Considers fundamental issues raised by current child and adolescent psychot
herapy research, including the neglect of theory in psychotherapy research
the distinction between theories of onset of dysfunction and therapeutic ch
ange, and the progression of knowledge from description to explanation and
from risk factors to causal agents. The complex relations of proposed influ
ences and clinical outcomes and constraints of current statistical models i
llustrate key challenges for understanding the nature of clinical disorders
and therapeutic change. Much more attention to understanding how treatment
achieves therapeutic change is needed, not only to address conspicuous lac
unae in the knowledge base but also to optimize the effects of treatment in
clinical work.