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Book Review - Psychotherapy with Children and Adolescents
Psychotherapy with Children and Adolescents
by Helmut Remschmidt
Cambridge University Press, 2001
Review by Michael Brodsky
Feb 19th 2003

Helmut Remschmidt is an internationally renowned child psychiatrist and currently serves as president of the pre-eminent international child psychiatry organization.  In addition, Remschmidt is a prominent academic psychiatrist in Germany, a country in which the theory, practice, and study of psychotherapy receives a higher societal priority than in North America.  Thus, it is fitting that Remschmidt serve as the editor of this volume, an anthology with the ambitious goal of surveying the vast expanse of child psychotherapeutic practice and the research, which supports its use.  In the course of nearly 600 pages, Remschmidt and a dozen other European child psychiatrists review the literature, indications, and challenges in contemporary child psychotherapy in a clear expository style and with rigorous attention to detail.  This volume, the latest in the prestigious Cambridge Press child psychiatry series, is intended to provide a virtually exhaustive review of the practice of contemporary child psychotherapy.

The book is clearly organized and effectively subdivided and indexed.  There are four major sections.  Part I defines addresses issues common to all psychotherapy paradigms, including a precise definition of psychotherapy, treatment planning strategies, approaches to psychotherapy research, and quality assurance.  The authors make clear their position that psychotherapy treatment planning should be evidence-based and disease-specific, rather than an idiosyncratic process based on the predilections of the treatment planner and patient.  The discussion of methodologies is thorough, lucid, and a potentially valuable resource for psychotherapy researchers worldwide.

 The second section of the book discusses the major psychotherapy paradigms and their advantages and limitations.  Included are chapters on psychodynamic, behavioral and cognitive-behavioral, interpersonal, group, and family therapies.  Again, the writing is meticulous yet succinct.  The level of detail is sufficient to cover all of the major principles of each paradigm, although not comprehensive enough to be a reference for experienced clinicians.  A final chapter reviews combined approaches to mental health treatment, although the use of medication with psychotherapy—the predominant combination therapy utilized in the Americas—receives scant attention.

In Part III of the book the authors present indications for specific psychotherapies for each of the mental disorders that affect children and adolescents.  Much of the material in this section will be familiar to therapists, such as the recommendation of behavioral strategies for the treatment of anxiety syndromes.  Nevertheless, a systematic review of the indications and contraindications for particular therapies in specific clinical situations provides a valuable resource for child clinicians, for whom the choice of comprehensive textbooks of psychotherapy is quite limited.

The final section of the volume discusses treatment settings, including inpatient, outpatient, day hospital, and home treatment modalities.  Here the disparities between child psychotherapeutic practice in Europe and in North America become obvious.  For example, the average length of stay for a child inpatient hospitalization is reported as 2 to 3 years in Germany; in the United States the figure is likely closer to 2 to 4 weeks in most facilities.  Europeans also advocate “home treatment” in some cases, in which therapists make housecalls to perform psychotherapy with children in their family milieu.  The availability of psychotherapy resources in North America varies markedly by geography and by demographics, and so the recommendations in this section will be of varying usefulness depending on local factors.

A number of other factors may limit the utility of this book for North American readers.  The English translation of this book was published four years after the German edition appeared, and so research findings from the past half-decade, such as recent reports about the cost-effectiveness of psychodynamic treatments, are not included.   Also, the majority of the references cited in the text are to German psychiatric journals, which are both linguistically and logistically inaccessible to most North Americans.  Another issue is that all of the chapter authors utilize the international diagnostic classification system known as ICD-10, rather than the DSM-IV classification system used throughout the United States and Canada. 

The comprehensive coverage of this volume represents an impressive compilation and distillation of a diverse and often contradictory body of literature.  North American readers may be surprised by the depth of research reviewed in this text, a testament to the importance of this treatment modality in European psychiatric practice.  It is perhaps not surprising that a comparable volume by North American authors has not appeared to date.  In spite of significant limitations of applicability in the United States and Canada, this volume serves as a valuable reference resource about the scope and practice of child psychotherapy.

 

© 2002 Michael Brodsky

 Michael Brodsky is a psychiatrist in training in Los Angeles, California, and an avid reader.

 

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