Target, H. M. A; (1994) The outcome of child psychoanalysis: A retrospective investigation. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis concerns the measurement and prediction of outcome in psychodynamic child psychotherapy. The literature on the outcome of child psychiatric treatments is reviewed, with emphasis on the outcome of psychosocial and psychodynamic therapies. Reasons are presented for assessing the outcome of child psychoanalytic treatment initially using a chart review. Three major forms of measure of child adaptation and symptomatology are described, and their usefulness for the planned study is discussed. The study sample is introduced: 763 cases of child psychoanalysis and psychotherapy treated over 40 years at the Anna Freud Centre. Predictor variables are chosen in the light of existing literature on natural history and therapeutic outcome. The operationalisation of these variables is described, and its success in terms of the reliability of information collected is presented. The choice of outcome measures is then considered further. The rationale for and development of a new global adaptation scale for children and adolescents are outlined, and preliminary data on its psychometric properties are reported. Four major outcome criteria are presented, based on clinically significant improvement. The organisation, reduction and aggregation of predictor variables is then described; this produced a manageable number of key variables for further analysis. The sample is characterised in terms of these key variables, and some difficulties in generalising from the present sample are considered. Outcome results are reported for the full sample, and then for those children whose treatment continued for at least six months. Variables associated with either attrition or improvement are identified. Diagnostic group and child age emerge as key predictors, and further analyses are performed contrasting groups matched on these variables. In the final chapter, a theoretical model is presented which integrates the results, and a plan is described for a prospective study which will rigorously test the hypotheses generated by the present investigation.

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