Adolescent Psychotherapy Research Articles

Transference-Focused Psychotherapy for Adolescents With Severe Personality Disorders

Back to table of contents Previous article Next article Book ReviewNo AccessTransference-Focused Psychotherapy for Adolescents With Severe Personality DisordersJeena Kar, D.O. and Elizabeth Wassenaar, M.S., M.D.Jeena KarSearch for more papers by this author, D.O. and Elizabeth WassenaarSearch for more papers by this author, M.S., M.D.Published Online:8 Jul 2021https://doi.org/10.1176/appi.psychotherapy.20210014AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article"Transference-Focused Psychotherapy for Adolescents With Severe Personality Disorders." American Journal of Psychotherapy, , pp. – Access content To read the fulltext, please use one of the options below to sign in or purchase access. Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - APT - American Journal of Psychotherapy $35.00 Add to cart PPV Articles - APT - American Journal of Psychotherapy Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Metrics PDF download History Received 31 March 2021 Accepted 12 April 2021 Published online 8 July 2021

Experience-Based Competency Training in Child and Adolescent Psychotherapy

Abstract. Background: Compared to adult psychotherapy training, there is little knowledge about the use of standardized actor-patients (SPs) for the development of professional competencies for younger patient populations. Objective: We assessed the effectiveness of two university-based training programs for diagnostic as well as intervention skills in child and adolescent psychotherapy. Methods: Psychology students took part in two courses on the development of diagnostic competencies ( N = 59) and on intervention skills ( N = 51). We applied active and experience-based learning strategies, including exercises on self-awareness, mindfulness, peer role-play, and the use of SPs. Competence gain as well as a general evaluation of the seminars were assessed by self-report. Results: For both seminars, self-reported competence increased significantly with a large effect. The retrospective evaluation of learning success and acceptance ratings of the didactic formats were high. Conclusions: Experience-based trainings that include SPs are a feasible option for child and adolescent psychotherapy. The findings are discussed from a conceptual as well as a practical perspective.

Movement Synchrony in the Psychotherapy of Adolescents With Borderline Personality Pathology - A Dyadic Trait Marker for Resilience?

Movement synchrony describes the coordination of body movements. In psychotherapy, higher movement synchrony between therapist and patient has been associated with higher levels of empathy, therapeutic alliance, better therapy outcome, and fewer drop-outs. The current study investigated movement synchrony during the psychotherapeutic treatment of female adolescents with borderline personality disorder. It was hypothesized that there are higher levels of movement synchrony in the analyzed therapy sessions compared to pseudo-interactions. Further, we tested whether higher levels of movement synchrony correlate with stronger patients’ symptom reduction and whether higher movement synchrony predicts higher post-session ratings. A total of 356 sessions from 16 completed psychotherapies of adolescent patients with BPD were analyzed. Movement synchrony was assessed with motion energy analysis and an index of synchrony was calculated by lagged cross-correlation analysis. As hypothesized, the findings support higher levels of movement synchrony in therapy sessions compared to pseudo-interactions (Cohen’s d = 0.85). Additionally, a correlation of movement synchrony with better therapy outcome was found (standardized beta = −0.43 indicating stronger personality functioning impairment reduction). The post-session ratings were negatively associated with higher levels of movement synchrony (standardized beta = −0.1). The relevance of movement synchrony and potential implications for clinical practice are discussed.

Interpersonal Counseling for College Students: Pilot Feasibility and Acceptability Study.

University counseling centers struggle to meet the growing demand for mental health treatment by students in distress. More acutely distressed students typically receive priority, whereas those with mild to moderate depression often face longer wait times and fewer available therapy sessions. For this reason, interpersonal counseling for college students (IPC-C) was created as a brief manualized psychotherapy, suitable for students with mild to moderate depression, that maintains the core components of interpersonal counseling and integrates components from interpersonal psychotherapy for adolescents and other developmentally appropriate techniques. This article describes a pilot trial of IPC-C. IPC-C is delivered in three to six psychotherapy sessions focused on alleviating depressive symptoms and increasing social support. Ten participants from two university counseling centers were recruited to receive IPC-C. The inclusion criterion was a Patient Health Questionnaire-9 (PHQ-9) score of 5-14, indicating mild to moderate depression. Participants completed the PHQ-9 at each session, the College Adjustment Test at baseline and termination, and the IPC Satisfaction Scale at termination. Nine of the 10 participants completed the study, attending an average of five therapy sessions each. Participants agreed that the number of sessions was appropriate and indicated satisfaction with the IPC-C intervention. Participants exhibited significantly reduced depression severity (Cohen's d=2.45) and significantly improved college adjustment (d=0.92). In this pilot trial, IPC-C was found to be a feasible and acceptable intervention for university-based treatment of young adults with mild to moderate depressive symptoms. IPC-C holds promise as a potentially effective intervention for this population and warrants further study in a randomized trial.

Confidentiality at the interface of an adolescent psychotherapy service

AimsAims included to explore how, within a London trust, staff at the interface between patients, relatives and access to services view their understanding of confidentiality, and to determine ways to improve knowledge if needed.BackgroundConfidentiality is essential to the trust and development of clinician-patient relationships. National policies set guidance on how confidential information should be recorded, secured and shared. However, confidentiality breaches are reportedly common within health professions. Working with adolescent patient groups brings additional issues regarding confidentiality. Care-givers who contact services, often desiring containment, may experience a sense of uncertainty when confidentiality policy prevents details being shared about a young person's clinical experience.MethodStakeholders were identified from the multidisciplinary team, with a collaborative rather than ‘top-down’ approach. Administrators in patient-facing roles were surveyed to ascertain current understanding and frequency of involvement in confidentiality issues. Based on feedback, a flowchart prompt was designed, ensuring it reflected best practice. Qualitative and quantitive data were collected before and after a two month implementation period.ResultAll respondents (n = 10) dealt with confidentiality issues at work, with 50% experiencing issues daily. 33% respondents did not feel confident dealing with confidentiality queries at work. The majority (60%) had received confidentiality training, but all respondents thought extra information would be useful. Of possible interventions, 70% supported a flowchart. Following an implementation period, 100% respondents re-surveyed agreed they felt confident dealing with issues related to confidentiality at work. The majority of respondents had used the flowchart and found it useful (83%). Qualitative data gathered suggested rolling-out the project elsewhere.ConclusionA lack of confidence surrounding issues with confidentiality, including information sharing, was identified. This can negatively impact patient engagement and delivery of care. The introduction of the confidentiality flowchart demonstrated improved understanding of, and confidence in, patient confidentiality issues. The small sample size means there are limitations in extrapolating findings to wider contexts. However, it is likely that more confidentiality training and practical information for NHS staff at the interface between patients, clinicians and services would reduce the risk of confidentiality breaches and reinforce positive relationships with services.

Clinical experiences during the COVID-19 pandemic.

Most of the clinical experiences discussed in this article arose from monthly Zoom meetings at Rome's Italian Centre of Analytical Psychology (CIPA). We set up a discussion group in April 2020, one month after lockdown began in Italy, and these monthly online meetings continue to this day. All senior analysts and analysts-in-training at Rome's CIPA, whose backgrounds range from child and adolescent psychotherapy to adult psychotherapy and analysis, to sandplay therapy and medicine and psychiatry, have been participating in these meetings. The group discussions focus on the present time and its impact on us, as well as on our relationships with patients. By further developing these reflections during the lockdown in Italy (9 March - 3 May 2020), it is fair to ask whether a sense of unreality, depersonalization, or derealization has occurred, either in the therapist or patient, and if so, whether it is possible that therapists miss the human contact more than clients. We will mainly refer to clinical and personal experiences as our most precious guidelines.

The psychoanalytic psychotherapy endeavour in the Greek public sector

The paper maps the services that provide psychoanalytic psychotherapy for children, adolescents and adults in the Greek public sector, the research projects that contribute to the development of psychoanalytic research, along with the training in psychoanalytic psychotherapy available in Greece. It underlines the lack of adequate psychotherapeutic services available to the Greek population, an unfortunate fact considering the troubled times that the Greek society has been through in the recent years (socio-economic crisis, refugee crisis, etc.). Finally, it discusses one of the prominent problems psychoanalytic psychotherapists in Greece face, that is the absence of official recognition of the specialty or title of ‘psychoanalytic psychotherapist’, as a psychotherapist is not a registered profession in Greece.

Barriers and Facilitators in Adolescent Psychotherapy Initiated by Adults-Experiences That Differentiate Adolescents' Trajectories Through Mental Health Care.

Mental health problems start early in life. However, the majority of adolescents fulfilling the criteria for mental health disorders do not receive treatment, and half of those who do get treatment drop out. This begs the question of what differentiates helpful from unhelpful treatment processes from the perspective of young clients. In this study, we interviewed 12 young people who entered mental health care reluctantly at the initiative of others before the age of 18. Their journeys through mental health care varied significantly despite sharing the same starting point. Our analyses resulted in a model of three trajectories. We describe relational and structural facilitators and obstacles within each trajectory and have formulated narratives highlighting core experiences differentiating them. Trajectory 1 (I never saw the point – Being met as a case) was characterized by a rapid loss of hope, leading the adolescents to conclude that mental health care was not worth the investment. Trajectory 2 (I gave it a go, but nothing came of it – Being met by a therapist representing a rigid and unhelpful system) was characterized by a lingering hope that never materialized into a constructive therapeutic process despite prevailing efforts by both therapists and adolescents. Trajectory 3 (Something good came of it – Being met by a therapist who cares and wants to help) was characterized by genuine meetings, allowing the therapist to transform from an unsafe stranger into a safe, competent, and benevolent adult. We discuss how our results have implications for understanding agency displayed by adolescent clients in therapy, therapist flexibility and authenticity, service organization, and attributional processes influencing clinical judgment and therapeutic processes when adolescent psychotherapy has a difficult starting point (i.e., initiated by adults).

Silence in the psychotherapy of adolescents with borderline personality pathology.

Silence in psychotherapy has been associated with different, sometimes opposing meanings. This study investigated silence during adolescent identity treatment in adolescent patients with borderline personality pathology. A more active therapeutic approach with less silence is advised in adolescent identity treatment. It was hypothesized that a session with more silence might be negatively perceived by adolescent patients. A total of 382 sessions that involved 21 female patients were analyzed. Silence was automatically detected from audio recordings. Diarization (segmenting an audio according to speaker identity) was performed. The patient's perception of the sessions was measured with the Session Evaluation Questionnaire. The amount of silence in the different speaker-switching patterns was not independent of one other. This finding supports the hypothesis of mutual attunement of patient and therapist concerning the amount of silence in a given session. Sessions with less silence were rated as being both smoother and better. The potential implications for clinical practice are discussed. The investigation of turn-taking and interpersonal temporal dynamics is relevant for psychotherapy research. The topic can be addressed efficiently using automated procedures. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mediators and theories of change in psychotherapy with adolescents: a systematic review protocol

IntroductionApproximately 75% of mental disorders emerge before the age of 25 years but less than half receive appropriate treatment. Little is known about the mechanisms underlying the therapeutic change of...

Family Dynamics in Psychotherapy in Adolescents with Anorexia

The article represents the question of the relationship between family dynamics and the emergence, development and treatment of eating disorders in adolescents, through the eyes of the psychodynamic and positive approaches in psychotherapy. The main conclusion is that without taking into account the dynamics of family relations, the function of the symptom cannot be understood.

Characteristics of effective online interventions: implications for adolescents with personality disorder during a global pandemic.

In recent years, the necessity of providing online interventions for adolescents, as an alternative to face-to-face interventions, has become apparent due to several barriers some adolescents face in accessing treatment. This need has become more critical with the coronavirus disease 2019 (COVID-19) global pandemic impacting the delivery of psychotherapy and limiting accessibility of face-to-face therapy. Whilst it has been established that face-to-face psychotherapy for adolescents with personality disorder can be effective in reducing the impact these complex mental illnesses have on functioning, online interventions for adolescents are rare, and to our knowledge there are no empirically validated online interventions for personality disorder. The development of novel online interventions are therefore necessary. To inform the development of online interventions for adolescents with personality disorder or symptoms of emerging personality disorder, a two-phase rapid review was conducted. Phase one consisted of a search and examination of existing online mental health programs for adolescents with symptoms of personality disorder, to understand how to best use online platforms. Phase two consisted of a rapid review of empirical literature examining online interventions for adolescents experiencing symptoms of personality disorder to identify characteristics that promote efficacy. There were no online programs specific to personality disorder in adolescence. However, 32 online mental health programs and 41 published empirical studies were included for analysis. Common intervention characteristics included timeframes of one to two months, regular confidential therapist contact, simple interactive online components and modules, and the inclusion of homework or workbook activities to practice new skills. There is an urgent need for online interventions targeting personality dysfunction in adolescence. Several characteristics of effective online interventions for adolescents were identified. These characteristics can help inform the development and implementation of novel online treatments to prevent and reduce the burden and impact of personality disorder, or symptoms of emerging personality disorder, in adolescents. This has implications for the COVID-19 pandemic when access to effective online interventions has become more urgent.

Psychotherapy and youth suicide prevention: An interpretative phenomenological analysis of specialist clinicians' experiences.

The study explored psychologists' experiences in delivering short-term psychotherapy for suicidal adolescents and sought to clarify how these experiences fit with empirically supported interventions and the interpersonal psychological theory of suicide. Semistructured interviews were conducted with 12 psychologists' who provided short-term psychotherapy in a suicide prevention programme for youth (12- to 25-year-olds). Interview transcripts were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: (i) understand the experience and context of the suicidality and the importance of a formulation-based approach to engagement and individualized treatment planning; (ii) involve broad support systems, and in particular families, to help the young person reduce feelings of burdensomeness and increase safety, connectedness and belonging; and (iii) improve affect regulation and reflective functioning, important not only for the young person but also for the support system to maximize the positive impact of supports via emotional coregulation and effective problem-solving. Interventions and approaches as well as the potential underlying processes of change being targeted are discussed in light of these findings. As an example, the development of a suicide safety plan was an intervention that traversed these themes. When used as a process tool, it helped foster a collaborative, formulation, dimensional and biopsychosocial approach to treat psychopathology and suicidality and extended beyond the therapist-client dyad. Moreover, treatment needs to be extended beyond the therapist-client dyad to allow therapists to facilitate a systemic treatment response, as this was seen as a major component of interventions for suicidal youth.

This is what I need a clinical feedback system to do for me: A qualitative inquiry into perspectives of adolescents and their therapists.

Routine outcome monitoring and clinical feedback systems might be beneficial for adolescent psychotherapy processes. Clinicians (n = 34) and adolescent clients (n = 22) aged 14-19 from seven different outpatient clinics located in Norway participated in the study. Adolescents were interviewed in individual in-depth interviews (n = 7) or in four adolescent-only focus groups (n = 15), clinicians participated in seven clinician-only focus groups. We report two core domains, (1) feedback about the therapeutic relationship and (2) feedback about the therapeutic work. Seven subthemes specify the functionality that participants need in a feedback system. Adolescents and therapists requested a feedback system that was relationally oriented, supported collaborative action, and was personalized to the needs of the individual adolescent. The research indicates that a clinical feedback system should have idiographic, as well as nomothetic, components. A clinical feedback system for adolescents should monitor experiences of personal autonomy and the quality of the therapeutic relationship.

The study of the relationship between the emotional component of family’s informational environment and adolescents’ disadaptive behaviour

Topicality of the study of the connection between the emotional component of family’s informational environment and the propensity for disadaptive behaviour of adolescents is determined by the tendency to increase the role of the information environment in society, in particular in the family. The study of the emotional component of the informational family environment and its connection with disadaptive behaviour of adolescents involved 70 people, representing 35 teen-parent dyads. The authors' method "Information environment of the family" and the method of determining the propensity to deviate behaviour of El'vira Leus were used. In 40% of cases, the family information environment is represented by the unity in the experience of adolescents and parents of interest and excitement while using gadgets. Their experience of joy, surprise and sadness reveals their individual differences in interaction with the family information environment. The tendency to deviant behaviour was considered to be the main indicator of the socio-psychological disadaptation of adolescents. All the 35 adolescents showed varying degrees of disadaptation. A connection was found in the experience of joy on the Internet with a tendency to addictive, aggressive and unlawful behaviour. The results can be used in the work of the school psychological service, as well as in psychotherapy of adolescents and families.

Bullying experiences in outpatients of a child and adolescent psychotherapy centre - A particularly vulnerable group?

Bullying experiences in outpatients of a child and adolescent psychotherapy centre - A particularly vulnerable group? Abstract. Objective: Bullying has both short- and long-term effects on physical and mental health. Thus, more victimized children might tend to be found in clinical samples. This is the first study to examine the prevalence of bullying roles and modes in children/adolescents in a psychotherapeutic outpatient setting in Germany. Method: 298 outpatients being treated in a child/adolescent psychotherapy centre (6-20 years, 50.7 % female) completed a questionnaire concerning their bullying experiences over the last 6 months. Results: 24.5 % of the patients reported from a victim's perspective, independent of being perpetrators of bullying. 19.1 % reported solely as victims, 5.4 % as victims who also bullied (bully-victims), and 2.0 % as bullies. More than one-third of those with victim or bully-victim experiences had been polyvictimized, 86.2 % were victims solely of traditional bullying, and 1.4 % solely of cyberbullying. The exploratory comparison to general-population school samples seems to show significantly more patients with victim experiences and significantly less patients who bullied others. There seem to be no significant effects for bully-victims. Compared to an inpatient sample, significantly fewer adolescent patients seem to state being victims or bully-victims. Conclusions: Bullying is a topic of particular importance in the context of psychotherapy. These findings have implications for the psychotherapeutic practice as well as training settings.

Médiation par l’écriture et symbolisation : évaluation d’un dispositif thérapeutique pour adolescents avec l’Adolescent Psychotherapy Q-Set

ObjectivesWriting therapies for adolescents are now widely used in clinical settings and also well studied in research. Even if their effects can be highlighted, the mechanisms underlying their emergence remain poorly understood (Doucet et al., 2018) requiring further research to identify the processes working in writing therapy. Our study aimed to highlight the emerging therapeutic processes in writing mediation with institutionalized adolescents. We focused on the processes that appear in the patient–therapist dyad, under the prism of the analysis of symbolization processes, reflexivity, and their interactions with the “malleable–medium” (Brun et al., 2020) function of the therapist (Roussillon, 2016). Furthermore, we proceeded with a comparison of writing therapy with other psychotherapeutic models (Bychkova et al., 2011) in order to identify specific tendencies. MethodWe evaluated seven patient–therapist dyads in a writing mediation therapy. Each dyad was assessed at three different times of therapy (beginning - middle - end). We analyzed the processes using the Adolescent Psychotherapy Q-Set (APQ), validated by Calderon et al. (2017), and then performed a factor analysis to identify three factors representing the major trends of the 21 sorts. ResultsThe three factors highlight diversified therapeutic trends, specific dyadic configurations within a single therapeutic writing workshop. The APQ also allowed us to account for the nature of the symbolization processes in the adolescents of the group and to describe the modalities of expression of the therapist's “malleable–medium” function. Finally, the data revealed that this writing therapeutic mediation is a polymorphic therapy whose particularities of the therapeutic attitude are adapted, within the dyads, to the adolescents who make up the group.

The Challenge of Empathy: Examining Processes in the Israeli-Palestinian Bi-National School for Psychotherapy for Children and Adolescents

ABSTRACT A 30-month-long training program in child and adolescent psychotherapy was established in response to specific Israeli and Palestinian mental health services’ needs. Trainees came from Israel, the West Bank, and Gaza. This article addresses the rationale for the program, the opposition it encountered upon its inception, and the empathic processes that arose in the training group through a short vignette from a group supervision hour. It demonstrates the delicate nature of empathy, and its retreat in the face of conflict and aggression. Attention to empathic processes is presented as central both to psychotherapeutic relationships, as well as to the process of learning from group dynamics. The group’s growing capacity for empathy paralleled an increased appreciation for complexity and meeting the unknown personal territory of another. Relating to the Israeli-Palestinian context of the group, enabled an expanded ability to recognize one another’s humanity, while accepting existing political conflicts and experiential differences.

Modifications of the therapeutic setting during the Covid-19 pandemic: thoughts based on the Greek experience with latency children and adolescents

ABSTRACT The paper reflects on the authors’ observations regarding the handling of the Covid-19 pandemic within the context of child and adolescent psychoanalytic psychotherapy in Greece. The specific conditions in Greece during the first general lockdown are described, and the necessary modifications to the therapeutic framework with latency children and adolescents are discussed. During the lockdown, the authors continued to meet with their patients online, a framework that had both advantages and limitations. The authors share their thoughts about the ways they tried to keep the connection with their patients alive, in the face of the first wave of the coronavirus crisis.

Väter in der Elternarbeit in psychodynamischer Kinderund Jugendlichenpsychotherapie und -psychiatrie: Wunsch und Realität

Summary Fathers in psychodynamic child and adolescent psychotherapy and psychiatry: Hopes and reality Central tasks of paternal education consist in triangulation, the promotion of exploration and autonomy development as well as structuring and setting boundaries. Especially in these developmental areas many of our patients have striking deficits. Therefore, these tasks often are taken on by the therapists, on behalf of parents, in the context of psychodynamic child and adolescent psychotherapy (Grieser 2018). However, fathers are of great importance for a successful and sustainable transfer of such developmental tasks into the everyday context. In this article, we will compare the role of fathers we would hope for as child and adolescent psychotherapists, with situations, as we experience them in everyday psychotherapy, and would like to use exemplary case vignettes, to provide an insight into our experiences with regard to challenges and opportunities in the work with fathers.