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When life gets in the way: Systematic review of life events, socioeconomic deprivation, and their impact on counselling and psychotherapy with children and adolescents

Abstract:

Background: Life events are recognised to link low socio-economic status (SES) with impaired mental health. Despite attention to patients’ historical environmental circumstances in psychotherapeutic practice, events that occur over the course of counselling and psychotherapy (‘intercurrent’ events) seem to have received little attention in research. Method: Life events were defined to include those that are chronic and severe, as well as minor, everyday occurrences. Outcomes were restricted to internalising problems related to depression and anxiety in child, or adolescent participants. Bibliographic databases and citations and review reference lists were searched, and relevant scholars were contacted. The conceptual and methodological nature of the literature is reported. Results: This review included 42 studies. Intercurrent events varied in severity and duration. Events were most frequently measured using questionnaires. The same questionnaire was rarely used in more than one study, and questionnaires were often adapted for use for the study's purpose/population. Events included in analyses tended to be analysed as a mediator of change in psychiatric symptomatology, or an outcome of therapy. Conclusions: Attention to intercurrent life events appears rare in psychotherapy research. This contributes to a systematic neglect of socio-economic issues in psychotherapy research and arguably psychotherapy more generally. This neglect is exacerbated by a lack of agreed measures of life events, both intensive and routine in nature. Recommendations are made to improve attention to such events.