A Retrospective Study of the Outcome of Psychoanalysis and Psychotherapy for Children with and without Chronic Medical Conditions

There is a good deal of evidence that medical and psychiatric conditions co-exist in patients considerably more frequently than would be expected by chance. Although the direction of causality is difficult to determine, there seems little doubt that childhood chronic physical illness or disability may precipitate emotional and behavioural pathology. Little is known about response to psychological treatment of children with severe long-term physical problems and few studies to date have compared the clinical response and outcome of such children with physically healthy control groups. In particular, children's reaction to psychoanalytic intervention has received almost no empirical attention at all. An extensive outcome study set up at the Anna Freud Centre, London, and reported on in this thesis is, as far as is known, the first large-scale study of child psychoanalysis ever attempted. The Centre is engaged in long-term, intensive psychoanalytic treatment of children and adolescents. Retrospective study of the process and outcome of child analysis, using material from cases spanning 40 years, has uncovered a large quantity of demographic, clinical and therapeutic information. This thesis presents a brief overview of the psychoanalytic or psychotherapeutic treatment of 769 children and young people between the ages of two and 19 years, looking at a wide range of variables associated with diagnostic profiles, demographic characteristics and parental and family factors and relating these, where possible, to treatment and outcome. More detailed attention has been paid to a subgroup of 81 children with long-term physical disabilities, including chronic handicaps such as visual, motor or auditory impairment, chronic organic illnesses like diabetes and epilepsy, and the chronic psychosomatic syndromes of asthma and eczema. They have been matched with appropriate control subjects to try to ascertain the extent to which the presence of a defined medical condition influences the effectiveness of psychotherapy. We found that medical conditions alone did not affect response to treatment. The target groups of chronically disordered children showed few differences from related control groups. However, a variety of other factors influencing outcome have been identified