Introduction to the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents

This chapter provides a brief historical and theoretical introduction to the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A), followed by practical guidance for using this volume to treat children and adolescents. The chapter situates transdiagnostic treatments within the historical development of evidence-based interventions for children and adolescents and distinguishes core-dysfunction–focused transdiagnostic treatments, such as the UP-C and UP-A, from other types of transdiagnostic treatments. The chapter reviews key core dysfunctions underlying emotional disorders that are addressed through treatment with the UP-C and UP-A. The authors discuss the rationale for this volume, which focuses on applications of the UP-C and UP-A to youth with diagnoses other than anxiety and depression and youth being treated in delivery settings outside of the standard weekly therapy format. Tips for using this volume in conjunction with the UP-C and UP-A therapist guide and workbooks are offered.

Retiring, Rethinking, and Reconstructing the Norm of Once-Weekly Psychotherapy

Psychotherapies hold clear potential to alleviate mental health problems, yet there is no scientifically-driven consensus for how long treatment should last, how intense sessions should be, or how frequently sessions should occur. In practice, once-weekly therapy is the dominant outpatient service available to youths and adults alike, largely due to long-held beliefs and insurance companies’ limiting reimbursable treatment-time to 50-minute, weekly sessions. But ubiquity cannot be mistaken for clinical or practical superiority. Indeed, weekly therapy sessions are among numerous treatment structures that can help patients achieve clinical gains, with numerous trials supporting the utility of brief, intensive, and concentrated treatments for widely-varying problem types. Further, existing psychological services—dominated by weekly, outpatient options—fall short of meeting population-level mental health needs. Most youths and adults with psychiatric disorders never access care due to financial and logistical constraints, and among those who do, premature drop-out is common. Despite repeated calls to diversify treatment options, the “weekly therapy hour” remains the practical default. Given limited accessibility of, and significant dropout from, weekly outpatient therapy, and the established efficacy of alternative treatment formats, our field’s continued overreliance on the “default” of once-weekly therapy cannot be considered benign. As clinical scientists and therapists, we assert that it is our field’s ethical obligation to retire and rebuild the longstanding “default” to once-weekly treatment. To be clear, we do not endorse eliminating weekly psychotherapy as an option for patients; many once-weekly, evidence-based treatments, if delivered as intended, may benefit patients greatly. However, repositioning weekly therapy as one of many treatment options, and diversifying available service types, may strengthen the accessibility, flexibility, and potentially the effectiveness of treatment overall.

Anne Sexton Listening to Anne Sexton

Anne Sexton Met Her Psychiatrist, Martin Orne, in 1956, After Her Second Suicide Attempt. They Started Recording Their twice- (sometimes thrice-)weekly therapy sessions in early 1961, continuing until 1964, and Orne advised Sexton to listen to these recordings and write down her responses while listening and later relistening to them. Several hundred recordings of these therapy sessions have survived and reside in the Sexton collection at the Arthur and Elizabeth Schlesinger Library on the History of Women in America at the Radcliffe Institute for Advanced Study, and Sexton's responses have been preserved in four handwritten and typed journals, dating from January 1961 to August 1964, held at the Harry Ransom Center at the University of Texas, Austin. Arguably, playing the sessions back to herself shaped Sexton's memories, her evolving understanding of her past, and her sense of identity. The extant ensemble of texts, comprising the audio recordings, typed and handwritten journal entries, and poetry, illustrate how playback influenced this evolution.

Why Dose Frequency Affects Spoken Vocabulary in Preschoolers With Down Syndrome

In an earlier randomized clinical trial, daily communication and language therapy resulted in more favorable spoken vocabulary outcomes than weekly therapy sessions in a subgroup of initially nonverbal preschoolers with intellectual disabilities that included only children with Down syndrome (DS). In this reanalysis of the dataset involving only the participants with DS, we found that more therapy led to larger spoken vocabularies at posttreatment because it increased children’s canonical syllabic communication and receptive vocabulary growth early in the treatment phase.