AACAP Adopts Policy Statement Affirming Psychotherapy's Role

The practice of psychotherapy is being undermined by economic and professional forces. In response, the American Academy of Child and Adolescent Psychiatry (AACAP) has adopted a new policy statement affirming that psychotherapy is a core skill and central to the practice of child psychiatry. The statement was approved unanimously by AACAP's Executive Council in June.

Rachel Ritvo, M.D., chair of AACAP's Task Force on Psychotherapy, told Psychiatric News, "Our concern is that the quality and scope of practice are being driven by economic forces rather than maintaining the standard of providing the best care for children."

She added, "We felt it was important to clarify what child psychiatrists stand for and to convey our views to general psychiatry, psychiatric training directors, and other medical specialties."

Ritvo mentioned that a small faction within the field supports a narrow neuromedical model to define the scope of practice rather than a biopsychosocial model that encompasses psychotherapy and a developmental approach.

"We know that children are responsive to psychotherapeutic and pharmacologic interventions. But a pill can't address a child's developmental needs. To lose psychotherapy would greatly diminish our capacity to provide and oversee care."

An additional impetus to define the scope of practice for child psychiatry came from the application by the American Board of Pediatrics to the American Board of Medical Specialties (ABMS) for a subspecialty board in developmental/behavioral pediatrics, according to Ritvo. AACAP opposes the application, which has been made on behalf of more than 400 pediatricians with a special interest in the behavioral development of children. AACAP believes the proposal duplicates existing training and clinical services, according to a January 22 letter from AACAP to ABMS. A triple-board program in pediatrics, general psychiatry, and child and adolescent psychiatry accomplishes the goals sought by the application, states the letter.

The new policy statement notes that "child and adolescent psychiatrists by the nature of their training inexorably combine the skills, knowledge, and mind-set of physician and psychotherapist."

The document continues, "The psychotherapies remain essential treatment modalities for children's cognitive, emotional, and behavioral problems. Additionally, psychotherapeutic knowledge and skills inform all psychiatric clinical activities including diagnostic assessment; pharmacotherapy; and consultation to agencies, schools, and other physicians, as well as collaboration with and supervision of staff and trainees."

Ritvo referred to the task force report, which supports the policy statement. The AACAP Committee on Psychotherapy will implement the report's recommendations. Among them:

• Developing approaches to address the inconsistencies in psychotherapy education in residency programs nationwide, the insufficient time allocated to psychotherapy training, and the lack of financial support for long-term psychotherapy training cases.



• Coordinating the efforts needed to revitalize psychotherapy research by child and adolescent psychiatrists and bringing current and future psychotherapy research findings to the attention of members.



• Studying the cost-effectiveness and clinical effectiveness of combined medication and psychotherapy treatment or split treatment with different clinicians providing psychotherapy and medication management.

Ritvo commented, "Research in child psychotherapy has virtually disappeared and has lagged behind adult psychiatry. It's very hard to hold onto a field in which members are not contributing to a research base. The committee is looking at ways to promote more research in child psychotherapy."

The committee also would like relevant APA components to be aware of its policy statement and to support it. David Fassler, M.D., chair of APA's Council on Children, Adolescents, and Their Families, told Psychiatric News, "I concur with the academy's position that psychotherapy is a core component of child and adolescent psychiatry and that it's important for psychiatry residents and fellows to be trained in its principles and practice."

Fassler said the council will review the policy statement at its May meeting and discuss any recommendations for APA action.

"In general, our position is that child and adolescent psychiatrists and adult psychiatrists working with children need to be broadly trained in a range of treatment modalities including psychotherapeutic interventions."

The policy statement on psychotherapy and the task force report are posted on AACAP's Web site. They can be accessed from an index page on psychotherapy by child and adolescent psychiatrists at www.aacap.org/clinical/Psych-1.htm.