Short-term Psychoanalytic Psychotherapy Research Articles

Dosage effects of psychodynamic and schema therapy in people with comorbid depression and personality disorder: four-arm pragmatic randomised controlled trial.

Higher intensity of psychotherapy might improve treatment outcome in depression, especially in those with comorbid personality disorder. To compare the effects of 25 individual sessions (weekly) of two forms of psychotherapy - short-term psychoanalytic supportive psychotherapy (SPSP) and schema therapy - with the same treatments given for 50 sessions (twice weekly) in people with depression and personality disorder. Trial registration: NTR5941. We conducted a pragmatic, double-randomised clinical trial and, over 37 months, recruited 246 adult out-patients with comorbid depression/dysthymia and personality disorder. A 2 × 2 factorial design randomised participants to 25 or 50 sessions of SPSP or schema therapy. The primary outcome was change in depression severity over 1 year on the Beck Depression Inventory II (BDI-II). Secondary outcomes were remission both of depression and personality disorder. Compared with 25 sessions, participants who received 50 sessions showed a significantly greater decrease in depressive symptoms over time (time × session dosage, P < 0.001), with a mean difference of 5.6 BDI points after 1 year (d = -0.53, 95% CI -0.18 to 0.882, P = 0.003). Remission from depression was also greater in the 50-session group (74% v. 58%, P = 0.025), as was remission of personality disorder (74% v. 56%, P = 0.010). Greater intensity of psychotherapy leads to better outcomes of both depression and personality status in people with comorbid depression and personality disorder.

Psychological interventions for depression in children and adolescents: A bibliometric analysis.

Depression has gradually become a common psychological disorder among children and adolescents. Depression in children and adolescents affects their physical and mental development. Psychotherapy is considered to be one of the main treatment options for depressed children and adolescents. However, our understanding of the global performance and progress of psychological interventions for depression in children and adolescents (PIDCA) research is limited. To identify collaborative research networks in this field and explore the current research status and hotspots through bibliometrics. Articles and reviews related to PIDCA from January 2010 to April 2023 were identified from the Web of Science Core Collection database. The Charticulator website, CiteSpace and VOSviewer software were used to visualize the trends in publications and citations, the collaborative research networks (countries, institutions, and authors), and the current research status and hotspots. Until April 16, 2023, 1482 publications were identified. The number of documents published each year and citations had increased rapidly in this field. The United States had the highest productivity in this field. The most prolific institution was the University of London. Pim Cuijpers was the most prolific author. In the context of research related to PIDCA, both reference co-citation analysis and keywords co-occurrence analysis identified 10 research hotspots, including third-wave cognitive behavior therapy, short-term psychoanalytic psychotherapy, cognitive behavioral analysis system of psychotherapy, family element in psychotherapy, modular treatment, mobile-health, emotion-regulation-based transdiagnostic intervention program, dementia risk in later life, predictors of the efficacy of psychological intervention, and risks of psychological intervention. This bibliometric study provides a comprehensive overview of PIDCA from 2010 to present. Psychological intervention characterized as psychological-process-focused, short, family-involved, modular, internet-based, emotion-regulation-based, and personalized may benefit more young people.

"You can't really have a relationship with them because they just ask you questions": understanding adolescent dropout - an empirical single case study.

High dropout rates are common in youth psychotherapy, including psychoanalytic psychotherapy, yet the reasons behind this trend remain obscure. A critical focus to enhance adolescent engagement could be the therapeutic alliance, particularly in resolving alliance ruptures. This study sought to clarify the complex relationships between the therapeutic alliance, encompassing alliance ruptures and resolutions, and dropout within the context of poor outcome. It investigated a single case of an adolescent with depression who dropped-out of Short-Term Psychoanalytic Psychotherapy, without showing clinical improvement. Data was garnered from diverse sources, including questionnaires, interviews, and session recordings, and analyzed through a mixed-method longitudinal framework. This encompassed views from the adolescent, therapist, parents, and external evaluators. The study identifies several factors impacting the decision to drop out, including initial profound distrust toward the therapist, a complex and difficult therapeutic relationship characterized by unresolved alliance ruptures, and sporadic attendance. External factors including minimal parental engagement with therapy were also seen as detrimental to the adolescent's involvement and progress. The research underscores the challenges in engaging adolescents, especially when there may be distrust of professionals, and in the absence of parental involvement with treatment.

Short-term psychoanalytic psychotherapy with depressed adolescents: Comparing in-session interactions in good and poor outcome cases

Objective: To identify and describe in-session interaction patterns between psychoanalytic therapists and adolescents diagnosed with major depressive disorder, comparing good and poor outcome cases. Method: Audio recordings for 100 psychotherapy sessions from 10 Short-Term Psychoanalytic Psychotherapies were analysed using the Adolescent Psychotherapy Q-Set (APQ). The cases and sessions were evenly divided into two groups (poor outcome and good outcome, 5 patients and 50 sessions per group). Interaction patterns were analysed with an Exploratory Factor Analysis (EFA), while group differences were assessed through t-tests. Results: The EFA revealed three factors: (1) “Open, engaged young person working collaboratively with a therapist to make sense of their experiences”, (2) “Directive therapist with a young person fluctuating in emotional state and unwilling to explore”, (3) “Young person expressing anger and irritation and challenging the therapist”. Factor 1 was significantly more prominent in the good outcome cases, while factor 3, on the contrary, was more significantly related to the poor outcome cases. Factor 2 was equally present in both groups. Conclusion: Besides reinforcing to researchers and clinicians the association between a collaborative psychotherapy process with good outcomes, our findings also provide empirical data regarding the role of anger in adolescent depression and the psychotherapy process.

The therapy process with depressed adolescents who drop out of psychoanalytic psychotherapy: an empirical case study

ABSTRACT Psychotherapy dropout is a common phenomenon in youth mental health, often due to dissatisfaction with treatment. However, little is known about the therapeutic processes that precede dropout due to dissatisfaction. This mixed-methods empirical case study aimed to explore the therapeutic process of a 12-session, prematurely ended therapy with a young person with depression in short-term psychoanalytic psychotherapy (STPP). The Adolescent Psychotherapy Q-set (APQ), an empirically validated process measure, was used as a framework for qualitative analysis exploring the therapy process over time. Analysis of APQ ratings of the 12 sessions found a productive patient-therapy dyad working collaboratively to understand the young person’s experiences and emotions. Following an initial phase of the young person presenting as emotional and vulnerable, she became increasingly ambivalent about continuing in psychotherapy. A lively and argumentative period exploring the young person’s ambivalence and increased sense of well-being culminated in eventual dropout. This study suggests that even in a strong, collaborative working relationship with an engaged young person, ambivalence around dependency and vulnerability can threaten treatment completion. Therapists’ enhanced sensitivity to relevant processes that precede therapy dropout have the potential to improve engagement of young people in psychotherapy, which may optimise outcomes.

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

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

Personality Disorders as a Possible Moderator of the Effects of Relational Interventions in Short-Term Psychoanalytic Psychotherapy with Depressed Adolescents.

A significant proportion of adolescents suffering from major depressive disorder (MDD) are likely to have a co-morbid personality disorder (PD). Short-term psychoanalytic psychotherapy (STPP) was found to be one treatment of choice for adolescents suffering from MDD. Background: The first experimental study of transference work-in teenagers (FEST-IT) demonstrated the efficaciousness of transference work in STPP with adolescents suffering from MDD. The usefulness of STPP may be enhanced by exploring possible moderators. Methods: Depressed adolescents (N = 69), aged 16–18 years, were diagnosed with the structured interview for DSM-IV PDs and randomized to 28 weeks of STPP with or without transference work. A mixed linear model was applied. The moderator effect was investigated by a three-way interaction including “time”, “treatment group” and “number of PD criteria”. Results: A small but significant moderator effect was found for cluster B personality pathology. Patients with a higher number of cluster B PD criteria at baseline did better up to one-year post-treatment where therapists encouraged patients to explore the patient–therapist relationship in the here and now. Conclusion: When treated with psychoanalytic psychotherapy for MDD, adolescents with cluster B PD symptoms seem to profit more from transference work than adolescents without such pathology.

The therapeutic alliance in psychotherapy for adolescent depression: Differences between treatment types and change over time.

Although the alliance is usually considered a generic factor common to all therapies, there are theoretical reasons to suspect that it may develop differently in different types of therapies. Yet, in youth psychotherapy, little is known about this issue to date. This study investigated whether the mean strength of the alliance, as well as its trajectory over time, differed between three equally effective psychological treatments for adolescent depression. Data were drawn from the IMPACT study, a randomized controlled trial comparing cognitive-behavioral therapy (CBT) and short-term psychoanalytic psychotherapy (STPP) versus a brief psychosocial intervention (BPI) in the treatment of adolescent depression. Adolescents’ (N = 338) and therapists’ (n = 159) ratings of the alliance were collected using the Working Alliance Inventory short form at 6, 12, and 36 weeks after randomization. Data were analyzed using multilevel linear models. Results showed that adolescents’ and therapists’ mean alliance ratings differed between treatment types, being highest in CBT and lowest in the STPP at all time points. Mean therapists’ alliance ratings increased slightly over time in all arms, while mean adolescents’ ratings were stable over time in CBT and BPI but slightly increased in the STPP group. These findings suggest that the mean strength of the alliance differs between treatment type, and future research is required to pinpoint what factors contribute to these differences and their relationship with treatment outcomes.

Alliance ruptures and resolutions in short-term psychoanalytic psychotherapy for adolescent depression: An empirical case study

ABSTRACT Most research on alliance rupture-repair processes in psychotherapy has been carried out with adults and little is known about the alliance dynamics with adolescents, especially in psychodynamic treatments. Objective: This study aimed to better understand the process of alliance rupture–resolution and its role in a good-outcome case of a depressed adolescent treated with short-term psychoanalytic-psychotherapy (STPP). Method: A longitudinal, mixed-methods empirical single-case approach was employed. Multiple sources of information (questionnaires, interviews, sessions recordings) from various perspectives (adolescent, therapist, observer) were assembled and analysed. Results: The different sources of evidence converged and showed that, despite the presence of frequent alliance ruptures, patient and therapist managed to resolve these and develop a good and collaborative relationship. Both patient and therapist regarded the evolution in their relationship as the treatment factor mainly responsible for the positive changes experienced by the adolescent. Based on both theoretical and empirical data, a preliminary model of how to explore and repair alliance ruptures in STPP is presented. Conclusion: This study illustrates one way of applying an empirical, mixed-method approach to a single case. Its finding supports the idea that the process of repairing ruptures is an important mechanism of change. Strengths, limitations, and possible implications are discussed.

Trajectories of change in general psychopathology levels among depressed adolescents in short-term psychotherapies

Objective to identify and describe trajectories of change in general psychopathology (p) levels among depressed adolescents who received one of three types of short-term therapies (namely Cognitive–Behavioural Therapy, Short-Term Psychoanalytic Psychotherapy, and a Brief Psychosocial Intervention). Method Participants were 465 adolescents with MDD who participated in an RCT comparing three treatments for depression. Narrow-band measures of depression, anxiety, obsessions-compulsions, and conduct problems were assessed at six-time points, and bifactor analysis was performed to extract p factor scores. These scores were submitted to Latent Class Growth Analyses to identify patterns of change over time. Results Three different trajectories of change in p were identified. Two trajectories displayed reductions in p across time-points: one a rapid decrease, and the other slower but steady improvement. The third trajectory indicated a limited decrease in p up until the 12th week after baseline but no further improvement at subsequent time-points. Patients’ baseline p significantly predicted their outcome trajectories. Conclusion Exploring change in p seemed to describe more parsimoniously the patients’ outcomes than the narrow-band assessment of depressive symptoms. Patients with high baseline p were more likely to have poorer outcomes, potentially indicating a need to develop more intensive and tailored treatments for this population.

Do Sleep Disturbances Improve Following Psychoanalytic Psychotherapy for Adolescent Depression?

Sleep disturbance is often a prominent symptom in adolescents diagnosed with major depressive disorder (MDD). Recent evidence indicates that short-term psychoanalytic psychotherapy (STPP) for depression may have an effect in reducing co-occurring sleep disturbance in youth. It is unknown if transference work (exploration of the patient–therapist relationship) has an additional effect in reducing sleep disturbance. Adolescents aged 16–18 years (n = 69, 84% female) who met diagnostic criteria for MDD based on the Mini International Neuropsychiatric Interview (M.I.N.I) were randomized to either STPP with transference work or without. Sleep problems were assessed at baseline, therapy session 20 (20 weeks), post-treatment (28 weeks), and one-year follow-up (80 weeks) with the Symptom Checklist-90-R. At baseline, 69% of the adolescents exhibited moderately to extreme sleep difficulties. Sleep disturbance was significantly correlated to depression depth at session 20 and at follow-up. Symptoms of insomnia significantly decreased from baseline to the end of treatment. Treatment gains were maintained until follow-up. No differences in recovery of sleep disturbance were found between the two treatment groups. The findings suggest that sleep disturbance improves following STPP for depression, with or without transference work. Future research should assess those with residual symptoms by different sleep measures.

How to do things with questions: the role of patients’ questions in Short-Term Psychoanalytic Psychotherapy (STPP) with depressed adolescents

ABSTRACT The role of patients’ questions in psychoanalytic psychotherapy is a neglected topic in the clinical and research literature. This qualitative study aims to bridge this gap by exploring the role of patients’ questions in Short-Term Psychoanalytic Psychotherapy (STPP) with adolescents suffering from depression. This is a single case study, focusing on the interaction between the patient and his therapist when questions were asked by the patient, using conversation analysis methodology. Data was taken from the IMPACT study, a randomised controlled trial, investigating three types of therapy in the treatment of adolescent depression. The findings identify some typical ways in which the therapist responded to the patient’s questions, and show that ‘surprising behaviours’ that seem associated with heightened affect appeared when the patient asked a question, leading to an enlivening of the therapeutic interaction. The study examines the significance of these findings within the context of the therapeutic relationship and discusses the implication of these findings for technique.

What contributes to good outcomes? The perspective of young people on short-term psychoanalytic psychotherapy for depressed adolescents.

Depression is the fourth leading cause of adolescent illness and disability worldwide. A growing evidence base demonstrates that Short Term Psychoanalytic Psychotherapy [STPP] is an efficacious treatment for moderate to severe adolescent depression. However, with research in its infancy, key factors contributing to efficacy are unknown. Service users' lived experiences provide valuable insight in this area. This study aimed to elucidate what adolescents value in treatment by inductively exploring lived experiences of STPP. Five adolescents with the largest reduction in depressive symptoms scores between baseline and end of treatment, who had taken part in a large-scale randomized controlled trial, were sampled. In-depth interviews carried out soon after the end of therapy were analysed using Interpretative Phenomenological Analysis. Three superordinate themes were identified: "Therapy as a Transformational Process", "Explorative and Exposing: The Therapeutic Space" and "Being Heard and Working Together: The Therapeutic Relationship". Adolescents valued a process of collaborative exploration with the therapist which when it was achieved was felt to facilitate a deep-rooted transformation in self-perception. Additionally, they described how an adjustment was needed to the particular frame of a psychoanalytic therapy. However, not all participants with a good treatment outcome experienced therapy in this way, suggesting a potential gap between the quantitative assessment of outcomes, and the way young people experience and understand the change process. Clinical implications and directions for research are discussed.

The alliance-outcome association in the treatment of adolescent depression.

A growing body of research has consistently demonstrated a relationship between alliance and treatment outcomes in youth psychotherapy. However, previous research often suffered methodological issues that prevented detailed investigation of temporal relationships between alliance and symptomatology. The current study explored the directions of effect between alliance and outcome by examining the associations between early alliance and subsequent outcome while controlling for patients' baseline severity and prior symptom change. It also examined potential moderators of this association. Data were drawn from the IMPACT study, a randomized controlled trial comparing cognitive-behavioral therapy and short-term psychoanalytic psychotherapy versus a brief psychosocial intervention in the treatment of adolescent depression. Adolescents (N = 224) and therapist (n = 139) rated the alliance 6 weeks after randomization. Depression severity and overall psychopathology were assessed at baseline, 6, 12, 36, 52, and 86 weeks after randomization. Patients' age, gender, baseline depression severity, conduct disorder symptoms, and treatment type were examined as potential moderators of the alliance-outcome association. Data were analyzed using multilevel models. Findings suggested that higher early alliance ratings were associated with subsequent symptom reduction, even after controlling for prior symptom change and baseline severity. There was some evidence that the strength of this association was strongest in cognitive-behavioral therapy, weaker in short-term psychoanalytic psychotherapy, and statistically indistinguishable from zero in brief psychosocial intervention. These findings suggest that early therapeutic alliance with adolescents may influence subsequent outcome independent of prior symptom change and initial severity but that the effect of the alliance on outcome might vary across treatment types. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The first experimental study of transference work\u2013in teenagers (FEST\u2013IT): a multicentre, observer- and patient-blind, randomised controlled component study

BackgroundLittle is known about the influence on outcome of exploration of the patient-therapist relationship (that is, transference work) in psychoanalytic psychotherapy. We hypothesized that depressed adolescents would have better long-term effects from psychoanalytic psychotherapy with than without transference work.MethodsDepressed adolescent (16 to 18 years) were recruited in health authority funded out-patient clinics in Oslo and Vestfold County, Norway. They were randomized to 28 weeks of treatment with psychoanalytic psychotherapy with or without transference work. Change was assessed using linear-mixed models. The primary outcome measure was the Psychodynamic Functioning Scale (pre- post-, and 1-year post-treatment). Level of depression was measured at the same time points and during therapy (week 12, and 20).Results69 adolescents were treated with (N = 39) or without (N = 31) transference work. The mean number of sessions was 18.6 (SD = 8,6) in the transference work group and 18.0 (SD = 10.9) in the non-transference work group.Both groups showed large and significant improvement on Psychodynamic Functioning Scale during the whole study period. The difference between the two groups was not significant during the treatment period (95% CI −.79 to 1.2, p = .674, F = .18), or from post-treatment to one-year follow-up (95% CI −.13 to .96; p = .134; F = 2.3). For the secondary outcome measures the transference work group had significantly better outcomes from 12 weeks in treatment to one-year follow-up (Beck Depression Inventory, 95% CI − 1.7 to −.14, p = .022; Montgomery and Åsberg Depression Rating Scale, 95% CI − 1.6 to −.23, p = .009).ConclusionThe findings suggest that exploration of the adolescents’ relations to the therapist amplify the effects of short-term psychoanalytic psychotherapy on their depressive symptoms for adolescents with a Major Depressive Disorder.Trial registrationClinicalTrials.gov. Id: NCT01531101. Registered 8 February 2012.

When adolescents stop psychological therapy: Rupture-repair in the therapeutic alliance and association with therapy ending.

The therapeutic alliance predicts dropout from psychological therapy, and ruptures in the therapeutic alliance may also predict dropout, yet there is a dearth of research with adolescents. This study investigated whether markers of rupture-repair in the alliance were indicative of different types of treatment ending in adolescents receiving psychological treatment for depression. Data were from the IMPACT study, a trial investigating the effectiveness of therapies for adolescent depression. Participants were randomly allocated to receive a brief psychosocial intervention, cognitive-behavioral therapy, or short-term psychoanalytic psychotherapy. The sample (N = 35) comprised adolescents who had either completed their treatment (n = 14) or dropped out (n = 21) according to their therapist. Dropout cases were further classified as dissatisfied (n = 14) or got-what-they-needed (n = 7) based on posttherapy interviews with the adolescent and therapist. Selected recordings of therapy sessions were rated using the Rupture Resolution Rating System and Working Alliance Inventory (observer version). Therapeutic alliance and rupture-repair during therapy were similar for completers and got-what-they-needed dropouts, whereas dissatisfied dropouts had poorer therapeutic alliance, more ruptures, ruptures that were frequently unresolved, and greater therapist contribution to ruptures. Qualitative analysis of sessions led to the construction of three categories of therapist contribution to ruptures: therapist minimal response, persisting with a therapeutic activity, and focus on risk. Results suggest that ruptures, especially when unresolved, could be warning signs of disengagement and dropout from therapy. Future research should investigate how ruptures may be effectively identified and resolved in treatment with adolescents. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Teenage Boys in Therapy: A Qualitative Study of Male Adolescents’ Experiences of Short-Term Psychoanalytic Psychotherapy

ABSTRACT Adolescent boys have the highest rates of disengagement and drop out from mental health services. Further, research suggests that when boys do enagage with services, they may value therapies that provide practical strategies rather than those that advocate the exploration of thoughts, feelings, and relationships. Research is therefore needed to gain a better understanding of teenage boys’ experiences of participating in such therapies. This qualitative study aimed to explore the therapeutic experiences of five male adolescents (aged 16 to 18 years) with moderate to severe depression, who engaged in Short-Term Psychoanalytic Psychotherapy (STPP) as part of a randomized controlled trial. Interpretative Phenomenological Analysis of semi-structured interviews was used for an in-depth and idiographic exploration of their experiences. Three themes were identified: ‘Pain in therapy for a worthwhile purpose’, ‘A relationship unlike others: creating a space for reflection’, and “Ending with ‘a little bit of relief and a little bit of hope’”. The findings offer insight into factors that made it possible for these adolescents to engage in and benefit from STPP – a positive therapeutic relationship and gaining self-understanding – and, aspects that hindered their engagement and led to premature endings. This knowledge could inform clinical practice with depressed adolescent boys.

A comprehensive mapping of outcomes following psychotherapy for adolescent depression: The perspectives of young people, their parents and therapists

As mental health systems move towards person-centred care, outcome measurement in clinical research and practice should track changes that matter to young people and their families. This study mapped the types of change described by three key stakeholder groups following psychotherapy for depression, and compared the salience of these outcomes with the frequency of their measurement in recent quantitative treatment effectiveness studies for adolescent depression.Using qualitative content analysis, this study identified and categorized outcomes across 102 semi-structured interviews that were conducted with depressed adolescents, their parents, and therapists, as part of a randomized superiority trial. Adolescents had been allocated to Cognitive-Behavioral Therapy, Short-Term Psychoanalytic Psychotherapy, or a Brief Psychosocial Intervention.The study mapped seven high-level outcome domains and 29 outcome categories. On average, participants discussed change in four domains and six outcome categories. The most frequently discussed outcome was an improvement in mood and affect (i.e., core depressive symptoms), but close to half of the participants also described changes in family functioning, coping and resilience, academic functioning, or social functioning. Coping had specific importance for adolescents, while parents and therapists showed particular interest in academic functioning. There was some variation in the outcomes discussed beyond these core themes, across stakeholder groups and treatment arms.Of the outcomes that were frequently discussed in stakeholder narratives, only symptomatic change has been commonly reported in recent treatment studies for adolescent depression. A shift towards considering multiple outcome domains and perspectives is needed to reflect stakeholder priorities and enable more nuanced insights into change processes.

Exploring silence in short-term psychoanalytic psychotherapy with adolescents with depression

ABSTRACT Psychotherapy process research is important in developing technique and enhancing clinical skills. Silence, as an aspect of child and adolescent psychoanalytic psychotherapy, has been a neglected area of research, despite it being acknowledged as an often challenging yet therapeutically useful aspect of the work. This study aims to explore silence in adolescent psychoanalytic psychotherapy, by studying the emergence of silence in therapy sessions. Three Short-Term Psychoanalytic Psychotherapies of adolescents with depression were used in the study, and silences occurring in six sessions of each therapy were coded, using the Pausing Inventory Categorization System (PICS). Findings showed that, in the three therapies sampled, almost one-third of session time was spent on average in silence, and most of this silence was coded as ‘obstructive’. Moreover, the amount of silence in every stage of therapy was different for each patient-therapist dyad. Follow-up interviews conducted with the adolescents were analysed using thematic analysis, and showed that the adolescents generally expressed negative feelings about silence in their therapy. Analysis suggests that the majority of the silence in these therapies related to conflict, which could be viewed as both an aspect of the developmental stage of adolescence, and a symptom of depression. These findings suggest that silences may not always be therapeutically productive in adolescent therapy, even if they are considered to be so in psychotherapy with adults, and so adaptations in therapeutic technique are required.

Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents

BackgroundThe longitudinal course of multiple symptom domains in adolescents treated for major depression is not known. Revealing the temporal course of general and specific psychopathology factors, including potential differences between psychotherapies, may aid therapeutic decision‐making.MethodsParticipants were adolescents with major depressive disorder (aged 11–17; 75% female; N = 465) who were part of the IMPACT trial, a randomized controlled trial comparing cognitive behavioral therapy, short‐term psychoanalytic psychotherapy, and brief psychosocial intervention. Self‐reported symptoms at baseline and 6, 12, 36, 52, and 86 weeks postrandomization were analyzed with bifactor modeling.ResultsGeneral psychopathology factor scores decreased across treatment and one‐year follow‐up. Specific melancholic features and depressive cognitions factors decreased from baseline to 6 weeks. Conduct problems decreased across treatment and follow‐up. Anxiety increased by 6 weeks and then reverted to baseline levels. Obsessions–compulsions did not change. Changes in general and specific factors were not significantly different between the three psychotherapies during treatment. During follow‐up, however, conduct problems decreased more in brief psychosocial intervention versus cognitive behavioral therapy (1.02, 95% Bayes credible interval 0.25, 1.96), but not versus short‐term psychoanalytic psychotherapy.ConclusionsThe clinical response signature in this trial is best revealed by rapid reductions in depression symptoms and general psychopathology. Protracted improvements in general psychopathology and conduct problems subsequently occur. Psychosocial treatments for adolescent depression have comparable effects on general and specific psychopathology, although a psychoeducational, goal‐focused approach may be indicated for youth with comorbid conduct problems.