Creating distance from adolescents’ anger: psychotherapists’ responses to conversational trouble in Short Term Psychoanalytic Psychotherapy

ABSTRACT

The exploration of negative feelings is one of the core principles of psychoanalytic psychotherapy, yet anger experienced towards the therapist may lead to increased risk, ruptures in the therapeutic relationship and dropout. This study explored the psychotherapists’ immediate responses to patients’ anger in Short Term Psychoanalytic Psychotherapy (STPP). Data came from a randomised controlled trial investigating the efficacy of three types of therapy in the treatment of adolescent depression, in which therapy sessions were audio-recorded. Purposive sampling was used to select ten extracts from four different patient-therapist couples where patients expressed anger towards their therapist. Those extracts were transcribed and analysed using conversation analysis (CA). The analysis showed that following patients’ anger expression, psychotherapists were inclined to create distance either by moving aside from the topic of conversation, or by referring to ‘other times’, past or future. In only one out of the ten extracts did the psychotherapist name the young person’s anger towards them in the moment. In all other cases, psychotherapists commented on patients’ latent feelings of anger, but were inclined to create distance from explicit and direct anger-expressions. Possible reasons for this are explored, along with both clinical and research implications.

KEYWORDS:

• Anger
• Short Term Psychoanalytic Psychotherapy
• adolescence
• depression
• conversation analysis

Acknowledgments

We are indebted to all the anonymous families, young people and child psychotherapists who took part in the original IMPACT study.

We would also like to thank Ana Calderon for sharing with us her database of cases scored using the APQ, as well as Nick Midgley and Sally O’Keeffe for their advice and support in accessing and using IMPACT data, particularly during the initial stages of data selection. Finally, we are grateful to Margaret Rustin for her valuable comments and suggestions and for helping us improve an earlier version of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical considerations

Sessions were anonymised and all recordings were encrypted to protect the confidentiality of the material. Access to sensitive data was obtained only for the sessions selected for this study. No identifying details of the young people were shared.

Permission for this study was granted by the IMPACT Principal Investigator at the Tavistock & Portman Trust in accordance with the ethical agreement between the IMPACT trial and the National Research Ethics Service Committee East of England – Cambridge Central. The study was further approved by the Tavistock Research Ethics Committee (permission granted on 13^th May 2019).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Notes

1. Improving Mood with Psychoanalytic and Cognitive Therapies.

2. Young Person.

3. The therapist’s ‘yeah at least you agree with that’ indicates that the patient might have nodded in agreement although we cannot hear her responding verbally to the therapist.

Additional information

Notes on contributors

Eleni Chourdaki

Eleni Chourdaki is a child and adolescent psychotherapist working both as part of a multidisciplinary team and in private practice in Athens, Greece. She has previously worked in CAMHS services within the NHS and in a specialist mental health service for adolescents. She is a member of the Association of Child Psychotherapists. This paper is based on research undertaken as part of her doctoral training at the Tavistock & Portman NHS Foundation Trust and University of Essex.

Jocelyn Catty

Jocelyn Catty is Research Lead for the child and adolescent psychoanalytic psychotherapy Doctoral training at the Tavistock and Portman NHS Foundation Trust. She is co-lead child and adolescent psychotherapist, Bromley CAMHS, and a member of the Association of Child Psychotherapists and the Foundation for Psychotherapy and Counselling. She co-edits the Tavistock Clinic Series, published by Routledge. Jocelyn supervised the original professional doctorate on which this article is based.

Elena Della Rosa

Elena Della Rosa is a child psychotherapist who trained at the Tavistock NHS Trust. She is currently working in private practice and supervises students on their professional doctorate in the child psychotherapy training at the Tavistock NHS Trust. She previously worked in the NHS and as a lecturer at the Department of Psychosocial Studies at the University of Essex. Her research interests are in Conversation Analysis, process research and adolescence. Elena provided external supervision on analysing the data of this study using Conversation Analysis.