The psychology of depression in young adolescents: A psychoanalytic view of origins, inner workings and implications

Abstract

This paper addresses the phenomenology of childhood depression as understood from the perspective of psychoanalytic child psychotherapy within National Health Service (NHS) practice. Brief time-limited psychotherapy has a promising outcome in working with severely depressed young people when combined with support for parents and careful attention to the child's social and educational context. The currently planned IMPACT study (Improving Mood-Promoting Access to Collaborative Treatment) led by Professor I. Goodyer will provide an opportunity to explore both the effectiveness of short-term therapy for a large cohort of moderate to severely depressed youngsters and also to research models of underlying mental processes and some of the processes of change in psychotherapy (Fonagy, 2009; Rustin, 2009). Child psychotherapy theory and practice is rooted in both psychoanalytic and developmental frames of reference and has been deeply influenced by Bowlby's work. The importance of aggression and particularly aggressive thoughts, both conscious and unconscious, in understanding depression is also fundamental. Two clinical cases are discussed which are typical of those patients seen in NHS child psychotherapy, and of the type of patients who will be seen in the IMPACT trial. They share serious adverse life histories: one with a focus on childhood abuse and the other on neglect and abandonment. The different nature of these traumatic experiences shapes the nature of the depression which can be observed. The importance of attending to the depressive elements of the co-morbid presentation characteristic of Child and Adolescent Mental Health Services (CAMHS) patients also needs to be emphasized. Psychotherapy provides an opportunity for containment of unbearable emotion and for the development of mental function which can serve as a bulwark against further breakdown. The conceptualization draws attention to the loss of personal potency which accompanies depression and the consequent risk of life failure in both work and personal spheres.

Keywords:

• Adolescent depression
• short-term psychotherapy
• adversity
• aggression
• containment
• mental functioning

Acknowledgements

I am indebted to my colleagues Maria Rhode and Nick Midgley for their work in our manual writing group, in which the fundamentals of the psychoanalytic child psychotherapy were formulated. I am extremely grateful to those responsible for giving their consent for the publication of this case material. Personal details have been disguised in order to preserve anonymity in both the cases discussed