How do adolescents with depression experience improvement in psychodynamic psychotherapy? A qualitative study

Abstract

BackgroundThere is emerging evidence for the effectiveness of psychodynamic psychotherapy for depressive disorders. However, we know less of how this relation-focused therapy mode is experienced and what the patients themselves identify as helpful. Hence, the purpose of this study is to explore adolescents’ experiences of factors promoting improvement in psychodynamic therapy.MethodsEight female patients participating in a Norwegian study on psychodynamic therapy, the First Experimental Study of Transference Work – In Teenagers (FEST-IT), were included. The participants were offered a total number of 28 sessions. Semi-structured qualitative interviews about experiences with therapy were then conducted and analysed with systematic text condensation and hermeneutic interpretation.ResultsThe analysis revealed four main themes. ‘Exploring oneself’ comprises autonomy and acknowledgment, openness, insight and acceptance of oneself. ‘Therapist relation and characteristics’ includes confidence and trust in and support from the therapist as well as having a trustworthy and experienced therapist. ‘Focusing on everyday life’ includes learning and practical orientation. ‘Time factors’ refers to duration and frequency.ConclusionsTogether with a supportive and listening therapist, the adolescents improve by exploring themselves within the frames of a time-limited treatment period. Improvement seems to be experienced through better relations to oneself and to others and by finding one’s place in the family, or at school. Adolescents value problem solving and help with concrete challenges. Hence, therapy should be tailored to the needs of adolescents with depression and incorporate the challenges they face in their everyday life.Trial registrationClinicalTrials.gov. Id: NCT01531101. Date of registry: 8 February 2012, retrospectively registered.

What Do Chinese Families With Depressed Adolescents Find Helpful in Family Therapy? A Qualitative Study

“…Our results implied that within the context of family therapy for depressed adolescents, the quality of the therapeutic alliance played an important role in improving the clients' experiences with therapy. This finding is consistent with reports from previous research that, within Chinese and Western culture, trustworthy therapeutic alliances not only constitute the basis of therapy, but also facilitate the process of change for adult and adolescent clients in family and individual therapy (Liu et al, 2013;Yoo et al, 2016;Lovgren et al, 2019).…”

“…Similar to previous research results, our results showed that among the factors affecting the therapeutic alliance, the therapists' personality traits and professional competence, such as their mildness, stability, openness, patience, empathy, attention to clients, meticulousness, skill in collating and analyzing information, and ability to give theoretical explanations, made the clients trust them more (Despland et al, 2009;Sundet, 2011;Anderson and Strupp, 2015;Schottke et al, 2017;Lovgren et al, 2019). This finding may indicate that the form of treatment that depressed adolescents and families need most is humanized attention and acceptance from clinicians.…”

“…First, in individual therapy for adults and adolescents with different clinical complaints, the prior literature has suggested a positive correlation between client satisfaction with therapy and therapist competence in terms of empathy, theoretical interpretation, psychoanalytic investigation, clear communication, respect, warmth, positive interpersonal skills, and therapist authenticity ( Despland et al, 2009 ; Anderson and Strupp, 2015 ; Anderson et al, 2016 ; Levitt et al, 2016 ; Schottke et al, 2017 ). The depressed adolescents who accepted psychodynamic individual therapy in Lovgren et al’s (2019) study highly valued the therapist’s confidence and professional experience.…”

“…Second, previous research has found that the setting of psychotherapy, including the involvement of parents, a shorter intake time and a moderate frequency and duration of sessions, was associated with better outcomes and less dropout in psychotherapy for adolescents with depression ( Dardas et al, 2017 ; Lovgren et al, 2019 ). Additionally, previous studies have suggested that stable, collaborative, supportive, and trustworthy relationships between therapists and clients in family and individual therapy not only help to reduce the dropout rate from therapy, but also promote clients’ improvement ( Robbins et al, 2006 ; Levitt et al, 2016 ; Yoo et al, 2016 ; Lovgren et al, 2019 ). For example, Feder and Diamond (2016) found that in attachment-based family therapy for suicidal and depressed adolescents, the strength of the parent-therapist alliance predicted parents’ subsequent attachment-promoting behaviors.…”

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

“…Our findings align with previous research in highlighting the importance of coping and resilience [17][18][19][20][21]; improved family functioning and relationships [17,24,26,68]; social functioning and connectedness [18,19,67]. In addition, a growing body of qualitative research examining procedural aspects of therapy and facilitators of good outcome is emphasizing the importance of young people feeling heard, listened to, and able to open up without feeling judged [69][70][71][72][73][74]. In this study, experiences of being worthy of another person's attention, of feeling listened to, or of discovering new perspectives on life were described as so transformative by more than a third of adolescents, that they might be considered outcomes in their own right rather than mere facilitators of change.…”