1
ARTICLE:
Does psychotherapy help some students?
overview of psychotherapy outcome research
Professional School Counseling,
June, 2006
An
by Kelly C. Eder,
Susan C. Whiston
This article provides a brief overview of the outcome research on
psychotherapy with children and adolescents. Outcome research
indicates that psychotherapy can be effective with both children and
adolescents,
with
meta-analyses
indicating
that
youth
who
participated in this type of intervention tended to score on the
outcome measures half of a standard deviation or more above those
who did not receive any intervention. Little is known about the
process of psychotherapy with children, but there are some
indications that the therapeutic relationship is important. Moreover,
there is some research that supports the assumption that certain
types of treatment are most helpful with specific clinical issues.
In the ASCA National Model[R] proposed by the American School
Counselor
Association
responsibility
for
(2005a),
promoting
school
the
counselors
academic,
have
career,
the
and
personal/social development of all students. This includes students
who
are
experiencing
difficulties
and
those
who
may
meet
diagnostic criteria for a psychiatric disorder. Furthermore, policy
initiatives at national and state levels, such as the No Child Left
Behind Act of 2001 (2002), are requiring that all children succeed
academically; however, this may be difficult for children who are
experiencing
emotional
problems.
The
number
of
students
experiencing difficulties does not appear to be trivial. For example,
the National Institute of Child Health and Human Development
(2005) recently reported that an estimated 2.7 million children are
noted by their parents to suffer from noticeable or severe emotional
or behavioral problems that may interfere with their family life, their
ability to learn, and their abilities to make friends.
2
Kazdin and Johnson (1994) noted that prevalence studies indicate
that between 17% and 22% of youth under 18 years of age suffer
developmental, emotional, or behavioral problems. Costello et al.
(1996) had similar findings that 20.3% of children between the
ages of 9 and 13 met the criteria for mental disorder as defined by
the Diagnostic and Statistical Manual of Mental Disorders (American
Psychiatric Association, 2000). This is also consistent with Doll's
(1996) findings that a typical school can expect to find between
18% and 22% of students with diagnosable psychiatric disorders,
most frequently anxiety disorders, conduct disorder, oppositional
defiant disorder, and attention deficit disorder. In secondary school
populations, Doll also found that depression and suicidal behaviors
were prevalent.
Schools and, subsequently, school counselors may be in a strategic
position to provide services to children and adolescents in need. The
child or adolescent's relations to peers, problem behaviors, prosocial
functioning, and academic performance can be observed and
assessed within the school. This allows professionals in the school to
identify when an intervention is needed and to evaluate whether an
intervention is having an impact (Kazdin & Johnson, 1994).
Additionally, the school setting has a broader reach as nearly all
children are required to attend school. Thus, schools have direct
access to nearly all children and adolescents and have the potential
to reach more children than clinic settings where parents must seek
out and take the child or adolescent for treatment. Thus, by default,
schools become the only avenue for some students to receive the
mental health services they need (Hoagwood & Erwin, 1997).
The intent of this article is to review the research related to
psychotherapy with children and adolescents to determine if these
types of services or interventions are helpful to students who are
experiencing
difficulties.
moderate
In
addition,
to
severe
this
article
emotional
is
or
designed
behavioral
to
review
psychotherapy research with the goal of informing school counselors
about aspects of psychotherapy that may assist them in either
3
referring students for appropriate treatment or providing services
within a school setting.
OVERALL
EFFECTIVENESS
OF
CHILD
AND
ADOLESCENT
PSYCHOTHERAPY
In considering the needs of students with emotional, behavioral,
and developmental disorders, the first issue is what can be done to
assist these students. For many of these students, it does appear
that psychotherapy can be quite effective and helpful. In metaanalytic studies, researchers seek to statistically combine results
from different studies in order to analyze across studies the
effectiveness of certain interventions. For each study, an effect size
is typically calculated by subtracting the mean of the control group
from the mean of the treatment group and dividing by the pooled
standard deviation, which results in a numerical index of whether
the individuals receiving the intervention did better or worse on the
outcome measure than those who did not receive the intervention
during the time of the study. These effect sizes then are combined
and often weighted related to sample size and error variance, which
produces an overall effect size for the intervention.
There are different ways to interpret effect sizes, such as noting
whether they are significantly different from 0 and using Cohen's
(1988) classification system. Although many factors need to be
considered when examining the magnitude of an average effect
size, Cohen hesitantly defined effect sizes as small when d = .20,
medium when d = .50, and large when d = .80. Casey and Berman
(1985) conducted one of the first meta-analyses to examine the
effectiveness of psychotherapy with children and adolescents.
Although there are different definitions of psychotherapy, this study
included various forms of psychotherapy with the most prevalent
being behavioral therapy. The age range of children was between 3
and 15 years old and the studies included a wide range of clinical
problems. The average effect size for the 75 studies was .71, which
indicates that, on average, the treatment or intervention groups
scored almost three-quarters of a standard deviation above the
4
control groups on various outcome measures. Some of the more
common
measures
used
in
these
early
studies
were
social
adjustment, global adjustment, achievement, and cognitive skills.
Weisz, Weiss, Alicke, and Klotz (1987) conducted a second major
meta-analysis
in
which
they
defined
psychotherapy
as
"any
intervention designed to alleviate psychological distress, reduce
maladaptive behavior, or enhance adaptive behavior through
counseling,
structured
or
unstructured
interaction,
a
training
program, or a predetermined treatment plan" (p. 543). This metaanalysis identified 108 well-designed studies that were conducted
with 4- to 18-year-olds. In addition, they included treatments
conducted by nontrained professionals (e.g., parents and teachers)
and included clients with a broad range of psychological and social
problems. Their average effect size was quite similar to that of
Casey and Berman (1985) and was .79. Weisz, Weiss, Han,
Granger, and Morton (1995) revisited the effects of psychotherapy
with
children
and
adolescents
and
used
more
sophisticated
statistical techniques to analyze studies published between 1967
and 1993. The unweighted mean effect size (.71) was similar to
that of the two previous meta-analyses; however, with the use of a
procedure recommended by Hedges and Olkin (1985) that considers
sample size and variance, the mean effect size was .54. Therefore,
even
with
this
more
conservative
procedure,
children
and
adolescents who received some form of psychotherapy scored on
average a little more than a half of a standard deviation above the
control group.
A meta-analysis of school-based studies of psychotherapy was
conducted by Prout and DeMartino (1986). They limited their metaanalysis to psychotherapy studies conducted in a school or
addressing school-related problems, with the broad definition of
psychotherapy that included
the informed and planful application of techniques
derived from established psychological
principles by persons qualified through training
5
and experience to understand these principles
and to apply these techniques with the
intention of assisting individuals to modify
such personal characteristics as feelings, values,
attitudes and behaviors which are judged by
the therapist to be maladaptive or maladjustive.
(Prout & DeMartino, pp. 286-287)
Unlike the previous meta-analyses, Prout and DeMartino's (1986)
school-based analysis examined the effect sizes of psychotherapy
on achievement as well as on other outcomes such as behavior
ratings, cognitive skills/ability, problem-solving, and self-concept.
They also focused only on interventions conducted by trained
professionals. They found that interventions in schools had an
overall average effect size of .58, with effect sizes of .68 for grade
point average, .58 on behavior ratings, 1.25 on observed behaviors,
.66 on cognitive abilities, and .94 on problem-solving outcomes.
These effect sizes are very encouraging. They suggest that school
counseling interventions are moderately effective overall with
students who participate in the interventions, and they have a
substantial impact on observed behaviors and problem-solving. This
Prout and DeMartino study included 33 studies published from 1962
to 1982, and Prout and Prout (1998) later expanded on this study
and analyzed 17 additional school-based psychotherapy studies
published between 1985 and 1994. They found an overall effect size
of .97; however, this result should be taken with some caution
because it is based on a relatively small number of studies.
Stage and Quiroz (1997) also conducted a meta-analysis of schoolbased interventions and analyzed the effectiveness of interventions
designed to decrease disruptive classroom behaviors. Based on 99
studies, they found that these interventions had an effect size of 0.78. In this case, a negative effect size indicates the interventions
were quite effective as disruptive behaviors declined when students
received treatment.
6
In qualitative reviews Of research related to psychotherapy with
children and adolescents, Kazdin (2003, 2004) supported the
overall effectiveness of therapeutic interventions with children and
adolescents. Kazdin (2003) argued that there is strong evidence for
the efficacy of certain treatments for certain issues. This conclusion
raises important issues related to which individuals benefit from
which types of psychotherapy and, furthermore, which types of
treatments may be applicable in school environments.
CLIENT FACTORS
Demographic Factors and Outcome
A significant amount of the psychotherapy outcome research with
children and adolescents has focused on client factors such as age,
grade, and gender. Casey and Berman (1985) did not find
differences in effect sizes for treatments based on age, intellectual
functioning, or school grade. Other research findings related to age
and grade level, however, are more equivocal. Although there is
some speculation that psychotherapy is more effective with older
children, Weisz et al. (1987) found the opposite, with studies on
treatments involving children (ages 4 to 12 years) having an effect
size of .92, which was significantly larger than the mean effect size
of .58 for the studies of treatments involving adolescents (13 to 18
years). Conversely, Weisz et al. (1995) found the reverse related to
outcome and age. Using a statistical weighting procedure, they
found a larger mean effect size for adolescents (.65) than for
studies treating children 11 years and younger (.48).
The same conflicting findings regarding at what age psychotherapy
with
children
is
most
effective
also
are
found
when
the
psychotherapy is conducted in school settings. Prout and DeMartino
(1986) concluded that psychotherapy interventions in schools were
slightly more helpful to adolescents or those at the secondary level
compared to elementary. However, using a smaller number of
studies, Prout and Prout (1998) found a larger effect size (1.31) for
elementary students and a somewhat smaller one (.73) for
7
secondary school-age students. On the other hand, in the metaanalysis on interventions to decrease disruptive classroom behavior
in public education settings, Stage and Quiroz (1997) did not find a
significant difference in effect sizes between grade levels.
Another focus of psychotherapy outcome research is whether there
are gender differences, with some researchers speculating that girls
are more likely to have positive outcomes. Weisz et al. (1987) did
not find significant differences in effect sizes based on gender
composition of the treatment groups, even though the groups that
were predominately female tended to have slightly larger effect
sizes than those groups that were predominately male. Casey and
Berman (1985) also found that effect sizes tended to be smaller
when the sample was predominately males. In Weisz et al.'s (1995)
meta-analysis, the researchers did find a significant gender main
effect, with the mean effect size for females being .71 as compared
to .41 for the predominately male sampies. This gender difference
remained significant even after controlling for type of problem.
Client Problems
Kazdin (1991) described two broad categorical areas: overcontrolled
and undercontrolled problems. Overcontrolled problems refer to
"inward-directed child disturbances, such as anxiety, depression,
and social withdrawal. Internalizing behaviors is another term used
for this category" (Kazdin, p. 788). Undercontrolled problems refer
to
"outward-directed
child
behaviors,
such
as
hyperactivity,
tantrums, aggression, and antisocial behavior" (p. 788). Acting out
and externalizing behaviors are other terms often used for this
category of undercontrolled problems. Weisz et al. (1987) found
that
psychotherapy
was
equally
effective
with
children
and
adolescents with no difference in outcome between those with
overcontrolled or undercontrolled problems. Casey and Berman
(1985) examined the effects of psychotherapy with children
according to the reported target problems and found psychotherapy
to be highly effective related to issues of impulsivity/hyperactivity,
phobias, and somatic problems and somewhat less effective with
8
social adjustment issues. In terms of client problems, Kazdin (2004)
argued that psychotherapy with children and adolescents should not
be considered as a uniform set of procedures as there are more
than 550 types of psychotherapy, and given that children have a
range
of
psychological
issues
and
dysfunctions,
specific
psychotherapeutic approaches may be more effective with certain
problem types.
COUNSELOR FACTORS
In psychotherapy research with adults, there is a history of
examining whether training and experience have an effect on
outcome (Lambert, Bergin, & Garfield, 2004), and, although the
results vary, the general trend is that training and experience tend
not to have a significant impact on positive outcome (Beutler et al.,
2004). However, with younger clients as compared to adults,
researchers have identified some interesting trends. For example,
Weisz et al. (1987) found that trained professionals were for the
most part equally effective with all different age groups, but
graduate students and paraprofessionals were more effective with
younger clients and less effective with adolescents. In terms of
overcontrolled and undercontrolled problems, with overcontrolled
problems the level of therapist training appeared to make a
difference, with a finding that as the amount of formal training
increased, so did the effectiveness of the psychotherapy. This
relationship between training and outcome, however, was not
evident with children with undercontrolled problems (Weisz et al.).
In their later study, Weisz et al. (1995) found somewhat more
complex findings regarding the interactions among problem type,
child
age,
and
therapist
training.
For
overcontrolled
youth,
professionals and students achieved higher effect sizes than did
paraprofessionals. Paraprofessionals, however, were more effective
than professionals and students were with undercontrolled youth.
Thus, with children and adolescents, training does appear at times
to
play
a
complex
role
in
terms
of
the
effectiveness
of
psychotherapy. What may be pertinent here are ethical standards
9
and the need for counselor practitioners to practice within their
competencies (American Counseling
Association, 2005; ASCA,
2004). Hence, only counselors and others who have adequate
training to provide psychotherapy to children and adolescents with
specific problems should do so.
TREATMENT FACTORS
Modality
For school counselors, there often are issues of time management
that may include decisions on whether to see a student individually
or in a group. Although it was not a statistically significant
difference, Weisz et al. (1987) found a somewhat larger effect size
for individual therapy than for group therapy, with effect sizes of
1.04 and .62, respectively. This difference further dissipated in the
later meta-analysis, in which Weisz et al. (1995) found only a
slightly
higher
mean
effect
size
for
individually
conducted
treatments (.63) than for group treatments (.50). Unlike the metaanalyses on child and adolescent therapy in various settings, Prout
and DeMartino (1986) found that in schools, group treatments were
more effective than individual interventions, with effect sizes of .63
and .39, respectively. In addition, Prout and Prout's (1998) findings
suggested that in school research, group modalities have been the
primary focus of research, with 20 of the 25 studies involving group
interventions. Interestingly, Prout and Prout found an effect size for
group interventions of .95; however, they also found a small
number of studies that involved a combination of group and
individual interventions that produced a quite large effect size of
1.33.
Theoretical Orientation
In terms of general psychotherapeutic approach, Casey and Berman
(1985) found in their meta-analyses that behavioral therapies led to
greater effect sizes (.91) than nonbehavioral therapies (.40). One of
the aspects to consider with this finding,
however, is that
10
differences appeared to be restricted to certain types of outcome
measures. Behavioral therapies were more likely to be evaluated by
outcome measures that were very similar to activities that occurred
during treatment. When differences in types of outcome were
controlled in Casey and Berman, many of the advantages of
behavioral therapies dissipated. Others have argued that the
relative effectiveness of behavioral versus nonbehavioral child
psychotherapy is due to the methodological quality of studies that
examine the different treatment types; however, Weiss and Weisz
(1995) conducted a meta-analysis to address this claim and their
results found little support for this hypothesis. Furthermore, Weisz
et al. (1987) found that behavioral techniques resulted in better
outcomes for clients than nonbehavioral techniques even when
secondary or unnecessary outcomes were removed.
Weisz et al. (1987) also examined treatment subtypes and found no
significant difference between behavioral subtypes (e.g., operant,
modeling) and nonbehavioral subtypes (e.g., psychodynamic, clientcentered). In addition, these researchers found that the efficacy of
behavioral approaches applied across problem types and with
different age groups. Weisz et al. (1995) found, by using more
sophisticated meta-analytic weighting techniques, that behavioral
therapies were more effective with children and adolescents than
were nonbehavioral therapies.
Similar to the findings in the meta-analyses on child and adolescent
psychotherapy in general, the school-based meta-analysis by Prout
and DeMartino (1986) found that behavioral interventions produced
stronger effects than did other approaches. Specifically within the
behavioral
interventions
category,
they
found
that
the
cognitive/rational interventions were particularly effective. Prout
and Prout (1998), however, delineated treatment type slightly
differently
and
grouped
the
treatment
types
into
cognitive-
behavioral, relaxation, and skills training. Using these categories,
they found cognitive-behavioral interventions to have the largest
effect size across all outcome variables. Hoagwood and Erwin
11
(1997) also found support for cognitive-behavioral approaches with
students in their examination of the effectiveness of mental health
services provided in schools.
Process Factors
The term process in the psychotherapy research often denotes
specific happenings or events that occur in therapy and can include
specific actions, experiences, or the degree of relatedness (Orlinsky,
Roonestad, & Willutzki, 2004). In adult psychotherapy research, the
relationship between the client and the counselor has been found to
be particularly important and one of the best predictors of positive
outcome (Horvath, 2001; Norcross, 2001; Sexton & Whiston,
1994). Oetzel and Scherer (2003) contended that considerably less
is known about the process of psychotherapy with children and
adolescents; however, they found that the therapeutic relationship
between the therapist and child or adolescent is critical to positive
change. They further argued that establishing a therapeutic alliance
is often more difficult with younger clients than adults because of
the stigma attached with psychotherapy and that children are often
forced, as compared to volunteering, to attend psychotherapy.
Kazdin (2004) stressed that psychotherapy has clear benefits for
many children and adolescents, but there needs to be additional
research that will clearly explain precisely the processes and
mechanisms of that positive change.
EVIDENCE-BASED PRACTICE
Although
there
are
some
other
general
conclusions
that
psychotherapy has applicability to many problems that youth
experience, numerous researchers and practitioners have argued
the most critical issue is what treatment works with which clients
(Evans & Seligman, 2005; Kazdin, 2003). As Kazdin indicated, there
are hundreds of available psychotherapeutic approaches for children
and adolescents, and not all of these are equally effective with
different types of problems. It is important to keep in mind that
meta-analytic reviews usually devise superordinate classes to group
12
techniques (e.g., behavior therapy, family therapy), and these
reflect broad orientations to treatment and not specific techniques
(Kazdin & Johnson, 1994). Findings of meta-analyses indicate there
are effective interventions for children with mental health problems,
but they do not always indicate the specific type of interventions
that
were
analyzed.
Lonigan,
Elbert,
and
Johnson
(1998)
tenaciously argued that the identification of specific interventions
for specific problems and diagnoses is required to best serve
children in need of mental health services. Although there are
differing definitions and some debate about what constitutes
empirically based or empirically supported interventions (American
Psychological Association, 2005; Wampold, Lichtenberg, & Waehler,
2002), we are not going to enter that debate, but we will provide
some suggestions related to empirically based interventions that
school counselors can explore further.
Concerning children and adolescent anxiety, fear, and phobias,
Kazdin (2003, 2004) contended there is sufficient evidence to
support systematic desensitization, modeling, reinforced practice,
and cognitive behavior therapy. King, Muris, and Ollendick (2005)
and Ollendick and King (1998) contended that in vivo/imaginal
desensitization, modeling, and contingency management have
substantial empirical support in the treatment of childhood phobias.
They also asserted that, although there is less research related to
cognitive-behavioral
treatments
as
compared
to
behavioral
interventions, there is support for the efficacy of cognitivebehavioral strategies with problems related to anxiety, fear, and
phobias. Readers interested in a manual for cognitive-behavioral
treatment for children with anxiety disorders that has been
empirically investigated should see Kendall (2000).
There is also support for cognitive-behavioral therapy for the
treatment of youth with depressive symptoms or subsyndromal
depression (Asarnow, Jaycox, & Tompson, 2001). A cognitivebehavioral-based intervention for depression is the Adolescent
Coping with Depression Course (CWD-A), which has been examined
13
in
four
randomized
trials
studies
with
positive
results.
The
applicability of this treatment may vary depending on the school
setting as this treatment includes 16 2-hour sessions over a period
of 8 weeks. It should be noted, however, that Evans and Seligman
(2005) found very little empirical evidence related to the treatment
of serious depression in preadolescents.
Sexton, Alexander, and Mease (2004) found substantial support for
some specific types of family therapies (i.e., functional family
therapy and multi-systemic therapy) for youth with oppositional
defiant disorder and conduct disorder. Kazdin (2004) also cited the
effectiveness of parent management training related to treatment
for oppositional and conduct disorders. Parent management training
also has been found to be helpful with attention deficit hyperactivity
disorder (Pelham, Wheeler, & Chronis, 1998). There are hundreds of
studies related to the effectiveness of family therapies, but the
literature is extensive and will not be addressed in this review as
our focus is primarily on psychotherapy.
In their review of mental health services provided in schools,
Hoagwood and Erwin (1997) found very few studies that examined
which
treatments
assisted
children
with
specific
psychiatric
problems. They further argued for the need for closer attention to
school-based mental health services, packaging those techniques
that are most effective in schools for replication, and making better
connections
between
school-based
services
and
promising
community treatments.
CONCLUSIONS
Related to the mental health of children, the U.S. Department of
Health and Human Services (1999) determined to promote costeffective, proactive systems of behavioral support at the school
level, which should include systems of behavioral support that
emphasize prevention while including selective individual student
supports for those who have more intense and long-term needs.
This effort seems laudatory as the National Institute of Mental
14
Health (NIMH, 1999) found that 1 in 10 children and adolescents
suffer from mental illness severe enough to cause some level of
impairment, yet fewer than 1 in 5 of these children receive
treatment. NIMH concluded that without treatment, schoolwork may
suffer, normal family and peer relationships may be disrupted, and
violent acts may occur. Some may suggest that schools are the best
place to reach the 80% of students who need mental health
assistance but are not receiving it. The issue then becomes who in
schools has the responsibility for mental health services. In a recent
survey of school personnel, Romer and McIntosh (2005) asked
1,402 schools for the individual most knowledgeable of the mental
health services of the school, and 49.1% of the time they spoke
with a school counselor. Other times these researchers were
directed to the school psychologist (25.7%), school social worker
(11.2%), school
nurse
or
nurse
practitioner
(3.0%), special
educator (2.9%), principal or assistant principal (2.8%), special
services or student services director (2.3%), teacher (0.3%), or
other (2.8%). Hence, it is clear that many schools see school
counselors as having the most knowledge of and responsibilities for
mental health services in a school; yet, providing these services
seems practically impossible with caseloads averaging in this
country around 481 students to 1 school counselor (ASCA, 2005b).
From this review, it appears that there are many children and
adolescents
who
might
benefit
from
psychotherapeutic
interventions, yet many of them are currently not receiving those
services that are supported empirically. In conclusion, this review
reflects that psychotherapy can be very effective for many children
and adolescents, but these youth need the opportunities to receive
these types of treatment in order be assisted.
15
References
American Counseling Association. (2005).ACA code of ethics.
Alexandria, VA: Author.
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (4th ed., text rev.). Washington, DC:
Author.
American Psychological Association. (2005). Report of the 2005
Presidential Task Force on Evidence-Based Practice. Washington,
DC: Author.
American School Counselor Association. (2004). Ethical standards
for school counselors. Alexandria, VA: Author.
American School Counselor Association. (2005a). The ASCA national
model: A framework for school counseling programs (2nd ed.).
Alexandria, VA: Author.
American School Counselor Association. (2005b). Total student-tocounselor ratio by state: 2002-2003 school year. Retrieved October
20, 2005, from
http://www. schoolcounselor.org/files/ratios02-
03.pdf
Asarnow, J. R., Jaycox, L. H., & Tompson, M. C. (2001). Depression
in youth: Psychosocial interventions. Journal of Clinical Psychology,
30, 33-47.
Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Talebi,
H., Noble, S., et al. (2004). Therapist variables. In M.J. Lambert
(Ed.), Bergin and Garfield's handbook of psychotherapy and
behavior change (5th ed., pp. 227-306). New York: John Wiley.
Casey, R. J., & Berman, J. S. (1985).The outcome of psychotherapy
with children. Psychological Bulletin, 98, 388-400.
16
Cohen, J. (1988). Statistical power analysis for the behavioral
sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
Costello, E.J., Angold, A., Burns, B. J., Stangl, D. K., Tweed, D. L.,
Erkanli, A., et al. (1996).The Great Smoky Mountains Study of
Youth: Goals, design, methods, and the prevalence of DSM-III-R
disorders. Archives of General Psychiatry, 53, 1129-1136.
Doll, 8. (1996). Prevalence of psychiatric disorders in children and
youth: An agenda for advocacy by school psychology. School
Psychology Quarterly, 11, 20-46.
Evans, D. L., & Seligman, M. E. P. (2005). Introduction. In D.L.
Evans, E. B. Foa, R. E. Gur, H. Hendin, C. P. O'Brien, M. E. P.
Seligman, et al. (Eds.), Treating and preventing adolescent mental
health disorders: What we know and what we don't know (pp. xxvxl). New York: Oxford University Press.
Hedges, L.V., & Olkin, I. (1985). Statistical methods for metaanalysis. Orlando, FL: Academic Press.
Hoagwood, K., & Erwin, H. D. (1997). Effectiveness of school-based
mental health services for children: A 10-year research review.
Journal of Child and Family Studies, 6, 435-451.
Horvath, A. O. (2001). The alliance. Psychotherapy: Theory,
Research, Practice, Training, 38, 365-372.
Kazdin, A. E. (1991). Effectiveness of psychotherapy with children
and adolescents. Journal of Consulting and Clinical Psychology, 59,
785-798.
Kazdin, A. E. (2003). Psychotherapy for children and adolescents.
Annual Review in Psychology, 54, 253-276.
Kazdin, A. E. (2004). Psychotherapy for children and adolescents. In
M.
J.
Lambert
(Ed.),
Bergin
and
Garfield's
handbook
of
17
psychotherapy and behavior change (5th ed., pp. 543-589). New
York: John Wiley.
Kazdin, A. E., & Johnson, B. (1994). Advances in psychotherapy for
children
and
adolescents:
Interrelations
of
adjustment,
development, and intervention. Journal of School Psychology, 32,
217-246.
Kendall, P. C. (2000). Cognitive-behavioral therapy for anxious
children: Treatment manual (2nd ed.). Ardmore, PA: Workbook
Publishing.
King, N. J., Muris, P., & Ollendick, T. H. (2005). Childhood fears and
phobias: Assessment and treatment. Child and Adolescent Mental
Health, 10, 50-56.
Lambert, M.J., Bergin, A. E., & Garfield, S. L. (2004). Introduction
and historical overview. In M. J. Lambert (Ed.), Bergin and
Garfield's handbook of psychotherapy and behavior change (5th
ed., pp. 3-15). New York: John Wiley.
Lonigan, C. J., Elbert, J. C., & Johnson, S. B. (1998). Empirically
supported psychosocial interventions for children: An overview.
Journal of Clinical Child Psychology, 27, 138-145.
National Institute of Child Health and Human Development. (2005).
Backgrounder.
Retrieved
October
20,
2005,
from
http://www.nichd.nih.gov/new/releases/americas_children05_bg_p
arents.cfm
National Institute of Mental Health. (1999). Myths and facts about
mental illness--June 7, 1999. Retrieved October 20, 2005, from
http://www.nimh.nih.gov/whitehouse/myths.asp
No Child Left Behind Act of 2001, Pub. L. No. 107-110 (2002).
18
Norcross, J. C. (2001). Purposes, processes, and products of the
Task
Force
on
Empirically
Supported
Therapy
Relationships.
Psychotherapy: Theory, Research, Practice, Training, 38, 345-356.
Oetzel, K. B., & Scherer, D. G. (2003).Therapeutic engagement with
adolescents in psychotherapy. Psychotherapy: Theory, Research,
Practice, Training, 40, 215-225.
Ollendick, T. H., & King, N. J. (1998). Empirically supported
treatments for children with phobic and anxiety disorders. Journal of
Clinical Child Psychology, 7, 98-106.
Orlinsky, D. E., Roonestad, M. H., & Willutzki, U. (2004). Fifty years
of
psychotherapy
process-outcome
research:
Continuity
and
change. In M.J. Lambert (Ed.), Bergin and Garfield's handbook of
psychotherapy and behavior change (5th ed., pp. 307-389). New
York: John Wiley.
Pelham, W. E., Wheeler, T., & Chronis, A. (1998). Empirically
supported psychosocial treatment for attention deficit hyperactivity
disorder. Journal of Clinical Child Psychology, 27, 190-205.
Prout, H.T., & DeMartino, R. A. (1986). A meta-analysis of schoolbased studies of psychotherapy. Journal of School Psychology, 24,
285-292.
Prout, S. M., & Prout, H.T. (1998). A meta-analysis of school-based
studies of counseling and psychotherapy: An update. Journal of
School Psychology, 36, 121-136.