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Effectiveness of School-Based Psychotherapy: A Meta-Analysis of Dissertation Research

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Title: Effectiveness of School-Based Psychotherapy: A Meta-Analysis of Dissertation Research
Language: English
Authors: Reese, Robert J., Prout, H. Thompson, Zirkelback, Emily H.
Source: Psychology in the Schools. Dec 2010 47(10):1035-1045.
Availability: John Wiley & Sons, Inc. Subscription Department, 111 River Street, Hoboken, NJ 07030-5774. Tel: 800-825-7550; Tel: 201-748-6645; Fax: 201-748-6021; e-mail: subinfo@wiley.com; Web site: http://www3.interscience.wiley.com/browse/?type=JOURNAL
Peer Reviewed: Y
Physical Description: PDF
Page Count: 11
Publication Date: 2010
Document Type: Journal Articles
Reports - Evaluative
Education Level: Elementary Secondary Education
Descriptors: Intervention, Outcomes of Treatment, Meta Analysis, Effect Size, Psychotherapy, Doctoral Dissertations, Cognitive Restructuring, Behavior Modification, Skill Development, School Psychology, Coding
DOI: 10.1002/pits.20522
ISSN: 0033-3085
Abstract: A meta-analysis was conducted with 65 school-based psychotherapy and counseling dissertations over the last 10 years (1998-2008) to assess if a file-drawer problem (i.e., studies conducted but not published that, as a whole, have different results than studies in the same area published) exists in the school-based outcome literature. An overall mean effect size of 0.44 was found for 73 treatment interventions. This effect size is comparable to Prout and DeMartino's 1986 meta-analysis conducted with published school-based studies and approximately half a standard deviation smaller than Prout and Prout's 1998 meta-analysis of school-based intervention studies. A bias does appear to exist but seems to be smaller than the bias found in the general child and adolescent psychotherapy outcome literature. Most of the dissertation studies evaluated group interventions and used a cognitive-behavioral or skills training intervention. Skills training and interventions with elementary-school students yielded the largest effect sizes. Comparisons of the current study with previous school-based intervention meta-analyses are discussed as are suggestions for future research. (Contains 1 figure and 3 tables.)
Abstractor: As Provided
Number of References: 91
Entry Date: 2010
Accession Number: EJ906085
Database: ERIC
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  Value: <anid>AN0055048604;pis01dec.10;2019Jun03.12:00;v2.2.500</anid> <title id="AN0055048604-1">Effectiveness of school-based psychotherapy: A meta-analysis of dissertation research. </title> <p>A meta‐analysis was conducted with 65 school‐based psychotherapy and counseling dissertations over the last 10 years (1998–2008) to assess if a file‐drawer problem (i.e., studies conducted but not published that, as a whole, have different results than studies in the same area published) exists in the school‐based outcome literature. An overall mean effect size of 0.44 was found for 73 treatment interventions. This effect size is comparable to Prout and DeMartino's 1986 meta‐analysis conducted with published school‐based studies and approximately half a standard deviation smaller than Prout and Prout's 1998 meta‐analysis of school‐based intervention studies. A bias does appear to exist but seems to be smaller than the bias found in the general child and adolescent psychotherapy outcome literature. Most of the dissertation studies evaluated group interventions and used a cognitive–behavioral or skills training intervention. Skills training and interventions with elementary‐school students yielded the largest effect sizes. Comparisons of the current study with previous school‐based intervention meta‐analyses are discussed as are suggestions for future research. © 2010 Wiley Periodicals, Inc.</p> <p>The effectiveness of counseling and psychotherapy has been a much debated and much researched topic. Smith and Glass (1977) published the first major meta‐analysis of psychotherapy outcome studies, and their study has spawned numerous subsequent meta‐analyses. In fact, meta‐analysis is widely used as a summative quantitative review method for a broad range of social science, medical, and educational disciplines. The typical approach for meta‐analysis in psychotherapy outcome research is to compare an experimental treatment group at the conclusion of an intervention with a control group, calculating an effect size (ES) using standard deviations (<emph>SD</emph>s) of the groups. Although there are variations for analysis, the ES values are pooled across studies to yield a measure of improvement or gain in treated groups. Additionally, the typical approach in meta‐analysis has been to primarily use published studies for the base of analysis.</p> <p>There have been numerous meta‐analyses of child/adolescent psychotherapy outcomes. There have been general meta‐analyses of child outcomes (e.g., Casey & Berman, [<reflink idref="bib12" id="ref1">12</reflink>]; Weisz, Jensen‐Doss, & Hawley, [<reflink idref="bib86" id="ref2">86</reflink>]; Weisz, Weiss, Alicke, & Klotz, [<reflink idref="bib88" id="ref3">88</reflink>]; Weisz, Weiss, Han, Granger, & Morton, [<reflink idref="bib89" id="ref4">89</reflink>]), as well as more specific analyses of play therapy (Bratton, Ray, Rhine, & Jones, [<reflink idref="bib5" id="ref5">5</reflink>]), rational emotive therapy with children (Gonzalez et al., [<reflink idref="bib35" id="ref6">35</reflink>]), and analyses of interventions for child/adolescent depression (Weisz, McCarty, & Valeri, [<reflink idref="bib86" id="ref7">86</reflink>]) and anger problems (Sukhodolsky, Kassinove, & Gorman, [<reflink idref="bib81" id="ref8">81</reflink>]). It is beyond the scope of this article to summarize all of these studies. These analyses, however, have pointed to the general effectiveness of therapeutic interventions with children and adolescents. The average ES for the majority of child/adolescent meta‐analytic studies are typically between 0.50 and 0.80 (Weisz, [<reflink idref="bib85" id="ref9">85</reflink>]). Two meta‐analyses have been conducted focusing on school‐based counseling and psychotherapy (Prout & DeMartino, [<reflink idref="bib65" id="ref10">65</reflink>]; Prout & Prout, [<reflink idref="bib66" id="ref11">66</reflink>]). These analyses were dominated by group interventions, but yielded overall ES values of 0.58 and 0.98, respectively, suggesting moderate to strong effects (Cohen, [<reflink idref="bib13" id="ref12">13</reflink>]) of school‐based counseling and psychotherapy.</p> <p>Some have criticized meta‐analysis for over‐reliance on published studies that may yield bias with resulting higher ES values and overestimation of actual treatment effectiveness. This is sometimes referred to as the "file drawer" problem in which nonsignificant studies are "filed" away and do not get published, thus not receiving consideration in meta‐analyses that use only published studies (Howell & Shields, [<reflink idref="bib42" id="ref13">42</reflink>]). McLeod and Weisz (2004) addressed this issue by analyzing the results of youth psychotherapy dissertation studies. They noted that dissertation studies are typically well‐designed, include review (i.e., committees) at several steps, and are completed (i.e., published as a dissertation) regardless of the results. A meta‐analysis of dissertations may be less biased than those analyses using only published studies. McLeod and Weisz found that the dissertation analysis yielded ES values of about half those of published studies (0.27 vs. 0.63) and concluded that analyses using only published studies may overestimate treatment effects.</p> <p>The purpose of the current study was to conduct a meta‐analysis of dissertations focusing on school‐based counseling and psychotherapy, roughly replicating the school‐based meta‐analyses of Prout and DeMartino (1986) and Prout and Prout (1998). The dissertation findings were compared to the findings from these earlier meta‐analyses to assess if published studies tended to overestimate treatment effects. Master's theses were not included because the quality of the studies tends to be more variable, and, when compared to dissertations and the published literature, theses are often conducted by less experienced researchers and are less sophisticated in design and execution.</p> <hd id="AN0055048604-2">METHOD</hd> <p></p> <hd id="AN0055048604-3">Identification of Dissertations</hd> <p>We searched the <emph>ProQuest</emph> database for dissertations and theses, considered to be the most comprehensive search tool for dissertations, published between 1998 and 2008. A 10‐year period was selected because there was no availability of dissertations electronically prior to 1997. Similar to the Prout and Prout ([<reflink idref="bib66" id="ref14">66</reflink>]) study, we used the search terms "counseling," "therapy," "psychotherapy," "interventions," "treatments," "children," "adolescents," and "schools" in a variety of combinations to identify school‐based counseling and psychotherapy dissertations. The search resulted in a total of 4,831 initial hits. A three‐step process was then followed to identify relevant studies. First, all master's theses were eliminated. Second, abstracts were then reviewed to identify studies that met the inclusion requirements. Finally, the methods and results sections of the remaining studies were reviewed for inclusion.</p> <p>Because we wanted to determine if there was a file drawer problem with the school‐based counseling outcome literature, the same inclusion and exclusion criteria outlined in the Prout and Prout ([<reflink idref="bib66" id="ref15">66</reflink>]) meta‐analysis were used to make comparisons to published studies. To merit inclusion, a dissertation had to meet four criteria. First, the study's intervention had to be consistent with the standard definition of psychotherapy. Prout and Prout used the Meltzoff and Kornreich ([<reflink idref="bib54" id="ref16">54</reflink>]) definition that has been used in other prominent psychotherapy meta‐analyses (e.g., Smith & Glass, [<reflink idref="bib77" id="ref17">77</reflink>]). The definition consists of having a trained professional use a planned approach based on well‐known psychological principles to address problems that are of a psychosocial nature. In sum, the intervention had to be provided by an individual with professional training and focused on the provision of counseling or psychotherapy. Studies that used graduate students to provide the interventions were included because the students were receiving professional training. Second, the study had to be conducted in a school setting or focused on a school‐related problem. All of the participants had to be of school age. The person(s) providing the intervention did not have to be school personnel, but the issue(s) addressed had to be considered school‐related (e.g., cognitive‐group therapy for reading achievement; behavior skills training for learning‐disabled adolescents) or germane to school functioning (e.g., anger management, anxiety, depression, self‐esteem). Third, the treatment had to be provided directly to the student. Studies that focused on family or indirect (e.g., consultation, teacher training) interventions were excluded. Fourth, the study had to use at least one treatment and one control group and include the requisite data to compute an ES.</p> <hd id="AN0055048604-4">Coding of Studies</hd> <p>A final sample of 65 dissertations was obtained. Six of the studies had an alternate treatment group included, and two of the studies used the same intervention with two independent samples. This resulted in a total of 73 interventions. All but six of the studies used multiple outcome measures (mean [<emph>M</emph>] = 4.10), ranging from 1 to 12 measures. Two of the authors independently coded the three outcome measures that were determined to be most central to the purpose of the study. For the studies in which there was a disagreement (<emph>N</emph> = 5), the other two authors were consulted to resolve the discrepancies. For example, if the intervention focused on adolescent depression and used a measure of leadership it was not included if there were three other measures more pertinent to the research hypotheses. This was done due to the variability of the number of outcome measures across studies (15 studies used 6 or more outcome measures), and dissertations often use more outcome measures than do published studies (McLeod & Weisz, [<reflink idref="bib53" id="ref18">53</reflink>]). Therefore, we decided to pick the three most salient outcome measures in an attempt to replicate more closely what is likely to be found in the published literature. This coding procedure resulted in a total of 188 outcome measures.</p> <p>The studies were coded similarly to other school‐based meta‐analyses (Prout & DeMartino, [<reflink idref="bib65" id="ref19">65</reflink>]; Prout & Prout, [<reflink idref="bib66" id="ref20">66</reflink>]) for comparison purposes. The variables coded for this study were the following: treatment format (individual vs. group), treatment type (cognitive–behavioral, relaxation, skills training, play therapy, other), person(s) providing treatment (mental health professional, graduate student, other), grade level of participants (elementary [K–5], middle school [Grades 6–8], high school [Grades 9–12]), source of outcome data (therapist, teacher, parent, self‐report, other), and target of the outcome measure (internalizing vs. externalizing). The mean number of participants across studies was 54.63 (<emph>SD</emph> = 35.37), with a mean of 29.48 (<emph>SD</emph> = 21.43) participants in the intervention condition and 25.11 (<emph>SD</emph> = 18.27) in the control condition. The mean treatment intervention length was 11.11 sessions (<emph>SD</emph> = 4.89).</p> <p>Following a brief training in the coding system, two raters (the third and fourth coauthors) independently coded the studies used in the meta‐analysis. Inter‐rater agreement was assessed by having the trainer (the first author) recode 20 articles, 10 from each rater. Kappa values ranged from.68 to 1.00 for all coding decisions. All but two codes were in the excellent agreement range (.75 and higher) and two were in the fair to good range (.40 to.74) as outlined by Fleiss ([<reflink idref="bib29" id="ref21">29</reflink>]).</p> <hd id="AN0055048604-5">Calculating of ES Values</hd> <p>Prout and Prout ([<reflink idref="bib66" id="ref22">66</reflink>]) computed unweighted ES values because they found sample size to be unrelated to resulting ES values. Therefore, we computed unweighted ES values to make direct comparisons. The choice seems to be reasonable given the correlation between the overall ES values, and sample size was not statistically significant (<emph>r</emph> = −.24). Additionally, to be consistent with the Prout and Prout and the Prout and DeMartino ([<reflink idref="bib65" id="ref23">65</reflink>]) studies, we computed ES values in the current study using the <emph>SD</emph> value of the pretreatment control group (ES = Post‐treatment experimental group mean – Post‐treatment control mean/<emph>SD</emph> of the pretreatment control group) for comparison purposes.</p> <p>ES values were calculated in two ways. First, an ES was computed for each treatment and corresponding outcome variable. This resulted in a total of 188 ES values being computed. Second, an "overall" ES was reported for each treatment by averaging all of the outcome measures for each treatment condition. Therefore, 73 ES values were calculated. To provide a context and aid in the interpretation of the ES values computed, we used Cohen's ([<reflink idref="bib13" id="ref24">13</reflink>]) general guidelines for interpreting ES values (0.20 is considered a small ES, 0.50 a medium ES and 0.80 a large ES). It should also be noted that the coding and calculation of ES values were completed independently to avoid bias.</p> <hd id="AN0055048604-6">RESULTS</hd> <p>The overall mean ES (one ES per treatment) for school‐based psychotherapy dissertation studies was 0.44 (<emph>SD</emph> = 1.28, range = −.92 to 7.85). Figure 1 illustrates that the ES values for the dissertation studies are considerably lower than those for the other meta‐analyses for published school‐based psychotherapy and counseling studies. The mean ES for the interventions across all 188 outcome measures was 0.34 (<emph>SD</emph> = 1.29, range = −1.17 to 14.24). The majority of the interventions were group (<emph>n</emph>=64) and yielded an ES of 0.47 (<emph>SD</emph> = 1.30), and the nine individual interventions had an ES of 0.17 (<emph>SD</emph> =.26).</p> <p>Graph: 1 Comparison of ES values for school‐based psychotherapy and counseling dissertations and published studies.</p> <p>Table 1 illustrates that the majority of the 73 treatment interventions were either cognitive–behavioral or involved skill‐based training. An overall ES for each treatment intervention was computed by averaging the ES values for all of the corresponding outcome variables across studies. Interventions in the "other" category (i.e., existential group therapy, relaxation, sandtray therapy, and play and/or art therapy) yielded the largest overall ES but also yielded the most within‐group variability. Interestingly, play therapy yielded the lowest mean ES.</p> <p>1 School‐Based Psychotherapy and Counseling Dissertation Mean ES Values by Type of Treatment Intervention</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Treatment Intervention</th><th align="center"><italic>n</italic></th><th align="center"><italic>ES</italic></th><th align="center"><italic>SD</italic></th></tr></thead><tbody valign="top"><tr><td align="left">Cognitive–Behavioral</td><td align="center">28</td><td align="center">0.24</td><td align="center">0.36</td></tr><tr><td align="left">Skills Training</td><td align="center">25</td><td align="center">0.55</td><td align="center">1.76</td></tr><tr><td align="left">Play Therapy</td><td align="center">7</td><td align="center">0.03</td><td align="center">0.21</td></tr><tr><td align="left">Other</td><td align="center">13</td><td align="center">0.89</td><td align="center">2.07</td></tr></tbody></table> </ephtml> </p> <p>The ES values in Table 2 represent the overall ES for each study categorized by age group: elementary‐, middle‐, or high‐school students. Elementary school students were the most frequently studied age group in the dissertations reviewed and also yielded a much larger overall ES compared to the other age groups.</p> <p>2 Mean ES Values by School Category of Participants</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">School Category</th><th align="center"><italic>n</italic></th><th align="center"><italic>ES</italic></th><th align="center"><italic>SD</italic></th></tr></thead><tbody valign="top"><tr><td align="left">Elementary</td><td align="center">29</td><td align="center">0.65</td><td align="center">1.78</td></tr><tr><td align="left">Middle</td><td align="center">9</td><td align="center">0.07</td><td align="center">0.47</td></tr><tr><td align="left">High</td><td align="center">15</td><td align="center">0.30</td><td align="center">0.43</td></tr><tr><td align="left">Elementary & Middle</td><td align="center">8</td><td align="center">0.20</td><td align="center">0.51</td></tr><tr><td align="left">Middle & High</td><td align="center">10</td><td align="center">0.36</td><td align="center">0.55</td></tr><tr><td align="left">Elementary, Middle, and High</td><td align="center">2</td><td align="center">1.22</td><td align="center">0.32</td></tr></tbody></table> </ephtml> </p> <p>Table 3 represents ES values categorized by the source of the outcome measure (parents, teacher, self‐report, other) and type of outcome measure (externalizing vs. internalizing). ES values for the outcome measure sources were computed by taking the ES for each respective outcome measure and computing an overall mean ES. As can be observed, the majority of the outcome measures were self‐report. Parent‐based evaluations yielded the lowest ES values overall. The "other" category had the largest ES values and was composed of observations from therapists or were based on performance variables, including academic grades and intelligence scores. The one study that used a therapist as an outcome source had an ES of 14.24, positively skewing the results. The ES for the other 11 studies in the "other" category was 1.40.</p> <p>3 Mean ES Values by Outcome Source and Type of Outcome Measure</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Variable Type</th><th align="center"><italic>n</italic></th><th align="center"><italic>ES</italic></th><th align="center"><italic>SD</italic></th></tr></thead><tbody valign="top"><tr><td align="left">Outcome Source</td><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"> Parents</td><td align="center">32</td><td align="center">0.15</td><td align="center">0.40</td></tr><tr><td align="left"> Teacher</td><td align="center">33</td><td align="center">0.17</td><td align="center">0.61</td></tr><tr><td align="left"> Self‐Report</td><td align="center">101</td><td align="center">0.21</td><td align="center">0.57</td></tr><tr><td align="left"> Other</td><td align="center">22</td><td align="center">1.48</td><td align="center">2.91</td></tr><tr><td align="left">Outcome Measure</td><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"> Externalizing</td><td align="center">59</td><td align="center">0.44</td><td align="center">1.00</td></tr><tr><td align="left"> Internalizing</td><td align="center">90</td><td align="center">0.23</td><td align="center">0.51</td></tr><tr><td align="left"> Other</td><td align="center">39</td><td align="center">0.44</td><td align="center">1.69</td></tr></tbody></table> </ephtml> </p> <p>The ES values categorized by type of outcome measure indicate that measures focused on externalizing behaviors resulted in larger ES values (0.44) compared to those focused on internalizing behaviors (0.23). The measures in the "other" category yielded the same treatment gains as did studies that used externalizing behaviors. The measures in this category were primarily measures that evaluated both internalizing and externalizing behaviors (i.e., Behavior Assessment System for Children [BASC] and Child Behavior Checklist [CBCL]) or performance‐based measures (i.e., academic performance or intelligence test scores).</p> <hd id="AN0055048604-7">Published versus Unpublished Dissertations</hd> <p>Of the 65 dissertations included in the study, 10 were subsequently published in peer‐reviewed journals. We analyzed the differences in ES values for the published versus unpublished dissertation studies. The overall mean ES was 0.30 for the dissertations that were eventually published and 0.47 for the unpublished dissertations; the differences were not statistically significant, <emph>t</emph>(<reflink idref="bib71" id="ref25">71</reflink>) =.42, <emph>p</emph> >.05. All of the subsequently published dissertations except two reported the same results as in the original dissertation. Those two studies left out results that were not statistically significant.</p> <hd id="AN0055048604-8">DISCUSSION</hd> <p>We conducted a meta‐analysis with 65 dissertations that met inclusion criteria to assess if there was a file‐drawer problem or publication bias within the school‐based psychotherapy and counseling literature. The overall mean ES for dissertations completed between 1998 and 2008 was 0.44 (a medium ES). Specifically, students who received a therapeutic intervention improved, on average, roughly.5 <emph>SD</emph> more than did students who received no treatment, a medium ES value. A bias appears to exist; the extent to which it exists is unclear. Compared to the Prout and Prout ([<reflink idref="bib66" id="ref26">66</reflink>]) ES of 0.98, there is a substantial difference. However, the Prout and DeMartino ([<reflink idref="bib65" id="ref27">65</reflink>]) meta‐analysis yielded a comparable ES of 0.58. Additionally, of the 65 dissertations analyzed, 10 were published and yielded a lower mean ES (0.30) compared to the other dissertations that were not subsequently published (0.47). Any resulting bias may be for reasons other than the perceived penchant for peer‐reviewed preferences for manuscripts that have robust results (Coursol & Wagner, [<reflink idref="bib17" id="ref28">17</reflink>]) or researchers only submitting manuscripts that report impressive findings (Lipsey & Wilson, [<reflink idref="bib49" id="ref29">49</reflink>]).</p> <p>The problem also appears to be smaller compared to the general child psychotherapy literature. McLeod and Weisz ([<reflink idref="bib53" id="ref30">53</reflink>]) found an unweighted ES of 0.27 for 121 dissertations compared to an ES of 0.63 for 134 published studies and child psychotherapy meta‐analyses that ranged from 0.71 to 0.88. Overall, it appears that the results for the current study, albeit less impressive than those of the published literature, provide additional support that school‐based therapeutic interventions are effective.</p> <p>The most frequent treatment intervention across studies were categorized as cognitive– behavioral or skills training. It should be noted, however, that the skills training approaches all included cognitive and/or behavioral components. Unlike much of the child and adolescent psychotherapy literature (e.g., Klein, Jacobs, & Reinecke, [<reflink idref="bib47" id="ref31">47</reflink>]), dissertations that used a general cognitive–behavioral approach did not yield impressive ES values (0.19). The school‐based literature has also typically found equally positive findings; Prout and Prout ([<reflink idref="bib66" id="ref32">66</reflink>]) reported ES values greater than 1.00 for cognitive–behavioral interventions. The most effective type of intervention found in the current study was skills training, with an ES = 0.55. This value was actually higher than that found in the Prout and Prout study (0.49). The majority of the dissertation studies categorized as skills training focused on improving social skills.</p> <p>Only 18 of the interventions could be categorized as nonbehavioral, and 7 of these were play therapy. Surprisingly, play therapy demonstrated a near‐zero ES. This finding is surprising given that other studies have consistently reported positive findings for play therapy. Bratton and colleagues ([<reflink idref="bib5" id="ref33">5</reflink>]) found an ES of 0.80 for 93 play therapy studies, of which 50 were unpublished dissertations. Given our small sampling, no definitive conclusions about play therapy's effectiveness as a school‐based intervention can be drawn. Bratton and colleagues, however, did find that play therapy studies conducted in a school setting yielded lower ES values due to session limits often found in schools. The current study did not find a relationship between the number of sessions and ES.</p> <p>Interventions with elementary students clearly yielded the largest ES values (0.65) when compared to the other school‐age categories. This finding was consistent with the Prout and DeMartino ([<reflink idref="bib65" id="ref34">65</reflink>]) and Prout and Prout ([<reflink idref="bib66" id="ref35">66</reflink>]) meta‐analyses that found larger ES values for elementary students. The broader child and adolescent literature, however, is decidedly mixed on age and benefit in therapy. Some studies indicate an inverse relationship between age and outcome (Weisz et al., [<reflink idref="bib88" id="ref36">88</reflink>]), and other studies indicate no relationship (Casey & Berman, [<reflink idref="bib12" id="ref37">12</reflink>]). Self‐report was the most frequently used outcome source and yielded a small ES of 0.21. The measures in the "other" category yielded the largest ES, even with the outlier outcome source removed (therapist). The majority of the other measures were performance‐based (e.g., number of discipline referrals, scores on a social comprehension game, scores on a cognitive ability test). Most studies also focused on addressing internalizing symptoms and/or issues (e.g., depression, anxiety, self‐esteem) compared to externalizing issues (e.g., social skills, aggressive behavior). School‐based interventions demonstrated more improvement for externalizing issues than for internal issues. Southam‐Gerow, Kendall, & Weersing ([<reflink idref="bib79" id="ref38">79</reflink>]) found that internalizing measures were associated with poor treatment responses. Weisz and colleagues ([<reflink idref="bib89" id="ref39">89</reflink>]), however, did not find a main effect for internalizing versus externalizing symptoms.</p> <p>This study had several limitations. First, the number of studies in the 10‐year period was not large when compared to many other meta‐analyses in the child and adolescent psychotherapy literature (Casey & Berman, [<reflink idref="bib12" id="ref40">12</reflink>]; Weisz, Jensen‐Doss, & Hawley, [<reflink idref="bib86" id="ref41">86</reflink>]). When compared to the other meta‐analyses conducted with school‐based interventions, however, the sample size is relatively large. We could have chosen to go back further than 10 years; however, the number of dissertation studies available online dropped considerably and left us uncertain if dissertations from an earlier period were representative of dissertations during that time period. The financial cost associated with obtaining hard copy dissertations was also prohibitive.</p> <p>Second, as consistent with the other school‐based meta‐analyses, there was a paucity of studies that focused on individual therapy (<emph>N</emph> = 9) and interventions that were not within a behavioral or cognitive–behavioral framework (<emph>N</emph> = 19). The individual interventions showed limited effectiveness, and, other than the play therapy studies, there was little semblance of studies that could be categorized beyond a nonbehavioral paradigm that would be appropriate for comparison. Treatments included existential group therapy, play and art therapy, and sandtray therapy.</p> <p>A third weakness is that many of the interventions (<emph>n</emph>=34) were either provided solely or in conjunction with graduate student(s), leaving questions about the generalizability and the efficacy of the results. A student coming in to complete a study is worried about more than providing excellent clinical services to a student; he or she is also concerned about the collection of the data and the study in general. Experience is likely less of a problem as studies have failed to find that experience is a predictor of successful outcome with children and adolescents (Casey & Berman, [<reflink idref="bib12" id="ref42">12</reflink>]; Michael, Huelsman, & Crowley, [<reflink idref="bib55" id="ref43">55</reflink>]). The lack of experience, however, may be reflected in the ability to implement a clinical study with the same level of expertise and refinement that a more experienced researcher may have. From a general perspective, dissertations have been found to be comparable in methodology rigor to the published literature with child and adolescent intervention studies (McLeod & Weisz, [<reflink idref="bib53" id="ref44">53</reflink>]). Dissertations, however, may still suffer from a lack of experience at the micro level (e.g., selecting appropriate outcome measures and/or controls), which is more difficult to objectively assess.</p> <p>The school‐based psychotherapy and counseling outcome literature appears to be lagging behind both the adult psychotherapy outcome literature and the general child and adolescent literature. The unpublished dissertations reviewed in this study were similar in terms of methodology, interventions, overall quality, and hypotheses to previous school‐based intervention studies. More research certainly needs to be undertaken; however, considerations other than sheer volume need to be considered. For example, most of the research conducted was with group interventions, although evidence suggests that individual counseling is the more frequent and preferred intervention mode (Prout, Alexander, Fletcher, Memis, & Miller, [<reflink idref="bib64" id="ref45">64</reflink>]). This has been lamented for more than 20 years in the school‐based intervention literature (Prout & DeMartino, [<reflink idref="bib65" id="ref46">65</reflink>]; Prout & Prout, [<reflink idref="bib66" id="ref47">66</reflink>]). There was also a paucity of studies that were not cognitive–behavioral in nature. This seems to reflect a trend that cognitive–behavioral interventions are more effective with child and adolescents. The adult psychotherapy literature has found that differences in treatment interventions typically disappear when treatment allegiance is accounted for in studies (Miller, Wampold, & Varhely, [<reflink idref="bib57" id="ref48">57</reflink>]). Studies in the adult literature are also now finding that therapist effects account for a substantial portion of outcome variance (Okiishi, Lambert, Nielsen, & Ogles, [<reflink idref="bib61" id="ref49">61</reflink>]). Therapists and counselors providing the same treatment can yield different outcomes. As a result, the adult literature has started moving away from analysis of variance (ANOVA)‐based analyses and beginning to use multilevel modeling techniques such as hierarchical linear modeling to take into consideration potential therapist differences and treating therapists as a "nested" variable. Few child and adolescent studies have addressed the possibility of therapist effects.</p> <p>Relatedly, a third suggestion for future research is to extend the school‐based psychotherapy literature to look at research designs beyond the pre–post design. For example, Bratton and colleagues ([<reflink idref="bib5" id="ref50">5</reflink>]) suggest that school‐based interventions may demonstrate lower ES values because treatment is shorter. Prout and colleagues ([<reflink idref="bib64" id="ref51">64</reflink>]) found that child counseling/psychotherapy provided in the schools was completed in fewer sessions and that sessions were typically shorter in length. The question inferred is "How much therapy or treatment is enough?" More therapy is typically better, but how much more? This question has been addressed in the adult literature and has consistently found a negatively accelerating curve as therapy continues (Howard, Moras, Brill, Martinovich, & Lutz, [<reflink idref="bib41" id="ref52">41</reflink>]). The majority of improvement tends to occur early in treatment. Little is known about the dose‐response across treatment with children and adolescents. More research needs to be conducted to evaluate the impact of such practices.</p> <p>The current study supports existing evidence that school‐based interventions are efficacious, albeit not to the degree of previous meta‐analyses that found larger treatment gains in the published literature. 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  Data: <searchLink fieldCode="AR" term="%22Reese%2C+Robert+J%2E%22">Reese, Robert J.</searchLink><br /><searchLink fieldCode="AR" term="%22Prout%2C+H%2E+Thompson%22">Prout, H. Thompson</searchLink><br /><searchLink fieldCode="AR" term="%22Zirkelback%2C+Emily+H%2E%22">Zirkelback, Emily H.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Psychology+in+the+Schools%22"><i>Psychology in the Schools</i></searchLink>. Dec 2010 47(10):1035-1045.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: John Wiley & Sons, Inc. Subscription Department, 111 River Street, Hoboken, NJ 07030-5774. Tel: 800-825-7550; Tel: 201-748-6645; Fax: 201-748-6021; e-mail: subinfo@wiley.com; Web site: http://www3.interscience.wiley.com/browse/?type=JOURNAL
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: PhysDesc
  Label: Physical Description
  Group: PhysDesc
  Data: PDF
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2010
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Evaluative
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Elementary+Secondary+Education%22">Elementary Secondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Outcomes+of+Treatment%22">Outcomes of Treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Meta+Analysis%22">Meta Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Effect+Size%22">Effect Size</searchLink><br /><searchLink fieldCode="DE" term="%22Psychotherapy%22">Psychotherapy</searchLink><br /><searchLink fieldCode="DE" term="%22Doctoral+Dissertations%22">Doctoral Dissertations</searchLink><br /><searchLink fieldCode="DE" term="%22Cognitive+Restructuring%22">Cognitive Restructuring</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink><br /><searchLink fieldCode="DE" term="%22Skill+Development%22">Skill Development</searchLink><br /><searchLink fieldCode="DE" term="%22School+Psychology%22">School Psychology</searchLink><br /><searchLink fieldCode="DE" term="%22Coding%22">Coding</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/pits.20522
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0033-3085
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: A meta-analysis was conducted with 65 school-based psychotherapy and counseling dissertations over the last 10 years (1998-2008) to assess if a file-drawer problem (i.e., studies conducted but not published that, as a whole, have different results than studies in the same area published) exists in the school-based outcome literature. An overall mean effect size of 0.44 was found for 73 treatment interventions. This effect size is comparable to Prout and DeMartino's 1986 meta-analysis conducted with published school-based studies and approximately half a standard deviation smaller than Prout and Prout's 1998 meta-analysis of school-based intervention studies. A bias does appear to exist but seems to be smaller than the bias found in the general child and adolescent psychotherapy outcome literature. Most of the dissertation studies evaluated group interventions and used a cognitive-behavioral or skills training intervention. Skills training and interventions with elementary-school students yielded the largest effect sizes. Comparisons of the current study with previous school-based intervention meta-analyses are discussed as are suggestions for future research. (Contains 1 figure and 3 tables.)
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 91
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2010
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ906085
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ906085
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      – Type: doi
        Value: 10.1002/pits.20522
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 1035
    Subjects:
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Outcomes of Treatment
        Type: general
      – SubjectFull: Meta Analysis
        Type: general
      – SubjectFull: Effect Size
        Type: general
      – SubjectFull: Psychotherapy
        Type: general
      – SubjectFull: Doctoral Dissertations
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      – SubjectFull: Cognitive Restructuring
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      – SubjectFull: Behavior Modification
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      – SubjectFull: Skill Development
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      – SubjectFull: School Psychology
        Type: general
      – SubjectFull: Coding
        Type: general
    Titles:
      – TitleFull: Effectiveness of School-Based Psychotherapy: A Meta-Analysis of Dissertation Research
        Type: main
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          Name:
            NameFull: Reese, Robert J.
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            NameFull: Prout, H. Thompson
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            NameFull: Zirkelback, Emily H.
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              Type: published
              Y: 2010
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              Value: 10
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            – TitleFull: Psychology in the Schools
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