The classic first "case" for clinical psychology was a child who came to Lightner Witmer's clinic at the University of Pennsylvania in 1896 (Witmer, 1909). The child was a poor speller, a prototype for learning problems of today. Witmer published his treatment of the child in his journal The Psychological Clinic the same year that Sigmund Freud described his treatment of Little Hans (S. Freud, 1909/1955), which also has implications for modern-day treatments. Freud treated Little Hans through his parent (father), which is again a popular treatment of choice with children under 6 years of age, as in parent-child interaction therapy (Schuhmann, Foote, Eyberg, & Boggs, 1998). In 1908, Clifford Beers founded the mental hygiene movement, which led to the establishment of child guidance clinics throughout the nation (Rie, 1974). However, all was not complete harmony within the burgeoning ranks of psychotherapists. William James discussed the work of Freud in his lectures at Harvard University and was criticized by Witmer, who wrote an article entitled "Is Psychology Taught at Harvard a National Peril?" (Postman, 1962).

During the 1920s and 1930s, the behavioral experiments of psychologists were paralleled by behavioral treatments of problems in children (Wolman, Egan, & Ross, 1978). During this time, behavioral and educational approaches to childhood problems seemed to hold sway, although there was some understanding that parent-child communication problems formed the basis of many difficulties (Chadwick, 1928; Wickes, 1927).

The psychodynamic or psychoanalytic movement's influence on child treatment began to emerge in the early 1930s and came into its own with the first publication of The Psychoanalytic Study of the Child in 1945. The work of Klein (1932/1960) with very young children and Aichorn (1935), particularly with adolescent youth, described various psychoanalytic techniques with children. A treatment emphasizing emotional release to undo depression was stressed by Levy (1938). Baker and Traphagen (1935) applied the theories of S. Freud, Adler, and Jung to children.

In the midst of the strong psychodynamic movement of the 1940s, an alternative to treatments that emphasized verbal exchanges with children was offered by Axline (1947), who described the use of play in therapy in a more nondirective approach. A review of child therapies in the 1940s can be found in Haworth (1947). However, the treatment of children was not entirely through communication and in relationship with a therapist. More severely disturbed children were not amenable to such approaches, and, reminiscent of the Middle Ages, professionals attempted electric shock, albeit with questionable results (Bender, 1947).

The field of child psychotherapy expanded rapidly in the late 1960s and 1970s. No one approach dominated the scene, with the exception of work with the severely and moderately retarded, for whom the advancements in behavior modification therapy were most beneficial (Finch & Kendall, 1979). A whole array of specific techniques were derived for children's learning difficulties, anxiety or behavior disturbances, and for those reacting to traumatic experiences.

Another indispensable approach to child therapy is treatment through the parents (Furman, 1957). Examples of specific guides to parents in treating the problems of their children are found in the work of Wright (1978) and Finch and Kendall (1979). And there are brave souls who treat both parents and children together in family treatment, viewing the family as a systemic, organic unit (German & Kniskern, 1981). In dealing with particularly difficult children with autistic behavior (Galatzer-Levy, 1987; Ross, 1981a) or subtle learning problems (Kenny & Burka, 1980), therapists have stressed the need for multiple and flexible interventions that utilize various approaches at different times with the same child.

In the 1980s and 1990s, there was a sea change in the field of child psychotherapy (Ollendick & Russ, 1999). Several factors contributed to this changing state. First, the move to managed care changed the climate within which child and family psychotherapists worked. There is now a focus on short-term approaches and efficient treatment strategies. There is an increasing need for "effectiveness and efficiency, " demanded by third-party payers (Koocher & D'Angelo, 1992). Second, the stress on empirically supported treatments -- on treatments that are proven to work -- has caused every conscientious therapist to reevaluate his or her practice by reviewing the scientific evidence for treatment effectiveness. Third, the growing awareness in the field about cultural and contextual variables, such as socioeconomic factors, ethnic minority background, and stability of family environment has resulted in an increased sophistication in choosing among treatment approaches. . .

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