Short-term psychoanalytic psychotherapy with a depressed adolescent with borderline personality disorder: an empirical, single case study

ABSTRACT

While clinical descriptions of psychotherapy with depressed adolescents with traits of borderline functioning exist, they are not yet supported by empirically-grounded research. This single-case study aims to identify meaningful therapist-patient interaction in the course of short-term psychoanalytic psychotherapy with an adolescent girl who meets diagnostic criteria for both Borderline Personality Disorder (BPD) and Major Depressive Disorder (MDD). Twenty-eight sessions of psychotherapy were coded, using the Adolescent Psychotherapy Q-Set. Five interaction structures were identified, which were distinguished by the nature of the adolescent’s emotional expression during sessions, and how the therapist responded to the young person. Exploration of the clinical and theoretical meaning of these interaction structures suggests that core elements of a young person’s depression and borderline functioning can be identified in sessions, and that the therapeutic process overall shows some significant departures from some of what is usually recognised as a typical psychoanalytic approach. The paper discusses whether these changes in technique can be understood as responses to the clinical challenges associated with working with adolescents with borderline features.

KEYWORDS:

• Adolescence
• psychotherapy process
• psychodynamic psychotherapy
• case study
• depression
• borderline personality disorder

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The IMPACT study 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 HTA programme, NIHR, National Health Service, or the Department of Health. This work was partly funded by the CONICYT PAI/INDUSTRIA 79090016.

Notes on contributors

Miriam Grossfeld

Miriam Grossfeld completed her MSc in Developmental Psychology and Clinical Practice at UCL and the Anna Freud Centre.

Ana Calderón

Ana Calderón, PhD, is a Clinical Psychologist. She has conducted research both in Chile and the UK. Ana’s research mainly focuses on the process and outcome of psychotherapy with adolescents.

Sally O’Keeffe

Sally O’Keeffe, PhD, is a Research Fellow in the School of Health Sciences at City, University of London.

Viviane Green

Viviane Green is an adult, child and adolescent psychotherapist. She is a Senior Lecturer in the Dept of Psychosocial Studies at Birkbeck College.

Nick Midgley

Nick Midgley is a Child and Adolescent Psychotherapist, and Associate Professor in the Research Department of Clinical, Educational and Health Psychology at UCL. He is co-director of the Child Attachment and Psychological Therapies Research Unit (ChAPTRe) at UCL / the Anna Freud Centre, and Academic Programme Director of the IPCAPA child psychotherapy training, a collaboration between UCL, the Anna Freud Centre and the british psychotherapy foundation (bpf).