Short-Term Therapy for Children

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Conceptual frameworks exist for adult forms of brief psychodynamic intervention , but not for child forms of brief intervention. However, as Messer and Warren (1995) pointed out, short-term therapy (6–12 sessions) is a frequent form of psychodynamic intervention.

The practical realities of HMOs and of clinical practice in general have led to briefer forms of treatment. Often, the time-limited nature of the therapy is by default, not by plan (Messer & Warren, 1995).

The average number of sessions for children in outpatient therapy is 6 or less in private and clinic settings (Dulcan & Piercy, 1985). There is little research or clinical theory about short-term psychotherapy with children (Clark, 1993; Messer & Warren, 1995). A few research studies have shown that explicit time limits reduced the likelihood of premature termination (Parad & Parad, 1968) and that children in time-limited psychotherapy showed as much improvement as those in long-term psychotherapy (Smyrnios & Kirby, 1993).

The time is right for development of theoretically based short-term interventions for children with systematic research studies. Messer and Warren (1995) suggested that the developmental approach utilized by psychodynamic theory provides a useful framework for short-term therapy. One can identify the developmental problems and obstacles involved in a particular case. They also stressed the use of play as a vehicle of change and, as Winnicott (1971) has said, of development.

They suggested that active interpretation of the meaning of the play can help the child feel understood, which in turn can result in lifelong changes in self perception and experience. In other words, the understanding of the metaphors in the child’s play could give the child insight, or an experience of empathy, or both.

This lasting change can be accomplished in a short time. Chethik (1989) discussed “focal therapy” as therapy that deals with “focal stress events” (p. 194) in the child’s life.

Chethik listed events such as death in the family, divorce, hospitalization, or illness in the family or of the child as examples of specific stresses. Focal therapy focuses on the problem and is usually of short duration. The basic principles of psychodynamic therapy and play therapy are applied.

The basic mechanism of change is insight and working through. Chethik views this approach as working best with children who have accomplished normal developmental tasks before the stressful event occurs. In general, brief forms of psychodynamic intervention are seen as more appropriate for the child who has accomplished the major developmental milestones.

Lester (1968) viewed problems such as transient regressions, mild exaggerations of age-appropriate behaviors, and acute phobias as most appropriate for brief intervention.

Proskauer (1969, 1971) stressed the child’s ability to quickly develop a relationship with the therapist, good trusting ability, the existence of a focal dynamic issue, and flexible and adaptive defenses as criteria for short-term intervention. Messer and Warren (1995) concluded that children with less severe psychopathology are more responsive to brief intervention than children with chronic developmental problems. My own view is that the internalizing disorders are most appropriate for brief psychodynamic intervention. The therapist is active, at times directive, and uses all mechanisms of change in the therapy. Insight and working through are essential, but modeling, rehearsal, discussing coping strategies are also part of the therapy.

Children with major deficits in object relations and with early developmental problems need longer term structure-building approaches. Messer and Warren (1995) also stressed the importance of the family and social environment in maximizing the effectiveness of brief intervention. A supportive environment and, often, active engagement of the parents and school are essential for brief intervention to work.

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