Psychotherapy Dropout: Using the Adolescent Psychotherapy Q-Set to Explore the Early In-Session Process of Short-Term Psychodynamic Psychotherapy

Abstract

Research suggests that short-term psychodynamic psychotherapy (STPP) is an effective treatment for depression in adolescence, yet treatment dropout is a major concern and what leads to dropout is poorly understood. Whilst studies have begun to explore the role of patient and therapist variables, there is a dearth of research on the actual therapy process and investigation of the interaction between patient and therapist. This study aims to address this paucity through the utilisation of the Adolescent Psychotherapy Q-set (APQ) to examine the early treatment period. The sample includes 69 adolescents aged 16–18 years with major depressive disorder receiving STPP as part of the First Experimental Study of Transference Work–in Teenagers (FEST-IT) trial. Of these, 21 were identified as dropouts and were compared to completers on pre-treatment patient characteristics, symptomatology, functioning, and working alliance. APQ ratings available for an early session from 16 of these drop out cases were analysed to explore the patient-therapist interaction structure. Results from the Q-factor analysis revealed three distinct interaction structures that explained 54.3% of the total variance. The first described a process of mutual trust and collaboration, the second was characterised by patient resistance and emotional detachment, the third by a mismatch and incongruence between therapist and adolescent. Comparison between the three revealed interesting differences which taken together provide further evidence that the reasons why adolescents drop out of therapy vary and are multidimensional in nature.

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

“…The first three interaction structures could be conceived as subdivisions of the first interaction structure found in Calderon and colleagues [ 13 ] and in Fredum and colleagues [ 17 ], i.e., reflecting a pattern in psychodynamic therapy in which the adolescent client is willing to cooperate and explore difficult feelings and experiences. Similarly, the fourth and fifth interaction structures of this study could be argued correspond to the third pattern found in Calderon and colleagues [ 13 ] and the second pattern in Fredum and colleagues [ 17 ] displaying a patient who does not show capacity for mentalization and cannot express vulnerability. In the present study the patient seemed somewhat more engaged in the therapeutic endeavour.…”

“…A recent study by Fredum and colleagues [ 17 ] used the APQ to examine whether there were unique interaction structures in the early sessions of those adolescents who subsequently dropped out. In a sample of 69 adolescents with major depressive disorder receiving STPP as part of the First Experimental Study of Transference Work–in Teenagers in Norway—FEST-IT [ 18 ], 21 were identified as dropouts.…”

“…In the IMPACT study the therapist worked toward making sense of the adolescents’ experience, asked for more information, and structured the sessions [ 13 ]. In the FEST-IT drop out study the therapist focused on their young patients’ symptoms, encouraged them to discuss assumptions behind their experiences, and refrained from taking position in relation to their thoughts and behaviour [ 17 ]. Whether these differences in the therapists’ behaviour when working with adolescents that resisted the attempts of the therapist to engage them, had any effect on dropout, we do not know.…”

“…Whether these differences in the therapists’ behaviour when working with adolescents that resisted the attempts of the therapist to engage them, had any effect on dropout, we do not know. Nonetheless, comparison between the three interaction structures found by Fredum and colleagues [ 17 ] suggested that the reasons why adolescents drop out of therapy vary and are multidimensional in nature.…”