Counselling and Psychotherapy Research, December 2006; 6(4): 233
237

ORIGINAL ARTICLE

Counselling children and young people: A review of the evidence

for its effectiveness

SUE PATTISON1 & BELINDA HARRIS2

1
University of Newcastle upon Tyne, Newcastle upon Tyne, UK, and 2University of Nottingham, Nottingham, UK

Abstract
This paper summarises and presents the results of a BACP commissioned systematic scoping review on the research evidence
on counselling children and young people. The methodology was based on a structured, hierarchical, systematic approach to
searching and reviewing the research literature. Inclusion criteria defined the scope of the review in relation to a range of issues
in counselling children and young people: behavioural problems and conduct disorders; emotional problems including anxiety,
depression and post-traumatic stress; medical illness; school-related issues; self-harming practices and sexual abuse. Four
groups of counselling approaches were examined: cognitive-behavioural; psychoanalytic; humanistic; and creative therapies.
The findings indicate that the four therapeutic approaches are effective to a greater or lesser degree in relation to the range of
issues. Although the findings show that there is little or no evidence for the effectiveness of some therapies for particular
issues, this may not reflect the lived experience of children and young people engaged in counselling in a range of community
and institutional settings. Instead, the absence of evidence is likely to reflect a lack of published studies that fit the inclusion
criteria for this review.

Keywords: Counselling, psychotherapy, children, young people, effectiveness

Introduction sion), medical illness, self-harming practices and

sexual abuse. The following therapies were excluded
This paper presents the results of the BACP commis-
from the review because they involved too many
sioned systematic scoping review of the research
variables outside the scope of the study: pharmaceu-
evidence on counselling and psychotherapy for chil-
tical treatments, psychiatric in-patient settings, teach-
dren and young people (Harris & Pattison, 2004). The
ing or tutoring to enhance knowledge of a specific
project proved challenging in terms of how to subject, except where they represented a minor part
produce and present a review that was both relevant of the intervention, family therapy, except where a
and accessible to counselling practitioners, service comparative analysis is made, psycho-educational
providers and policy makers, yet rigorous enough to therapy, guidance and peer counselling, behaviour
be useful to other researchers in the field. The therapy, modification or social skills training, bib-
following key question drives this study: Is counselling liotherapy, online counselling, telephone counselling.
effective with children and young people? The full The following inclusion criteria and rules were
report (Harris & Pattison, 2004) summarises each applied: group and individual counselling carried out
piece of research in a standard format that offers a over the short, medium and long-term. Counselling or
succinct account of the key points of the investigation psychotherapy was only included if carried out by
being described. This paper cannot provide such therapists with some form of training in the specific
detailed information but the major findings will be therapeutic approach under investigation. In order for
identified and highlighted. a research study to be included, outcome indicators
were required based on empirical measures taken
Research methods and procedures before and after a period of counselling in one or
more of the following areas: improvements in beha-
The initial scoping process produced a range of viour, raised self-esteem, effectiveness or quality of
themes and issues relevant to counselling children interpersonal relationships, increased sociability, im-
and young people. The issues were organised into six provements in academic performance, increased
main categories: behavioural problems and conduct self-awareness. In order to qualify for inclusion in
disorders, emotional problems (anxiety and depres- the review change indicators were required to be

Correspondence: Sue Pattison, School of Education, Communication and Language Sciences, University of Newcastle upon Tyne, Joseph
Cowen House, St Thomas Street, Newcastle upon Tyne, NE1 7RU, UK. E-mail: susan.pattison@ncl.ac.uk

1473-3145 (print)/1746-1405 (online) – 2006 British Association for Counselling and Psychotherapy
DOI: 10.1080/14733140601022659
234 S. Pattison & B. Harris
demonstration of clinical significance. Tests of clinical
What does this study explore? significance seek to determine whether the outcomes
of psychological therapy are important in a clinical
j Research evidence for the effectiveness of sense. There are a number of different ways of doing
counselling for children and young people this. For example, a treatment may be described as
having clinically significant effects if it returns a high
proportion of clients to a state similar to that of a non-
assessed by recognised psychometric testing, pre/ clinical sample (such as the general population). It is
post-test and follow-up, along with qualitative indi- possible for a study to demonstrate a statistically
cators as reported by the child, young person and significant effect that has little clinical significance.
therapist and/or significant other. The self-report of The remainder of the studies were assessed through
the counsellor was not considered sufficient evidence outcome measures and research design/methodolo-
of change in a child unless it was supported by other gies.
data.
The following question was used to drive the
Findings
research process: Is counselling effective with children
and young people? This was supplemented by three Many of the reviews and primary studies referred to a
further questions: Which types of counselling work? wide age range of children or young people with a
For whom? For which issues? The sample age-group lack of consistent differentiation of outcomes for
was 3
19 years, both male and female. Electronic, specific age groups. It is recommended, therefore,
hand and opportunistic searches via professional that the findings are interpreted with caution and
networks and existing projects were undertaken. A original studies should be referred to for further
hierarchical approach was adopted when assessing information.
the type of research studies: The search found four reviews of counselling and
psychotherapy on behavioural and conduct problems.
1. Systematic reviews and meta-analyses Three of these focused on cognitive behavioural
2. Experimental studies: randomised-controlled therapy (Bennett & Gibbons, 2000; Baer & Nietzel,
trials, controlled before and after studies 1991; Robinson et al., 1999). These studies evidence a
3. Other studies: simple before and after studies, mild to moderate effect for antisocial behaviour,
qualitative studies hyperactivity-impulsivity and aggression, and a sig-
nificant effect for behavioural therapy in the treat-
The quality and category of individual studies was
ment of impulsivity. One primary study supported the
assessed according to criteria outlined in the Co-
medium-term effect for cognitive behavioural therapy
chrane Reviewers Handbook (Clarke & Oxman, 2003).
with aggressive and defiant behaviour (Ensinck et al.,
Firstly, review articles and meta-analyses were identi-
1997). A third review provided evidence for individual
fied as best quality evidence in relation to the key behavioural and non-behavioural therapies for con-
counselling issues. High quality controlled trials not duct problems (Weisz et al., 1987). One randomised
included in such reviews and meta-analyses were controlled study suggested that a combination of
located to add to the data. Other sources of evidence psychodynamic, humanistic and cognitive therapy
(qualitative and process studies) were included where was effective in reducing aggression and developing
they could offer valuable insights into therapies, issues a commitment to change in children and pre-adoles-
or populations that were under represented in the cents (Schechtman & Ben-David, 1999). Other sup-
best quality evidence. Review articles and meta- porting evidence indicates the potential of
analyses were assessed and assigned to three bands psychoanalysis with children and adolescents across
(A, B, C) using eight quality criteria described by the age range (Fonagy & Target, 1994). Two studies
Oxman and Guyatt (1988), including only bands A challenge the use of individual therapies with ethnic
and B in the review. Two members of the research minority children and adolescents with severe beha-
team double rated a sample of 25% of the reviews viour problems (Szapocznik, 1989; Weiss, Catron &
and meta-analyses and any differences in opinion Harris, 2000).
were resolved through discussion. The search located one review of psychological
Randomised controlled trials were assessed through therapy for anxiety (Compton et al., 2003) plus one
statistical significance, clinical significance and effect RCT (Mendlowitz et al., 1999), one controlled before
size. The measurement using the value of p /0.05 or and after study (Pfeffer et al., 2002) and five simple
lower is conventionally considered ‘statistically signifi- before and after studies (Benazon et al., 2002; Kaplan
cant’ and was applied to the assessment of studies for et al., 2001; Thieneman, 2001; March et al., 1998;
this review. Although statistical significance is impor- Ovaert et al., 2003), which provide evidence that
tant, there are some caveats. Firstly, the sample size cognitive behavioural therapy is effective with a range
of the study is important; small studies are less able to of anxiety problems and that it is superior to no
demonstrate statistical significance. Secondly, finding treatment in the short and medium term. Group
a statistically significant difference does not mean that cognitive behavioural therapy is effective with chil-
the results are clinically important; that requires a dren and adolescents across the range of anxiety
 Counselling children and young people: the research 235
fourth RCT (King et al., 1998) provides evidence for
What does this study tell us? CBT in enhancing school attendance in child and
adolescent school refusers. The two qualitative studies
j Counselling is a positive, useful and effective identified show the benefits of counselling for im-
intervention across the full range of issues proving self-concept and reducing violent behaviour
presented by children and young people towards other children (Flitton & Buckroyd, 2002;
j There is a greater body of evidence for CBT, Meredith, 1992).
indicating that this form of counselling may be This search in relation to self-harming practices
more effective for older children and adoles- located two randomised controlled trials of substance
cents
abuse that provide evidence for the effectiveness of
j There is a lack of high quality research evidence
individual and group cognitive behavioural therapy in
published in support of other counselling reducing alcohol and marijuana use with adolescents
approaches (Kaminer et al., 2000; Waldron, 2001). A third study
provides preliminary evidence that brief therapy is
effective in reducing drug use and related conse-
quences with this group (Breslin et al., 2002). One
problems. One controlled study (Muratori et al., 2002) primary study found individual therapy to be as
and two simple before and after studies (Blos, 1983; effective as family therapy in producing weight gain
Fonagy & Target, 1994) provide evidence for psycho- and return to menstruation in adolescent females
analysis across the age range with children under the with anorexia nervosa (Robin et al., 1999). Group CBT
age of 11 years experiencing greater improvements. combined with longer-term group process (humanis-
Intensity and length of treatment are associated with tic) therapy showed promising results with adolescent
enhanced treatment gains. females who repeatedly self-harm (Wood et al.,
The search found four reviews of psychological 2001). A further study suggests that a focus on self-
therapies for depression (Compton et al., 2002; development within a specific style of therapeutic
Harrington, Whitaker & Shoebridge, 1998; Merry relationship is a key factor in facilitating the recovery
et al., 2004; Michael & Crowley, 2002). The studies of suicidal adolescents (Paulson & Everall, 2003).
demonstrate a significant short-term effect of cogni- Two review studies were identified in relation to
tive behavioural therapy for depression with incon- sexual abuse. Reeker et al. (1999) provide evidence
clusive results in terms of the longer-term efficacy of for group treatment for children and adolescents who
therapy over waiting list controls. There is some have been sexually abused and Finkelhor and Berliner
evidence of a moderate effect for interpersonal (1995) found therapy to be more effective than no
therapy (Mufson, 1999; Rossello & Bernal, 1999), treatment with little difference in effect between
non-directive supportive therapy (Birmaher et al., specific therapies. Two RCTs were identified, both
2000; Michael & Crowley, 2002) and personal growth finding counselling to be effective for children who
groups (Merry et al., 2004), but no evidence for social have been sexually abused (Cohen & Mannarino,
skills training. Different models of therapy produce 2000; Deblinger et al., 1999) and that these improve-
differential effects (e.g. enhanced personal control ments are maintained for up to two years (Deblinger
associated with personal growth and positive expla- et al., 1999). A controlled before and after study
natory style with CBT (Merry et al., 2004). (Nolan et al., 2002) and three simple before and after
Three studies of cognitive behavioural therapy for studies (Berman, 1995; De Luca et al., 1995; Trowell
different severe pain conditions or procedures were et al., 2002) provided supplementary evidence for
located (Eccleston, 2004; Jay et al., 1995; Elliot & therapy in ameliorating the effects of sexual abuse in
Olson, 1983). A Cochrane review of chronic pain children.
(Eccleston, 2004) finds cognitive behavioural therapy
effective in the management of chronic headaches in
Conclusion
children and adolescents. There is some preliminary
evidence for the use of CBT in reducing distress The results of the review show counselling to be a
during painful medical procedures (Elliot & Olson, positive, useful and effective intervention across the
1983) such as the changing of burns dressings. full range of issues presented by children and young
One review (Wilson et al., 2003), four RCTs, two people. There is a greater body of evidence for CBT,
before and after and two qualitative studies were indicating that this form of counselling may be more
identified for school related issues. The review in- effective for older children and adolescents. However,
dicates that a range of counselling approaches is this finding needs to be interpreted with some caution
effective in reducing the incidence of aggressive due to the lack of high quality research evidence
behaviour in children and adolescents (Wilson et al., published in support of other counselling approaches.
2003). Two RCTs provide evidence for the efficacy of In the light of increasing evidence that promoting
group therapy for children with behavioural problems mental health in children and young people can have
in school (McArdle et al., 2002; Omizo & Omizo, positive effects upon learning, achievement, atten-
1987). A third RCT finds therapy to be ineffective for dance and behaviour (DfES, 2001; DfES, 2004; BACP,
behavioural problems (English & Higgins, 1971). A 2004; Pettitt, 2003) it seems that the commissioning
236 S. Pattison & B. Harris
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Ensink, K., Robertson, B. A., Zississ, C., Leger, P., & de Jager, W.
with practitioners, service managers and Local Educa- (1997). Conduct disorder among children in an informal settle-
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Journal of the American Academy of Child and Adolescent
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Dr Sue Pattison
upon Tyne


University of Newcastle
Rican adolescents. Journal of Consulting and Clinical Psychology, Sue is a BACP Accredited Counsellor and lecturer
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in Counselling and International Education in the
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Sherr, L., & Sterne, A. (1999). Evaluation of a counselling interven- PhD in Education and Communication, the MEd. in
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Belinda Harris University of Nottingham
Belinda is a UKCP Registered Gestalt Psychotherapist
Szapocznik, J., Rio, A., Murray, E., Scopetta, M., Rivas-Vazquez, A.,
Hervis, O., Posada, V., & Kurtines, W. (1989). Consulting and
and lecturer in the Centre for the Study of Human
Clinical Psychology, 57, 571
578. Relations at the University of Nottingham, where she
Thieneman, M., Martin, J., Cregger, B., Holly, B., & Dyer-Friedman, is course leader for the MA Counselling Studies and
J. (2001). Manual-driven group cognitive-behavioral therapy for teaches on a variety of postgraduate programmes
adolescents with obsessive-compulsive disorder. Journal of the including human relations, educational leadership and
American Academy of Child and Adolescent Psychiatry, 40,
1254
1260. special needs education. Belinda is a qualified teacher
Trowell, J., Kolvin, I., Weermanthri, T., Sadowski, H., Berelowitz, and winner of the Lord Dearing Award for excellence
M., Glaser, D., Leitch, I., & Glasser, D. (2002). Psychotherapy for in teaching.