Saturday, August 26, 2017
Looking for a Child or Family Psychotherapist? Here's a Great Place to Start
When family members feel that a child’s mental health is problematic, they may often delay finding treatment because they don’t know how to find a good therapist. Blogs like this one may even have scared them by pointing out that not all practitioners are helpful, and that some have even been harmful!
Here’s a newly-furbished website that provides a lot of helpful information about choosing a therapist and figuring out whether a treatment is effective: http://effectivechildtherapy.org. This website is created and maintained by the Society for Clinical Child and Adolescent Psychology (SCCAP), a division of the American Psychological Association.
Effectivechildtherapy.org offers some links to groups that list names and contact information for professional psychologists, but even more importantly, it offers information that is hard for parents to find, about how people decide whether a treatment is effective and whether a therapist has the training needed for the job.
Psychotherapies can be evaluated in terms of the evidence for their effectiveness. The issue is not simply whether a treatment IS or IS NOT effective, but how confident we can be that a claim of effectiveness is correct. Very few practitioners would decide to keep using a treatment if they thought it didn’t work—but how certain can they be that their decision for or against use is the right one? That decision should depend on evidence, but what kind? The evidence people bring forward may range from the highest level of systematic investigation down to a few anecdotes or testimonials. All of these are in some broad sense evidence, but they are not all equally supportive of confidence in a treatment choice.
Effectivechildtherapy.org includes a section that describes the levels of evidence (and therefore confidence) that may apply to particular therapies. There are a lot of different ways to describe levels of evidence, but effectivechildtherapy.org uses a method that ranks treatments from 1—the highest level of evidence and confidence—down to 5.
Level 1 treatments (sometimes referred to as Evidence Based Therapies, EBTs) have been supported by at least two studies that meet certain criteria. The studies are independent—not carried out by the same group of researchers. They involve randomized designs, in which child or adult clients who seek help are assigned randomly (i.e., without regard to their choices or other characteristics) to a treatment group or to some other comparison group; the other group could receive the usual care they would get in their community, or another treatment known to be effective, or some other arrangement. The use of a comparison group is especially important when studying child psychotherapies, because children’s moods and behavior may change as they mature, whether they are receiving treatment or not. Without a comparison group, researchers might accidentally conclude that the treatment caused any changes the children experienced; with a comparison group, it’s possible to tell the difference between effects of a treatment and effects of growth and maturation.
Effectivechildtherapy.org describes level 2 treatments as involving less evidence than was the case for level 1. Level 2 treatments are described as “probably efficacious”. There may be only one study showing that a level 2 treatment works better than an established treatment, or there may be two studies showing that it works better than no treatment. (Keep in mind, though, that there are general factors shared by various therapies, such as a warm relationship with a therapist, and that these tend to be helpful to people receiving treatment. For a treatment to work better than no treatment may mean that there is nothing special about the particular treatment, just that it shares those general factors.)
Level 3 treatments are described as “possibly efficacious”. One of these treatments might be supported by one study showing that the treatment worked better than no treatment, or by several small studies that did not include design factors like randomization.
Level 4 treatments are untested or experimental methods that are being used but cannot be claimed with confidence to be effective.
Level 5 treatments have been tested and either not shown to work, or have been tested and shown not to work but to actually make problems worse. More evidence from further research in the future may lead to a more encouraging conclusion, but at this point it is better not to choose a level 5 treatment.
Please notice that none of these levels of evidence depends on anecdotes or testimonials. When proponents of a treatment try to use testimonials to argue that their treatment is effective, they are admitting that they do not have the kind of research evidence that would get their methods listed at effectivechildtherapy.org.
So how do parents know which treatments are evaluated at which level? To do this would require reading all the research studies related to a treatment, and that’s a task that most parents will have neither the time nor the expertise to do. That’s exactly the reason why effectivechildtherapies.org was developed, and why it lists a variety of specific treatments which research evidence has placed at level 1. Effectivechildtherapies.org is directed primarily to parents of school-age children and of adolescents. ( The treatments listed are usually not focused on infants or toddlers.) The site has a helpful search function that enables users to look for information about specific problems or treatments and to find videos that are useful for parents.
If you are thinking about finding treatment for a child or family problem, have a look at http://effectivechildtherapy.org. It’s really helpful.