Adolescent Psychotherapy Research Articles

A Primate Model of the Effects of Childhood Antidepressant Treatment

A Primate Model of the Effects of Childhood Antidepressant Treatment

Psychotherapy for adolescents and young adults at high risk for psychosis: a systematic review

Unlike medication treatment, which may confer an unfavourable risk-benefit ratio, psychosocial intervention has been an emerging target of recent randomized controlled trials (RCTs) assessing its efficacy in delaying or preventing the onset of psychosis in individuals identified at 'clinical high risk'. Literature comparing qualitative differences in these psychotherapeutic interventions is scarce. The aim of the current study was to conduct a PRISMA systematic review evaluating the efficacy of psychotherapeutic interventions in reducing the rates of conversion to psychosis in clinical high-risk individuals. RCTs were identified in PubMed, Medline and PsycINFO databases up to 30 November 2013. Six studies (comprising 800 participants) met review inclusion criteria. Three investigators performed data extraction independently by using a pre-structured selection form, and conducted risk of bias assessment employing the Cochrane approach. All six studies employed cognitive behaviour therapy as a core element. Three trials achieved a significant effect. The two trials that employed cognitive behaviour therapy enhanced for the specialized needs of clinical high-risk patients maintained significant effects at post-treatment follow up. Evidence from recent trials suggest that cognitive behaviour therapy may be beneficial in delaying or preventing onset of psychosis in clinical high-risk individuals, although effect sizes to date appear small. Further research is needed in larger samples to establish whether cognitive behaviour therapy is efficacious, and if additional intervention components can enhance established psychotherapies.

Hospitalisation soin-études à l’adolescence : analyse des facteurs prédictifs de bonne évolution

InterestThe Dupré clinic of Sceaux is a “care and study” center, which has developed a multidimensional program including medical care, institutional psychotherapy and school studies for adolescents and young adults aged 16 to 25 suffering from severe psychiatric disorder, social impairment and/or school drop-out. To our knowledge, there are very few studies that have been conducted on the patient's clinical characteristics and the specific cares that can influence outcomes. MethodWe studied a sample of 55 patients treated at the Dupré clinic between 2007 and 2012 (mean duration of hospitalization=570 days; mean admission Global Assessment of Functioning Scale (GAF) score=43.6). GAF scores at time of admission and at time of discharge, other relevant clinical and socio-demographic characteristics of the patients and the specific cares received during hospitalization were collected. Most of the patients had a diagnosis of psychotic disorder (28%), personality disorder (25%) or eating disorder (23%). ResultsSixty percent of these patients were considered as “good responders” (i.e., an increase in GAF scores≥25%) and the others (40%) were considered as “poor responders”. Adolescents who participated in a specific care focusing on the professional integration were more likely to be good responder (75% versus 44% among adolescents who did not participate in this specific care, P=0.023). ConclusionGiven the limitations of our study (small sample, observational study), the potential interests of specific cares focusing on the professional integration of adolescents in “care and study” center should be further studied.

Integrative psychotherapy for children and adolescents: A practice-oriented literature review.

Integrative psychotherapy for children and adolescents: A practice-oriented literature review.

“Psychic Twins”: A Psycho-Dynamically Informed Treatment of a Selectively Mute Adolescent and Her Mother

A discussion of the first part of a two-year treatment of a selectively mute adolescent, J, during the writer's predoctoral internship attempts to add to the limited literature on treating adolescents with selective mutism (SM) and, specifically, the use of mother-child dyadic work. Hayden's (1981) description of symbiotic mutism and Mahler's theory of separation and individuation (Mahler, Pine, & Bergman, 1975) are used as a relational lens through which to conceptualize J's symptom picture, understand evolving transference and countertransference dynamics and guide therapeutic interventions. The use of photography and drawing as nonverbal mediums to facilitate J's emerging “voice” and differentiation from mother are discussed. Despite J's continued silence with the therapist, the considerable intra-psychic and behavioral shifts exhibited by J (including increased speech with strangers) and her family over the course of the treatment, and built upon in the second year of the treatment with Lauren DeMille, described elsewhere in this issue of Journal of Infant, Child, and Adolescent Psychotherapy, attest to the possibility of therapeutic progress in the absence of speech.

Through the Looking-Glass: Exploring Identity Development for a Beginning Therapist and her Late Adolescent Patient

This article summarizes an adolescent psychotherapy case with a beginning doctoral level therapist in an urban community setting. The author reviews the course of treatment with particular attention to clinical issues related to developmental changes for both the patient and this beginning therapist. Vignettes are used to illustrate the patient's conflicts and to explore therapist “mistakes” that led to inevitable frustrations with, and eventual breakthroughs in, the work done by the pair. These include, but are not limited to, tracking authenticity as a mode of object-relatedness, complementary and concordant identifications that help to illuminate transference and countertransference themes, multidetermined impacts of voluntary versus involuntary immigration on identity development, therapist reveries as an aspect of the therapeutic communication worthy of contemplation and future exploration, and direct uses of reverie experiences in supervision as representative of the content co-created in the patient-therapist dyad.

Predictors of treatment outcome of Inpatient Psychotherapy for Adolescents with personality pathology

Little is known about the effectiveness of treatment programmes for personality disordered adolescents. This study investigates the treatment outcome of Inpatient Psychotherapy for Adolescents (IPA), i.e. an intensive programme for treatment refractory adolescents with personality pathology. In addition, this study examines predictors of treatment outcome. One hundred and nine adolescents admitted for treatment of their personality problems were followed up during their stay in IPA. Axis I and Axis II disorders were measured using semi-structured interviews, and the adolescents completed several questionnaires to measure symptom severity (global indices of distress), personality styles and functioning, and quality of life at both start and 12 months after start of treatment. Patients showed improvement in level of symptom severity, personality functioning and quality of life (d ranging from 0.49 to 0.97). As for level of symptom severity, 29% of the adolescents moved into a normative range of symptom severity. Higher levels of self-criticism significantly predicted poorer outcome in terms of symptom severity. Type of personality disorder did not predict treatment outcome. IPA is a potentially effective treatment programme for (a subgroup of) treatment refractory adolescents with personality pathology.

Complex Histories and Complex Presentations: Implementation of a Manually-Guided Group Treatment for Traumatized Adolescents

It is consistently recognized that children and adolescents who have repeatedly experienced or witnessed violence are at significant risk for a multitude of lasting difficulties across many domains of functioning. Adolescents in residential settings often have extensive trauma histories and experience profound behavioral, emotional, and interpersonal difficulties. Unfortunately, there are few structured trauma-informed treatments that have been implemented in residential settings, and even fewer that have been evaluated. This article describes the core components of Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS), a manually-guided trauma-informed group treatment, and provides clinical examples within residential facilities for adolescents with emotional and behavioral difficulties and extensive victimization histories. Preliminary data on self-reported emotional, behavioral, and posttraumatic stress symptoms are presented.

Problem Solving in Child and Adolescent Psychotherapy: a Skills‐Based, Collaborative ApproachK.ManassisNew York: Guilford Press, 2012. pp. 222, £19.99 (hb). ISBN: 978‐1‐4625‐0370‐4.

Child and Adolescent Mental HealthVolume 18, Issue 3 p. 192-192 Book News Problem Solving in Child and Adolescent Psychotherapy: a Skills-Based, Collaborative Approach , Manassis, K. , New York: Guilford Press, 2012. pp. 222, £19.99 (hb). ISBN: 978-1-4625-0370-4. Art O'Malley, Art O'Malley Consultant in Child and Adolescent Psychiatry, Stockport, UKSearch for more papers by this author Art O'Malley, Art O'Malley Consultant in Child and Adolescent Psychiatry, Stockport, UKSearch for more papers by this author First published: 22 August 2013 https://doi.org/10.1111/camh.12037_5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume18, Issue3Special Issue: Focus on child and adolescent mental health in schoolsSeptember 2013Pages 192-192 RelatedInformation

Psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused

The sexual abuse of children and adolescents is a significant worldwide problem. It is associated with a wide variety of negative psychological, social and physical consequences for the victims. These effects can often be seen immediately following sexual abuse, but they may manifest later on and sometimes only in adult life. There are a number of different interventions aimed at helping children and adolescents who have been sexually abused, and psychoanalytic/psychodynamic psychotherapy has a long-established tradition of being used for such victims. In this review, we set out to find the evidence for its effectiveness specifically in children and adolescents who have been sexually abused. To assess the effectiveness of psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused. We searched the following databases in May 2013: CENTRAL, Ovid MEDLINE, Embase, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, Conference Proceedings Citation Index - Social Science and Humanities, LILACS and WorldCat. We also searched three trials registers, checked the reference lists of relevant studies and contacted known experts. Randomised and quasi-randomised trials comparing psychoanalytic/psychodynamic psychotherapy with treatment as usual or no treatment/waiting list control for children and adolescents up to age of 18 who had experienced sexual abuse at any time prior to the intervention. The review authors (BP and WT) independently screened search results to identify studies that met eligibility criteria. No studies were identified that met the inclusion criteria for this review. There are no randomised and quasi-randomised trials that compare psychoanalytic/psychodynamic therapy with treatment as usual, no treatment or waiting list control for children and adolescents who have been sexually abused. As a result, we cannot draw any conclusions as to the effectiveness of psychoanalytic/psychodynamic psychotherapy for this population. This important gap emphasises the need for further research into the effectiveness of psychoanalytic/psychodynamic psychotherapy in this population. Such research should ideally be in the form of methodologically high-quality, large-scale randomised controlled trials. If these are not conducted, future systematic reviews on this subject may need to consider including other lower quality evidence in order to avoid overlooking important research.

Irreducibly Human Encounters: Therapeutic Alliance and Treatment Outcome in Child and Adolescent Psychotherapy

The concept of therapeutic alliance is examined in relation to treatment outcomes in youth psychotherapy. The first section of the article develops an intuitive account wherein the relationship between the therapist and youth client is purported to hold great significance for treatment effectiveness in psychological interventions. The remainder of the article aims to validate this deep-rooted intuition via close examination of how therapeutic alliance has been defined, measured, and meta-analyzed in the current literature. Methodological and philosophical challenges to the concept and implications for future research and practice are discussed. Cautious, but optimistic conclusions are drawn affirming the intuitive position that the relationship between therapist and youth client does indeed impact treatment outcome.

A pilot study of depressed adolescents’ cortisol patterns during parent–adolescent conflict and response to interpersonal psychotherapy (IPT-A)

BackgroundThis study examined functioning of the Hypothalamic Pituitary Adrenal (HPA) axis, a neurobiological stress system centrally implicated in depression, as a predictor of treatment response to Interpersonal Psychotherapy for Depressed Adolescents (IPT-A; Mufson et al., 2004. Interpersonal psychotherapy for depressed adolescents. (second ed.). New York, Guilford Press). MethodsThe sample consisted of fifteen depressed adolescents (age 12–17; mean age=15.2; 86.7% female) experiencing high levels of conflict with their parents who were recruited to participate in a pilot study of individual IPT-A and IPT-A delivered with greater and more structured involvement of parents. Adolescents came primarily from low-income Latino (93.3%) families. Prior to treatment, adolescents participated in a 15min conflict negotiation task with their parents in which salivary cortisol was collected prior to and 10, 20, and 30min post-conflict. Adolescents’ depression symptoms were assessed pre-treatment and post-treatment (week 16) using the Children's Depression Rating Scale (CDRS-R). ResultsHigher levels of cortisol 30min after the conflict task were associated with greater improvement in depression symptoms with IPT-A, controlling for baseline levels of depression. LimitationsThe study has a small sample size. ConclusionsThis is the first study to examine HPA functioning as a predictor of depressed adolescents’ response to a psychotherapeutic intervention. If replicated with larger samples, these results have important implications for advancing the use of neurobiological markers to personalize psychotherapeutic interventions for depressed adolescents.

Implementing an aim-based outcome measure in a psychoanalytic child psychotherapy service: Insights, experiences and evidence

In this paper, we describe the use of an aim-based outcome measure used in routine outcome monitoring of child and adolescent psychotherapy within a child and adolescent mental health service. We aim to explore the clinical feasibility and implications of the routine use of this measure. We argue that use of the measure provides a simple and useful way of clarifying the focus of the clinical work and reflecting its progress, while also having the potential to illuminate the clinical picture by contributing an additional source of clinical information from a collaborative process with the patient, parents or both. We argue that while there are some cases where use of the measure may be impossible, or even perverse, in general it enhances rather than detracts from clinical work.

Evidence-based psychotherapy in children and adolescents: advances, methodological and conceptual limitations, and perspectives

Evidence-based psychotherapy in children and adolescents: advances, methodological and conceptual limitations, and perspectives

The State of the Evidence Base for Psychodynamic Psychotherapy for Children and Adolescents

This article reviews outcomes of psychodynamic psychotherapy (PP) for children and adolescents reported in articles identified by a comprehensive review of the literature on treatment evaluations of psychological and medical interventions for mental disorders in pediatric populations. The review identified 48 reports based on 33 studies. While there is evidence of substantial clinical gains associated with PP, in almost all the studies, when contrasted with family-based interventions, PP fares no better and appears to produce outcomes with some delay relative to family-based therapies. Further rigorous evaluations are needed, but evidence to date suggests that the context in which PP is delivered should be extended from the traditional context of individual therapy and parents should be included in the treatment of children.

A New Model of Techniques for Concurrent Psychodynamic Work with Parents of Child and Adolescent Psychotherapy Patients

To address the neglect of the importance of parent work in the psychodynamic psychotherapy of children and adolescents, the authors present a model of concurrent dynamic parent work that has demonstrated success with patients of all ages. The model includes dual goals for all therapies, addresses the challenge of confidentiality by differentiating privacy and secrecy, and emphasizes the importance of parent work throughout treatment.

Spiritual interventions in child and adolescent psychotherapy

Spiritual Interventions in Child and Adolescent Psychotherapy. Donald F. Walker and William L. Hathaway (Eds.). Washington, DC: American Psychological Association, 2013, Pp. 282, Pb, Reviewed by Tami Sullivan (Roberts Wesleyan College, Rochester, NY).Spiritual Interventions in Child and Adolescent Psychotherapy puts at our disposal a comprehensive guide from which psychotherapists who work with children, adolescents, and their families can acknowledge and integrate religious and spiritual principles into their professional work. The authors successfully navigate a compendium of religiously guided assessments, interventions, and case conceptualizations that aid psychotherapists in discerning the importance of culturally diverse religious beliefs and practices of their child and family clients.In the first section, the authors lay a foundation in which the reader can understand the role of religion in a child and adolescent's life from an ethical, contextual and developmental perspective that is respectful of different religious orientations. With the emphasis that religiouslyminded treatment can be integrated with secular interventions or stand on its own, the second section introduces practical guidelines and considerations from different theoretical models for psychotherapists interested in incorporating religion and spirituality into their work.Chapter 1: Ethics, Religious Issues, and Clinical Child Psychology provides the reader with solid guidance to issues pertaining to client spirituality through the introduction of compelling case studies and the application of the American Psychological Association's code of ethics.Chapter 2: Assessment of Religious and Spiritual Issues in Clinical Child Psychology authors present general guidance for assessing the role of religion and spirituality in the child or adolescent's presenting problem. The Faith Situations Questionnaire, an assessment of Judeo-Christian religious behaviors is discussed in some detail.Chapter 3: Addressing Parental Spirituality in Family Psychotherapy follows a systematic exploration of the interrelationships between parental spirituality and child and adolescent psychopathology. A useful relational spirituality framework is presented in which psychotherapists can assess and come to understand how child and adolescent problems are situated in familial religious practices, and design ecologically valid interventions.Chapter 4: Spiritually Oriented Interventions in Developmental Context presents a conceptual model for understanding the religious and spiritual development of children and frames interventions within developmentally appropriate cognitive, psychosocial, and spiritual domains.Chapter 5: Acceptance we are generously reminded of the universality of acceptance in psychotherapeutic approaches. The authors' supposition that acceptance is a spiritual intervention is evidenced through a detailed analysis of both an object relations and child-centered therapeutic approach.Chapter 6: Spiritual Awareness Psychotherapy opens up a therapeutic path in which the child and adolescent's journey is guided by the psychotherapist through accord with the universe, or the divine, that ultimately bring about a spiritual awareness that leads to awareness, hope, and growth. …

Feeling accepted: A phenomenological exploration of adolescent patients’ experiences of the relational qualities that enable them to express themselves freely

Objectives: The aim of this study was to explore adolescent psychotherapy patients’ experiences of the relational qualities that make it possible for them to express themselves freely and to continue their self-consolidation.Design: An interview-based study using thematic analysis based on hermeneutical–phenomenological epistemology.Methods: Semi-structured in-depth qualitative interviews with 14 adolescents.Results: The adolescents’ experiences were clustered around five themes: (1) receiving full and genuine attention; (2) not having to take care of and responsibility for the therapist; (3) being accepted and valued; (4) the therapist staying with them through emotionally painful moments; and (5) the therapist facilitating openness by sharing.Conclusions: The results from the current study suggest that there are particular ways that therapists can relate to adolescent patients which would make them feel more able to express themselves freely and that create an atmosphere which facilitates the consolidation of the adolescents’ sense of self.

The Interface between Cyberspace and Psychotherapeutic Space: Relationship Avoidance and Intimacy in Adolescent Psychotherapy

This paper documents one aspect of an adolescent boy's psychotherapy, as a basis for discussion of the theoretical issues for introducing cyberspace communication into psychodynamic therapy. The patient's "blogging" serves as a platform for consideration of several seemingly contradictory functions. It is an avenue for the patient to reveal himself while maintaining comfortable control and also avoiding direct contact with the therapist and diluting communication. The blog writing allows for the regulation of emotions to some degree as well as an experience of solitude with an imagined audience. This therapy is in the context of the adolescent roller coaster--loss, anger, distancing while yearning for intimacy, and acting out. Changes in the therapy are mirrored by vicissitudes in the function and content of the blog. Cyberspace communication is a hallmark of the present generation. The implications of introducing it into adolescent therapy as well as refraining from it need to be considered. We attempt here to examine the role of this new space with regard to the patient, the therapist, the therapeutic relationship, and the course of therapy.

Psychoanalytic/Psycho‐dynamic Psychotherapy for Children and Adolescents Who Have Been Sexually Abused: A Systematic Review

The sexual abuse of children and adolescents remains a significant problem worldwide. Children and adolescents who have been sexually abused often experience a wide range of psychological, social and physical problems and these problems often follow them into adulthood. This makes it very important to know how best to help those who have been subjected to sexual abuse.Treatments based on psychoanalytic or psychodynamic psychotherapy are often provided to victims of sexual abuse. These treatments work on the idea that difficulties in past relationships or experiences are often pushed into the unconscious, but later reemerge in the form of problems in the present. Through a relationship with a psychoanalytic/psychodynamic psychotherapist, the person is helped to gain a greater conscious understanding of their unconscious conflicts and this is thought to help them recover.However, we did not find any studies of this kind of therapy that met the strict inclusion criteria for this review. As a result, we cannot draw any conclusions as to the effectiveness of psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused. The implications of this lack of evidence for research and clinical practice are discussed. High quality randomised controlled trials should be conducted, but future systematic reviews on this subject may need to consider including other lower quality evidence in order to avoid overlooking important research.AbstractBACKGROUNDThe sexual abuse of children and adolescents is a significant worldwide problem. It is associated with a wide variety of negative psychological, social and physical consequences for the victims. These effects can often be seen immediately following sexual abuse, but they may manifest later on and sometimes only in adult life. There are a number of different interventions aimed at helping children and adolescents who have been sexually abused, and psychoanalytic/psychodynamic psychotherapy has a long‐established tradition of being used for such victims. In this review, we set out to find the evidence for its effectiveness specifically in children and adolescents who have been sexually abused.OBJECTIVESTo assess the effectiveness of psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused.SEARCH METHODSWe searched the following databases in May 2013: CENTRAL, Ovid MEDLINE, Embase, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, Conference Proceedings Citation Index ‐ Social Science and Humanities, LILACS and WorldCat. We also searched three trials registers, checked the reference lists of relevant studies and contacted known experts.SELECTION CRITERIARandomised and quasi‐randomised trials comparing psychoanalytic/psychodynamic psychotherapy with treatment as usual or no treatment/waiting list control for children and adolescents up to age of 18 who had experienced sexual abuse at any time prior to the intervention.DATA COLLECTION AND ANALYSISThe review authors (BP and WT) independently screened search results to identify studies that met eligibility criteria.RESULTSNo studies were identified that met the inclusion criteria for this review.AUTHORS' CONCLUSIONSThere are no randomised and quasi‐randomised trials that compare psychoanalytic/psychodynamic therapy with treatment as usual, no treatment or waiting list control for children and adolescents who have been sexually abused. As a result, we cannot draw any conclusions as to the effectiveness of psychoanalytic/psychodynamic psychotherapy for this population. This important gap emphasises the need for further research into the effectiveness of psychoanalytic/psychodynamic psychotherapy in this population. Such research should ideally be in the form of methodologically high‐quality, large‐scale randomised controlled trials. If these are not conducted, future systematic reviews on this subject may need to consider including other lower quality evidence in order to avoid overlooking important research.Plain language summaryThe sexual abuse of children and adolescents remains a significant problem worldwide. Children and adolescents who have been sexually abused often experience a wide range of psychological, social and physical problems and these problems often follow them into adulthood. This makes it very important to know how best to help those who have been subjected to sexual abuse. Treatments based on psychoanalytic or psychodynamic psychotherapy are often provided to victims of sexual abuse. These treatments work on the idea that difficulties in past relationships or experiences are often pushed into the unconscious, but later re‐emerge in the form of problems in the present. Through a relationship with a psychoanalytic/psychodynamic psychotherapist, the person is helped to gain a greater conscious understanding of their unconscious conflicts and this is thought to help them recover. However, we did not find any studies of this kind of therapy that met the strict inclusion criteria for this review. As a result, we cannot draw any conclusions as to the effectiveness of psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused. The implications of this lack of evidence for research and clinical practice are discussed. High quality randomised controlled trials should be conducted, but future systematic reviews on this subject may need to consider including other lower quality evidence in order to avoid overlooking important research.