What Happens in Therapy? Adolescents’ Expectations and Perceptions of Psychotherapy

A measure of adolescent pre-treatment expectations/perceptions of psychotherapy was developed, evaluated, and used to examine adolescent expectancies of psychotherapy. The development of the Psychotherapy Expectations and Perceptions Inventory (PEPI) is described and initial psychometric properties reported. Utilizing a sample of adolescents (N = 546), expectancies of psychotherapy were assessed using the PEPI. Results indicate adequate internal consistency and a 3 factor structure. Specifically, factors identified were labeled (1) measuring negative expectancies, (2) process/outcome expectancies, and (3) expectancies for a positive therapeutic relationship. Boys reported greater negative expectancies, but also greater expectancies for a positive therapeutic relationship. Girls reported greater therapy process/outcome expectancies. Prior contact with mental illness was not related to any studied factors. Clinicians may benefit from assessing adolescent expectancies to facilitate rapport and engagement in the therapy to foster more therapeutic change. Future research that examines the relationships between specific demographic characteristics (e.g., socioeconomic status, race/ethnicity, etc.) and service utilization variables among adolescents is warranted.     

Gender identity disorder in adolescence: outcomes of psychotherapy.

Gender identity disorder (GID) is characterized by strong and persistent cross-gender identification and by persistent discomfort with one's sex. This paper reviews reports of GID in which adolescent psychotherapy patients initially desired sex reassignment. In addition, four case studies of adolescents with GID, demonstrating different outcomes of psychotherapy, are presented. It is concluded that great caution must be exercised when treating adolescents with GID, and that sex reassignment must not be started before patients have reached eighteen years of age.     

Psychotherapy: Definitions, Mechanisms of Action, and Relationship to Etiological Models

In this paper, we define psychotherapy as a modality of treatment in which the therapist and patient(s) work together to ameliorate psychopathologic conditions and functional impairment through focus on the therapeutic relationship; the patient's attitudes, thoughts, affect, and behavior; and social context and development. The possible mechanisms of action and active ingredients of psychotherapy in children and adolescents are discussed, with an emphasis on the above-noted domains. The adult psychotherapy literature strongly supports the central roles of the therapeutic relationship and therapeutic empathy; this has been much less intensively explored in the child and adolescent psychotherapy literature. Similarly, there have been few studies examining the mediation of treatment effects by impact on specific domains. Ideally, treatment studies should gather data that can be informative about the impact of putative mediating and moderating psychosocial and biological variables on outcome and course. The results of such studies can aid further refinements in both theories of etiology and improvement in treatments for children and adolescents.     

Outcomes for Children and Adolescents After Residential Treatment: A Review of Research from 1993 to 2003

The focus of this research review is to determine what factors increase the likelihood that positive individual and systemic changes occur for children and adolescents following discharge from residential treatment. Residential treatment outcome studies from 1993 to 2003 that fulfilled predetermined criteria were located through 4 on-line databases using key word combinations. The research selected was: (a) 7 studies that measured outcome immediately upon completion of treatment and discharge, and (b) 11 studies where outcome progress was assessed at one or more follow-up dates after discharge. Results showed that children and adolescents with severe emotional and behaviour disorders can benefit and sustain positive outcomes from residential treatment that is multi-modal, holistic and ecological in its approach. Similar to the clinical child psychotherapy research, conclusions must be tempered due to the limited number of studies and methodological weaknesses. Future considerations highlight how research results can more realistically reflect intervention effectiveness when elements of the ecological and systemic landscape of care are addressed.     

Motivating institutionalized adolescents for psychotherapy

In the study of psychotherapy, one surely must come to appreciate the importance of client motivation. Intuitively, its value in obtaining a successful outcome would seem unquestioned. Nonetheless, motivation for treatment has not received the attention in the literature that its importance might warrant. This paper deals exclusively with the adolescent and in particular, the institutionalized adolescent. Often members of this population become known as "untreatable cases" and attempts at treatment result in frustration from emotional and economic drain. This paper reviews the literature regarding client motivation, client preferences, and token economies, and offers recommendations for designing a program to increase motivation for psychotherapy in institutionalized adolescents.     

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.     

Changes in adolescent and parent hopefulness in psychotherapy: effects on adolescent outcomes as evaluated by adolescents,parents, and therapists

We examined the role of hope in the behavioral and socioemotional outcomes of adolescents referred to psychotherapy. Adolescents (n = 3517), aged 12–17 years, and their parents rated adolescents’ behavior problems, adolescents’ adaptive behavior, and their own subjective experience of hopefulness at intake and at 3-month follow-up. Therapists also rated adolescents’ behavior problems and adaptive behavior at intake and follow-up. Adolescents who reported increased hopefulness during treatment showed significantly fewer problems and significantly greater adaptive behavior at follow-up than adolescents who reported stable or decreased hopefulness. Similarly, adolescents’ outcomes were significantly associated with parents’ change in hopefulness during treatment. Results were consistent for adolescent, parent, and therapist ratings of outcomes. Our findings provide some of the first empirical evidence for the importance of hopefulness in the psychosocial treatment of adolescents and highlight the need to attend to hopefulness in both youths and their parents.     

Clinical Improvement in Adolescents Comorbid for Substance Abuse and Psychiatric Diagnoses Through Multiple Group Psychotherapy

In a pilot study, the authors examined the outcome of group psychotherapy for the treatment of 19 adolescents, comorbid for substance abuse and psychiatric diagnoses, in terms of symptom reduction. They compared presenting symptomatology of treatment completers with treatment noncompleters. A retrospective study of the outcome of a multiple group psychotherapy treatment program using the Drug Use Screening Inventory-Revised Version (DUSI-R) to assess change over time was conducted. Depressive disorders were the most prevalent psychiatric diagnoses (68%), and marijuana was the substance most commonly abused on a frequent basis. Treatment completers showed improvement in behavior problems, health status, and social competence. As part of an integrated treatment program, multiple group psychotherapy is a promising treatment modality for adolescent patients, comorbid for substance abuse and psychiatric diagnoses, pending further assessment of the complex issues involved in combined treatment.     

Psychotherapy outcome studies do not accurately represent current models of psychotherapy. A proposed remedy

It is argued that the design of contemporary psychotherapy outcome studies is conceptually incompatible with the models of psychotherapy evaluated in those studies. Contemporary outcome studies are incompatible with psychotherapy models because the outcome studies treat patients with standardized treatments that are assigned on the basis of psychiatric diagnosis rather than with individualized treatments based on a theory-driven psychological assessment of the individual's difficulties. One possible remedy, idiographic outcome studies using a case formulation model of assessment and treatment, is proposed here. It is suggested that this research strategy may narrow the scientist-practitioner gap and make it easier to demonstrate differential outcomes of different treatments.     

Community Disadvantage and Adolescent’s Academic Achievement: The Mediating Role of Father Influence

Among adolescents, positive parenting behavior has been found to lessen the negative effects associated with living in an impoverished community. Few studies however, have focused on the association between macro-level community influences and adolescent outcomes, and the possible parenting mechanisms through which this relationship exists. Further, less empirical attention has been directed towards the unique role played by fathers in mediating contextual influences on adolescent outcomes. To address this gap in the literature, using a nationally representative subsample of adolescents, the current study explores the mediating role of father’s school-related involvement and father–adolescent relationship quality on the association between community-level disadvantage and adolescent’s academic achievement. Results from multilevel structural equation modeling revealed a significant relationship between community disadvantage and adolescent’s academic achievement, which was further mediated by aspects of father’s influence. Among other things, findings lend support for a model outlining father’s influence as a mediator of the relationship between contextual factors and adolescent’s academic success.     

延迟折扣及其与青少年物质滥用与成瘾、外化问题的关系

延迟折扣指由于发生时间上的延迟,未来结果的当前价值低于其实际价值或控制当前行为效力下降的心理现象。本文在介绍了延迟折扣的概念及测量方法与指标的基础上,综述了延迟折扣与青少年物质滥用与成瘾、外化问题间关系的研究,发现青少年酗酒者、烟瘾者及网络成瘾者的延迟折扣率高于非成瘾者,而延迟折扣与青少年外化问题之间的关系尚无一致性结论,最后指出了延迟折扣及其与青少年物质滥用与成瘾、外化问题间关系的未来研究方向。     

化危为机：青少年学校转折期的过渡

从生命历程的角度看, 学校过渡是青少年成长过程中的重要发展转折点, 对个体的发展轨迹具有重要影响。先前研究多基于缺陷的视角, 将学校过渡视为充满挑战和风险的危机时期, 并发现青少年在这一时期伴随着各种消极的发展结果。但从青少年积极发展的视角来看, 学校过渡可能是青少年获得适应性的、健康发展的重要机遇, 也是发展可塑性表现最为充分的时期。如果青少年的内部和外部资源能够很好的融合, 他们就有可能获得积极的学校过渡。     

A Multi-Theoretical,Evidence-Based Approach for Understanding and Managing Adolescent Resistance to Psychotherapy

Adolescents are often labeled as “resistant” to psychotherapy. Rather than blaming adolescent clients or psychotherapists, this article conceptualizes adolescent resistance as normal behavior emanating from a challenging situation. Based on a developmentally sensitive foundation and drawing from person-centered, motivational, solution-focused, choice theory, cognitive-behavioral, and multicultural perspectives, several practical and evidence-based strategies for managing, reducing, or eliminating resistance are provided. Case vignettes are used to illustrate specific strategies. Successful psychotherapy with adolescents requires flexibility and openness, integration of diverse theoretical perspectives with contemporary empirical knowledge, and an attitude of respect for adolescent autonomy.     

Interventions for Child and Adolescent Depression: Do Professional Therapists Produce Better Results?

We reviewed and analyzed child and adolescent depression treatment studies (1980–2001) through a comprehensive literature search. The outcome data from 19 studies (31 treatments) were extracted and weighted standard mean effect sizes were computed. Outcomes were compared across two levels of therapist training: professional and graduate student. Moreover, age was examined to test for differential effects on treatment outcome. Overall, professionals and graduate student therapists produced impressive yet commensurate outcomes when treating depressed youth. There were no significant differences found when treating children versus adolescents. The implications and limitations are reviewed, as are the suggestions for future research.     

The Development and Role of the Therapeutic Alliance in Supportive Psychotherapy with Adolescents

The formation of a therapeutic alliance is considered a central issue in therapy, and particularly crucial and challenging in work with adolescents. The relational and technical components of the therapeutic alliance were examined from the perspective of the adolescent client. 40 emotionally disturbed adolescent girls, aged 13 to 16 years, received brief supportive psychotherapy in the school setting. The alliance was assessed at sessions 3, 6 and 9, and outcome was evaluated on measures of internalizing problems, self-esteem, adjustment and client satisfaction. The results indicated the stability of the alliance between sessions 3 and 6, followed by significant linear increases between sessions 6 and 9. The strength of the alliance was most consistently related to reductions in internalising problems and client estimates of change. The implications for training and clinical practice with adolescent clients are discussed and future research avenues outlined.     

Family interaction and the course of adolescent psychopathology: An analysis of adolescent and parent effects

This study focused on evaluating the utility of three family measures for predicting outcome in a sample of disturbed but nonpsychotic adolescents: (a) the affective quality of the adolescents' voice tone when communicating with his/her parents; (b) the predominant affective quality of the parents' voice tones when communicating with the adolescent, and (c) the affective quality of the content of the parents' verbalizations to the adolescent. These measures were derived from 5-minute face to face discussions between parents and their disturbed adolescent. Results indicated that adolescents using positive or neutral voice tones during emotionally laden discussions with their parents tended to show relatively adequate levels of psychosocial adjustment as young adults, while adolescents using exclusively negative voice tones tended to show sufficient adjustment difficulties in early adulthood to warrant diagnoses within the extended schizophrenia spectrum. Although adolescent voice tone was associated with outcome, considering both adolescent and parent affective response led to improved prediction, with consideration of adolescent and parent variables leading to accurate prediction of outcome for 30 of the 33 sample cases.     

„Beyond efficacy“:

In this study, treatment efficacies of 30 short and long-term treatments with adolescents were presented from the perspective of the afflicted adolescent, the parents and the therapists. Assessments were made 3 times over 1.5 years after 97 therapy sessions on average. Short-term psychotherapy did not significantly contribute to symptom reduction. In the long-term treatments, therapists reported a strong reduction in symptomatology and in communicative disturbances with parents, siblings and friends over time. However, parents perceived less change in symptomatology compared to their children. The quality of the therapists' work with parents did not impact psychotherapy outcome. Tendentially, the type of treatment and the experience of the therapist were relevant for treatment efficacy.     

Parentification and the Impostor Phenomenon: An Empirical Investigation

The therapeutic alliance has consistently predicted client outcomes in psychotherapy. This study uses attachment theory as a resource in understanding the therapeutic alliance. Participants in this study were 27 mothers, 15 fathers, and 23 adolescents that participated in family therapy. Results indicate that mothers' reports of trust in their oldest child predicted the alliance, and adolescent ratings of trust in mothers and fathers moderated the relationship between therapy alliance and symptom distress. Implications for family therapy research and practice are discussed.