Assessment of dynamic change in psychotherapy with adolescents

Abstract

BackgroundDiagnostic interviews and questionnaires are commonly used in the assessment of adolescents referred to child and adolescent mental health services. Many of these rating scales are constructed for adults and focus on symptoms related to diagnosis. Psychodynamic Functioning Scales (PFS) focus on relational aspects and how the patients handle affects and solve problems, rather than manifest symptoms. As these aspects are considered important for mental health, the PFS were developed to assess change in adults, consistent with the relational and intrapsychic concepts of dynamic psychotherapy. The scales describe internal predispositions and psychological resources that can be mobilized to achieve adaptive functioning and life satisfaction. PFS consist of six subscales; the relational subscales Family, Friends and Romantic/Sexual relationships and the dynamic subscales Tolerance for Affects, Insight and Problem-solving Capacity. PFS has been used for the first time as a measure of change in adolescent psychotherapy. This study examines the reliability of PFS when used to assess adolescents’ level of relational functioning, affective tolerance, insight, and problem-solving capacities.MethodsOutpatient adolescents 16–18 years old with a major depressive disorder were included in the First Experimental Study of Transference work in Teenagers (FEST-IT). They were evaluated before and after time-limited psychodynamic psychotherapy with an audio-recorded semi-structured psychodynamic interview. Based on the audio-tapes, raters with different clinical background rated all the available interviews at pre-treatment (n = 66) and post-treatment (n = 30) using PFS. Interrater reliability, the reliability of change ratings and the discriminability from general symptoms were calculated in SPSS.ResultsThe interrater reliability was on average good on the relational subscales and fair to good on the dynamic subscales. All pre-post changes were significant, and the analyses indicated discriminability from general symptoms. The interrater reliability on PFS (mean) and Global Assessment of Functioning were good to excellent.ConclusionBased on the interrater reliability in our study, PFS could be recommended in psychotherapy with adolescents by experienced clinicians without extensive training. From the post-treatment evaluations available, the scales seem to capture statistically and clinically significant changes. However, the interrater reliability on dynamic subscales indicates that subscales of PFS might be considered revised or adjusted for adolescents.Trial registration First Experimental Study of Transference-Work-In Teenagers (2011/1424 FEST-IT). ClinicalTrials.gov Identifier: NCT01531101Electronic supplementary materialThe online version of this article (10.1186/s13034-018-0246-z) contains supplementary material, which is available to authorized users.

The first experimental study of transference work–in teenagers (FEST–IT): a multicentre, observer- and patient-blind, randomised controlled component study

“…One patient was taking antipsychotics throughout the study period. One patient at pre-treatment and 4 patients at post-treatment were taking sleeping medicine [ 14 ].…”

“…Psychodynamic Functioning Scales (PFS) [ 13 ] is a measure developed to capture evaluator-rated dynamic change. PFS has shown promising features when it comes to capture statistically and clinically significant changes in adolescents [ 14 ]. The patient’s functioning during the last three months is rated based on a semi-structured dynamic interview [ 15 ].…”

Dynamic Psychotherapy: The Therapeutic Process in the Treatment of Obsessive-Compulsive Disorder

“…"The normal development in young people, like growth in size, sexual maturity, emotional development, and cognitive capacity, may be potential triggers or amplifiers of psychiatric disorder, or a potential for their subjective quality of life" [29] (p. 2). Sara and Paul grew up with excessive orders and imposition of rules (demands of order, cleanliness and high school performance), making it even more difficult to deal with the challenges of adolescence.…”

“…Dynamic Psychotherapy has traditionally placed emphasis on insight into relationship patterns and processing avoided emotions. This technique aims at helping patients to enhance self-understanding, gaining insight into their lives and present-day problems, which may allow them not only to maintain therapeutic improvements but to continue to improve after the end of treatment [13,29].…”

“…The narrative review conducted in this study identified as the main research lines of Dynamic Psychotherapy (Supplementary Table S1) the treatment of Depressive, Anxiety and Personality Disorders, through an average of 20 weekly sessions focusing on unconscious therapeutic alliance for reaching awareness of hidden feelings and experiences. Through emotional exploration, identification of patters in the patients' life, confrontation of defensive functioning and interpretative interventions about intrapsychic conflicts, the treatments obtained favorable outcomes, with the reduction of symptoms and an increase in patients' quality of life [11,13,14,16,20,[26][27][28][29][30][31].…”