| dc.description.abstract | Background: Mental health difficulties are a growing global problem among young people, and major depressive disorder (MDD) is one of the most prevalent mental disorders within adolescents. However, psychotherapy research concerning adolescents is scarce, and little is known about what characterizes the process and outcome of psychotherapy with youth. Psychodynamic theories suggest the phenomenon of resistance to be an important element in therapy, and it is expected more often in therapy with adolescents. Resistance is thought to have an important impact on the therapeutic process, being one of the primary obstacles to change. However, this therapeutic concept is complex and lack a common definition in literature, making it challenging to study empirically. This study seek to operationalize the concept and will examine the phenomenon of resistance in the initial phase of short-term psychodynamic therapy with depressed adolescents using a measure developed to study psychotherapy process, the Adolescent Psychotherapy Q-Set (APQ). Methods: This study included 56 adolescents aged 16-18 years diagnosed with depression and other psychological difficulties as a part of the First Experimental Study of Transference Work-In Teenagers (FEST-IT). The patients were offered 28 sessions with short-term psychoanalytic psychotherapy. Using audio recordings, one session from the first part of therapy (session three) were coded for all patients using the APQ. Resistance was operationalized based on theory and items from the Q-set. Process and outcome measures from patients, therapists and external raters were conducted before, during and after therapy ended. Statistical analyzes based on these measurements were performed in SPSS to examine relationships between resistance and other factors. Results: Resistance was operationalized based on six items from the Q-set. A statistically significant negative correlation between alliance and resistance was found in the early phase of treatment. Patients were divided into a resistance group and a no-resistance group based on level of resistance as measured by observers on these six items in session three. There were no differences between the groups in expectancies or level of symptoms at pre-treatment. However, the resistance group attended significantly less therapy sessions, consisted of more male patients and had a lower insight score on PFS than the no-resistance group. Also, there was a trend that the patients in the resistance group were somewhat younger, showed less symptom relief post-treatment, higher drop-out, and a lower average PFS score. However, these findings were not significant. Conclusions: The APQ seems to be a meaningful tool for operationalizing and measuring resistance. Results indicate that there are substantial differences between adolescent patients who express high degrees of resistance and those who do not, both concerning the psychotherapeutic alliance, patient characteristics and outcome. Better understanding of resistance as it plays out in the process of psychotherapy, will provide increased comprehension of the complexity regarding this phenomenon in therapy, and hopefully diminish its negative consequences. | eng |