Introduction
“Children in psychodynamic psychotherapy: Changes in global functioning” is a study that was conducted by Fredrik Odhammar, Eva C. Sundin, Mattias Jonson, and Gunnar Carlberg as part of Erica Process and Outcome Study on children. The study was carried out with the aim of establishing the effectiveness of the participants’ global functioning following psychodynamic psychotherapy. The participants involved children who had undergone psychodynamic psychotherapy. The work of Odhammar and the other researchers will be appraised in this critique, with particular emphasis on the research topic, the theoretical coherence, and logical structure, and the research design used. Also, the major findings of the study, their validity and reliability, and their practical implications to clinical practice will be examined.
Brief Summary
Odhammar and other researchers carried out their study as part of the Erica Process and Outcome Study. This is a study that investigated children’s global functioning following psychodynamic psychotherapy with the main focus being to establish whether global functioning is enhanced after treatment. The researchers assessed the factors that are thought to influence global functioning, such as age, sex, type of disorder, and co-morbidities among others using quantitative and statistical methods. The participants in the study included 33 children between the ages of 5 and 10 years who had been involved in psychodynamic psychotherapy at the same time with their parents. Twenty-nine (29) of the study participants were diagnosed with some mental health disorders, whereas fifteen (15) of the participants were diagnosed with co-morbid conditions. The diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).
The psychotherapists used CGAS and HCAM tools to measure the participants’ global functioning. From the study, the researchers showed that psychodynamic psychotherapy significantly enhanced the children’s global functioning, even though the study did not establish any significant relationship in regard to factors like age and sex that are thought to influence global functioning. The researchers also sought to disambiguate the complex relationship existing between the psychodynamic psychotherapy procedure and the enhancement in global functioning. The researchers, thus, incorporated a qualitative study approach whereby in-depth case studies were performed using data generated from questionnaires that were obtained from two therapies and filled at intervals of 3 months. The researchers sampled two such therapies, including one that reported great improvement and one that reported minimal improvement in global functioning as measured under CGAS. On evaluation, the researchers established that significant changes, such as the achievement of set goals, in the patients were not regularly captured in the measurements on the CGAS (Odhammar et al. 2011).
Theoretical approaches and evaluation of the study by Odhammar et al. (2011)
To justify the need for their study, Odhammar et al. (2011) researched extensively about psychodynamic psychotherapy through broad literature review. The intense research on available relevant literature was important in improving the study’s reliability and validity, in addition to bringing out the research topic clearly (Riegelman, 2005). The researchers, therefore, started by illustrating the magnitude of psychological conditions among young people and the increasing range of psychotherapies and other interventions for children with these mental disorders. From the literature review, the researchers demonstrated that the increasing incidents of mental disorders in young people require the mental health sectors to avail knowledge concerning variables that influence therapy outcomes.
Odhammar et al. (2011) highlight the increasing number of studies that have been carried out in response to the need to identify the variables that affect psychotherapeutic outcomes in young people. According to Odhammar et al. (2011), a dominant feature of these studies is that the findings are not consistent. This makes it hard for inferences to be done. The researchers in particular highlighted studies that have been conducted to establish the effects of gender on child psychotherapy, whereby some findings indicated that females showed improved outcomes than males the following psychotherapy. Other studies on the same demonstrated no significant differences based on gender. Similarly, Odhammar et al. (2011) explored literature that investigated the impact of gender on psychotherapy outcomes. The researchers also found discrepancies in the findings, with some studies showing that younger children responded much better to psychotherapy compared to those who are much older. Nevertheless, other studies have failed to establish a link between a person’s age and the treatment outcomes (Odhammar et al., 2011).
The researchers further explored the reviews that have been carried out on psychotherapy studies, indicating the various beliefs as embraced by different people concerning cognitive behavioral therapy. From the analyses, it comes out that some people advocate for systemic therapy evaluations, whereas others are for psychodynamic time-limited therapies. With regard to psychodynamic psychotherapy, which was the core aspect of the study, the researchers also further analyzed literature reporting on how other conditions influence treatment outcomes. From these analyses, the researchers demonstrated that the existing information is also conflicting concerning the duration of psychodynamic psychotherapy. Whereas some studies showed that time-limited interventions produced desirable outcomes, other studies indicate that therapy outcome is positively associated with the duration taken to carry out the procedure.
The researchers indicate the need for further studies that can be able to address the observed shortcomings. These studies ought to be more detailed and adequately explore factors that influence effective therapeutic outcomes. This, according to the researchers, demands a comprehensive understanding of the treatment process and comprehending any other variables such as those related to the therapeutic procedure, individual patient, therapist, and the formation of a therapeutic alliance. These are variables that underlie change factors with respect to treatment outcome. In reinforcing their research topic, Odhammar et al. (2011) also point to the challenges involved in quantifying outcome aspects like quality of life, in addition to the failure of efficacy studies to represent real practical settings. This calls for the need for naturalistic studies.
The motivation for the Study
Odhammar et al. (2011) were motivated by the recognition that psychological problems are on the rise among children, yet research on this field fails to adequately address the variables that influence psychotherapy outcomes. The contradictions in research findings on child psychotherapy from various studies also motivated the researchers to conduct the study. Odhammar and the other researchers hoped to advance knowledge concerning the variables that influence psychotherapy treatment outcomes in children through this study, thereby allowing for effective interpretation.
Research Questions
Odhammer et al. (2011) formulated research questions to address different aspects of psychodynamic psychotherapy in children. The main area was assessing changes in global functioning in young people following psychodynamic psychotherapy. Another aspect of the research questions was establishing variables that influence the likely changes in global functioning following therapy, while the last part of the research questions aimed at qualitatively analyzing the deviations of the outcomes by evaluating processes of therapy.
Research Design
The study by Odhammer et al. (2011) was naturalistic in design, combining both quantitative and qualitative techniques to assess global functioning following psychotherapy. This design allowed the subjects to be observed in the natural settings, thus allowing the description of outcomes to be performed without controlling the situation. The design was also significant in examining the outcomes and drawing inferences since the variables could easily be conceptualized and operationalized. The quantitative technique involved the use of questionnaires that were administered to psychotherapists and parents of the participants, whereas the qualitative study was conducted through comprehensive case studies.
Study Findings
The study results demonstrated that global functioning in children improved significantly following psychodynamic psychotherapy, indicating the effectiveness of the treatment modality. In quantitative analyses, the factors that determine enhancement of global functioning under CGAS scale were shown to be, “age, sex, diagnosis, co-morbidity, frequency and number of sessions, length in weeks of child therapy and a number of sessions for parents” (Odhammar et al. 2011, p. 267). These factors, however, showed no major relationship with the change scores. Under the HCAM measurement, global functioning was also shown to be large, especially with regard to “general mood and mood shifts, ability to tolerate frustration and control impulses, development of confidence and self-esteem and ability to cope with very stressful events” (Odhammar et al. 2011, p. 267). Qualitative analyses showed that significant enhancements obtained following treatment are frequently missed in psychometric tools, thus they are often not considered as important outcome factors following treatment.
Limitations of the Study
The findings of the study may not be readily generalized to the entire population given that the participants were mainly included in the study using clinical criteria. In addition, the study did not include a comparison group in order to obtain a deep comprehension of the level of a desirable outcome. The fact that it is psychotherapists who were measuring the global functioning of the participants also implies that the results may be biased. Additionally, the number of participants was small. This would have affected the validity, reliability and the ability to generalize of the study findings (Odhammar et al., 2011).
Clinical Implications of the study
The study was significant in clinical practice given that it helped in closing the knowledge gap concerning the effect of psychodynamic psychotherapy in global functioning. The research further highlighted the effect of various factors, such as age and gender, on global functioning; besides giving insights on the way the treatment modality influences outcomes. The study, therefore, contributes to knowledge regarding factors that influence psychodynamic child psychotherapy outcomes, the knowledge that will be critical in the management and treatment of psychological disorders in young people.
Reliability and Validity of the Study
The use of a small population in the study enhanced transferability of the results since the researchers were able to obtain a natural and interpretative understanding of the variables that affect psychotherapy outcomes. Nevertheless, the small number of participants means that the findings cannot be readily generalized to the entire population. It will, therefore, be important for future research on the same area to include a large population in order to improve the ability to generalize the findings. The use of both qualitative and quantitative methods enhanced the reliability of the study findings since the researchers were able to combine the strengths of the two methods (Riegelman, 2005). The methods also facilitated the interpretation of the study findings since the data generated provided deep insights on various aspects of the study topic. The study can also be said to have achieved high credibility given the diverse amount of literature that was reviewed.
References
Odhammar, F., Sundin, E. C., Jonson, M., & Carlberg, G. (2011). Children in psychodynamic psychotherapy: changes in global functioning. Journal of child Psychotherapy, 37(3), 261-279. Web.
Riegelman, R. K. (2005). Studying a study and testing a test: How to read the medical evidence, 5th Ed. Philadelphia, PA: Lippincott Williams & Wilkins. Web.