Involving Parents in Child Mental Health Treatments: Survey of Clinician Practices and Variables in Decision Making.

OBJECTIVE: Child therapy outcomes research has indicated that involving parents in child mental health treatments is generally beneficial. This study aimed to explore clinicians' decisions to involve parents in treatment for childhood disorders and child-, parent-, and clinician-related variables influencing these decisions. METHODS: Data on decision making and reported use of parent involvement by 40 therapists with patients ages 6-12 were obtained from a self-report survey. Most clinicians were psychologists, White, and female and worked in community-based clinics. They reported using cognitive-behavioral and family system interventions considerably more than psychodynamic therapy. RESULTS: Clinician-reported use of parent involvement was significantly greater for children with oppositional defiant or conduct disorder than for those with attention-deficit hyperactivity disorder, depression, anxiety, or posttraumatic stress disorder or trauma. A child's age and diagnosis (100% of clinicians), parental level of stress (85%), and parent interest in working with the clinician (60%) were frequently reported as being important to clinicians' decisions. Ninety percent of clinicians reported that they believed working with parents was effective, whereas only 25% reported their own training to be influential in decision making. CONCLUSIONS: Findings regarding use of parent involvement stratified by common childhood disorder were not surprising, given the behavioral and treatment complexities of oppositional defiant or conduct disorder. Clinicians often reported parents' stress level and interest in working with the clinician as influencing decision making, reflecting the importance of lesser researched decision variables. The relatively limited influence of training on decision making suggests the need for better parent involvement education for clinicians treating children.

Psychodynamic therapy for depression in women with infants and young children.

BACKGROUND: It has long been known that the rate of depression is high among women with infants and young children. In recent research a psychodynamic therapy group was found to be beneficial for a self-selected, postnatal subgroup of women who were of middle socio-economic status (SES), educated and who met DSM-IV criteria for clinical or subclinical depression. The current study sought to replicate these findings with individual psychodynamic therapy and to compare outcomes for three psychodynamic treatment conditions: individual, group, and combined individual and group. METHOD: Patients began and left treatment from each of the three psychodynamic therapy conditions on a self-determined basis. Pre- and postintervention DSM-IV Global Assessment of Functioning (GAF) were obtained by reliable blind raters. A ten-variable, self-administered postintervention outcome questionnaire provided further data. RESULTS: Women (n = 58) in all three therapeutic conditions showed statistically significant improvement in their pre-to-post GAF and large treatment effects. On the questionnaire, they indicated that they were affected positively by all three conditions. Statistically significant differences among treatment conditions favored the individual treatment. CONCLUSIONS: Psychodynamic therapy appears well suited for the population of women in this study, especially when administered on an individual basis. The model employed here emphasized receiving and developing empathic emotional attunement, insight into one's relationships and early experiences, and a process for expressing feelings and resolving problems. Compared to group and combination therapies, the individual treatment may afford the greatest opportunity for receiving and developing these features and, thus, the best outcomes.

Relational-developmental therapy group for postnatal depression.

Postnatal depression has been estimated to affect as many as 30% of childbearing women. Emerging evidence offers reason to believe that psychoanalytically-oriented group treatment may be beneficial for some women with postnatal depression. This study was designed to evaluate the effectiveness of one model of analytic group therapy for this clinical population. Our findings suggest that the women had a positive response to the group treatment. The particulars of the psychoanalytic group approach, here referred to as relational-developmental, are described in detail and an analysis is offered about why this approach may be beneficial. Also discussed are limitations of the research design and suggestions for studying a relational-developmental group-centered prevention program for children at-risk from postnatal depression.