How to do things with questions: the role of patients’ questions in Short-Term Psychoanalytic Psychotherapy (STPP) with depressed adolescents

ABSTRACT

The role of patients’ questions in psychoanalytic psychotherapy is a neglected topic in the clinical and research literature. This qualitative study aims to bridge this gap by exploring the role of patients’ questions in Short-Term Psychoanalytic Psychotherapy (STPP) with adolescents suffering from depression. This is a single case study, focusing on the interaction between the patient and his therapist when questions were asked by the patient, using conversation analysis methodology. Data was taken from the IMPACT study, a randomised controlled trial, investigating three types of therapy in the treatment of adolescent depression. The findings identify some typical ways in which the therapist responded to the patient’s questions, and show that ‘surprising behaviours’ that seem associated with heightened affect appeared when the patient asked a question, leading to an enlivening of the therapeutic interaction. The study examines the significance of these findings within the context of the therapeutic relationship and discusses the implication of these findings for technique.

KEYWORDS:

• Questions
• short-term psychotherapy
• adolescence
• depression
• conversation analysis
• IMPACT study
• youth psychotherapy
• psychoanalytic

Acknowledgments

The original IMPACT study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA), and the IMPACT-ME study was funded by the Monument Trust. The authors would like to thank everyone who was involved in the original projects, especially the families who participated in the studies. The views expressed in this publication are those of the authors and do not necessarily reflect those of the Monument Trust, the HTA programme, NIHR UK, National Health Service or the Department of Health, UK.

Disclosure statement

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

Correction Statement

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

Notes

1. The name is a pseudonym selected by the authors for this study.

2. This refers to questions that demand that the therapist elaborate on her previous utterance, without adding any new interpretations/ideas. Questions such as, ‘What do you mean?’ were omitted from this research, but questions such as, ‘Did you mean that I was depressed?’ were not omitted. Whilst the former question solely asked for clarification, the latter added the idea of depression.

Additional information

Notes on contributors

Yael Yadlin

Yael Yadlin is a child and adolescent psychotherapist, currently working at Open Door Young people’s consultation service in Haringey, North London. This paper is based on research undertaken as part of her doctoral training as a child and adolescent psychotherapist at IPCAPA, the Anna Freud Centre and UCL.

Elizabeth Edginton

Elizabeth Edginton is a Child and Adolescent Psychotherapist who works at the University of Warwick Counselling and Psychology Interventions Team and in private practice. Elizabeth co-supervised the clinical doctorate on which this article is based while Research Tutor at the Anna Freud Centre for Children and Families, was Chief Investigator on TIGA-CUB, an NIHR funded feasibility RCT for children aged 5-11 with treatment resistant conduct disorders and their parents, has also worked in CAMHS, and was formerly a university lecturer.

Georgia Lepper

Georgia Lepper was a practicing psychoanalytic psychotherapist before training in Conversation Analysis and focusing on psychotherapy research. She was Senior Lecturer in Psychotherapy at the University of Kent and is the author of two research methods textbooks.

Nick Midgley

Nick Midgley is Professor of Psychological Therapies with Children and Young People at UCL, and director of the Child Attachment and Psychological Therapies Research Unit (ChAPTRe) at UCL/Anna Freud Centre. He is also Academic Director of the Independent Training, a collaboration between IPCAPA at the British Psychotherapy Foundation, the Anna Freud Centre and UCL. Nick was chief investigator on the IMPACT-ME study, exploring the experience of young people who took part in the IMPACT clinical trial, and co-authored Short-Term Psychoanalytic Psychotherapy For Adolescents with Depression: A Treatment Guide (Cregeen et al., 2016). Other books include Reading Anna Freud (Routledge, 2012), Mentalization-Based Treatment for Children: A Time-Limited Approach (APA, 2017), Essential Research Findings in Child and Adolescent Counselling and Psychotherapy (Sage, 2017) and Ideal-Type Analysis: A Qualitative Approach to Constructing Typologies (APA, 2021).