The Bernard L. Pacella, MD Parent Child Center

Resources: Expert Opinion

The Key To Child Therapy

"Longer term, more intensive psychotherapy."

By Leon Hoffman, MD

Forward, July 19, 1996

Your article by E.J. Kessler ("Child Therapy: An Analysis," June 21) points to the difficulties parents have in selecting the best treatment for their children who need psychological help. As Ms. Kessler, writes, in the current managed health care environment only brief psychotherapy is often authorized for children as well as adults.

A landmark study has organized the observations and clinical records of 40 years of child psychoanalysis. This study has been published very recently in the April issue of the Journal of the American Psychoanalytic Association. The report documents that "more intensive and longer treatments are much more effective than less intensive and shorter forms of therapy." The study is based on the work of child psychoanalysts in London, working under the supervision of Anna Freud, daughter of Sigmund Freud. The records of nearly 800 children treated over four decades were systematically examined using modern diagnostic assessment methods.

As Ms. Kessler discusses, often it is difficult for parents to determine which type of therapy is most appropriate for their child who needs psychological help. The study published in JAPA should help parents consider the value of longer term more intensive psychotherapy and psychoanalysis because this report documents that intensive treatment was shown to be more effective than shorter therapies or a combination of short term therapy and drugs. In addition, longer treatments were independently associated with greater improvement.

NEW REPORT SHOWS LONG TERM, MORE FREQUENT PSYCHOTHERAPY MORE EFFECTIVE FOR CHILDREN

In the current managed healthcare environment, when only brief psychotherapy is authorized for children as well as adults, a landmark study has organized the observations and clinical records of 40 years of child psychoanalysis. The report documents the efficacy of long term, intensive psychological treatment. Reporting their findings in the Journal of the American Psychoanalytic Association (JAPA) in April 1996, child psychoanalyst, Peter Fonagy, Ph.D., and Mary Target, Ph.D., of the University of London and the Anna Freud Centre, were able to document that "MDBI"more intensive and longer treatments were much more effective than less intensive and shorter forms of therapy "MDNM".

The study, carried out in collaboration with the Yale University Child Study Center, is based on the work of child psychoanalysts in London, working under the supervision of Anna Freud, daughter of Sigmund Freud. The records of nearly 800 children treated over four decades were systematically examined using modern diagnostic assessment methods. Dr. Fonagy, who is also the coordinator of the Child and Family Study Center of the Menninger Clinic in the United States, recognized how difficult it is for parents to determine which type of therapy is most appropriate for their troubled child:

"There is a bewildering array of psychotherapies. Until now there has been little documentation about what types of treatments work best for different emotional problems, yet these are the central concerns of parents and mental healthcare providers as well as the purchasers of such care."

Young children with the most severe emotional disorders respond best to psychoanalysis of six months or more. This intensive treatment was shown to be more effective than shorter therapies or a combination of therapy and drugs. In addition, longer treatments were independently associated with greater improvement: 51 percent of the children studied improved if treated for one or two years, and 74 percent improved when treatment lasted at least three years. The study also proved that more frequent treatment is the most effective therapy for older children and adolescents: 74 percent of preschool children significantly improved after long term treatment, 67 percent of children six to twelve years old, and 58 percent of adolescents showed marked improvement with intensive psychoanalysis.

"This study may well be a key to determining the best treatment options for our children," Dr. Fonagy noted, "as it demonstrates, scientifically, the significant benefits of long term, intensive psychoanalysis." He added that while the study needs to be confirmed by further work, the information provides "important data to third party payers as well as to parents. Particularly in the case of children, the investment of time and money is worthwhile."

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