Adolescent Psychotherapy Research Articles

Innovations in Practice: The relationship betweensleep disturbances, depression, and interpersonal functioning in treatment for adolescent depression.

Sleep disturbance is frequently comorbid with depression and sleep complaints are the most common residual symptoms after treatment among adolescents with depression. The present analyses investigated the effect of sleep disturbance in depressed adolescents treated with Interpersonal Psychotherapy for Adolescents (IPT-A) versus Treatment as Usual (TAU) in school-based mental health clinics. 63 adolescents participated in a randomized clinical trial of IPT-A versus TAU for adolescent depression. Participants were diagnosed with a DSM-IV depressive disorder and assessed for symptoms of depression, interpersonal functioning and sleep disturbance. Measures were assessed at baseline, session 4 and 8 of treatment, and session 12 for post-acute treatment follow-up. Hierarchical linear modeling (HLM) was used to model change in depression, interpersonal functioning and sleep disturbance. Ongoing sleep disturbance was significantly associated with worse depression scores as rated by clinician (γ = 1.04, SE = 0.22, p < .001) and self-report (γ = 1.63, SE = 0.29, p < .001), as well as worse interpersonal functioning across the course of treatment (γ = 0.09, SE = 0.02, p < .001). Treatment condition did not predict change in sleep disturbance (γ = -0.13, SE = 0.14, p = ns). For all patients in the study, sleep disturbance was a predictor of depression and interpersonal functioning for depressed adolescents. Sleep disturbance predicted more depression and interpersonal stress across treatments and led to a slower improvement in depression and interpersonal functioning. This data suggests that sleep disturbance should be a target for future treatment development research among depressed adolescents.

Modular psychotherapy with children and adolescents

The implementation of evidence-based psychotherapy with children and adolescents has been limited so far. This is mainly due to the fact that patients in service settings tend to have higher rates of comorbidities and more frequently changing therapy needs than those in research settings. Thus, modular psychotherapies are promising, as they allow the treatment protocol to be adapted to patients’ individual needs. Because no review on modular psychotherapy for children and adolescents exists, we conducted a systematic literature research. The results of the 15 randomized controlled trials identified demonstrate that modular psychotherapy is associated with significant reductions in symptom levels as well as with higher rates of diagnostic remission compared to control conditions. Because of the lack of evidence, future studies should investigate the incremental efficacy of modular approaches and test the validity of underlying theoretical models as well as of decision flowcharts. Modular psychotherapy approaches have the potential to personalize evidence-based interventions for children and adolescents across various therapeutical traditions, and to facilitate their implementation into clinical practice.

Beyond DSM-5 and IQ Scores: Integrating the Four Pillars to Forensic Evaluations

The current adult and child forensic psychiatrist is well trained, familiar, and comfortable with the use of the semi-structured Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, APA 2013 (DSM-5) [In APA, 2003] interview style. The author's assertion is not that this method is invalid or unreliable; rather, that it can be complemented by integrating elements of the defendant's four pillar assessment. Assessing the four pillars expands on the information provided by a semi-structured DSM-5-style interview in psychiatry. The four pillars are the foundation of a person's personality; temperament, cognition (learning abilities or weaknesses), cognitive flexibility (theory of mind) and internal working models of attachment, within the backdrop of the family and of the social and cultural environment in which they have lived. The importance of the study of four pillars is based on the understanding that human behavior and psychopathology as a complex and multifaceted process that includes the level of social-emotional maturity and cognitive abilities (In Delgado et al. Contemporary Psychodynamic Psychotherapy for Children and Adolescents: Integrating Intersubjectivity and Neuroscience. Springer, Berlin, 2015). The four pillars are not new concepts, rather they had been studied by separate non-clinical disciplines, and had not been integrated to the clinical practice. As far as we know, it wasn't until Delgado et al. (Contemporary Psychodynamic Psychotherapy for Children and Adolescents: Integrating Intersubjectivity and Neuroscience. Springer, Berlin, 2015) incorporated the four pillars in a user-friendly manner to clinical practice.

Therapists’ continuations following I don’t know—responses of adolescents in psychotherapy

ObjectiveIn psychotherapy clients’ I don’t know—responses (IDK-responses) to therapists’ questions are typically considered to be non-cooperating behaviors. How therapists actually handle these behaviors remains unclear. This study therefore aims to assess client-therapist interactions following IDK-responses. MethodsData were collected in a Dutch child and adolescent mental healthcare service by observing Dialectical Behavior Therapy aimed at adolescents with severe emotional distress. Eighteen individual psychotherapy sessions involving two therapists with six clients were video-recorded and transcribed. Stand-alone IDK-responses were selected (n=77) and analyzed using conversation analysis. ResultsAdolescents' IDK-responses led to varying actions of therapists. We identified five categories of continuations after IDK-responses: no IDK-related continuation; redoing of the question; proposing a candidate answer; employing therapy-specific techniques; and meta-talk on the problematic nature of the IDK-response. ConclusionsTherapists treat IDK-responses not just as non-cooperative behavior on the part of the client; IDK-responses are also used as a starting point to collaboratively enhance clients’ insights in their own thoughts, emotions, and behaviors. Practice implicationsAfter IDK-responses therapists can use a variety of continuation strategies with varying therapeutic functions. These strategies can be embedded in training of therapists to deal with potentially non-cooperative behavior.

Innovations in Practice: a pilot study of interpersonal psychotherapy for depressed adolescents and their parents.

Problems in adolescents' relationships with their parents are a significant risk factor for the development and maintenance of depression. The purpose of this pilot study was to examine the feasibility and acceptability of an adaptation of interpersonal psychotherapy for depressed adolescents (IPT-A) who were also experiencing problems in their relationships with parents. The adaptation includes greater and more structured parent involvement in the treatment (IPT-AP). Fifteen adolescents (age 12-17) who were diagnosed with depression and were also experiencing conflictual or emotionally disengaged relationships with their parents (based on adolescent or parent report on the Conflict Behavior Questionnaire) participated in a 16week randomized clinical trial of individually delivered IPT-A versus IPT-AP. Data regarding the feasibility and acceptability of IPT-AP were collected. Assessments of depression and family functioning were completed at baseline and weeks 4, 8, 12, and 16 by evaluators blind to treatment condition. IPT-AP was feasible to implement, and adolescents and parents reported high treatment satisfaction. Adolescents demonstrated significant improvements in depressive symptoms, general functioning, and family functioning. IPT-AP was more efficacious than individual IPT-A in improving adolescents' perceptions of father-adolescent relations and mothers' perceptions of mother-adolescent relations. Interpersonal psychotherapy for depressed adolescents and their parents was feasible to implement and acceptable to families, indicating that a full-scale randomized controlled trial to evaluate its efficacy is warranted.

Division of Child and Adolescent Psychotherapy

Division of Child and Adolescent Psychotherapy

Introduction to the Special issue on Qualitative and Quantitative Research in Child and Adolescent Psychotherapy

Not available.

Effectiveness of cognitive-behavioral therapy in children and adolescents with obsessive-compulsive disorders treated in an outpatient clinic

Cognitive-behavioral therapy (CBT) is considered as treatment of first choice for children and adolescents with obsessive-compulsive disorders (OCD). However, its effectiveness has so far mostly been examined in randomized controlled trials with strictly manualized interventions. Only few studies have examined whether the effectiveness of CBT for juvenile OCD generalizes to clinical practice. To test the effectiveness of CBT under routine care conditions, data of n = 53 patients with parent-ratings and n = 53 patients with self-ratings that were treated in a university-based outpatient clinic for child and adolescent psychotherapy was analyzed. Pre-post-mean-comparisons, effect sizes and the clinical significance of changes of the symptoms were examined. OCD and comorbid symptoms were significantly reduced during treatment. Strong effect sizes (Cohen’s d) were found for parent rated (d = 0.91) and patient rated (d = 0.88) OCD symptoms. Moderate to strong pre-post-effect sizes were found for the reduction of parent rated (d = 0.55 to d = 0.87) and patient rated (d = 0.46 to d = 0.74) comorbid symptoms. The percentage of children and adolescents who achieved clinically significant improvements and no longer showed dysfunctional OCD symptoms post-treatment was 46.3 % according to the parent-ratings and 59.4 % according to the self-ratings. Concerning comorbid symptoms the same was reached for between 22.5 % and 45.5 % of the patients (parent-ratings) and between 32.0 % and 81.8 % (self-ratings) respectively. Significant reductions in both OCD and comorbid symptoms were demonstrated over the course of cognitive-behavioral therapy of juvenile OCD disorders in a university outpatient clinic for child and adolescent psychotherapy. These results indicate that routine CBT treatment is an effective way to treat juvenile OCD disorders in clinical practice.

A Short-term Psychodynamic Supportive Psychotherapy for Adolescents with Depressive Disorders: A New Approach

ABSTRACTDepression is one of the most common psychiatric disorders in both adolescents and adults. In this article, we introduce Short-term Psychodynamic Supportive Psychotherapy (SPSP) for adolescents, a relatively new form of psychodynamic therapy for depression that has been studied in a range of randomized controlled trials with adult patients. SPSP emphasizes the relational aetiology and significance of depression and is characterized by a supportive attitude which focuses more on working in the here-and-now relational patterns rather than interpreting transference manifestations. The supportive attitude of the therapist is advocated to engage the adolescent in the therapeutic relationship and to foster his or her innate developmental capacities by attending to previously unaddressed developmental needs. The developmental perspective’s interest in defense styles and stagnation resulting from problems in past and current relationships opens up opportunities for acquiring insight and change. The focus on relational functioning makes it a promising approach for adolescents because they can implement any positive change immediately in their actual environment, immersed as they are in many new and varied relationships.

New Developments in Video Games for Psychotherapy

A literature survey on new developments in the area of video games and psychotherapy of children and adolescents was conducted. Despite the omnipresence of computers and the internet, development of therapeutic games seems rather slow. The video game Treasure Hunt was introduced in 2008 to support treatment of children with internalizing and externalizing disorders. Camp Cope-A-Lot was developed for treatment of anxious children, whereas the self-help game SPARX is directed at depressed adolescents. Rage-Control is a biofeedback game for children with anger problems. The game Zoo U aims to assess and train social skills of primary school children. Ricky and the Spider for young children with obsessive compulsive disorder is meant to support the cognitive-behavioural treatment of these patients. Clash- Back is a French game for adolescents with externalizing problems. Possible reasons for the relatively slow development of therapeutic games are the high methodological demands concerning an evaluation as well as the high costs of game development. Nonetheless, computers and the internet are bound to influence psychotherapy with children and adolescents in the long run.

The creative therapy by M. Burno in the psychotherapy of adolescents

Psychotherapeutic work with adolescents is a complex and challenging work. Clinical psychotherapy and creative psychotherapy (invented by M. Burno) have got an indisputable potential in use for the children and adolescents with mental disorders. A key feature of the psychotherapeutic approach for children and adolescents is obligatory taking into account all the aspects of mental ontogenesis/dysontogenesis of the patient. In the article we consider the basic clinical psychotherapeutic aspects of the new programme based on the creative psychotherapy (invented by М. Burno) to use in psychiatric departments for adolescents.

Psychotherapy for Children and Adolescents from the Viewpoint of Psychoanalytic Psychotherapy

Psychotherapy for Children and Adolescents from the Viewpoint of Psychoanalytic Psychotherapy

Group-based cognitive behavioural psychotherapy for children and adolescents with ASD: the randomized, multicentre, controlled SOSTA-net trial.

Group-based psychotherapy in Autism Spectrum Disorder (ASD) has predominantly been studied in the United States by small studies in school-aged children without long-term follow-up. We report results of a large, confirmatory, multicentre randomized-controlled phase-III trial in children and adolescents studying the ASD specific, manualized group-based cognitive behavioural SOSTA-FRA approach. High-functioning ASD individuals aged 8-19years old were randomized to 12 sessions SOSTA-FRA or treatment as usual. Primary outcomes were change in total raw score of the parent-rated Social Responsiveness Scale (pSRS) between baseline (T2) and end of intervention (T4), and between T2 and 3 months after end of intervention (T5). ISRCTN94863788. Between 20/5/2010 and 14/2/2013, n=320 ASD patients were screened, n=228 patients were randomized, and N=209 analysed. Mean pSRS difference between groups at T4 was -6.5 (95% CI -11.6 to - 1.4; p=.013), and at T5 -6.4 (-11.5 to -1.3, p=.015). Pre-treatment SRS and IQ were positively associated with stronger improvement at T4 and T5. Short-term ASD-specific add-on group-based psychotherapy has shown postintervention efficacy with regard to parent-rated social responsiveness predominantly in male high-functioning children and adolescents with ASD. Future studies should implement blinded standardized observational measures of peer-related social interaction.

A developmental perspective on adolescent psychoanalytic psychotherapy. An Italian study with the Adolescent Psychotherapy Q-Set

Introduction: despite large and widely accepted research on effectiveness, most of psychotherapy research has been done with adults; few studies have been published on the process of adolescent psychotherapy, due to the complexity of the subject and the absence of instruments sensitive enough to empirically capture its nuances. Within psychoanalytic framework, a developmental approach is particu-larly helpful in the psychotherapy of adolescents. Objective: the purpose of this study was to investigate the typical features of Italian Adolescence Psychodynamic Psychotherapy and its similarities and differences with other adolescence psycho-therapeutic approaches; We also aimed at analyzing typical therapists’ responses to adolescent patients. Method: 50 italian adolescence psychotherapists filled a brief questionnaire about their clinical expertise, completed the Adolescent Psychothe-rapy Q – Set (APQ) and the Therapist Response Questionnaire (TRQ) in order to describe their “actual” practice with adolescents. Results: therapeutic process is characterized by a priority to helping adolescent make sense of his own experience, it focuses on present relationships and emotions rather than on past. Strong similar-ities with Mentalization Based Therapy, mild and no correlations with Cognitive-Behavioral Therapy and Classical Psychoanalysis respectively were found; towards adolescents therapists generaly display positive and protective countertransference responses. They less frequenlty show negative responses as overprotection, hostility or feeling of overwhelming. Conclusions: APQ and TRQ can provide meaningfull information about adolescent psychotherapy process. Instruments’ improvement (i.e. reviewd items for APQ) and future perspectives are also discussed.

Qualitative research in adolescent psychotherapy: attachment and reflective functioning as psychotherapy’s outcomes of an adolescent with anorexia nervosa

The aim of this study was to examine both the change in attachment state of mind and mentalization competencies as outcomes of a two-year weekly psychodynamic psychotherapy of a female adolescent with anorexia nervosa. The Attachment Interview for Childhood and Adolescence (AICA) was administered at pre and post-treatment, and coded both with the attachment coding system and the Reflective Functioning (RF) scale. At the pre-treatment, the anorexic adolescent was assessed as insecure dismissing with very low level of RF, while in the post-treatment a secure attachment model and higher RF were highlighted. The AICA can be considered a useful method to assess the outcomes in adolescent psychotherapy, like the AAI is useful in adult psychotherapy.

Treating Chronically Traumatized Children

Article Abstract Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text. In the area of child and adolescent psychotherapy, it is well accepted that trauma processing is essential for the long-term prognosis of traumatized children. The AACAP practice parameters recommend that trauma-focused psychotherapy be first-line treatment for children with posttraumatic stress disorder (well before antidepressants, which, although commonly used, have little evidence to support their use in pediatric trauma). It is also apparent that trauma processing is no easy treatment for the child, the family, and the therapist.

Storied images of psychotherapeutic change: approaching children's voices through drawings

Introduction: In the field of child psychotherapy research it is common to evaluate psychotherapeutic change through the perspective of adults, such as the child’s parents or designated therapist. Research that actively includes children’s perspectives of psychotherapy generally turn to verbal methods of gathering information, such as interviews. It is important, however, to take into account non-verbal resources that better facilitate expression among children. Aim: This article explores the use of drawings in order to better understand how children view psychotherapy and psychotherapeutic change. It aims to contribute to child and adolescent psychotherapy research by proposing a new methodology. Method: This study presents a single case analysis of the “before and after psychotherapy” drawing of an eight year-old boy who was sexually abused and successfully completed the psychotherapeutic process due to this experience. Data collection methods include soliciting a drawing and carrying out an in-depth interview, both of which were examined using thematic and visual narrative analysis. Results: Participant drawing provided crucial insight into the psychotherapy process, such as perceived changes in emotional states and personal growth and empowerment, all of which allowed the child to make sense of the abusive experience. Meanings that emerged when analyzing the drawing complement verbal narratives. Discussion: The implications of these results are discussed, highlighting the importance of non-traditional research methodologies that are sensitive to children’s developmental needs. Methodologies that consider the developmental characteristics of children allow them to express themselves fully, articulate their narratives and voices, and allow us to reach an understanding of their meanings of their psychotherapeutic processes.

Interventions for self-harm in children and adolescents.

Self-harm (SH; intentional self-poisoning or self-injury) is common in children and adolescents, often repeated, and strongly associated with suicide. This is an update of a broader Cochrane review on psychosocial and pharmacological treatments for SH published in 1998 and updated in 1999. We have

Compliments and accounts: Positive evaluation of reported behavior in psychotherapy for adolescents

AbstractBased on conversation analysis (CA) of video-recorded therapy sessions, the article explicates a particular interactional project of positively evaluating client-reported behavior in psychotherapy. The analysis focuses on the therapist's actions that convey a positive evaluation of client-reported behavior that represents therapeutic progress. First, the data analysis revealed three components that constitute the evaluation project: discourse marker, compliment, and account. Second, the article shows that participants orient towards the observed evaluation project, both as a unified whole and as a combination of discrete and separate interactional turns. The article suggests that this evaluation project functions as a tool for achieving the institutional goal of reinforcing therapeutically desired behaviors. The empirical findings are discussed in relation to the Stocks of Interactional Knowledge, described in handbooks on dialectical behavior therapy (the specific setting in which the data were collected). (Professional-client interaction, adolescent, psychotherapy, evaluation, complimenting, conversation analysis)*

Bion’s Thinking on Psychotic and Non-Psychotic Functioning Applied to Work with an Adolescent Psychotherapy Group

This paper explores Bion’s thinking about the co-existence of psychotic and non-psychotic states in the personality. I contend that Bion’s description of psychotic states, in particular, is highly relevant when applied to adolescent states of mind. The processes that emerged from an adolescent psychotherapy group are presented to provide an illustration of Bion’s thinking and to reinforce the idea that such states are indeed present during the adolescent process. This work was undertaken in London, and the paper began its journey towards publication during the latter part of my work with this group and since my arrival here in Aotearoa New Zealand.&#x0D; Whakarāpopotonga&#x0D; E wherawhera ana tēnei pepa i te tirohanga a Bion ki te nohotahitanga o te mate rangirua me te kore-rangiruatanga mai o te āhua tuakiri. E tautohe ana au i te whakamāramatanga o te noho rangiruatanga, inarā, e tino hāngai ana inā whakatauhia ki te hinengaro o te taiohi. Ko ngā whakaputaranga i puta mai i ngā whakarōpūtanga kaiwhakaora hinengaro taiohi e whakatauhia ana hai whakaahua i ngā whakaaro o Bion, ā, hai tautoko ake i te whakaaro e mau ana aua āhua i te wā tipuranga o te taiohi. I mahia tēnei mahi i Rānana, ka tīmata ake te haerenga o tēnei pepa kia tāia i te pito whakamutunga o taku mahi i te taha o tēnei rōpū, ā, mai i taku taenga mai ki Aotearoa.