Research digest: Therapeutic work with children and adolescents who have experienced trauma

Abstract

One is conscious when approaching this area of research what a mammoth task lies ahead. Trauma is a complex and much debated field, both theoretically and clinically, and as the range of papers in this special issue demonstrates, can be approached and thought about from many different angles. As established in one of the abstracts included in this review (Norman et al., 2012), all forms of child maltreatment can have serious and significant impacts on several health indices, making the development of effective treatments all the more important. There is a plethora of research examining the treatment of trauma within youth psychotherapy, with the majority of it centring around trauma-focused cognitive behavioural therapy (TF-CBT). This approach, developed in the 1990s, is a shortterm intervention involving individual, parent, and family work, and focuses on the learning of cognitive strategies to manage negative emotions and beliefs stemming from highly distressing and/or abusive experiences. Meta-analysis (Morinaab et al., 2016) and systematic review (Carey & McMillen, 2012) have established the ‘high quality’ evidence for TF-CBT that subsequently has the most influence on public policy. However, eye-movement desensitization and reprocessing (EMDR) is also emerging as an alternative treatment with a good evidence base (Moreno-Alcázar et al., 2017). Currently, The National Institute for Health and Care Excellence (NICE) recommends both these treatments for children and adolescents who have experienced trauma. To a lay observer of the field, decisions surrounding choice of intervention could easily appear quite straightforward. There is high quality evidence for short-term manualised treatments, which are well suited to delivery within a public health setting. However, these treatments rely on a level of functioning that does not exist in all children and families that have experienced trauma, and fail to address the multiple and insidious ways complex trauma can imbed within the psyche, as discussed in many of the papers in this special issue. The complexity and ‘livedexperience’ of engaging in therapy focused on treating trauma symptoms are addressed by some of the research abstracts included below. Eastwood et al. (2021) and Graham & Johnson (2021) seem to broadly highlight the importance of a relational and individual approach, while Tiwaria et al. (2021) echo this with a call for ‘client-centred, eclectic approaches.’ Psychodynamic psychotherapy has been widely used with children who have experienced maltreatment, especially those who have been placed in foster care or have been adopted. Some of these studies have been included in this review, amongst them a randomised controlled trial looking at the effectiveness of individual child psychotherapy for girls who were JOURNAL OF CHILD PSYCHOTHERAPY 2021, VOL. 47, NO. 3, 499–512 https://doi.org/10.1080/0075417X.2021.2013928