| dc.description.abstract | Background: Depression seems to be a growing problem among adolescents and is one of the leading causes of illness and disability in the age group 15-19 years. When followed into adulthood, adolescents with onset depression are twice as likely to have major depressive episodes, five times more likely to attempt suicide, and are at increased risk for death by suicide. Psychotherapy research on adolescent is scarce compared to research on adults, although the field has grown in the past few decades. Now, a vast number of outcome studies has established that psychotherapy is an effective way to treat many adolescents struggling with mental health problems. However, there are still major gaps in research-based knowledge on what it is in the process of psychotherapy for adolescents that contributes to successful outcome. In the present study our aim is to identify both which patients, but mainly what processes are associated with good outcome in fully completed, successful short-term psychodynamic psychotherapies for depressed adolescents. Methods: A search was conducted in data from The First Experimental Study of Transference Work–In Teenagers (FEST-IT) (Ulberg et al, 2012) for patients who show clinical change and had completed the offered treatment. These were compared with the rest of the FEST-IT population on pre-treatment variables, and various outcome measures after treatment. Using audio recordings, 3 sessions were coded from each selected therapy (24 sessions all together), representing early, middle and late phase, by the use of Adolescent Psychotherapy Q-Set (APQ), a pan-theoretical process measure that allows for an investigation of entire sessions, capturing the contribution of the patient, the therapist and the interaction between in a clinical meaningful way and in a form suitable for quantitative comparison and analysis. Q-factor analysis was then used to identify repeating mutually influencing interactions between patient and therapist (interaction structures). Results: Eight patients met the inclusion criteria. No significant differences were found between these and the rest of the patients on pre-treatment variables. Differences were found in the perceived satisfaction with and change after therapy. The Q-analysis evidenced two interaction structures, one explained 45 percent of the variance in the material, indicating that the successful therapies shared important features: active use of psychodynamic techniques, strong and trusting therapeutic relationship, actively engaged young person. Self-image and interpersonal relationship where topics in the sessions. The young person in the other interaction structure was disengaged and indifferent, the therapist thoughtful and non-judgmental. In the last phase of therapy only the first interaction structure was present across the efficacious therapies. Conclusion: The use of psychodynamic interventions with depressed adolescents were associated with good outcome. APQ gave clinical meaningful descriptions of the sessions which were characterized by a “trusting working relationship between a vulnerable and actively involved young person who explore interpersonal relationships and a therapist who work with the young person to try make sense of experience and encouraging reflection on internal states and affects”, suggesting that the active ingredients that contribute to successful outcome are a combination of specific and common factors. | eng |