A Review of the Effectiveness of Psychodynamic Therapy for Children with Externalizing Psychopathology
DOI:
https://doi.org/10.58445/rars.3275Keywords:
Psychodynamic Therapy, Externalizing Disorders, Attention-Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Conduct Disorder, Emotion Regulation, Object Relations Theory, Ego PsychologyAbstract
This review examines the effectiveness of psychodynamic therapy (PDT) for children with externalizing psychopathology, including Attention Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD). Taking from psychoanalytic theory and combining insights from modern developmental psychology and neuroscience, PDT offers a unique approach that emphasizes emotional regulation, unconscious processes, and relational dynamics. Unlike behaviorally focused interventions such as Cognitive Behavioral Therapy (CBT), PDT examines the underlying meaning behind disruptive behaviors and creates long-term psychological development through secure therapeutic relationships rather than looking purely at surface symptoms. Overall, studies show that PDT is at least as effective as CBT and other behavioral therapies in reducing externalizing symptoms, along with additional benefits for internalizing problems and also long-term outcomes. Standardized and short term models display additional positive results, showing the possibility of scalability and a wider application within therapies. Despite these strengths, PDT still faces barriers. These barriers include limited large-scale randomized controlled trials, differences within practices, a difficulty in measuring the unconscious changes and practical obstacles such as stigma, clinician training gaps, and accessibility issues. Studies suggest that future directions in PDT should include allowing caregiver involvement, developing situational appropriate and adapted modes of therapy, public education of modern psychodynamic treatment, using neurobiological and observational outcome measures, and expanding brief, manualized PDT models. Overall, PDT offers a strong alternative mode of treatment to symptom focused treatments by working with the emotions beneath the disruptive behaviors. With continued research, advocacy, and possible integrations, PDT holds significant promise within the field of child mental health care.
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