Depression in Children and Adolescents: Include psychoanalytical procedures

by Prof. Dr. med. Claudia Mehler-Wex, Dr. med. Michael Kölch in volume 9/2008

The authors maintain that there are „hardly any empirical data are available“ for the use of family therapy, client-centered play therapy and deep psychological therapy in the treatment of depressive disorders in children and adolescents, but that level of evidence I for cognitive behavioral therapy and level of evidence II for interpersonal therapy have been demonstrated. This assertion is based on the guidelines for the diagnosis and therapy of psychiatric disorders in babies, children and adolescents. This unambiguously states: "There have been no controlled studies on the use of play therapy or deep psychological therapy in the treatment of depressive children or adolescents."

This assertion is wrong; Controlled studies have been performed by Horn et al. (1) and Muratori et al. (2). Both studies include catamneses and demonstrate significant effects with depressive and dysthymiac patients - corresponding to level of evidence II - and in comparison with either a waiting control group or "treatment as usual". As these are both short term studies (also with recourse to Malan's focal therapy), this also shows that short term psychodynamic interventions are effective. Moreover, other workers, including Trowell et al. (3), have demonstrated the efficacy of psychoanalytical or psychodynamic procedures on the basis of catamneses, as well as naturalistic and comparative therapeutic studies.

These studies have been published and could easily have been found with a little research. This leaves the impression that the scientific research was incomplete, due to a bias towards behavioral therapy. As this has repeatedly happened, particularly in the guidelines, it may be inferred that the intention is to restrict psychoanalytical procedures by marginalizing them. Although it must be admitted that psychodynamic studies are comparatively rare, those that are known should not be withheld or presented as being of little significance.
DOI: 10.3238/arztebl.2008.0363b


Dr. phil. Eberhard Windaus
Länderweg 45
60599 Frankfurt am Main
Germany

Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

References

1. Horn H et al.: Zur Wirksamkeit psychodynamischer Kurzzeitpsychotherapie bei Kindern und Jugendlichen mit Depressionen. Praxis der Kinderpsychologie und Kinderpsychiatrie 2005; 5: 52–71.

2. Muratori F et al.: Efficacy of brief psychotherapy for children with emotional disorders. Psychother Psychosom 2002; 71: 28–38.

3. Trowell J et al.: Childhood depression: a place for psychotherapy: an outcome study comparing individual psychodynamic psychotherapy and family therapy. Eur Child Adolesc Psychiatry 2007; 10: 584 ff.