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Research on counselling and psychotherapy with children and young people a systematic scoping. review of the evidence for its effectiveness from 2003 2011 is published by the British Association for. Counselling Psychotherapy BACP House 15 St John s Business Park Lutterworth Leicestershire. t 01455 883300,f 01455 550243,e bacp bacp co uk,w www bacp co uk. BACP is the largest professional organisation for counselling and psychotherapy in the UK is a. company limited by guarantee 2175320 in England and Wales and a registered charity 298361. British Association for Counselling Psychotherapy 2013. Correspondence to,Carol Holliday, Affiliated lecturer Faculty of Education University of Cambridge 184 Hills Road Cambridge CB2 8PQ. e cah66 cam ac uk,Colleen McLaughlin, Professor of Education Faculty of Education University of Cambridge at the time of writing and now of. the Department of Education University of Sussex Falmer Brighton BN1 9QQ UK. e C M McLaughlin sussex ac uk,Dr Barbie Clarke, Associate Researcher Faculty of Education University of Cambridge 184 Hills Road Cambridge. e Bhc24 cam ac uk,Sonia Ilie, PhD Candidate Faculty of Education University of Cambridge 184 Hills Road Cambridge CB2 8PQ. e isi22 cam ac uk,Acknowledgements, The authors would like to thank wholeheartedly the following people and organisations. BACP for funding this review, Lyndsay Upex for her meticulous and invaluable work at every stage. Peter Bowers for his supervision and support, Julia Macpherson for her support and work during this process. Martyn Richards for the work on the search,Our partners for their patience and support. This publication is protected under copyright under the Berne Convention and the Universal. Copyright Convention All rights reserved No part of this publication may be produced or. transmitted in any form or by any means including photocopying microfilming and. recording without the written permission of the copyright holder application for which should. be addressed to the Chief Executive at BACP Such written permission must always be. obtained before any part of this publication is stored in a retrieval system of any nature or. electronically, BACP 2013 Research on counselling and psychotherapy with children and young people 1. Executive summary 3,Introduction 7,Methodology 11,Findings 16. Methodological reflections 76,Conclusions and implications 80. Appendices 82, 2 Research on counselling and psychotherapy with children and young people BACP 2013. Executive summary,Objectives, Therapeutic work with children and young people is receiving more resources and attention in the UK. as shown in the recent development of a national strategy for school based counselling in Wales. Pattison et al 2007 This arises from recognition of the mental health needs of children and young. people In 2004 BACP published a review of the effectiveness of therapeutic interventions with. children and young people Harris and Pattison 2004 This study updates that review and seeks to. answer the same questions In addressing the overall question Is counselling and psychotherapy. effective for children and young people three sub questions were identified. 1 Which types of counselling and psychotherapy interventions work. 2 For which presenting problems,3 For whom, These questions informed the 2004 review and this update. The nature of the review, The 2004 review was informed by the BACP definition of counselling at the time of publication that. Counselling takes place when a counsellor sees a client in a private and confidential setting to. explore a difficulty the client is having distress they may be experiencing or perhaps their. dissatisfaction with life or loss of a sense of direction and purpose It is always at the request of. the client as no one can properly be sent for counselling Harris and Pattison 2004. This study takes on board the updated 2012 BACP definition of counselling particularly in relation to. counselling in schools, Counselling and psychotherapy are umbrella terms that cover a range of talking therapies. They are delivered by trained practitioners who work with people over a short or long term to. help them bring about effective change or enhance their wellbeing. Counselling can be an effective early intervention strategy for children and young people who. have emotional behavioural or social difficulties with the aim of alleviating lessening or. preventing these problems from becoming more complex costly and requiring referral to. specialist services, School based counselling is a professional activity delivered by qualified practitioners in. schools Counsellors offer troubled and or distressed children and young people an. opportunity to talk about their difficulties within a relationship of agreed confidentiality. Scoping study definition of terms, This study is a systematic scoping review whose aim is to map rapidly the key concepts underpinning. the research area and the main sources and types of evidence available Statistical methods were not. used nor were the studies in meta analyses reanalysed Instead a narrative approach was adopted to. describe the extent and nature of the literature Systematic methods were used to review the. evidence as described in the methodology section Judgements about the quality of studies were. made when deciding which should be included in the review and the quality of included studies was. also appraised and reported on Two broad categories of study were included in the review new. studies published since 2003 and systematic reviews published post 2003 which may have included. pre 2003 studies,The nature of the evidence, Studies that fell into any of the following domains as categorised in the 2004 review were included in. the update, 1 The evidence from systematic reviews and meta analyses. 2 The evidence from controlled trials including randomised control trials RCTs and controlled. before and after studies CBAs that did not use randomisation. 3 Supporting evidence from cohort studies case studies observational and exploratory studies. and methodological papers that raise issues for future research in this field. BACP 2013 Research on counselling and psychotherapy with children and young people 3. Review methods, Bibliographic databases searched using CSA Illumina which provides access to more than. 100 databases,517 papers identified through Illumina. 513 records identified after duplicates removed,317 excluded after screening. 196 records further screened and 53 excluded after reading abstracts. 143 full text articles assessed for eligibility,41 excluded. 102 full text articles included in the review, Additional 12 papers identified through other sources. 114 included in the final synthesis,Which types of interventions work. Cognitive behavioural therapy, Cognitive behavioural therapies CBT were found to be effective for anxiety and behavioural and. conduct problems There is less evidence of the effectiveness of CBT for children as opposed to. adolescents and for depression as opposed to anxiety More studies investigated CBT than any other. therapeutic intervention 36 per cent of total interventions There is a need for further research to. investigate the long term effects of CBT interventions and to explore differential responses to CBT in. children and adolescents with anxiety and depression. Psychodynamic therapy, Unlike CBT studies which have been carried out predominantly in the US studies using. psychodynamic therapies have a much wider geographical spread Psychodynamic interventions are. effective for a variety of presenting problems including mood disorders such as depression There is a. small amount of evidence to support the construct of a sleeper effect for psychodynamic therapy. which refers to how symptomatic recovery can be greater at six month follow up than at the end of. therapy There is a need for further research in this area. Play therapy, The number of studies investigating play therapy has grown from just two in the 2004 review to 14 in. this update One of these is a systematic review of 93 studies marking the growth in the evidence. base for this type of therapy As a therapeutic intervention play therapy is highly effective for a variety. of presenting problems particularly anxiety and behaviour conduct problems for a range of young. populations but particularly primary aged children and in a number of settings particularly clinics and. Humanistic therapies and interpersonal psychotherapy. As evidenced by a number of studies humanistic therapies are effective in school settings. Interpersonal psychotherapy IPT was found to be beneficial for children and adolescents with. depression particularly when presenting problems involved relational issues rooted in conflict. Non specific factors, Beyond specific therapeutic approaches certain therapist behaviours and practices were found to be. associated with outcome Therapists behaviour in the first stages of treatment was associated with. young people s subsequent engagement in their therapy Other factors positively associated with. outcomes were paying attention to the client s level of motivation less structuring of the therapy and. paying attention to the young person s experiences Therapists selection of an appropriate treatment. strategy was also important along with offering choice to clients and being sensitive to gender and. cultural issues, 4 Research on counselling and psychotherapy with children and young people BACP 2013. For which types of problems,Depression, In the case of depression psychological therapy was generally found to be beneficial and more. effective than either no treatment or treatment as usual A range of therapeutic approaches emerged. as effective in the treatment of adolescent depression including CBT IPT psychodynamic and family. therapies Treatments were effective in the short term up to six months and there was little. discernible difference in outcomes between therapeutic approaches. As in the 2004 review CBT emerged as an effective therapy for anxious children and adolescents. Little evidence was found for the effectiveness of other approaches in the treatment of this problem. Since 2004 the amount of research in this area has grown steadily providing a more detailed. understanding of the active processes involved in CBT interventions Evidence has also been. accumulating for the effectiveness of IPT in reducing anxiety in young people who are also suffering. from depression,Post traumatic stress disorder, Most of the therapeutic interventions for PTSD involved short term CBT based therapies including re. exposure interventions psycho education Emotion Recognition and Expression or Eye Movement. Desensitization and Reprocessing EMDR Parental involvement in the therapy was important for the. success of CBT interventions with the exception of cases where there were especially negative family. circumstances or where parents may be perpetrators of abuse. Behaviour and conduct disorders, Similar to the 2004 review the majority of studies investigating behaviour and conduct disorders. employed CBT interventions that were found to be effective Conduct disorders were sometimes. associated with PTSD Other effective interventions included Behavioural Parent Training BPT for. both pre school and school aged children which was less effective with adolescents than with. younger children More generic work with parents to help young people with conduct disorders also. had evidence of effectiveness Some interventions had detrimental effects where following the. intervention levels of antisocial behaviour actually increased Such programmes based on a get. tough approach were not appropriate for the developmental stage of the child and ignored the. powerful influences of the psychosocial context eg peer pressure. Learning difficulties and school related problems, Counselling interventions are reasonably well established in UK and US schools although defined. differently in the two countries A dearth of research into the counselling of children with learning. difficulties persists The small amount of research available suggests that treating learning difficulties. and school related problems in school settings may have some advantages over treatment in mental. health clinics Additionally a comparative study found humanistic therapy more effective than CBT for. children with learning difficulties,Children affected by medical conditions. There is a lack of evidence relating to psychological therapy for children affected by medical conditions. or for children with parents experiencing serious health issues More research is needed in this area. More research is also needed in relation to self harm in children and young people The current. evidence is inconclusive and this has consistently been identified by reviews and by a national. enquiry as an under researched area,Children and young people with eating disorders. There is a stronger evidence base regarding interventions for young people with eating disorders. Family therapy and CBT including guided self care exhibited the most positive results Other. therapies including IPT yielded more modest improvements in depressive symptoms and eating. behaviours in the treatment of bulimia nervosa In the case of anorexia nervosa the importance of an. empathic engagement and a therapeutic relationship that can be maintained over time were.