Interaction Structures in Psychodynamic Psychotherapy for Adolescents

Overview

Journal Int J Environ Res Public Health

Publisher MDPI

Specialties Environmental Health
Public Health

Date 2021 Dec 24

PMID 34948618

Citations 1

Authors

Baris Can

Sibel Halfon

Affiliations

Soon will be listed here.

Abstract

Despite advances in psychotherapy research showing an evidence-base for psychodynamic psychotherapy (PDT) in adolescents, developmentally specific treatment characteristics are under-researched. We aimed to identify interaction structures (IS: reciprocal patterns of in-session interactions involving therapist interventions, patient behaviors, and the therapeutic relationship) and assess associations between IS and outcome. The study cohort comprised 43 adolescents ( = 13.02 years) with nonclinical, internalizing, and comorbid internalizing-externalizing problems in PDT. A total of 123 sessions from different treatment phases were rated based on the Adolescent Psychotherapy Q-Set (APQ). Outcome was assessed with the Brief Problem Monitor-Youth (BPM-Y) administered repeatedly over the treatment course. Principal component analysis of APQ items resulted in five IS, named "Negative Therapeutic Alliance", "Demanding Patient, Accommodating Therapist", "Emotionally Distant Resistant Patient", "Inexpressive Patient, Inviting Therapist", and "Exploratory Psychodynamic Technique" (EPT). Multilevel modeling analyses with Bayesian Markov chain Monte Carlo (MCMC) estimations indicated a two-way interaction effect between EPT and problem levels at baseline such that patients with lower problems at baseline showed good outcome in the context of EPT, whereas an inverse relationship was found for patients with higher problems. Findings provide empirical evidence for characteristic components of PDT for adolescents and preliminary answers about who benefits from psychodynamic techniques.

Citing Articles

Examining Psychotherapeutic Processes with Depressed Adolescents: A Comparative Study of Two Psychodynamic Therapies.

Calderon A, Storeide K, Elvejord C, Nissen-Lie H, Ulberg R, Johnsen Dahl H Int J Environ Res Public Health. 2022; 19(24).

PMID: 36554820 PMC: 9779625. DOI: 10.3390/ijerph192416939.

References

Calderon A, Schneider C, Target M, Midgley N . 'Interaction structures' between depressed adolescents and their therapists in short-term psychoanalytic psychotherapy and cognitive behavioural therapy. Clin Child Psychol Psychiatry. 2018; 24(3):446-461. DOI: 10.1177/1359104518807734. View

Goodyer I, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J . Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled.... Lancet Psychiatry. 2016; 4(2):109-119. PMC: 5285447. DOI: 10.1016/S2215-0366(16)30378-9. View

Midgley N, Mortimer R, Cirasola A, Batra P, Kennedy E . The Evidence-Base for Psychodynamic Psychotherapy With Children and Adolescents: A Narrative Synthesis. Front Psychol. 2021; 12:662671. PMC: 8110733. DOI: 10.3389/fpsyg.2021.662671. View

Midgley N, Holmes J, Parkinson S, Stapley E, Eatough V, Target M . "Just like talking to someone about like shit in your life and stuff, and they help you": Hopes and expectations for therapy among depressed adolescents. Psychother Res. 2014; 26(1):11-21. DOI: 10.1080/10503307.2014.973922. View

Mensi M, Orlandi M, Rogantini C, Borgatti R, Chiappedi M . Effectiveness of Short-Term Psychodynamic Psychotherapy in Preadolescents and Adolescents Affected by Psychiatric Disorders. Psychiatry Investig. 2021; 18(10):923-927. PMC: 8542745. DOI: 10.30773/pi.2021.0015. View

Jones E, Ghannam J, Nigg J, Dyer J . A paradigm for single-case research: the time series study of a long-term psychotherapy for depression. J Consult Clin Psychol. 1993; 61(3):381-94. DOI: 10.1037//0022-006x.61.3.381. View

Palmer R, Nascimento L, Fonagy P . The state of the evidence base for psychodynamic psychotherapy for children and adolescents. Child Adolesc Psychiatr Clin N Am. 2013; 22(2):149-214. DOI: 10.1016/j.chc.2012.12.001. View

BLOS P . The second individuation process of adolescence. Psychoanal Study Child. 1967; 22:162-86. DOI: 10.1080/00797308.1967.11822595. View

Goodyer I, Tsancheva S, Byford S, Dubicka B, Hill J, Kelvin R . Improving mood with psychoanalytic and cognitive therapies (IMPACT): a pragmatic effectiveness superiority trial to investigate whether specialised psychological treatment reduces the risk for relapse in adolescents with moderate to severe unipolar.... Trials. 2011; 12:175. PMC: 3148993. DOI: 10.1186/1745-6215-12-175. View

10.

Eubanks-Carter C, Muran J, Safran J . Alliance-focused training. Psychotherapy (Chic). 2014; 52(2):169-73. DOI: 10.1037/a0037596. View

11.

Jones E, CUMMING J, Horowitz M . Another look at the nonspecific hypothesis of therapeutic effectiveness. J Consult Clin Psychol. 1988; 56(1):48-55. DOI: 10.1037//0022-006x.56.1.48. View

12.

Halfon S . Psychodynamic technique and therapeutic alliance in prediction of outcome in psychodynamic child psychotherapy. J Consult Clin Psychol. 2021; 89(2):96-109. DOI: 10.1037/ccp0000620. View

13.

Aitken M, Haltigan J, Szatmari P, Dubicka B, Fonagy P, Kelvin R . Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents. J Child Psychol Psychiatry. 2020; 61(9):998-1008. PMC: 7496892. DOI: 10.1111/jcpp.13194. View

14.

OKeeffe S, Martin P, Goodyer I, Kelvin R, Dubicka B, Midgley N . Prognostic Implications for Adolescents With Depression Who Drop Out of Psychological Treatment During a Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry. 2019; 58(10):983-992. DOI: 10.1016/j.jaac.2018.11.019. View

15.

Kernberg P, Ritvo R, Keable H . Practice Parameter for psychodynamic psychotherapy with children. J Am Acad Child Adolesc Psychiatry. 2012; 51(5):541-57. DOI: 10.1016/j.jaac.2012.02.015. View

16.

Owen J, Hilsenroth M . Interaction between alliance and technique in predicting patient outcome during psychodynamic psychotherapy. J Nerv Ment Dis. 2011; 199(6):384-9. DOI: 10.1097/NMD.0b013e31821cd28a. View

17.

Abbass A, Rabung S, Leichsenring F, Refseth J, Midgley N . Psychodynamic psychotherapy for children and adolescents: a meta-analysis of short-term psychodynamic models. J Am Acad Child Adolesc Psychiatry. 2013; 52(8):863-75. DOI: 10.1016/j.jaac.2013.05.014. View

18.

Halfon S, Goodman G, Bulut P . Interaction structures as predictors of outcome in a naturalistic study of psychodynamic child psychotherapy. Psychother Res. 2018; 30(2):251-266. DOI: 10.1080/10503307.2018.1519267. View

19.

Winkelmann K, Stefini A, Hartmann M, Geiser-Elze A, Kronmuller A, Schenkenbach C . [Efficacy of psychodynamic short-term psychotherapy for children and adolescents with behavioral disorders]. Prax Kinderpsychol Kinderpsychiatr. 2005; 54(7):598-614. View

20.

Midgley N, Reynolds S, Kelvin R, Loades M, Calderon A, Martin P . Therapists' techniques in the treatment of adolescent depression. J Psychother Integr. 2018; 28(4):413-428. PMC: 6276999. DOI: 10.1037/int0000119. View