Assessment of dynamic change in psychotherapy with asdolescents

Elisabeth Ness, Hanne-Sofie Johnsen Dahl, Peter Tallberg, Svein Amlo, Per Høglend, Agneta Thorén, Jens Egeland, Randi Ulberg, Elisabeth Ness, Hanne-Sofie Johnsen Dahl, Peter Tallberg, Svein Amlo, Per Høglend, Agneta Thorén, Jens Egeland, Randi Ulberg

Abstract

Background: Diagnostic interviews and questionnaires are commonly used in the assessment of adolescents referred to child and adolescent mental health services. Many of these rating scales are constructed for adults and focus on symptoms related to diagnosis. Psychodynamic Functioning Scales (PFS) focus on relational aspects and how the patients handle affects and solve problems, rather than manifest symptoms. As these aspects are considered important for mental health, the PFS were developed to assess change in adults, consistent with the relational and intrapsychic concepts of dynamic psychotherapy. The scales describe internal predispositions and psychological resources that can be mobilized to achieve adaptive functioning and life satisfaction. PFS consist of six subscales; the relational subscales Family, Friends and Romantic/Sexual relationships and the dynamic subscales Tolerance for Affects, Insight and Problem-solving Capacity. PFS has been used for the first time as a measure of change in adolescent psychotherapy. This study examines the reliability of PFS when used to assess adolescents' level of relational functioning, affective tolerance, insight, and problem-solving capacities.

Methods: Outpatient adolescents 16-18 years old with a major depressive disorder were included in the First Experimental Study of Transference work in Teenagers (FEST-IT). They were evaluated before and after time-limited psychodynamic psychotherapy with an audio-recorded semi-structured psychodynamic interview. Based on the audio-tapes, raters with different clinical background rated all the available interviews at pre-treatment (n = 66) and post-treatment (n = 30) using PFS. Interrater reliability, the reliability of change ratings and the discriminability from general symptoms were calculated in SPSS.

Results: The interrater reliability was on average good on the relational subscales and fair to good on the dynamic subscales. All pre-post changes were significant, and the analyses indicated discriminability from general symptoms. The interrater reliability on PFS (mean) and Global Assessment of Functioning were good to excellent.

Conclusion: Based on the interrater reliability in our study, PFS could be recommended in psychotherapy with adolescents by experienced clinicians without extensive training. From the post-treatment evaluations available, the scales seem to capture statistically and clinically significant changes. However, the interrater reliability on dynamic subscales indicates that subscales of PFS might be considered revised or adjusted for adolescents.Trial registration First Experimental Study of Transference-Work-In Teenagers (2011/1424 FEST-IT). ClinicalTrials.gov Identifier: NCT01531101.

Keywords: Adolescent; Outcome; Rating scales; Short-term psychodynamic psychotherapy (STTP).

References

    1. Green J. Editorial: process to progress? Investigative trials, mechanism and clinical science. J Child Psychol Psychiatry. 2015;56(1):1–3. doi: 10.1111/jcpp.12377.
    1. Von Below C. When psychotherapy does not help…and when it does: lessons from young adults’ experiences of psychoanalytic psychotherapy. Stockholm: Stockholm University; 2017.
    1. Arain M, Haque M, Johal L, Mathur P, Nel W, Rais A, et al. Maturation of the adolescent brain. Neuropsychiatr Dis Treat. 2013;9:449–461.
    1. Reyna VF, Chapman SB, Dougherty MR, Confrey JE. The adolescent brain: Learning, reasoning, and decision making. Washington, DC: American Psychological Association; 2012.
    1. O’Keeffe S, Martin P, Goodyer IM, Wilkinson P, Consortium I, Midgley N. Predicting dropout in adolescents receiving therapy for depression. Psychother Res. 2017
    1. Ormhaug SM, Jensen TK. Investigating treatment characteristics and first-session relationship variables as predictors of dropout in the treatment of traumatized youth. Psychother Res. 2018;28(2):235–249. doi: 10.1080/10503307.2016.1189617.
    1. Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, 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. The Lancet Psychiatry. 2016
    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. Crits-Christoph P, Connolly Gibbons MB, Mukherjee D. Psychotherapy process-outcome research. In: Lambert MJ, editor. Bergin and Garfield’s handbook of psychotherapy and behavior change. Hoboken: Wiley; 2013.
    1. Johansson P, Hoglend P, Ulberg R, Amlo S, Marble A, Bogwald KP, et al. The mediating role of insight for long-term improvements in psychodynamic therapy. J Consult Clin Psychol. 2010;78(3):438–448. doi: 10.1037/a0019245.
    1. Shedler J. The efficacy of psychodynamic psychotherapy. Am Psychol. 2010;65(2):98–109. doi: 10.1037/a0018378.
    1. Abbass AA, Rabung S, Leichsenring F, Refseth JS, Midgley N. Psychodynamic psychotherapy for children and adolescents: a meta-analysis of short-term psychodynamic models. J Am Acad Child Adolesc Psychiatry. 2013;52(8):863–875. doi: 10.1016/j.jaac.2013.05.014.
    1. Johnston C, Gowers S. Routine outcome measurement: a survey of UK child and adolescent mental health services. Child Adolesc Ment Health. 2005;10(3):133–139. doi: 10.1111/j.1475-3588.2005.00357.x.
    1. Deighton J, Croudace T, Fonagy P, Brown J, Patalay P, Wolpert M. Measuring mental health and wellbeing outcomes for children and adolescents to inform practice and policy: a review of child self-report measures. Child Adolesc Psychiatry Ment Health. 2014;8:14. doi: 10.1186/1753-2000-8-14.
    1. Fonagy P, Target M, Steele H, Steele M. Reflective-functioning manual version 5.0 for application to adult attachment interviews. London: University College London; 1998. pp. 161–162.
    1. Lingiardi V, McWilliams N, Bornstein RF, Gazzillo F, Gordon RM. The Psychodynamic Diagnostic Manual Version 2 (PDM-2): assessing patients for improved clinical practice and research. Psychoanal Psychol. 2015;32(1):94–115. doi: 10.1037/a0038546.
    1. Arbeitskreis OPDKJ. OPD-KJ-2-Operationalisierte Psychodynamische Diagnostik im Kindes-und Jugendalter. Grundlagen und Manual. Bern: Huber; 2013.
    1. Shedler J, Westen D. The Shedler–Westen assessment procedure (SWAP): making personality diagnosis clinically meaningful. J Pers Assess. 2007;89(1):41–55. doi: 10.1080/00223890701357092.
    1. DeWitt KN, Milbrath C, Simon NM. Wallerstein’s Scales of Psychological Capacities: a clinically useful measure of character change. Psychoanal Psychol. 2018;35(1):115–126. doi: 10.1037/pap0000139.
    1. Greenfield B, Filip C, Schiffrin A, Bond M, Amsel R, Zhang X. The Scales of psychological capacities: adaptation to an adolescent population. Psychother Res. 2012;23:232–246. doi: 10.1080/10503307.2012.735776.
    1. Wells MG, Burlingame GM, Lambert MJ, Hoag MJ, Hope CA. Conceptualization and measurement of patient change during psychotherapy: development of the Outcome Questionnaire and Youth Outcome Questionnaire. Psychotherapy. 1996;33(2):275–283. doi: 10.1037/0033-3204.33.2.275.
    1. Høglend P, Bøgwald KP, Amlo S, Heyerdahl O, Sørbye O, Marble A, et al. Assessment of change in dynamic psychotherapy. J Psychother Pract Res. 2000;9(4):190–199.
    1. Jones E. Manual for the psychotherapy process Q-set. Unpublished manuscript. Berkeley: University of California; 1985.
    1. Jones EE, Windholz M. The psychoanalytic case study: toward a method for systematic inquiry. J Am Psychoanal Assoc. 1990;38(4):985–1015. doi: 10.1177/000306519003800405.
    1. Ablon JS, Jones EE. On analytic process. J Am Psychoanal Assoc. 2005;53(2):541–568. doi: 10.1177/00030651050530020201.
    1. Bøgwald K-P, Dahlbender RW. Procedures for testing some aspects of the content validity of the Psychodynamic Functioning Scales and the Global Assessment of Functioning Scale. Psychother Res. 2004;14(4):453–468. doi: 10.1093/ptr/kph038.
    1. Aas IH. Guidelines for rating Global Assessment Of Functioning (GAF) Ann Gen Psychiatry. 2011;10:2. doi: 10.1186/1744-859X-10-2.
    1. Derogatis L. SCL-90-R: Administration, scoring and procedure manual. Towson: Clin Psychom Research; 1983.
    1. Ulberg R, Hersoug AG, Hoglend P. Treatment of adolescents with depression: the effect of transference interventions in a randomized controlled study of dynamic psychotherapy. Trials. 2012;13:159. doi: 10.1186/1745-6215-13-159.
    1. Midgley N, Rhode M, Rustin M, Hughes C, Cregeen S. IMPACT group: short-term psychoanalytic psychotherapy (STPP) for adolescents with moderate or severe depression: a treatment manual. Cambridge: IMPACT trial Office; 2010.
    1. Grøholt B. Medikamentell behandling av depresjon hos barn og ungdom. Tidsskrift Nor Legeforen. 2011;131(22):2243–2245. doi: 10.4045/tidsskr.10.0282.
    1. Aas M. Global Assessment of Functioning (GAF): properties and frontier of current knowledge. Ann Gen Psychiatry. 2010
    1. Hilsenroth MJ, Ackerman SJ, Blagys MD, Baumann BD, Baity MR, Smith SR, et al. Reliability and validity of DSM-IV axis V. Am J Psychiatry. 2000;157(11):1858–1863. doi: 10.1176/appi.ajp.157.11.1858.
    1. Rytilä-Manninen M, Fröjd S, Haravuori H, Lindberg N, Marttunen M, Kettunen K, et al. Psychometric properties of the symptom checklist-90 in adolescent psychiatric inpatients and age-and gender-matched community youth. Child Adolesc Psychiatry Ment Health. 2016;10:23. doi: 10.1186/s13034-016-0111-x.
    1. Derogatis LR, Unger R. Symptom checklist-90-revised. Hoboken: Wiley; 2010.
    1. Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories—IA and -II in psychiatric outpatients. J Pers Assess. 1996;67(3):588–597. doi: 10.1207/s15327752jpa6703_13.
    1. Wang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Revista brasileira de psiquiatria. 2013;35(4):416–431. doi: 10.1590/1516-4446-2012-1048.
    1. Malan D. The frontier of brief psychotherapy. New York: Plenum Press; 1976.
    1. Sifneos PE. Short-term anxiety-provoking psychotherapy: a treatment manual. New York: Plenum Press; 1992.
    1. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86(2):420–428. doi: 10.1037/0033-2909.86.2.420.
    1. Cicchetti D. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instrument in psychology. Psychol Assess. 1994;6:284. doi: 10.1037/1040-3590.6.4.284.
    1. Fleiss JL. Statistical methods for rates and proportions. Hoboken: Wiley; 1981.
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–174. doi: 10.2307/2529310.
    1. Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59(1):12–19. doi: 10.1037/0022-006X.59.1.12.
    1. Midgley N, Kennedy E. Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base. J Child Psychother. 2011;37(3):232–260. doi: 10.1080/0075417X.2011.614738.
    1. Kazdin AE. Understanding how and why psychotherapy leads to change. Psychother Res. 2009;19(4–5):418–428. doi: 10.1080/10503300802448899.
    1. Kazdin AE. Mediators and mechanisms of change in psychotherapy research. Annu Rev Clin Psychol. 2007;3:1–27. doi: 10.1146/annurev.clinpsy.3.022806.091432.
    1. Beutler LE. Making science matter in clinical practice: redefining psychotherapy. Clin Psychol Sci Pract. 2009;16(3):301–317. doi: 10.1111/j.1468-2850.2009.01168.x.
    1. Beutler LE, Someah K, Kimpara S, Miller K. Selecting the most appropriate treatment for each patient. Int J Clin Health Psychol. 2016;16(1):99–108. doi: 10.1016/j.ijchp.2015.08.001.
    1. Wampold BE. The Great psychotherapy debate: models, methods, and findings. Mahwah: L. Erlbaum Associates; 2001.
    1. Mander J. The individual therapy process questionnaire: development and validation of a revised measure to evaluate general change mechanisms in psychotherapy. Clin Psychol Psychother. 2015;22(4):328–345. doi: 10.1002/cpp.1892.
    1. Cuijpers P, Li J, Hofmann SG, Andersson G. Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: a meta-analysis. Clin Psychol Rev. 2010;30(6):768–778. doi: 10.1016/j.cpr.2010.06.001.
    1. Uher R, Perlis RH, Placentino A, Dernovšek MZ, Henigsberg N, Mors O, et al. Self-report and clinician-rated measures of depression severity: can one replace the other? Depress Anxiety. 2012;29(12):1043–1049. doi: 10.1002/da.21993.

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