What Works for Children?

    Psychological Treatments for Mental Health Issues

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    The gap between what researchers have learned about which psychological therapies work and what happens when clients seek psychological services in the community has been a long-time concern. One recent estimate suggested that it takes more than fifteen years for an empirically based treatment to be used consistently in the community. That is about half a generation! Current events consistently remind us how concerned we need to be about the high prevalence of child and adolescent mental health problems. And despite literally hundreds of studies demonstrating the potency of hundreds of treatments for those problems, we remain a society struggling to meet the mental health needs of children and adolescents.

    As parents and caregivers, what should we know?

    Psychological treatment is not one-size-fits-all. Considerable evidence supports the idea that specific treatments work well for some problems and less well for others. This point may seem obvious, but it is an important one for families to keep in mind. There was a time when some thought that all treatments worked. Different problems in children and adolescents may require different treatments. Some treatments do work for some problems, whereas others do not work. It is important to remember that not all therapists will be equipped to provide all treatments. A frank conversation with prospective therapists will help you to identify what the therapist does and does not know how to deliver.

    Your therapist is a good resource for evidence. Unlike pharmacological treatments, psychological treatments are not developed by for-profit companies. As a result, there is very little, if any marketing of psychological treatments. Many of us have seen advertisements for medicines for depression, social anxiety, and bipolar disorder on television, in print, and online. Because psychological treatments are not advertised, the public does not learn very much about which particular psychological treatments exist, which work, and for which problems. As a result, families should ask therapists for a description of the treatment options available. And they should ask what evidence there is to support the use of those options.

    Fortunately, there are also websites that families can use to learn what works before  seeking treatment: www.nrepp.samhsa.gov or effectivechildtherapy.com. That way, you can come to a provider asking about particular treatments.

    Examples of some of the best psychological treatments for
    common problems:

    My child has anxiety problems, like excessive worrying, social anxiety, separation anxiety, phobias, and trauma. Then, consider…

    Cognitive-Behavioral Therapy (CBT) A treatment that emphasizes (a) education about anxiety, (b) coping skills development, including helping children and adolescents learn about and modify their thinking patterns, and (c) activities that involve approaching and engaging in feared situations, called exposures.

    CBT for Trauma Like CBT for anxiety, CBT for trauma involves (a) education about anxiety, (b) coping skills development, including helping children and adolescents learn about and modify their thinking patterns, and (c) exposures. With trauma, though, the exposures often include what is called a trauma narrative, a retelling of the traumatic event designed to help the child or adolescent resolve her anxiety about the event.

    Exposure Therapy Like CBT, but with more emphasis on the exposure tasks – that is, helping children and adolescents do non-dangerous things they fear doing. Some phobias in particular may be treated using exposure alone.

    My child seems to be depressed all the time. Then consider…

    CBT for Depression CBT focuses on (a) education about depression, (b) coping skills development, including helping children and adolescents learn about and modify their thinking patterns, and (c) increase in doing enjoyable and/or social activities.

    Interpersonal Therapy (IPT) This treatment involves helping a child or adolescent talk through and resolve significant interpersonal challenges, such as role transitions or loss.

    My child is always getting into trouble – with me, at school, or everywhere. Then consider…

    Parent Training Primarily used with younger children, this treatment involves helping caregivers use specific parenting strategies that increase desired behaviors in children. There are many different brand names for these therapies.

    Family and Ecological Family Therapies (like multisystemic therapy) Often used with older children, these approaches focus on improving family communication and family problem solving. Some of these approaches also focus on working with others in the community who may influence the youth’s behavior (extended family, teacher, coach).

    The good news is that there are hundreds of studies of treatments for these problems. As a result, there is likely a good treatment for our children’s problems. However, as with so many of our choices these days, we do need to educate ourselves about those options.

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    Michael Southam-Gerow
    Michael Southam-Gerow, PhD, has been helping children and families learn to process emotions for over twenty years, including the last thirteen in Richmond. He conducts research and teaches undergraduate and graduate students at VCU’s Department of Psychology. He is also the co-director of the Anxiety Clinic at VCU. His recent book, “Emotion Regulation in Children and Adolescents: A Practitioner’s Guide” is available in bookstores. He lives in the city of Richmond with his wife, two teen-aged children, and one very shrewd Collie mix.