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

André Løvgren, Jan Ivar Røssberg, Liv Nilsen, Eivind Engebretsen, Randi Ulberg, André Løvgren, Jan Ivar Røssberg, Liv Nilsen, Eivind Engebretsen, Randi Ulberg

Abstract

Background: There 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.

Methods: Eight 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.

Results: The 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.

Conclusions: Together 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 registration: ClinicalTrials.gov . Id: NCT01531101. Date of registry: 8 February 2012, retrospectively registered.

Keywords: Adolescent depression; Experiences of improvement; Psychodynamic psychotherapy; Qualitative study; Therapeutic change.

Conflict of interest statement

Ethics approval and consent to participate

Regional Committees for Medical and Health Research Ethics in Norway approved the study protocol and the information given to the patients (REC Central, 2011/1424). Written informed consent was obtained from each participant, aged 16–18 years at inclusion. According to Norwegian legislation, ethical consent for participation in research may be given from age 16.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The figure reveals the different aspects of experienced improvement in PDT for adolescents

References

    1. WHO . Mental health: new understanding, New hope, vol. 2001. Geneva: World Health Organization; 2001.
    1. Mojtabai R, Olfson M, Han B. National Trends in the 2016;138(6);1–10.
    1. Sund AM, Larsson B, Wichstrøm L. Prevalence and characteristics of depressive disorders in early adolescents in Central Norway. Child Adolesc Psychiatry Ment Health. 2011;5:28.
    1. Dunn V, Goodyer IM. Longitudinal investigation into childhood- and adolescence-onset depression: psychiatric outcome in early adulthood. Br J Psychiatry. 2006;188(3):216–222.
    1. Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, Holland F, Kelvin R, Midgley N, Roberts C, et al. Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial. Lancet Psychiatry. 2017;4(2):109–119.
    1. Midgley N, O’Keeffe S, French L, Kennedy E. Psychodynamic psychotherapy for children and adolescents: an updated narrative review of the evidence base. J Child Psychother. 2017:1–23.
    1. David-Ferdon C, Kaslow NJ. Evidence-based psychosocial treatments for child and adolescent depression. J Clin Child Adolesc Psychol. 2008;37(1):62–104.
    1. Binder P-E, Schanche E, Holgersen H, Nielsen GH, Hjeltnes A, Stige SH, Veseth M, Moltu C. Why do we need qualitative research on psychological treatments? The case for discovery, reflexivity, critique, receptivity, and evocation. Scand Psychol. 2016;3:1–22.
    1. Gibson K, Cartwright C. Young clients' narratives of the purpose and outcome of counselling. Br J Guid Couns. 2014;42(5):511–524.
    1. McLeod J. Qualitative research. Methods and contributions. In: Lambert MJ, editor. Bergin and Garfield’s handbook of psychotherapy and behavior change. 6 edn. Oxford: John Wiley & Sons; 2013. pp. 49–84.
    1. Cuijpers P. The patient perspective in research on major depression. BMC Psychiatry. 2011;11:89.
    1. Ekroll VB, Rønnestad MH. Processes and changes experienced by clients during and after naturalistic good-outcome therapies conducted by experienced psychotherapists. Psychother Res. 2017;27(4):450–468.
    1. Nilsson T, Svensson M, Sandell R, Clinton D. Patients’ experiences of change in cognitive–behavioral therapy and psychodynamic therapy: a qualitative comparative study. Psychother Res. 2007;17(5):553–566.
    1. Gostas MW, Wiberg B, Neander K, Kjellin L. ‘Hard work’ in a new context: Clients’ experiences of psychotherapy. Qual Soc Work. 2012;12(3):340–357.
    1. Gibson K, Cartwright C, Kerrisk K, Campbell J, Seymour F. What young people want: a qualitative study of adolescents’ priorities for engagement across psychological services. J Child Fam Stud. 2016;25(4):1057–1065.
    1. Henriksen AK. Adolescents’ reflections on successful outpatient treatment and how they may inform therapeutic decision making—a holistic approach. J Psychother Integr. 2014;24(4):284–297.
    1. Hirschfeld RM, Keller MB, Panico S, Arons BS, Barlow D, Davidoff F, Endicott J, Froom J, Goldstein M, Gorman JM, et al. The National Depressive and manic-depressive association consensus statement on the undertreatment of depression. JAMA. 1997;277(4):333–340.
    1. Block AM, Greeno CG. Examining outpatient treatment dropout in adolescents: a literature review. Child Adolesc Soc Work J. 2011;28(5):393–420.
    1. de Haan AM, Boon AE, de Jong JTVM, Hoeve M, Vermeiren RRJM. A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care. Clin Psychol Rev. 2013;33(5):698–711.
    1. Kazdin AE. Dropping out of child psychotherapy: issues for research and implications for practice. Clin Child Psychol Psychiatry. 1996;1(1):133–156.
    1. Ulberg R, Hersoug AG, Høglend P. Treatment of adolescents with depression: the effect of transference interventions in a randomized controlled study of dynamic psychotherapy. Trials. 2012;13(1):1.
    1. Cregeen S, Hughes C, Midgley N, Rhode M, Rustin M: Short-term psychoanalytic psychotherapy for adolescents with depression: A treatment manual: Karnac Books; 2016.
    1. Goodyer IM, Tsancheva S, Byford S, Dubicka B, Hill J, Kelvin R, Reynolds S, Roberts C, Senior R, Suckling J, et al. Improving mood with psychoanalytic and cognitive therapies (IMPACT): a pragmatic effectiveness superiority trial to investigate whether specialised psychological treatment reduces the risk for relapse in adolescents with moderate to severe unipolar depression: study protocol for a randomised controlled trial. Trials. 2011;12(1):175.
    1. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.
    1. Beck AT, Steer RA, Ball R, Ranieri WF. Comparison of Beck depression inventories-IA and-II in psychiatric outpatients. J Pers Assess. 1996;67(3):588–597.
    1. Justesen L, Mik-Meyer N. Qualitative research methods in organisation studies. København: Hans Reitzels Forl. 2012:51–74.
    1. Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scandinavian J Public Health. 2012;40(8):795–805.
    1. Jungbluth NJ, Shirk SR. Therapist strategies for building involvement in cognitive–behavioral therapy for adolescent depression. J Consult Clin Psychol. 2009;77(6):1179.
    1. Binder P-E, Moltu C, Hummelsund D, Sagen SH, Holgersen H. Meeting an adult ally on the way out into the world: adolescent patients' experiences of useful psychotherapeutic ways of working at an age when independence really matters. Psychother Res. 2011;21(5):554–566.
    1. Karver MS, Handelsman JB, Fields S, Bickman L. A theoretical model of common process factors in youth and family therapy. Ment Health Serv Res. 2005;7(1):35–51.
    1. Sauter FM, Heyne D, Michiel Westenberg P. Cognitive behavior therapy for anxious adolescents: developmental influences on treatment design and delivery. Clin Child Fam Psychol Rev. 2009;12(4):310–335.
    1. Gibson K, Cartwright C. Agency in young clients’ narratives of counseling: “It’s whatever you want to make of it”. J Couns Psychol. 2013;60(3):340.
    1. Karver MS, Handelsman JB, Fields S, Bickman L. Meta-analysis of therapeutic relationship variables in youth and family therapy: the evidence for different relationship variables in the child and adolescent treatment outcome literature. Clin Psychol Rev. 2006;26(1):50–65.
    1. Hollidge C. Adolescents’ perceptions of the factors that enhance the therapeutic relationship: a qualitative study in school-based health settings. Adolesc Psychiatry. 2013;3(3):277–287.
    1. Everall RD, Paulson BL. The therapeutic alliance: adolescent perspectives. Couns Psychother Res. 2002;2(2):78–87.
    1. Nissen-Lie HA, Rønnestad MH, Høglend PA, Havik OE, Solbakken OA, Stiles TC, Monsen JT. Love yourself as a person, doubt yourself as a therapist? Clin Psychol Psychother. 2017;24(1):48–60.
    1. Dunne A, Thompson W, Leitch R. Adolescent males’ experience of the counselling process. J Adolesc. 2000;23(1):79–93.
    1. Griffiths G: Helpful and unhelpful factors in school-based counselling: clients’ perspectives. Lutterworth: British Association for Counselling and Psychotherapy 2013.
    1. Hanley T, Noble J: Therapy outcomes: Is child therapy effecdtive? In: Essential Research Findings in Child and Adolescent Counselling and Psychotherapy. 1th edn. Edited by Midgley N, Cooper M, Hayes J: SAGE; 2017: 59–78.
    1. Pattison S, Harris B. Counselling children and young people: a review of the evidence for its effectiveness. Couns Psychother Res. 2006;6(4):233–237.
    1. Hayes J, Brunst C: What leads to change? II. Therapeutic techniques and practises with children and young people. In: Essential Research Findings in Child and Adolescent Counselling and Psychotherapy. edn.; 2017: 148–173.
    1. Juritzen TI, Soberg HL, Røe C, Saebu M, Engen G, Bliksvaer T, Engebretsen E. The one or the many. Qual Health Res. 2017;27(1):51–59.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere