Creating distance from adolescents’ anger: psychotherapists’ responses to conversational trouble in Short Term Psychoanalytic Psychotherapy

Abstract

ABSTRACT The exploration of negative feelings is one of the core principles of psychoanalytic psychotherapy, yet anger experienced towards the therapist may lead to increased risk, ruptures in the therapeutic relationship and dropout. This study explored the psychotherapists’ immediate responses to patients’ anger in Short Term Psychoanalytic Psychotherapy (STPP). Data came from a randomised controlled trial investigating the efficacy of three types of therapy in the treatment of adolescent depression, in which therapy sessions were audio-recorded. Purposive sampling was used to select ten extracts from four different patient-therapist couples where patients expressed anger towards their therapist. Those extracts were transcribed and analysed using conversation analysis (CA). The analysis showed that following patients’ anger expression, psychotherapists were inclined to create distance either by moving aside from the topic of conversation, or by referring to ‘other times’, past or future. In only one out of the ten extracts did the psychotherapist name the young person’s anger towards them in the moment. In all other cases, psychotherapists commented on patients’ latent feelings of anger, but were inclined to create distance from explicit and direct anger-expressions. Possible reasons for this are explored, along with both clinical and research implications.