Adolescent Psychotherapy Research Articles

Psychotherapies for the Youth: Evolution, Progress, and On Way to Eclecticism

Psychotherapies for the youth have resulted from the confluence of 3 major disciplines: adult psychology and psychiatry, developmental neurology and pediatrics, and developmental psychology and ethology. Since their humble origins in the psychoanalytically oriented play therapy and the related theories in the pre-War Germany, over more than a century, they have embraced diverse theoretical views that include but not limited to the integration of developmental issues, evolution of the child guidance movement, and the various influences of institutional and social policies. Such a rich journey has eventually resulted in evidence-based practices (EBPs)—powerful interventions for children and families for complex behavioral problems. In this chapter, we attempt to trace the blooming field of youth psychotherapies in their historical contexts, provide an account of the existing gaps of knowledge, briefly narrate the modern-day developments, mostly regarding the multimodal/eclectic treatment aspects and finally, given their rapid growth, we speculate about their (positive) future. Child and adolescent therapies have progressed considerably, as reflected in the number of controlled studies, their methodological quality, and identification of evidence-based treatments. Despite the methodological difficulties in outcome studies, the field has witnessed major advances regarding the efficacy of selected treatments in child and adolescent psychotherapy and good quality meta-analyses do suggest that 75% of children and young people who attend therapy benefit from it. However, despite the comforting data related to efficacy, major challenges still remain, especially in regard to patient engagement and dropout rates, gap in knowledge about what works and why it works, cultural sensitivity, and data of cost- effectiveness—just to quote a few. Several key areas have been neglected in research, such as the mechanisms of change, the moderators of treatment outcome, and the generalizability of the research findings to the clinical practice arena—this has greatly limited what we know about treatment and partly explains the relative lack of personalized psychotherapies and scarcity in their dissemination/generalization despite the documented evidence on their efficacy. Tailoring treatment more specifically to each patient may be necessary to reduce this nonresponsiveness and dropping outs, as one treatment does not fit all. This necessitates the need for eclecticism—to combine youth psychotherapies with other modes of treatments, such as medications, neuromodulation interventions, and Yoga and mindfulness-based cognitive therapy. Future practice for treatment of mental health conditions in the youth will likely adapt to this huge need for development of eclectic modalities and also reflect cost effectiveness and cultural sensitivity to an increasingly diverse population.

Virtual reality assisted psychotherapy in children and adolescents

Virtual reality assisted psychotherapy in children and adolescents

MDMA-assisted psychotherapy with adolescents suffering from PTSD: Do or don’t? a qualitative study with youth, parents, and clinicians

Background PTSD in adolescence causes much suffering and has substantial health-care costs. Many patients with severe PTSD do not respond to psychotherapy or continue to have symptoms despite trauma-focused psychotherapies and psychopharmacological treatment. A recent alternative in the search for cost-effective treatments for PTSD in adults is 3,4-methylenedioxymethamphetamine-assisted psychotherapy (MDMA-assisted psychotherapy). However, no research has yet been conducted on the therapeutic potential of MDMA for adolescents. Aims of the study The purpose of this study is to investigate the perspectives of adolescents, parents, and clinicians about the possible clinical application of MDMA-assisted psychotherapy for adolescents with PTSD. Method We performed focus groups in three samples: (a) 16–24-year-olds who had undergone trauma therapy ( N = 9), (b) parents of traumatized children ( N = 4), and (c) trauma clinicians ( N = 6). Focus group topics included: perception of and associations with MDMA, opinions on MDMA-assisted psychotherapy, risks/benefits, and precautions to take prior to possible adolescent clinical trials with MDMA-assisted psychotherapy. Results In all groups, initial participant attitudes towards MDMA were predominantly unfavorable, except for several adolescents who had conducted preliminary research on the subject. After a standardized explanation of MDMA-assisted psychotherapy, provided in each group, all but one participant changed their minds and supported the idea of implementing MDMA-assisted psychotherapy for adolescents. They all emphasized the importance of conducting research first. Conclusion Our findings suggest that when provided with information on what MDMA-assisted psychotherapy entails, adolescents, parents, and clinicians are open to the idea of exploring this type of treatment for adolescents.

Using wearable activity trackers for research in the global south: Lessons learned from adolescent psychotherapy research in Kenya.

Wearable activity trackers have emerged as valuable tools for health research, providing high-resolution data on measures such as physical activity. While most research on these devices has been conducted in high-income countries, there is growing interest in their use in the global south. This perspective discusses the challenges faced and strategies employed when using wearable activity trackers to test the effects of a school-based intervention for depression and anxiety among Kenyan youth. Lessons learned include the importance of validating data output, establishing an internal procedure for international procurement, providing on-site support for participants, designating a full-time team member for wearable activity tracker operation, and issuing a paper-based information sheet to participants. The insights shared in this perspective serve as guidance for researchers undertaking studies with wearables in similar settings, contributing to the evidence base for mental health interventions targeting youth in the global south. Despite the challenges to set up, deploy and extract data from wearable activity trackers, we believe that wearables are a relatively economical approach to provide insight into the daily lives of research participants, and recommend their use to other researchers.

Motywacja osiągnięć, kluczowe autoewaluacje i kompetencje społeczne młodocianych przestępców

Adolescence is characterised by dynamic changes in both physical and mental development. During this period, it is particularly easy to develop antisocial behaviours and contact with people from criminal groups. The article presents the results of a pilot study which aim was to compare the results of the level of social competences, core self-evaluations and achievement motivation between a group of adolescents placed in juvenile detention centres and a group of high school students. According to the author, these variables may be psychological resources that contribute to effective resocialization and psychotherapy of adolescents placed in correctional institutions. The analysis of the results showed significant differences in the level of core self-evaluations, except that the group of juvenile offenders scored significantly higher than the comparison group. The remaining differences were not statistically significant. Additional analyses showed a strong relationship between the level of core self-evaluations and the level of social competence and a moderate correlation between the level of achievement motivation and the level of social competence in the group of juvenile offenders. Appropriate use of the results may contribute to increasing the effectiveness of resocialization and reducing the risk of recidivism.

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

To understand processes associated with better or poorer psychotherapy outcomes is vital. This study examined and contrasted interaction patterns between one therapist and two depressed 17-year-old girls, Johanna (good outcome) and Sonja (poor outcome), in short-term psychoanalytic therapies selected from an RCT. Outcome data were collected regarding level of inter- and intra-personal functioning and symptoms of depression. Process data were obtained using the Adolescent Psychotherapy Q-Set on all available sessions. Analyses yielded five relational patterns or "interaction structures" in the two therapy processes; Three explained most of the variance in sessions with Johanna (i.e., 'positive working alliance', 'therapist's active use of psychodynamic techniques', and 'a receptive patient') and two explained more of the variance in sessions with Sonja (i.e., 'therapist using a more problem-solving and symptom-oriented approach' and 'patient displaying limited capacity for mentalization'). The processes in the two cases presented differences related to mentalization, psychological mindedness, and attachment style of the patients. The therapist used different therapeutic approaches, favouring more psychodynamic interventions in the good outcome case and a more problem-solving and symptom-oriented approach with the poor outcome case. In the latter case, the relationship seemed to be more of a struggle.

Executive functioning as a predictor of response to interpersonal psychotherapy in adolescents with depression: A pilot study.

• Twenty-five adolescents with a depressive disorder participated in this preliminary study. • Results show that poor baseline executive functioning predicts a favorable psychotherapy response. • This line of work is relevant to personalization, allowing patients to maximize treatment resources that are best matched for them.

A Three-level Meta-analysis on the Alliance-Outcome Association in Child and Adolescent Psychotherapy.

Previous meta-analyses have found small to moderate associations between child-therapist alliance and treatment outcomes. However, these meta-analyses have not taken into account changes in alliance (i.e., alliance shifts), alliance agreement (i.e., congruence or discrepancies between child-therapist ratings), and the role of alliance as a moderator in relation to treatment outcomes (i.e., an interaction effect of alliance and treatment condition on treatment outcomes). A series of multilevel meta-analyses of 99 studies was conducted to investigate several types of alliance-outcome associations in child and adolescent psychotherapy. Associations between child-therapist alliance and child outcomes (r = 0.17), changes in child-therapist alliance and child outcomes (r = 0.19), child-therapist alliance as a moderator of outcomes (r = 0.09), and parent-therapist alliance and child outcomes (r = 0.13) were small. Associations between child-therapist alliance agreement and outcomes (r = 0.21) and between parent-therapist alliance and parent outcomes (r = 0.24) were small to moderate. This meta-analysis provides the most updated and comprehensive overview of the alliance-outcome association in child and adolescent psychotherapy, showing that the alliance continues to show impact on treatment outcomes. Alliance research in youth psychotherapy has increasingly focused on several complex aspects of the alliance-outcome association, such as the role of changes in alliance, alliance discrepancies, client and therapist variability, and the reciprocal association between alliance and prior symptom change in relation to treatment outcomes. Implications for future research and clinical practice are discussed.

Programs for Training in Child and Adolescent Psychotherapy in China: An Introduction to the Section

Programs for Training in Child and Adolescent Psychotherapy in China: An Introduction to the Section

Review: An Integrative Perspective on Psychotherapy with Children and Adolescents with ASD

Purpose of the study: The review aims to present methods and techniques of psychotherapy for children with ASD in various approaches and extend understanding of autistic patients' difficulties in the context of psychotherapeutic interventions.
 Methodology: Six different methods, approaches and technics were presented in the article: Multimodal Anxiety and Social Skills Intervention; Narrative family therapy incorporating the externalization technique; Embodied mentalization-based psychodynamic psychotherapy; Psychoanalytic family psychotherapy; Simultaneous psychotherapy with child and family based on Erica method; Psychodynamic-oriented psychotherapy of adolescents based on dream sharing and interpretation. Selection of best interventions based on technical eclecticism and theoretical integration was proposed as the most appropriate for the clients with ASD
 Main findings: Various models of psychotherapy for Children and Adolescents with ASD were developed with a specific therapeutic approach. Relatively few of these treatments are widely used in everyday therapeutic practice. The benefit level for patients with ASD and their families depends on appropriate selection approaches, methods, technics, and their integration. To develop a personalized integrative approach to each case, the therapists need to be fluent in more than one therapy approach, and have know of a wide range of theories and skills.
 Application of the study: The personalized intervention depending on the child's needs, especially the type and severity of difficulties, the stage of development, and the family's readiness for psychotherapy was recommended. Furthermore, the selection of methods, technics and their integration were based on described interventions.
 Original/Novelty of the study: The practical example of developing a psychotherapeutic integrative approach to children and adolescents with ASD was presented in this article.

Therapists' Emotional Responses in Individual Therapy with Depressed Adolescents: An Evaluation of the Data Structure of the Feeling-Word Checklist-28.

Countertransference (CT) responses during therapy sessions can be understood as the therapist’s emotional reactions towards the patient. Within adolescents’ psychotherapy, little is known about the effects of the therapists’ feelings on treatment outcome. The Feeling-Word Checklist—28 (FWC-28) is a self-report questionnaire designed to evaluate the therapist’s in-session feelings during therapy with younger patients. The aim of the study was to evaluate the psychometric properties of the clinician-rated FWC-28 and explore the associations between the CT-subscales and therapeutic alliance. Data were collected from a randomized controlled trial in which 11 therapists specialized in child and adolescent psychotherapy treated 16- to 18-year-old patients (n = 62) with major depressive disorder in outpatient clinics. The patients received psychodynamic psychotherapy treatment over 28 sessions. Therapists rated their emotional responses towards their patients on FWC-28 after sessions 3, 12, 20, and 28. Principal component analysis (PCA) with oblique rotation was performed to find clinically meaningful subscales of the FWC-28. PCA revealed four clinically meaningful components termed as follows: inadequate, confident, motherly, and disengaged. The psychometric properties of the FWC and the reliability of the CT subscales measured with Cronbach’s alpha were acceptable. The therapist-reported alliance showed significant and clinically meaningful correlations with all CT-subscales. Our findings indicate that the checklist is adequate for clinical practice and countertransference research in adolescents’ psychotherapy.

Teaching dialectical thinking to enhance graduate trainees’ competence in outpatient psychotherapy for adolescents experiencing suicidal thoughts and behaviors.

Teaching dialectical thinking to enhance graduate trainees’ competence in outpatient psychotherapy for adolescents experiencing suicidal thoughts and behaviors.

A Meta-Analysis on Differences and Associations between Alliance Ratings in Child and Adolescent Psychotherapy

ABSTRACT Objective The alliance in child and adolescent psychotherapy is widely recognized as an important factor in therapy. Studies on the alliance have increasingly focused on assessment of the alliance as a dyadic construct, measuring both client and therapist alliance ratings. However, cross-informant reports of the alliance in child psychotherapy have not yet been subjected to meta-analysis. Therefore, the present meta-analysis aims to increase knowledge on the degree of convergence and divergence between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy. Methods A series of three-level meta-analyses of 78 studies was conducted to investigate differences and associations between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy. Results Findings indicated that children and parents in general rated the alliance more positively than their therapists (d = 0.35, d = 0.72, respectively), and that child-therapist and parent-therapist alliance ratings were moderately correlated (r = .32, r = .23, respectively). Associations between child and therapist ratings and observer ratings were moderate to large (r = .43, r = .53, respectively). Conclusions It can be concluded that children and parents generally report more positively on the alliance compared to their therapists, which is consistent with research on the alliance in adult populations. The small to moderate associations between alliance ratings indicate that individuals to some extent have a shared perspective on their alliance, and that the various perspectives on alliance should be acknowledged when dealing with children and parents in therapy. Implications for future research are discussed.

Investigating the feasibility and effectiveness of a modular treatment program for children and adolescents with depression and interpersonal problems: study protocol of a quasi-experimental pilot feasibility trial (CBASP@YoungAge)

BackgroundDepression is a serious disorder in childhood and adolescence. Affected children and adolescents show significant impairments in various aspects of life. Studies on the effectiveness or efficacy of psychotherapy in depressed children and adolescents are qualitatively very heterogeneous and reveal small effect sizes. There is thus a need to better tailor psychotherapy approaches to these age groups to improve outcomes like parent-child relationship, symptomatology, or quality of life.To address this gap, we designed a modular, individualized treatment program for children and adolescents based on the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) including caregiver involvement.MethodThis quasi-experimental pilot feasibility trial is a phase 1 to phase 2 study investigating the feasibility and effectiveness of CBASP@YoungAge by including an intervention group (CBASP@YoungAge) and a treatment-as-usual control group. The treatment of depressive symptoms as well as interpersonal problems with primary caregivers are the main targets of CBASP@YoungAge. Personalization is ensured concerning the treatment course, caregivers’ involvement, and the patient’s age. The primary outcome relates to two areas: the feasibility of the CBASP@YoungAge treatment program in an outpatient context and a change in patients' depressive symptomatology from before to after treatment. We conduct a brief process evaluation after each session in the intervention group to closely monitor the treatment process and examine feasibility from the therapists' and patients' perspectives and mechanisms of symptom change. In addition, we consider interpersonal behavior between children and caregivers, parenting behavior, and monitor the global-health-index in children and parents as secondary outcomes. Pre-, post-, and follow-up data are evaluated.DiscussionThis is the first study of a modular-based intervention program for children and adolescents with depression and a clear focus on the interpersonal problems between the depressed young patient and her/his caregiver. It will provide important knowledge on the feasibility and effectiveness of the program and potential benefits of including caregivers in psychotherapy. Based on this study’s results, we plan a multicenter, randomized, controlled trial whose long-term aim is to improve the psychotherapeutic care of young patients with depression while preventing persistent courses of depressive disorders.Trial registrationGerman Clinical Trials Register, DRKS (identifier DRKS00023281). Registered 17 November 2020–Retrospectively registered

Effects of a smartphone app-augmented treatment for children with oppositional defiant disorder / conduct disorder and peer-related aggressive behavior – a pilot study

BackgroundSocial competence training interventions, especially child-focused ones, have proven to be effective in the treatment of children with conduct disorder. Therapy homework assignments implemented between the therapy sessions are essential for practicing strategies developed during treatment sessions and transferring them to everyday life. However, clinical experience shows that patients’ adherence regarding these assignments is often low, thus diminishing the treatment success. One obstacle in this regard is a lack of motivation. The use of smartphone apps in the context of child and adolescent psychotherapy is relatively new, and may provide novel ways to improve the transfer of coping strategies to daily life between treatment sessions. However, only a small number of high-quality studies have analyzed the systematic use of smartphone apps in therapy. The present study will therefore evaluate patients’ homework assignment adherence when using a smartphone app as compared to a paper-and-pencil method.MethodThe study will be conducted as a randomized controlled trial to evaluate the impact of a smartphone app on the adherence to therapy homework assignments (n = 35) in the treatment of children with aggressive behavior aged 6–12 years compared to paper-and-pencil homework assignments (n = 35).DiscussionThis trial is intended as a pilot study and aims to provide a basis for a subsequent multicenter trial. However, the results may already lead to recommendations for the development and use of mental health-related smartphone apps for children and adolescents with aggressive behavior problems.Trial registrationTrial registration AUTHARK: German Clinical Trials Register (DRKS) DRKS00015625. Registered on 15th October 2019.

Discussion of Dr Mallouh’s Presentation, “Primary Maternal Preoccupation: Disturbance in Pregnancy and the Postpartum”

"Discussion of Dr Mallouh’s Presentation, “Primary Maternal Preoccupation: Disturbance in Pregnancy and the Postpartum”." Journal of Infant, Child, and Adolescent Psychotherapy, 21(3), pp. 288–289

Особенности применения методов когнитивно-поведенческой психотерапии в работе психолога с подростками

The article is devoted to the using of cognitive behavioral psychotherapy methods in the work of a psychologist with adolescents. Based on the analysis of literary sources devoted to the development of mental activity, emotional sphere, behavioral characteristics of adolescents, the use of methods of cognitive behavioral psychotherapy is reasoned and justified. The purpose of the study is to determine the psychological and pedagogical conditions for using the method of cognitive behavioral psychotherapy, psychoconditioning and psychocorrective work with adolescents. The following research methods were used in this work: analysis of scientific psychological and pedagogical literature, study of the resources of educational Internet portals, materials of scientific and practical conferences and forums. As a result of the study, the following features of psychosocial development of children in adolescence, their connection with mental activity, emotions and behavior were identified, effective diagnostic methods and techniques, techniques for tracking automatic thoughts and images, techniques for changing dysfunctional beliefs (role-playing, cognitive conceptualization, etc.) were clarified. The methods of work proposed in the article can be used in the organization of preventive, counseling and correctional work with adolescents with emotional and behavioral disorders, with low educational motivation, problems in the personal, emotional sphere and socialization. From what has been said, the conclusion suggests that an important condition for psychotherapy and correction of adolescents is the work on changing dis-functional beliefs, automatic thoughts, negative emotional states, destructive behavior in adolescents. In our opinion, it is the methods of cognitive behavioral psychotherapy that contribute to the resolution of age-related problems of adolescents: they will help to cope with stress, anxiety, increase self-esteem, improve relationships with peers and adults.

Kombination von Einzel- und Gruppenbehandlung in der ambulanten psychodynamischen Kinder- und Jugendlichenpsychotherapie

Since 2015 the combination of individual and group treatment within psychoanalytically based procedures is possible in both adult and child and adolescent psychotherapy. Neither theoretical specialist discourses nor research about the combination of individual and group therapy in child and adolescent psychotherapies have hitherto occurred for this age group. Therefore discussion threads of adult therapy regarding the combination of individual and group therapy will be illustrated to derive their theoretic meaning for child and adolescent therapy. Furthermore first experiences in the area of combined therapy in child and adolescent therapy will be described.

The impact of session-introducing mindfulness and relaxation interventions in individual psychotherapy for children and adolescents: a randomized controlled trial (MARS-CA)

BackgroundThe investigation of mindfulness-based interventions (MBIs) in cognitive-behavioral therapy has greatly increased over the past years. However, most MBI research with youth focuses on structured, manualized group programs, conducted in school settings. Knowledge about the implementation and effects of MBIs in individual psychotherapy with children and adolescents is scarce. To fill this research gap, the “Mindfulness and Relaxation Study – Children and Adolescents” (MARS-CA) is designed. It aims to assess the effects of short session-introducing interventions with mindfulness elements on juvenile patients’ symptomatic outcome and therapeutic alliance in individual child and adolescent psychotherapy.MethodsMARS-CA is conducted at a university outpatient training center for cognitive-behavior therapy. Short session-introducing interventions with mindfulness elements will be compared to short session-introducing relaxation interventions and no session-introducing intervention to explore their effects on symptomatic outcome and therapeutic alliance. The session-introducing interventions will take place at the beginning of 24 subsequent therapy sessions. We hypothesize that patients’ symptomatic outcome and therapeutic alliance improve more strongly in the mindfulness condition than in the other two conditions and that the mindfulness condition moderates the relationship between therapeutic alliance and symptomatic outcome. Patients and their trainee therapists will be randomized to one of the three treatment arms. Participants aged between 11 and 19 years and having a primary diagnosis of either a depressive disorder, an anxiety disorder, or a hyperkinetic disorder will be included. Therapeutic alliance will be assessed after every therapy session (therapy session 1 to therapy session 24), symptomatic outcome will be assessed before the start of treatment (pre), after the 3rd, the 10th, and the 17th therapy sessions, at the end of treatment (24th therapy session, post), and at a 6-month follow-up. Additionally, mindfulness and mindfulness-related measures as well as demographic data, adherence, allegiance, and therapeutic techniques will be assessed. It is our aim to assess a sample of 135 patients. We will conduct multilevel modeling to address the nested data structure.DiscussionThe study can provide information about how add-on MBIs, conducted by trainee therapists, influence therapeutic alliance and symptomatic outcome in individual psychotherapy in children and adolescents.Trial registrationClinicalTrials.gov NCT04034576. Registered on July 17, 2019

Changing the Narrative. Refusing the Script

ABSTRACT Rarely do we hear a narrative written in the first person, written from the perspective of a child who grew up in the foster care system. This paper provides a window into the interior world of a child who experienced traumatic loss and abandonment. This child–born to emigrant Jamaican parents–grew up in the foster care system in the UK from the early 1970ʹs through the late 1980ʹs. This first-person account is written from the perspective of a child, but also from the perspective of a licensed social worker, a clinician with 26+ years of experience working with foster care youth and families. The writer is a graduate of The New School for Psychoanalytic Psychotherapy and Psychoanalysis, where he received training in Child and Adolescent Psychotherapy. This narrative is just one perspective of a personal journey, and in no way aims to speak for all children who grow up in the foster care system. Given some of the emotionally charged content in this paper, a few details are written in a deliberately vague way to protect the privacy of all persons involved.