Psychodynamic Psychotherapy as Treatment for Depression in Adolescence

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Key Points

  • Encouraging indications from research studies are that short-term psychodynamic psychotherapy (STPP) may be effective for the treatment of internalizing disorders and, in particular, child and adolescent depression.

  • Psychodynamic therapy may be the treatment of choice for depressed teenagers with complex, chronic difficulties and comorbidities, whereby the emphasis is on supporting the developmental process more broadly rather than focusing exclusively on a reduction of symptoms.

  • Attentiveness to

Introduction: depression in adolescence

According to a report funded by the World Bank and the World Health Organization,1 depression is the leading cause of disability in the world, with over half of mental health costs in Europe each year going toward the treatment of people suffering from anxiety and depression. Among those suffering from clinical depression, more than 60% report that they first suffered from depression during their teenage years. The outcomes for those who become depressed as adolescents are not encouraging, with

Psychodynamic psychotherapy as a treatment option for depression in adolescence

Compared with some other therapies, psychodynamic treatment has lagged in developing a robust evidence base, but the pace of research is now accelerating.a

A psychoanalytic understanding of the development of depression in adolescence

Josie lives with her birth parents, Mr and Mrs B, and her younger brother Kenny (5 years old). Josie has an older sister Rebecca (19) who recently became engaged and moved in with her fiancé. Mrs B has long-standing mental health difficulties which have affected her capacity to care for her children. Rebecca had been a major caregiver for her younger siblings, a role that Josie was expected to take on for her brother, Kenny, when her older sister started work and became engaged. Josie has a

Two psychoanalytic formulations of depression

Rooted in the work of Freud,19 Abraham,20 and Klein,21 early psychoanalysts offered an understanding of depression as related to loss, guilt and a sense of responsibility for having attacked and damaged the ambivalently loved or lost object. “Object” is a term in psychoanalysis that refers both to significant external figures (particularly parental), and to internal representations of those figures. These internal representations are developed on the basis of lived experiences (especially early

Indications for referral for psychodynamic psychotherapy for adolescent depression

The child psychiatrist who met Josie and her parents immediately after she had taken an overdose concluded that Josie was not at immediate risk of further self harm, but he did think that Josie needed further help. He discussed medication but, based on his assessment, the psychiatrist considered that they should “watch and wait” before deciding whether to go ahead with a course of fluoxetine. Instead he suggested that Josie might be helped by CBT. However, Josie's parents said to the

Developing a psychoanalytic formulation to guide treatment

The initial meetings between Josie and her psychotherapist established that she was a bright, high-achieving girl, whose previously “warm” personality had changed about 6 months before her referral. At the time of the referral, Josie met the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for Major Depression (moderate). Although she was no longer actively suicidal at the time of the therapy assessment, she continued to be depressed, had thoughts about self harm,

The aims of psychodynamic treatment for depressed adolescents

At first Josie couldn't manage without her father or a friend in the therapy room, feeling she didn't know what she felt or how to describe what was happening to her. Only later in the therapy did she feel able to come into the room on her own. Over time she and her therapist came to understand how the onset of adolescence took her unawares, despite her physical maturation. She was not emotionally ready to be a teenager. Now that she was in therapy, she spoke of wanting to find “her old self”

The technique of psychodynamic psychotherapy with depressed young people

Much of Josie's early therapy was conducted in silence. She chose to draw, her drawings being dark and forbidding. There were disturbing scenes of death: decaying cadavers, bloody skulls transfixed by daggers, and wounded bodies with bleeding gashes. Josie seemed absorbed in these images as well as in the process of image making. She seemed to “attack” the paper with pencil and black pens. Her therapist found herself watching and thinking intently, mirroring the intensity of Josie's

Psychodynamic treatment in a multimodal treatment plan

Josie's parents (Michelle and David) were offered a space to meet a “parent worker” separately from Josie's meetings with her therapist. Concerns about the emotional environment in the family and Michelle's own mental health, and consequent multiagency involvement, helped gather and heighten the parents' awareness of the imperative for them to engage in some work themselves. Michelle's initial wariness, fear, and unfamiliarity with emotions being “thinkable about” and put into words, soon gave

Looking to the future in the treatment of depression in adolescents

Josie made good use of therapy, and by the end of the 28 sessions of therapy she no longer met diagnostic criteria for depression. Her scores on the Mood and Feelings Questionnaire57 had changed from 41 (well above the clinical cutoff point) to 26 (just below it). She was more optimistic about life and had plans for the future.

Josie seemed relieved to find containment in her relationship with her therapist—someone who could reflect, make sense of nonverbal communication, and really hear and

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