Handbook of Psychological Services for Children and Adolescents

By Jan N. Hughes; Annette M. La Greca et al. | Go to book overview

3
The Road to Effective Child
Psychological Services

Treatment Process and Outcome Research
STEPHEN R. SHIRK

One way to characterize the history of child psychotherapy research is through the assumptions that have guided investigations of treatment. Early research was based on the uniformity assumptions of psychotherapy (Kiesler, 1966); distinctions among types of patients, variations in treatments, and differences across therapists were minimized (Shirk & Russell, 1996). A corollary of this assumption was that distressed children who received the “same” treatment would show comparable outcomes. Given this assumption, it is not surprising that early child treatment investigators, like their adult counterparts, were preoccupied with the efficacy of child psychotherapy in general.

Over the years, however, uniformity assumptions have gradually given way to assumptions of specificity. Paul's (1967) well-known reframing of the central question for psychotherapy researchers—“What treatment, delivered by whom, is most effective for what problem, under which set of circumstances?”—prompted a new emphasis on the heterogeneity of patients, therapists, and treatments. Treatment samples that once contained children with poorly defined or diverse problems have been replaced by more homogeneous samples; for example, typically only children who meet diagnostic criteria for a specific disorder are included in a clinical trial. Similarly, on the therapy side, substantial attention has been directed to the specification of treatments, often through manualization of therapy and monitoring therapist adherence to treatment techniques. This stands in sharp contrast to early studies that rarely examined therapist behaviors in sessions and frequently defined treatment in terms of the professed orientation of the therapist (Russell & Shirk, 1998).

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