Efficacy of psychoanalysis for children with emotional disorders

This is the second report from a chart review of 763 cases of child psychoanalysis and psychotherapy at the Anna Freud Centre.

Three hundred fifty-two children and adolescents were identified who met DSM-III-R criteria for emotional disorders or who had sleep or somatoform symptoms with marked emotional disturbance. Two hundred fifty-four were treated in full psychoanalysis, the remainder one to three times per week, for an average of 2 years. Outcome was indicated by diagnostic change and by change in overall adaptation, measured by the Children's Global Assessment Scale (CGAS).

Of those treated for at least 6 months, 72% showed reliable improvement in adaptation, 24% still had some diagnosis at termination, and 15% still had an emotional disorder. Simple phobias were most likely to remit, and depressed children were least likely to return to normal CGAS levels. Children younger than 11 years were considerably more likely to be well at the end of treatment. Intensive treatment generally led to greater improvements, independently of age and treatment length. Certain disorders, and more severe pathology, required intensive treatment; 50% of severe cases showed no improvement in psychotherapy. Thirty-one percent of variance in CGAS change could be predicted, and greater than 50% when diagnostic groupings were examined separately.

Despite methodological limitations, the study identifies predictors of improvement (e.g., younger age, phobic symptoms, intensity and length of treatment) and shows that severe or pervasive pathology requires intensive analytic help.