Two mental health specialists discuss the effectiveness of psychotherapies for children.
- All studies showed superior efficacy of psychotherapeutic treatments over placebo, but this superiority was extremely small.
- However, there is indeed noticeable variability in individual results, with some people benefiting significantly more than others from the therapeutic approaches offered.
- According to the researchers, the psychic care of the child should better take into account the different facets of each child, their singularity and their specificity, to adapt to each situation.
The recent report which pointed out that the consumption of psychotropic drugs has doubled in ten years among children and adolescents has shown that the psychological suffering of children is an increasingly major public health issue in France. Numerous public reports also point to a chronic deficit in the supply of care, difficulties in accessing psychotherapeutic, educational and social practices as well as an increase in the prescriptions of psychotropic drugs.
Xavier Briffault, researcher in social sciences and epistemology of mental health at CERMES3 and CNRS, and Sébastien Ponnou, psychoanalyst, lecturer in education sciences at the University of Rouen Normandy, return to an item for The Conversation on the effectiveness of psychotherapies – recommended in the psychological care of children and adults alike by the WHO.
The effectiveness of psychotherapies remains low
There are many different psychotherapeutic practices (behavioral therapy, psychoanalysis, EMDR…). “Combining psychotherapies is common. The psychic care of the child must indeed take into account the specificity and the diversity of the approaches which make its richness to adapt to each case. The therapeutic setting becomes a space offering him the means to testify and put his suffering to work, by his word as well as his unspoken, his symptoms – including bodily”explain the two researchers.
“However, unfortunately, the effectiveness of psychotherapies measured according to the criteria of so-called evidence-based medicine remains low”, he points out. It is in particular the conclusion of an important study by the Falk Leichsenring team (University of Giessen in Germany) about theeffectiveness of psychotherapies and drug treatments in psychiatrypublished at the end of 2022 in the journal World Psychiatry. This research corroborates the results of many others published in recent years.
All studies showed superior efficacy of psychotherapeutic treatments over placebo, but this superiority was extremely small. “There standardized difference of the means was on average around 0.3 for depression, knowing that 20% of the studies had a low risk of bias, and that when these risks were taken into account, the effect sizes were systematically smaller”write the two specialists.
The slightly more effective psychotherapy for post-traumatic stress and OCD
Only the psychotherapies of post-traumatic stress syndromes and borderline personality disorders obtained scores slightly higher than 0.5, as well as those of obsessive-compulsive disorders (slightly higher than 1), this last result being however difficult to interpret in reason for numerous co-prescriptions of psychotropic drugs.
“Regarding efficacy, for depression, remission was achieved in 43% of patients on therapy, 33% of patients on usual treatment, and 23% of patients in a placebo group. No significant difference was demonstrated between the different types of psychotherapy, a result already known Moreover”observe the two experts.
In summary, “almost all the results taken into account in the sum published in World Psychiatry could be considered ‘clinically not important’, with limited additional gain for psychotherapies and pharmacotherapies”write the authors of the study cited above.
There are some people for whom psychotherapy is really effective
However, they point out, “this should not be seen as a nihilistic or dismissive conclusion, as there is no doubt that some patients benefit from available treatments”. There is indeed a notable variability in the individual results, with some people benefiting significantly more than others from the therapeutic approaches offered.
“The reality of the problems of suffering and psychological care for children is complex and multifactorial. It involves the different facets of the child – his personality, his experiences and his emotions, his relationship to himself, his family ties and his environment, his school career and his cultural ties… Hence the low measured effectiveness of the approaches simplistic short-term therapies, protocolized, and implemented by poorly or poorly trained professionals”conclude the two researchers.
According to them, “it would be necessary to implement systems and care policies adapted to the difficulties encountered by children and families, and to support the diversity of serious therapeutic practices (…) in a time that would not be determined in advance, but established according to the singularity of the situations.”