Resistance and countertransference in child and adolescent psychotherapy

Countertransference brings to light the influence of both anxiety and family processes on the child's or adolescent's maturation and character development. The significance of developmental, dynamic, and family-interpersonal factors have all been stressed as part of the latent communication inherent in resistance. Family influences on resistance and countertransference have to be the subject of analytic scrutiny. The engagement of children and adolescents in the therapeutic process seriously threatens parents' defensive operations both as couples and as individuals. Countertransference responses afford the opportunity not only to clarify the meaning of resistances but also to pinpoint anxieties that have been reexperienced by the child or adolescent with the analyst at points of threat and disorganization. The twofold therapeutic task with children and adolescents consists of delineating and counteracting the family's negative impact on the child's development and self, in addition to addressing the children's contribution to their own pathological traits and immaturities. Countertransference anxiety confirms the dynamic and family implications of the analyst's participation with the patient. Countertransference resistance suggests the analyst's lack of openness in investigating how the treatment has evoked the child's anxiety, the parent's anxiety, and the analyst's anxiety. Resistance-transference-countertransference exchanges reveal the child's or adolescent's efforts to move towards health while emerging from the internalized family.     

Discussing the therapeutic setting in child and adolescent psychoanalytic psychotherapy

The aim of this paper is to contribute to a debate on the particular characteristics of the therapeutic setting in child and adolescent psychoanalytic psychotherapy and its differences from the setting in adult therapy. In our opinion, there is a fundamental difference between these two, as in child and adolescent psychotherapy two distinct aspects co-exist and in some areas, overlap. In this paper, we attempt to delineate these two aspects, following Green’s division of the analytical setting into the active matrix and the casing. We propose that in child and adolescent psychotherapy the therapeutic contract, the active matrix, concerning the necessary conditions for making a therapy psychoanalytic – namely, the therapist’s free-floating attention and the patient’s free associations – is agreed between the therapist and the child/adolescent. We argue that in contrast, the contract regarding the casing – the timings of sessions, the fees and so on – is agreed primarily with the parents or carers of the child/adolescent. Ruptures and possible modifications in both the matrix and the casing of the setting are discussed through the presentation of clinical material.     

Grounded Theory methods in child psychotherapy research

This article considers the place of qualitative research in psychoanalysis and child psychotherapy. It discusses why research methodology for many years occupied so small a place in these fields, and examines the cultural and social developments since the 1960s which have changed this situation, giving formal but also qualitative methods of research much greater significance. It reflects on the different pressures to develop explicit research methods which arise both from outside the psychoanalytic field, as a condition of its continued professional survival, and from within it, where its main aim is the development of fundamental psychoanalytic knowledge. It suggests that the conduct of mainly quantitative research into treatment outcomes is largely a response to these external pressures, whilst the main benefits to be gained from the development of qualitative research methods, such as Grounded Theory, are in facilitating the knowledge-generating capacities and achievements of child psychotherapists themselves. The paper describes Grounded Theory methods, and explains how they can be valuable in the recognition of hitherto unrecognised meanings and patterns as these are made visible in clinical practice. Finally, it briefly describes three examples of completed doctoral studies, all of which have added significantly to the knowledge-base of child psychotherapy, and which demonstrate how much can be accomplished using this method of research.     

Planned short-term psychotherapy: Current status and future challenges

The history and rationale of planned short-term psychotherapy is reviewed in the process of considering its optimal future development. To judge by the early literature on the topic, planned short-term psychotherapy (often as short as one session) began either as an interesting anomaly or as a second-best treatment whose justification was the chronic mismatch between the supply and demand of traditional time-unlimited therapy. In recent years, the growing appeal and remarkable effectiveness of brief psychotherapy have been repeatedly documented, and the field is now achieving all the hallmarks of a professional subspecialty in its own right. Future development of planned short-term psychotherapy will depend on recruiting young mental-health professionals who have been trained in short-term therapy techniques, in encouraging increased flexibility in planning the therapeutic enterprise, and in rewarding therapeutic effectiveness and efficiency.     

The lab versus the clinic. Effects of child and adolescent psychotherapy.

Four recent meta-analyses, involving more than 200 controlled outcome studies, have shown consistent evidence of beneficial therapy effects with children and adolescents. However, most of the studies involved experimental procedures, nonreferred subjects, specially trained therapists with small caseloads, and other features that may not represent conventional clinic therapy. Research focused on more representative treatment of referred clients in clinics has shown more modest effects; in fact, most clinic studies have not shown significant effects. Interpretation studies have not shown significant effects. Interpretation of these findings requires caution; such studies are few and most could profit from improved methodology. The clinic studies do raise questions as to whether the positive lab findings can be generalized to the clinics where most therapy occurs; however, the lab interventions that have worked so well may point the way to enhanced therapy effects in clinics.     

The research agenda: the vital need for empirical research in child psychotherapy

In this paper I shall describe how work discussion groups offered to staff on-site as part of a mental health in schools outreach project can have a significant impact on the thinking, attitudes and culture within a school. Through the use of some detailed examples of these work discussion groups in action, I hope to illustrate the way these groups can enable staff to enhance their observational skills, develop a deeper understanding of the factors that impact on learning, behaviour and teaching, and reduce staff stress. Finally, I hope to highlight the ways in which such groups not only extend staff skills in engaging with pupils at risk of emotional breakdown and school exclusion, but can also promote a learning environment for all, in which development and growth is promoted at a personal, professional and whole-school level.     

Working with the complexities of adolescent mental health problems: applying time-limited adolescent psychodynamic psychotherapy (TAPP)

This article discusses the application in a CAMHS setting of a distinctive intervention for adolescent mental health difficulties, time-limited adolescent psychodynamic psychotherapy (TAPP). TAPP has been developed specifically for working with adolescents and the characteristic developmental and psychosocial complexities they present to mental health services. It is widely recognised that supporting the developmental process in adolescence is central to therapeutic interventions and the therapeutic aim of TAPP is to enable recovery of the capacity to meet developmental challenges. The key factors of TAPP are described, including the formulation and working with a developmental focus, the therapeutic stance, working with transference and counter-transference, working with time limits, and the emphasis is placed on engagement of adolescents in therapy in TAPP. The experiences of introducing and developing TAPP in the CAMHS service are discussed with two brief and one extended case examples and this leads to a discussion of the kinds of outcomes achieved. It is concluded that TAPP is a key and relevant intervention for adolescents in complex and vulnerable situations; further work will be undertaken to continue its application in these settings and to formally assess outcomes.     

Current status of psychological research in organ transplantation

Research addressing the psychological concomitants of organ transplantation is reviewed. Specifically, cognitive, behavioral, and psychosocial correlates of kidney, heart, liver, and bone marrow transplantation in both children and adults are discussed. Despite several conceptual and methodological shortcomings of the psychologically-based research in this area, results seem to indicate that organ transplantation is associated with many psychological issues at pretransplantation, posttransplantation, and follow-up periods. Implications of these general findings for the advancing roles of the health psychologist in organ transplantation are discussed.     

Systems theory and psychotherapy

All systems behave, interact, vary in their level of complexity, and are related in subsystem-suprasystem hierarchical relationships. The behaviour of the whole system is more complex than the sum of its parts. Systems are seen to evolve in complexity along a continuum from nonliving matter, to simple living matter with the ability to reproduce itself, and on to organisms with increasing levels of complexity and consciousness.     

Narrative in psychotherapy theory,practice, and research: A critical review

This paper offers a critical review of narrative approaches to therapy, in terms of theory, practice and research. It proposes that narrative approaches currently lack a theory that explains adequately how the reworking of narratives brings about changes and how a client's various narratives are integrated. Research approaches to the study of narrative in therapy are at an early stage. A review of current research into narrative approaches to therapy is presented, and suggestions are offered for further research.     

Importance of developmental theory and investigation to research in clinical child psychology

Focuses on the developmental periods of infancy, childhood, and adolescence to offer illustrations of the advantages of using developmental theory and research to establish targets for research on intervention, assessment and treatment planning, and evaluation of effective strategies for prevention of childhood and later adult disorders. The importance for training clinical graduate students in developmental approaches to research is stressed, and hopes for a future of mutual contributions of developmental and clinical psychology are expressed in light of the fact that, after a troubled history of isolation from one another and even active denigration of one another's goals and methods, developmental and clinical psychology are exhibiting joint recognition of the advantages of collaborative research.