Interaction Structures in Psychodynamic Psychotherapy for Adolescents

Abstract

Despite advances in psychotherapy research showing an evidence-base for psychodynamic psychotherapy (PDT) in adolescents, developmentally specific treatment characteristics are under-researched. We aimed to identify interaction structures (IS: reciprocal patterns of in-session interactions involving therapist interventions, patient behaviors, and the therapeutic relationship) and assess associations between IS and outcome. The study cohort comprised 43 adolescents (Mage = 13.02 years) with nonclinical, internalizing, and comorbid internalizing–externalizing problems in PDT. A total of 123 sessions from different treatment phases were rated based on the Adolescent Psychotherapy Q-Set (APQ). Outcome was assessed with the Brief Problem Monitor-Youth (BPM-Y) administered repeatedly over the treatment course. Principal component analysis of APQ items resulted in five IS, named “Negative Therapeutic Alliance”, “Demanding Patient, Accommodating Therapist”, “Emotionally Distant Resistant Patient”, “Inexpressive Patient, Inviting Therapist”, and “Exploratory Psychodynamic Technique” (EPT). Multilevel modeling analyses with Bayesian Markov chain Monte Carlo (MCMC) estimations indicated a two-way interaction effect between EPT and problem levels at baseline such that patients with lower problems at baseline showed good outcome in the context of EPT, whereas an inverse relationship was found for patients with higher problems. Findings provide empirical evidence for characteristic components of PDT for adolescents and preliminary answers about who benefits from psychodynamic techniques.

An Integrated Therapeutic Approach To Enhance Quality of Life: A Case Study

“…Human psychology emphasises compassionate therapy environments to promote self-discovery and human growth (Rebillon et al, 2023). Multiple therapy methods help comprehend people's psychological needs and provide a more thorough treatment strategy (Can & Halfon, 2021).…”

Examining Psychotherapeutic Processes with Depressed Adolescents: A Comparative Study of Two Psychodynamic Therapies

“…In another study, Can and Halfon [ 16 ] examined interaction structures within a psychodynamic treatment and how these interaction structures might affect outcome. They included a heterogeneous population of 43 young people and conducted a principal component analysis of the 100 APQ items over 123 sessions, which resulted in five interaction structures: Negative Therapeutic Alliance Demanding Patient, Accommodating Therapist Emotionally Distant Resistant Patient Inexpressive Patient, Inviting Therapist Exploratory Psychodynamic Technique” (EPT).…”

“…None of the interaction structures was found to have a direct effect on symptom change. However, a two-way interaction effect between problem levels at baseline and EPT came forth; patients with higher problems at baseline showed poor outcome in EPT, whilst patients with lower problems at baseline showed good outcome in EPT [ 16 ]. Can and Halfon [ 16 ] did not use Q-analysis, hence the interaction structures they present are less comparable to those found in the other APQ studies using Q-analysis.…”