Helmut Remschmidt is an
internationally renowned child psychiatrist and currently serves as president
of the pre-eminent international child psychiatry organization. In addition, Remschmidt is a prominent
academic psychiatrist in Germany, a country in which the theory, practice, and
study of psychotherapy receives a higher societal priority than in North
America. Thus, it is fitting that
Remschmidt serve as the editor of this volume, an anthology with the ambitious
goal of surveying the vast expanse of child psychotherapeutic practice and the
research, which supports its use. In
the course of nearly 600 pages, Remschmidt and a dozen other European child
psychiatrists review the literature, indications, and challenges in
contemporary child psychotherapy in a clear expository style and with rigorous
attention to detail. This volume, the
latest in the prestigious Cambridge Press child psychiatry series, is intended
to provide a virtually exhaustive review of the practice of contemporary child
psychotherapy.

The book is clearly organized and
effectively subdivided and indexed. 
There are four major sections. 
Part I defines addresses issues common to all psychotherapy paradigms,
including a precise definition of psychotherapy, treatment planning strategies,
approaches to psychotherapy research, and quality assurance. The authors make clear their position that
psychotherapy treatment planning should be evidence-based and disease-specific,
rather than an idiosyncratic process based on the predilections of the
treatment planner and patient. The
discussion of methodologies is thorough, lucid, and a potentially valuable
resource for psychotherapy researchers worldwide.

 The second section of the book discusses the major psychotherapy
paradigms and their advantages and limitations. Included are chapters on psychodynamic, behavioral and
cognitive-behavioral, interpersonal, group, and family therapies. Again, the writing is meticulous yet
succinct. The level of detail is
sufficient to cover all of the major principles of each paradigm, although not
comprehensive enough to be a reference for experienced clinicians. A final chapter reviews combined approaches
to mental health treatment, although the use of medication with
psychotherapy—the predominant combination therapy utilized in the
Americas—receives scant attention.

In Part III of the book the authors
present indications for specific psychotherapies for each of the mental
disorders that affect children and adolescents. Much of the material in this section will be familiar to therapists,
such as the recommendation of behavioral strategies for the treatment of
anxiety syndromes. Nevertheless, a
systematic review of the indications and contraindications for particular
therapies in specific clinical situations provides a valuable resource for
child clinicians, for whom the choice of comprehensive textbooks of
psychotherapy is quite limited.

The final section of the volume
discusses treatment settings, including inpatient, outpatient, day hospital,
and home treatment modalities. Here the
disparities between child psychotherapeutic practice in Europe and in North
America become obvious. For example,
the average length of stay for a child inpatient hospitalization is reported as
2 to 3 years in Germany; in the United States the figure is likely closer to 2
to 4 weeks in most facilities. 
Europeans also advocate “home treatment” in some cases, in which
therapists make housecalls to perform psychotherapy with children in their
family milieu. The availability of
psychotherapy resources in North America varies markedly by geography and by
demographics, and so the recommendations in this section will be of varying
usefulness depending on local factors.

A number of other factors may limit
the utility of this book for North American readers. The English translation of this book was published four years
after the German edition appeared, and so research findings from the past
half-decade, such as recent reports about the cost-effectiveness of
psychodynamic treatments, are not included.  
Also, the majority of the references cited in the text are to German
psychiatric journals, which are both linguistically and logistically
inaccessible to most North Americans. 
Another issue is that all of the chapter authors utilize the
international diagnostic classification system known as ICD-10, rather than the
DSM-IV classification system used throughout the United States and Canada.

The comprehensive coverage of this
volume represents an impressive compilation and distillation of a diverse and
often contradictory body of literature. 
North American readers may be surprised by the depth of research
reviewed in this text, a testament to the importance of this treatment modality
in European psychiatric practice. It is
perhaps not surprising that a comparable volume by North American authors has
not appeared to date. In spite of
significant limitations of applicability in the United States and Canada, this
volume serves as a valuable reference resource about the scope and practice of
child psychotherapy.

© 2002 Michael Brodsky

 Michael Brodsky
is a psychiatrist in training in Los Angeles, California, and an avid reader.

Categories: ChildhoodDisorders, Psychotherapy