Limitations of Psychotherapy Research

Several major caveats exist with regard to the conclusions that can currently be drawn from the existing body of literature describing psychotherapy research in physically ill children and adolescents. These include the use of small and heterogeneous study samples, variations in age and developmental status across studies, poorly defined therapeutic interventions without measures of treatment fidelity, different locations of treatment settings (inpatient versus outpatient), variable follow-up periods, and wide variation in the internal and external validity of both treatment interventions and outcome measures. In many cases, outcome measures have not been standardized, and many were not sensitive to treatment change. In other studies, treatment interventions are not described in sufficient detail, and there are significant differences with respect to treatment intensity and duration and/or presence of a theoretical construct (e.g., self-efficacy or empowerment). Studies and meta-analyses also varied in how they defined effect size, with some studies comparing pre- and posttreatment changes within patients, whereas others compared the active treatment with a control condition. In addition, cultural and socioeconomic differences across pediatric illness populations need to be better characterized so that results can be interpreted based on the composition of specific pediatric subpopulations.

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