There is extensive evidence that people strongly value and are reluctant to relinquish the perception of control. Yet, both helplessness and locus of control theorists interpret various "inward" behaviors (passivity, withdrawal, and submissiveness) as signs of relinquished perceived control. As evidence, they note that inward behavior frequently is accompanied by causal attributions to limited ability, chance, and powerful others-all attributions that suggest uncontrollability. In contrast, we claim,that these attributions and the behaviors to which they relate may often reflect a type of perceived control that is generally overlooked. People attempt to gain control not only by bringing the environment into line with their wishes (primary control) but also by bringing themselves into line with environmental forces (secondary control). Four manifestations of secondary control are considered: (a) Attributions to severely, limited ability can serve to enhance predictive control and to protect against disappointment. Passive and withdrawn behaviors reflect the attempt to inhibit unfulfillable expectations, (b) Attributions to chance can reflect illusory control, since people often construe chance as a personal characteristic akin to an ability ("luck"). Individuals who make attributions to chance may exhibit passivity and withdrawal in skill situations, reserving energy and emotional investment for situations that allow them to capitalize on their perceived strength-that is, being lucky, (c) Attributions to powerful others permit vicarious control when the individual identifies with these others. Submission to a powerful leader, a group, or a deity sometimes enables the individual to join in their power, (d) All of the preceding attributions may foster interpretive control, in which the individual seeks to understand and derive meaning from otherwise uncontrollable events in order to accept them. When perceived control is recognized in both its primary and secondary forms, a broad range of inward behaviors can be seen as efforts to sustain rather than relinquish the perception of control.Factor analytic studies with children (reviewed in Achenbach & Edelbrock, 1978) and systematic observations of adults (e.g., Beck, 1967;Marks, 1977) have identified a This article was funded in part by National Institute of Mental Health Grant 1-RO1-MH-34210-01.The authors are indebted to Camille Wortman for her unusually thorough review of a draft of this article. Her comments added depth and clarity to many of the Central points.Requests for reprints should be sent to Fred Rothbaum, Department of Child Study, Tufts University, Medford, Massachusetts 02155. set of interrelated problem behaviors including passivity, withdrawal, and submissiveness (hereafter referred to as inward behavior). The popularity of the learned helplessness model (Abramson, Seligman, & Teasdale, 1978;Seligman, 1975) is due largely to its lucid account of at least some of these seemingly maladaptive behaviors (especially passivity and withdrawal). Adherents o...

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A meta-analysis of 47 studies was used to shed light on inconsistencies in the concurrent association between parental caregiving and child externalizing behavior. Parent-child associations were strongest when the measure of caregiving relied on observations or interviews, as opposed to questionnaires, and when the measure tapped combinations of parent behaviors (patterns), as opposed to single behaviors. Stronger parent-child associations were also found for older than for younger children, and for mothers than for fathers. Finally, externalizing was more strongly linked to parental caregiving for boys than for girls, especially among preadolescents and their mothers. The meta-analysis helps account for inconsistencies in findings across previous studies and supports theories emphasizing reciprocity of parent and child behavior.

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short-but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability. Keywords depression; children; adolescents; psychotherapy; meta-analysis Depression in children and adolescents (herein referred to collectively as youths) is a significant, persistent, and recurrent public health problem that undermines social and school functioning, generates severe family stress, and prompts significant use of mental health services (Angold et al., 1998;Clarke, DeBar, & Lewinsohn, 2003). Youth depression is also linked to increased risk of other psychiatric disorders (Angold & Costello, 1993) as well as drug use and suicide (Gould et al., 1998;Rohde, Lewinsohn, & Seeley, 1991), which is the third most common cause of death among adolescents (Arias, MacDorman, Strobino, & Guyer, 2003). Relapse rates have been reported at 12% within 1 year and 33% within 4 years (Lewinsohn, Clarke, Seeley, & Rohde, 1994), and by the age of 18 years, some 20% of youths will have met criteria for a diagnosis of major depressive disorder at least once (Birmaher et al., 1996). Prospective longitudinal research has shown substantial continuity of youth depression into adulthood, with impaired functioning in work, social, and family life, and markedly elevated risk of adult suicide attempts and completed suicide (see, e.g., Costello et al., 2002;Weissman et al., 1999). The extent, impact, and long-term sequelae of youth depression underscore the need for effective treatment. A primary purpose of the current article was to assess the effects of the most extensively tested genre of youth depression treatment: psychotherapy. In this article, we seek to answer the six questions listed below. What Is the Overall Effect of Psychotherapy on Youth Depression?The need to examine psychotherapy effects is underscored not only by evidence on the extent, impact, and sequelae of youth depression but also by recent debate over medication risks. Selective serotonin reuptake inhibitors (SSRIs) have become a widely used treatment for depressed youths (Safer, 1997; Treatment for Adolescents with Depression Study [TADS] Team, 2004;Weisz & Jensen, 1999), but concerns over possible risks, including suicidal ideation and suicide attempts (Vitiello & Swedo, 2004;Whittington...

The modular approach outperformed usual care and standard evidence-based treatments on multiple clinical outcome measures. The modular approach may be a promising way to build on the strengths of evidence-based treatments, improving their utility and effectiveness with referred youths in clinical practice settings. Trial Registration  clinicaltrials.gov Identifier: NCT01178554.

A meta-analysis of child and adolescent psychotherapy outcome research tested previous findings using a new sample of 150 outcome studies and weighted least squares methods. The overall mean effect of therapy was positive and highly significant. Effects were more positive for behavioral than for nonbehavioral treatments, and samples of adolescent girls showed better outcomes than other Age X Gender groups. Paraprofessionals produced larger overall treatment effects than professional therapists or students, but professionals produced larger effects than paraprofessionals in treating overcontrolled problems (e.g., anxiety and depression). Results supported the specificity of treatment effects: Outcomes were stronger for the particular problems targeted in treatment than for problems not targeted. The findings shed new light on previous results and raise significant issues for future study.Over the past decade, applications of the technique known as meta-analysis (see Cooper & Hedges, 1994;Mann, 1990;Smith, Glass, & Miller, 1980) have enriched our understanding of the impact of psychotherapy with children and adolescents (herein referred to collectively as "children"). At least three general meta-analyses encompassing diverse treatment methods and diverse child problems have indicated that the overall impact of child psychotherapy is positive, with effect sizes averaging not far below Cohen's (1988) threshold of 0.80 for a "large" effect. Casey and Herman (1985) reported a mean effect size of 0.71 for a collection of treatment outcome studies with children 12 years of age and younger (studies published from . Weisz, Weiss, Alicke, and Klotz (1987) We are grateful to Danika Kauneckis and Julie Mosk for their help with various phases of the project. We also thank the outcome study authors who provided us with information needed to calculate effectsize values for this meta-analysis.

There are at least two general paths to a feeling of control. In primary control, individuals enhance their rewards by influencing existing realities (e.g., other people, circumstances, symptoms, or behavior problems). In secondary control, individuals enhance their rewards by accommodating to existing realities and maximizing satisfaction or goodness of fit with things as they are. American psychologists have written extensively about control, but have generally defined it only in terms of its primary form. This, we argue, reflects a cultural context in which primary control is heavily emphasized and highly valued. In Japan, by contrast, primary control has traditionally been less highly valued and less often anticipated, and secondary control has assumed a more central role in everyday life than in our own culture. To illustrate this cross-cultural difference, we contrast Japanese and American perspectives and practices in child rearing, socialization, religion and philosophy, work, and psychotherapy. These Japanese-American comparisons reveal some key benefits, and some costs, of both primary and secondary approaches to control. In the process, the comparisons reveal the disadvantages of a one-sided pursuit of either form of control. They suggest that an important goal, both for individuals and for cultures, is an optimally adaptive blend of primary and secondary control, a goal best achieved with one's cultural blinders removed.

A model is proposed whereby the intervention literature can be empirically factored or distilled to derive profiles from evidence-based approaches. The profiles can then be matched to individual clients based on consideration of their target problems, as well as demographic and contextual factors. Application of the model is illustrated by an analysis of the youth treatment literature. Benefits of the model include its potential to facilitate improved understanding of similarities and differences among treatments, to guide treatment selection and matching to clients, to address gaps in the literature, and to point to possibilities for new interventions based on the current research base.