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.

KEYWORDS:

• Adolescence
• psychotherapy process
• psychoanalytic psychotherapy
• case study
• dropout
• STPP

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical considerations

Ethical approval for the IMPACT and IMPACT-ME studies was granted by the Cambridgeshire 2 Research Ethics Committee (reference 09/H0308/137). Written informed consent was obtained from all participants in the IMPACT and IMPACT-ME studies. To ensure anonymity, identifiable details in the data have been removed or disguised and a pseudonym has been assigned to the participant.

Additional information

Funding

The current study was carried out without funding but involved secondary analysis of data from the IMPACT study, which was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project number 06/05/01). The views expressed in this publication are those of the authors and do not necessarily reflect those of the NIHR.

Notes on contributors

Jasmin Meier

Jasmin Meier is a child and adolescent psychotherapist. She completed the Independent Child Psychotherapy training, jointly run by IPCAPA, the Anna Freud Centre and UCL. The published study is part of her doctoral thesis. She currently works as a child and adolescent psychotherapist in a CAMHS service in north west London.

Nick Midgley

Nick Midgley is a child and adolescent psychotherapist and Professor of Psychological Therapies with Children and Young People at UCL. He is also the Academic Director of the Independent Child Psychotherapy training, a collaboration between IPCAPA, the Anna Freud Centre and UCL. As well as his work on the IMPACT study, Nick’s recent research includes the development and testing of an internet-based psychodynamic therapy for depressed teens (the D:OTS study) and the NIHR-funded Reflective Fostering Study, a randomised clinical trial to evaluate the impact of a mentalization-based support programme for foster carers. He is also the chief investigator for the ERiC (Emotion Regulation in Children) Study, a clinical trial evaluating the effectiveness of mentalization-based treatment for school-age children with mixed emotional and behavioural difficulties, funded by the Kavli Trust, and due to launch in CAMHS early in 2023.

Sally O’Keeffe

Sally O’Keeffe is a post-doctoral research associate at Newcastle University. She is a Mental Health Fellow for the NIHR Applied Research Collaboration in the North East and North Cumbria. Her research focuses on mental health support for children and families, and she has a particular interest in interventions for young people who self-harm.

Lisa Thackeray

Lisa Thackeray is a post-graduate research tutor at the Anna Freud Centre where she supervises MSc and doctoral students. She specialises in qualitative research methods, particularly Interpretative Phenomenological Analysis, working in the field of child, adolescent and family mental health.