During case consultation meetings at most child psychotherapy clinics, a therapist presents a case and seeks recommendations from other clinicians. The clinicians discuss the specifics of the case and then offer suggestions that could benefit the child. I remember the first year I started attending these case conferences how surprised I was at how often the recommendation was for parents to also receive their own individual therapy. Sometimes the recommendation was simply intended to provide stressed parents with some resources that could benefit them. But often the parents were struggling with symptoms themselves and the group believed that addressing the parental symptoms would also help the child. The assumption was simple: children respond better to interventions if their parents are not struggling with psychological difficulties themselves.
Last night I read an interesting article just published in the Journal of Abnormal Child Psychology that provides some scientific support for such assumption. The article reported the findings of a study that examined the effectiveness of two different child therapies for Post-Traumatic Stress Disorder (PTSD). Specifically, the study compared an intervention called Trauma-Based Cognitive Behavioral Therapy (TB-CBT) against a similar intervention called Trauma Based Cognitive Therapy (TB-CT) (For my clinician readers, the TB-CT did not involve exposure).
I was not surprised at all at the fact that both interventions were very effective in reducing PTSD and other similar symptoms. What was most surprising is how much parents impacted the effectiveness of the intervention.
Specifically, maternal depression significantly impacted the effectiveness of the intervention among kids who presented with severe PTSD symptoms. See this graph:
That line reflects kids whose parents had low levels of depression. You can see based on that line that the PTSD symptoms at the end of the treatment were very low regardless of whether the kids had severe or non-severe PTSD symptoms at the start of the intervention. That is, after the intervention, most kids, whether they had severe or non-severe PTSD at the start of the treatment, had low levels of PTSD symptoms. In sum, the therapy worked.
However, the solid line reflects the kids whose mothers had high levels of depression. As you can see, the PTSD symptoms at the end of the treatment were really high for those kids who had severe symptoms of PTSD at the start of the intervention. That is, the therapy did not work for kids who had severe symptoms of depression at the start of treatment if their mothers were also depressed.
For clinicians and parents the implications are the same. It is extremely important that parents and clinicians pay attention to parental depression when dealing with a child who has been traumatized. Parents should know that it is common for them to feel many symptoms of depression when their child has experienced trauma. But in such cases, it is important for the parent to receive help for their own symptoms in order to help their child recover from the trauma.
The reference: Nixon, R., Sterk, J., & Pearce, A. (2011). A Randomized Trial of Cognitive Behaviour Therapy and Cognitive Therapy for Children with Posttraumatic Stress Disorder Following Single-Incident Trauma Journal of Abnormal Child Psychology DOI: 10.1007/s10802-011-9566-7
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