Psychotherapy as a Core Competence of Child and Adolescent Psychiatrist
Psychotherapy is and must remain a core skill in the practice of child and adolescent psychiatry. The psychotherapies* remain essential treatment modalities for children's cognitive, emotional, behavioral and relational problems and evidence suggests their efficacy as monotherapy1,2 or in combination with psychopharmacologic treatments3-5 for multiple disorders in youth, including major depressive disorder, generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, posttraumatic stress disorder, obsessive compulsive disorder, reactive attachment disorder and others. Importantly, psychotherapy knowledge and skills also inform all psychiatric clinical activities, including diagnostic assessment, pharmacotherapy, and consultation to agencies, schools, and other physicians, as well as collaboration with and supervision of staff and trainees. Child and adolescent psychiatrists are trained to differentiate the presentation and treatment of medical illnesses from psychiatric and developmental disorders, including psychological factors affecting somatic complaints, and to integrate psychotherapeutic with biological and psychosocial interventions. Child and adolescent psychiatrists, by the nature of their training, inextricably combine the skills, knowledge, and mind set of the physician and psychotherapist.
Psychotherapy concepts, including psychodynamic, cognitive and behavioral as well as relational concepts, should be an integral part of the thinking of the psychiatrist in all endeavors, including medication management. The ability to consistently incorporate psychotherapeutic principles and techniques in the physician-patient interaction is one of the skills that differentiates the child and adolescent psychiatrist from the pediatrician or other physicians. Similarly, the ability to incorporate a knowledge of psychological development, attachment, biology, physiology, pathology, and the various domains of medicine into these interactions differentiates child and adolescent psychiatrists from other mental health professionals.
- Psychotherapy is effective in treating a constellation of psychiatric disorders in children and adolescents.1-5
- Psychotherapeutic concepts are of central importance in assessing and providing care to children, adolescents, their families and their communities (ex. Schools, other health care providers).1
- AACAP thus endorses psychotherapy as a core skill of central importance to the practice of child and adolescent psychiatry.
* Psychotherapy refers broadly to the many established schools of psychotherapy, including but not limited to psychodynamic psychotherapies, psychoanalysis, cognitive-behavioral therapies, interpersonal therapy, relational psychotherapy, family therapies, and group therapies.
- Kernberg PF, Ritvo R, Keable H; American Academy of Child an Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice Parameter for psychodynamic psychotherapy with children. J Am Acad Child Adolesc Psychiatry. 2012;51(5):541-57
- Gilboa-Schechtman E, Foa EB, Shafran N, Aderka IM, Powers MB, Rachamim L, Rosenbach L, Yadin E, Apter A. Prolonged exposure versus dynamic therapy for adolescent PTSD: a pilot randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2010;49(10):1034-42.
- Franklin ME, Sapyta J, Freeman JB, Khanna M, Compton S, Almirall D, Moore P, Choate-Summers M, Garcia A, Edson AL, Foa EB, March JS. Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: the Pediatric OCD Treatment Study II (POTS II) randomized controlled trial. JAMA. 2011;306(11):1224-32
- Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, Ginsburg GS, Rynn MA, McCracken J, Waslick B, Iyengar S, March JS, Kendall PC. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med. 2008;359(26):2753-66.
- Brent D, Emslie G, Clarke G, Wagner KD, Asarnow JR, Keller M, Vitiello B, Ritz L, Iyengar S, Abebe K, Birmaher B, Ryan N, Kennard B, Hughes C, DeBar L, McCracken J, Strober M, Suddath R, Spirito A, Leonard H, Melhem N, Porta G, Onorato M, Zelazny J. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA. 2008;299(8):901-13.