The Evidence-Base for Psychodynamic Psychotherapy With Children and Adolescents: A Narrative Synthesis

Abstract

Despite a rich theoretical and clinical history, psychodynamic child and adolescent psychotherapy has been slow to engage in the empirical assessment of its effectiveness. This systematic review aims to provide a narrative synthesis of the evidence base for psychodynamic therapy with children and adolescents. Building on two earlier systematic reviews, which covered the period up to 2017, the current study involved two stages: an updated literature search, covering the period between January 2017 and May 2020, and a narrative synthesis of these new studies with those identified in the earlier reviews. The updated search identified 37 papers (28 distinct studies). When combined with papers identified in the earlier systematic reviews, this resulted in a combined total of 123 papers (82 distinct studies). The narrative synthesis of findings indicates that there is evidence of effectiveness for psychodynamic therapy in treating a wide range of mental health difficulties in children and adolescents. The evidence suggests this approach may be especially effective for internalizing disorders such as depression and anxiety, as well as in the treatment of emerging personality disorders and in the treatment of children who have experience of adversity. Both the quality and quantity of empirical papers in this field has increased over time. However, much of the research demonstrates a range of methodological limitations (small sample sizes, lack of control groups etc.), and only 22 studies were Randomized Controlled Trials. Further high-quality research is needed in order to better understand the effectiveness of psychodynamic psychotherapy for children and young people.

Psychotherapy Dropout: Using the Adolescent Psychotherapy Q-Set to Explore the Early In-Session Process of Short-Term Psychodynamic Psychotherapy

“…Short-term psychodynamic psychotherapy (STPP) is effective for treating depression in adults (Leichsenring et al, 2004;Abbass et al, 2014;Steinert et al, 2017), and there is growing evidence that it may be beneficial for adolescents too (Abbass et al, 2013;Midgley et al, 2021). STPP is an umbrella term that captures a range of brief psychodynamic/psychoanalytic therapies that share common goals and processes (Malda Castillo et al, 2020).…”

Interaction Structures in Psychodynamic Psychotherapy for Adolescents

“…Recent reviews on the evidence base of psychodynamic psychotherapy (PDT) with children and adolescents have shown support for the efficacy of PDT for a wide range of mental disorders [ 1 , 2 , 3 , 4 , 5 ]. However, knowledge is limited on the core treatment processes that may answer how PDT with adolescents works and on specific treatment markers which can identify who benefits most from this modality [ 6 ].…”

“…While the evidence base for adolescent PDT grows, recent studies have underscored the specific predictors and differential therapeutic responses to child–adolescent PDT [ 1 , 3 , 4 ]. Emotional and internalizing problems respond better to psychotherapy than those with disruptive disorders and adolescents with more severe psychopathology [ 14 , 15 , 16 , 17 ].…”

Mediators in Psychological Treatments for Anxiety and Depression in Adolescents and Young People: A Protocol of a Systematic Review

“…IPT is less studied than CBT but shows promising results for anxiety disorders (although with no superiority compared to other bona fide therapies) ( Markowitz et al, 2014 ). Other treatment approaches such as psychodynamic psychotherapy, acceptance and commitment therapy, or mindfulness have also been used for anxiety and depressive disorders ( Abbass et al, 2013 ; Chi et al, 2018 ; González-Valero et al, 2019 ; Harris and Samuel, 2020 ; Midgley et al, 2021 ).…”

“…Another meta-analysis focused exclusively on mindfulness had moderate effects in reducing depression in young people at post-test ( Chi et al, 2018 ). Regarding psychodynamic therapy, the evidence suggests this approach may be especially effective for treating anxiety and depression in children and adolescents ( Abbass et al, 2013 ; Midgley et al, 2021 ). In order to optimize treatments, one of the main challenges for psychotherapy research is to identify the mechanisms and therapeutic processes that lead to positive outcomes and improvements over the course of psychological treatments.…”