Psychodynamic Psychotherapy with Severely Disturbed Adolescents: Changes in Reflective Functioning

ABSTRACT

Over the last few decades Reflective Functioning (RF) has become an important construct for the understanding and treatment of several patient groups. While RF has been well studied in adult samples, few studies have been conducted on RF in adolescence. The present study is the first examining RF in an adolescent sample of 38 inpatients with comorbid disorders of conduct and emotions. Data were collected in a randomized controlled trial. A severe symptomatology and extremely low RF scores at admission (M = 1.39) characterized the adolescent patient group. RF scores of the clinical sample were significantly lower than those of non-hospitalized adolescent samples. During the inpatient psychodynamic treatment the adolescents’ RF capacities improved significantly (p = .04). The corresponding within-group effect size was medium (r = −0.33). The reported results must be regarded as preliminary because of some limitations of the study. Further research on RF in clinical adolescent samples is essential.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. The AAI is a semistructured interview asking for attachment-related autobiographical memories, which should be evaluated from the interviewee’s current perspective. It was originally developed to assess attachment representations in adults (see George et al., 1996).

2. Hypermentalizing is a special type of RF impairment, characterized by an excessive, but inaccurate mentalizing, i.e. intentions or beliefs are attributed to other people without having appropriate evidence supporting these attributions. This over-attribution of mental states to others often leads to misinterpretation and misunderstanding (Sharp & Vanwoerden, 2015).

3. The study was funded by Förderverein für analytische Kinder- und Jugendpsychotherapie e.V. Krefeld; Gesellschaft zur Förderung Analytischer Kinder- und Jugendlichen-Psychotherapie e.V.; and Vereinigung Analytischer Kinder- und Jugendlichen-Psychotherapeuten in Deutschland e.V. (VAKJP). The study was approved by the ethics committee at the University of Goettingen.

4. Recent studies used the Child Attachment Interview (CAI: Shmueli-Goetz et al., 2008) for the rating of RF in adolescents (Chow et al., 2017; Chow, Shmueli-Goetz, & Fearon, 2014). This interview may be more age-appropriate. However, it did not yet exist when we started data collection (in 2007).

Additional information

Funding

This work was supported by Förderverein für analytische Kinder- und Jugendpsychotherapie e.V. Krefeld; Gesellschaft zur Förderung Analytischer Kinder- und Jugendlichen-Psychotherapie e.V.; and Vereinigung Analytischer Kinder- und Jugendlichen-Psychotherapeuten in Deutschland e.V. (VAKJP).

Notes on contributors

Carola Cropp

Carola Cropp, M.Sc., works as Clinical Psychologist at the Asklepios Clinic Tiefenbrunn, Rosdorf (Germany), Clinic for Child and Adolescent Psychiatry and Psychotherapy. She is PhD candidate at the University of Kassel (Germany) and psychoanalytic candidate at the Lou Andreas-Salomé Institute for Psychoanalysis and Psychotherapy, Goettingen (Germany).

Svenja Taubner

Svenja Taubner is full professor and director of the Institute for Psychosocial Prevention at the University Hospital Heidelberg (Germany) and the current president of the European Chapter of the Society for Psychotherapy Research (SPR). Her research focuses on mentalization and psychotherapy.

Simone Salzer

Simone Salzer, D.Sc., is professor of Clinical Psychology and Psychoanalysis at the International Psychoanalytic University Berlin (Germany).

Annette Streeck-Fischer

Annette Streeck-Fischer, MD PhD, 1993-2013 director of the Clinic for Child and Adolescent Psychiatry and Psychotherapy at the Asklepios Clinic Tiefenbrunn, Rosdorf (Germany). She is professor of Developmental Psychology and Diagnostics at the International Psychoanalytic University Berlin (Germany), and training analyst and supervisor at the Lou Andreas-Salomé Institute for Psychoanalysis and Psychotherapy, Goettingen (Germany).