Paediatrics: Individual psychotherapy

Individual psychotherapy

All health professionals working with children talk to the children by themselves sometimes. All try to be helpful, and probably most of us are helpful at least some of the time. So in what way is psychotherapy differ-ent from an informal helpful chat? Perhaps the key elements are that the treatment is delivered by a trained therapist who carries out therapy with-in a theoretical framework. There are a wide range of individual therapies including the following.

Behaviour therapy

This is brief and is directed at encouraging desired behaviours and the eliminating problem behaviours. Problems are dealt within a behavioural framework rather than through focus on underlying thoughts, feelings, or past causes.

Cognitive behaviour therapy

As above, but with a wider focus on thoughts and attribution of mean-ing, as well as behaviour. This is one of the better researched therapies, though there remains a shortage of trained therapists. CBT involves the keeping of diaries and homework carried out between sessions.

Psychodynamic psychotherapy

Longer-term treatment directed at underlying problems and the present-ing symptom. Central to treatment are theories of the unconscious mind. The patient is encouraged to use their relationship with the therapist to explore dysfunctional patterns of behaviour. The therapist is able to com-ment on these and help the patient to understand new ways of relating. Therapy in the younger age group may be based more around play materi-als such as animals, crayons, and paper. Just to complicate matters there are also play therapists who are not necessarily psychodynamic in their orientation.

Which therapy is best?

The inevitable question arises as to which therapy is better. It is difficult to answer as short therapies directed to diagnostic related groups are easier to evaluate. In particular there is a growing body of evidence to support the use of CBT in a range of conditions. That being said it is also probably true those well motivated, intelligent, articulate patients without previous problems and from well functioning families are likely to do better with whichever therapy. Non-specific factors about therapists (e.g. empathy, good listening, and warmth) may be pre-requisites to effective treatment whatever the model.