Expert clinicians’ prototypes of an adolescent treatment: Common and unique factors among four treatment models

Abstract

Objective:

To investigate (1) whether expert clinicians within psychodynamic therapy (PDT), mentalization-based treatment (MBT), cognitive-behavioral therapy (CBT), and interpersonal psychotherapy (IPT) agree on the essential adolescent psychotherapy processes using the Adolescent Psychotherapy Q-Set (APQ); (2) whether these four session prototypes can be empirically distinguished; and (3) whether mentalization is a shared component in expert clinicians’ conceptualizations of these four treatment models.

Method:

Thirty-nine raters with expertize in PDT, MBT, CBT, and IPT provided ratings of the 100 APQ items to characterize a prototypical session that adheres to the principles of their treatment model. A Q-factor analysis with varimax rotation was conducted.

Results:

Expert clinicians reached a high level of agreement on their respective session prototypes, which loaded onto five independent factors. The PDT session prototype straddled two different factors, suggesting more variability in PDT expert clinicians’ understanding of PDT process for adolescents than in the views of the expert clinicians representing the other treatment models. Mentalization process was shared among all four session prototypes; however, the correlation between the CBT and IPT session prototypes remained significant after controlling for the MBT session prototype.

Conclusions:

Researchers can now assess adherence to four adolescent treatments and identify change processes beyond these labels.

Keywords:

• Adolescent Psychotherapy Q-Set (APQ)
• psychotherapy process
• session prototypes
• mentalization
• comparative psychotherapy

Acknowledgements

The 10 PDT expert clinicians, 10 MBT expert clinicians, 10 CBT expert clinicians, and nine IPT expert clinicians deserve special recognition for offering their valuable time to complete the prototypical Q-sorts. The author wishes to thank Valeda Dent for her indispensable assistance with acquiring references.

Disclosure statement

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

Additional information

Funding

This research was supported by a generous grant from the International Psychoanalytical Association.