.
41.
Cramer B: Mother-infant psychotherapies: A widening scope in technique. Infant Mental Health J 1998;19:151–167.
42.
Fraiberg S: Clinical Studies in Infant Mental Health: The First Year of Life. New York, Basic Books, 1980.
43.
Lieberman A, Weston DR, Pawl JH: Preventive intervention and outcome with anxiously attached dyads. Child Dev 1991;62:205–208.
44.
Seligman S: Applying psychoanalysis in an unconventional context: Adapting infant-parent psychotherapy to a changing population. Psychoanal Study Child 1994;49:481–500.
45.
Luborsky L, Crits-Christoph P, Mintz I, Auerbach A: Who Will Benefit from Psychotherapy? Predicting Therapeutic Outcome. New York, Basic Books, 1988.
46.
Sifneos P: Psychothérapie brève et crise émotionnelle. Bruxelles, Mardaga, 1979.
47.
Chambers WJ, Puig Antich J, Hirsch M, Paez P, Ambrosini PJ, Tabrizi MA, Davies M: The assessment of affective disorders in children and adolescent by semistructured interviews: Test-retest reliability of the Kiddie-Sads P. Arch Gen Psychiatry 1985;42:696–702.
48.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 3 rev. Washington, APA, 1987.
49.
Ambrosini PJ: Historical developmental and present status of the schedule for affective disorders and schizophrenia for school-age children (K-SADS). J Am Acad Child Adolesc Psychiatry 2000;39:49–56.
50.
Sandler RN: Social support resources, stress and maladjustment of poor children. Am J Commun Psychol 1980;8:41–52.
51.
Hollingshead AB, Redlich FC: Social Class and Mental Illness. New York, Wiley & Sons, 1958.
52.
Crijnen AA, Achembach TM, Verhulst FC: Problems reported by parents of children in multiple cultures. Am J Psychiatry 1999;156:569–574.
53.
Gould MS, Bird H, Jaramillo BS: Correspondences between statistically derived behavior problem syndromes and child psychiatric diagnoses in a community sample. J Abnorm Child Psychol 1993; 21:287–313.
54.
Kasius MC, Ferdinand RF, van den Berg H, Verhust FC: Association between different diagnostic approaches for child and adolescent psychopathology. J Child Psychol Psychiatry 1997;38:625–632.
55.
Krol NP: Validity of th CBCL. J Am Acad Child Adolesc Psychiatry 1990;29:986–987.
56.
Shaffer D, Gould MS, Brasic J: A Children’s Global Assessment Scale (CGAS). Arch Gen Psychiatry 1983;40:1128–1231.
57.
Bird HR, Canino G, Rubio-Stipee M, Ribera JC: Further measures of the psychometric properties of the Children’s Global Assessment Scale. Arch Gen Psychiatry 1987;44:821–824.
58.
Dill DL, Eisen SV, Grob MC: Validity of record ratings of the Global Assessment Scale. Compr Psychiatry 1989;30:320–323.
59.
Sourander A, Helenius H, Piha J: Child psychiatric short term inpatient treatment: CGAS as follow-up measure. Child Psychiatry Hum Dev 1996;27:93–104.
60.
Rey JM, Starling J, Wever C, Dossetor DR, Plapp JM: Inter-rater reliability of global assessment of functioning in a clinical setting. J Child Psychol Psychiatry 1995;36:782–792.
61.
Green B, Shirk S, Hanze D, Wanstrath J: The Children’s Global Assessment Scale in clinical practice: An empirical evaluation. J Am Acad Child Adolesc Psychiatry 1994;33:1158–1165.
62.
Fairbairn CG, Norman PA, Welch SL, O’Connor ME, Doll HA, Peveler RC: A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments. Arch Gen Psychiatry 1995;52:304–312.
63.
Last CG, Perrin S, Hersen M, Kazdin AE: DSM III-R anxiety disorders in children: Sociodemographics and clinical characteristics. J Am Acad Child Adolesc Psychiatry 1992;31:1070–1076.
64.
Robins LN: Deviant Children Grown-Up. Baltimore, Williams and Wilkins, 1966.
65.
Harrington R, Fudge H, Rutter M, Pickles A, Hill J: Adult outcomes of childhood and adolescent depression. Arch Gen Psychiatry 1990;47:465–473.
66.
Flament MF, Koby E, Rapoport JL, Berg CJ, Zahn T, Cox C, Denckla M, Lenane M: Childhood compulsive disorder: A prospective follow-up study. J Child Psychol Psychiatry 1990;31:363–380.
67.
Francis G, Ollendick TH: Anxiety disorders; in Frame CL, Matson JL (eds): Handbook of Assessment in Child Psychopathology. New York, Plenum Press, 1986.
68.
Ollendick TH, King NJ: Diagnosis, assessment and treatment of internalizing problems in children: The role of longitudinal data. J Consult Clin Psychol 1994;62:918–927.
69.
Cantwell DP, Baker L: Stability and natural history of DSM III childhood diagnoses. J Am Acad Child Adolesc Psychiatry 1989;28:691–700.
70.
Strupp HH: The nonspecific hypothesis of therapeutic effectiveness: A current assessment. Am J Orthopsychiatry 1986;30:513–520.
71.
Fisher SG: Time-limited brief therapy with families: A one-year follow-up study. Fam Process 1984;23:101–106.
72.
Weltner JS: One-to three-session therapy with children and families. Fam Process 1982;21:281–289.
73.
Barret CL, Hampe IE, Miller LC: Research on child psychotherapy; in Garfield SL, Bergin AE (eds): Handbook of Psychotherapy and Behavior Change: An Empirical Analysis. New York, Wiley, 1978.
74.
Bandura A, Cervane D: Self-evaluation and self-efficacy mechanisms governing the motivational effects of goal systems. J Pers Soc Psychol 1983;45:1017–1028.
75.
Stern DN, Fava Vizziello G: Dalle cure materne all’interpretazione. Milano, Cortina, 1992.
76.
Giles TR, Prial EM, Neims DM: Evaluating psychotherapies: A comparison of effectiveness. Int J Ment Health 1993;XXII:540–551.
77.
Horowitz MJ, Marmar ChR, Weiss DS, Kaltreider NB, Wilner NR: Comprehensive analysis of change after brief dynamic psychotherapy. Am J Psychiatry 1986;143:585–589.
78.
Luborsky L, Spence DP: Quantitative research on psychoanalytic therapy; in Garfield SL, Bergin AE (eds): Handbook of Psychotherapy and Behaviour Change. New York, Wiley, 1978.
79.
Shapiro T: Developmental issues in psychotherapy research. J Abnorm Child Psychol 1996;23:31–44.
80.
Fonagy P, Taget M: Efficacy of psychoanalysis for children with disruptive disorders. J Am Acad Child Adolesc Psychiatry 1994;33:45–55.
81.
Kendall PC, Kortlander E, Chansky TE, Brady EU: Comorbidity of anxiety and depression in youth: Treatment implications. J Consult Clin Psychol 1992;60:869–880.
82.
Verhulst FC, van der Ende J: Comorbidity in an epidemiological sample: A longitudinal perspective. J Child Psychol Psychiatry 1993;34:767–784.
83.
Kovacs M, Lohr D: Research on psychotherapy with children and adolescents: An overview of evolving trends and currents issues. J Abnorm Child Psychol 1995;23:11–30.
84.
Gabbard O, Lazar SG, Hornberger J, Spiegel D: The economic impact of psychotherapy: A review. Am J Psychiatry 1997;154:147–155.
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