The future of psychotherapy for mentally ill children and adolescents

Authors


  • Conflict of interest statement: Dr. March is a consultant or scientific advisor to Eli Lilly, Pfizer, Wyeth and GlaxoSmithKline; an equity holder in MedAvante; the author of the Multidimensional Anxiety Scale for Children (MASC); a member of a DSMB overseeing research conducted by Astra-Zeneca and Johnson & Johnson; and under separate independent grants receives study drug from Eli Lilly and Pfizer for two NIMH-funded clinical trials. Dr. March does not participate in Speaker’s bureaus or other promotional activities.

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    Since it is apparent that the treatment of mentally ill patients will be ‘housed’ within the broad field of neurosciences medicine, I use the term ‘psychiatry’ to refer not to a particular professional discipline but to the conceptual umbrella under which the currently heterogeneous clinical, research and teaching tasks of Journal readers will increasing be subsumed.

John S. March, Duke Clinical research Institute, 2400 Pratt Street, Room 031, Durham, NC 27705, USA; Email: john.march@duke.edu

Abstract

Objective:  Given striking advances in translational developmental neuroscience and its convergence with developmental psychopathology and developmental epidemiology, it is now clear that mental illnesses are best thought of as neurodevelopmental disorders. This simple fact has enormous implications for the nature and organization of psychotherapy for mentally ill children, adolescents and adults.

Method:  This article reviews the ‘trajectory’ of psychosocial interventions in pediatric psychiatry, and makes some general predictions about where this field is heading over the next several decades.

Results:  Driven largely by scientific advances in molecular, cellular and systems neuroscience, psychotherapy in the future will focus less on personal narratives and more on the developing brain. In place of disorders as intervention targets, modularized psychosocial treatment components derived from current cognitive-behavior therapies will target corresponding central nervous system (CNS) information processes and their functional behavioral consequences. Either preventive or rehabilitative, the goal of psychotherapy will be to promote development along typical developmental trajectories. In place of guilds, psychotherapy will be organized professionally much as physical therapy is organized today. As with other forms of increasingly personalized health care, internet-based delivery of psychotherapy will become commonplace.

Conclusion:  Informed by the new field of translational developmental neuroscience, psychotherapy in the future will take aim at the developing brain in a service delivery model that closely resembles the place and role of psychosocial interventions in the rest of medicine. Getting there will be, as they say, interesting.

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