What is the study about?
Children who come for individual psychotherapy normally come for at least a year and often for longer. They can be very different from each other and may be troubled with very different issues. How can we find our more about how children experience their therapy? What do parents make of it? Do things go in the way the psychotherapists expect, or do things develop for the child in ways that are sometimes surprising? Do parents feel they understand what happens in their children’s psychotherapy, and do they feel that their commitment to bringing the child for treatment is worth it?
What exactly are we doing?
This study evaluates the relative progress and kinds of changes that we may see in children undertaking individual psychotherapy. It aims to find out more about the experience of individual children’s psychotherapy and what changes from the points of view of:
- The psychotherapist
- The parents and to some extent
- The child
Before psychotherapy begins it is usual for a child to see a child psychotherapist for two or three individual assessment sessions. This helps the psychotherapist to build a picture of how the child experiences the world, what his or her issues are and what he or she would like to change. The assessment also gives children and parents a sense of what the psychotherapy will involve.
After the assessment the psychotherapist, the parents and the person who has already been working with the family meet together to talk about how the child got on and if and why psychotherapy may be helpful.
In the HETA project, if psychotherapy is recommended, the psychotherapist puts forward three ‘hopes and expectations’ for how the child may have changed: a) in the psychotherapy and b) at home and at school in the course of one year of treatment, giving examples of what a change might look like in each case.
Similarly, based on their understanding of the psychotherapist’s feedback, the parents put forward three areas where they would hope and expect change, giving examples. In the last assessment session, the child would also have been asked for his or her views. All these hopes and expectations are written down on a special form - the HETA form.
Alongside the child psychotherapy, it is usual for work with parents to continue, to work on things at home and to support the child’s psychotherapy. Parents and a parent worker meet with the psychotherapist once a term to talk about how things are going.
In HETA, at the reviews at the end of the second and third terms, the parents and the psychotherapist rate how far each of their initial ‘hopes and expectations’ has been achieved on a 5-point scale.
As in most Child and Adolescent Mental Health Services, we also use standard questionnaires given to parents and clinicians every 6 months to measure relative change.
What will the impact of the study be – how will it make a difference? Or how has it made a difference if the work has finished.
We hope that this study will show the benefits of child psychotherapy for children showing a wide range of difficulties. We hope to learn more about how to improve our service and work more effectively with different kinds of difficulties that children may have. We also think that the study will help us understand how parallel work with parents can be useful to their children.
Who is working on this study?
Dr Cathy Urwin is the Chief Investigator at the Tavistock Centre and of the project as a whole. At the Tavistock Sandra Correia, Dr Eilis Kennedy and Dr Tony Lee are also on the research team. The study also involves several other Trusts across England and Scotland. This allows us to include a relatively large number of children in the group.
Can patients take part in this study – if so how do they go about getting involved?
Children and parents are central to the project. If your child is being assessed or considered for psychotherapy and is between 4 and 13 years old, you may want to ask the person working with you and your family more about the HETA project.
Where are we currently with this study?
The study involves more than 13 Trusts across Scotland and England. We are now recruiting families and several children have already started their psychotherapy. We will follow the children for at least one year and hope to follow them for longer.
There are several books in the Tavistock Series that describe child psychotherapy and the kinds of children’s issues that it may help with. For example: M.Rustin, M.Rhode, A.Dubinsky and H.Dubinsky (eds) Psychotic States in Children (1997) London, Karnac; M.Rustin and E.Quagliata, (eds.) Assessment in Child Psychotherapy. London: Karnac. See also N.Midgely, J.Anderson, E.Grainger, T. Vockovic Nesic and C.Urwin (eds) Child Psychotherapy and Research: New Approaches, Emergent Findings. (2009) London: Routledge