Adolescents coping with the COVID-19 pandemic: ‘every day is like another Sunday’

COVID-19 has upended the way analysts and psychotherapists practice. Many use the phone for their sessions, many are using video platforms, and many use a combination of the two. Work with adolescents is very challenging in this new modality because of the loss of in-person connection and immediate non-verbal cues. The public health restrictions put in place to manage COVID-19 spread are at odds with the adolescent tasks of adventuring, experimenting and gaining new experiences. In addition, increased anxieties about infection, contamination and invasion are often manifest and adolescents can regress in the face of them. Using seminal ideas from Bion, this article looks at two process examples from adolescent boys who struggled with parts of themselves that felt disturbing and unacceptable. The author discusses the clinical exchanges in detail and offers ideas about the difficulty of creating psychic space when working virtually.     

Therapist Interventions and Skills as Predictors of Dropout in Outpatient Psychotherapy

The current study employed machine learning to investigate whether the inclusion of observer-rated therapist interventions and skills in early sessions of psychotherapy improved dropout prediction beyond intake assessments. Patients were treated by postgraduate clinicians at a university outpatient clinic. Psychometric instruments were assessed at intake and therapeutic interventions and skills in the third session were routinely rated by independent observers. After variable preselection, an elastic net algorithm was used to build two dropout prediction models, one including and one excluding observer-rated session variables. The best model included observer-rated variables and was significantly superior to the model including intake variables only. Alongside intake variables, two observer-rated variables significantly predicted dropout: therapist use of feedback and summaries and treatment difficulty. Although not retained in the final prediction model, the observer-rated use of cognitive techniques was also significantly correlated with dropout. Observer ratings of therapist interventions and skills in early sessions of psychotherapy improve predictors of dropout from psychotherapy beyond intake variables alone. Future research could work toward personalizing dropout predictions to the specific dyad, thereby improving their validity and aiding therapists to recognize and react to increased dropout risk.     

Homework Compliance and Quality in Cognitive Behavioral Therapies for Anxiety Disorders and Obsessive-Compulsive Disorder

Homework assignments are an integral part of cognitive behavioral therapy, providing patients with opportunities to practice skills between sessions. Generally, greater homework compliance is associated with better treatment outcomes. However, fewer studies have examined the effect of homework quality on treatment outcomes. This study examined homework compliance and quality as predictors of outcome and attrition across five CBT protocols. A sample of 179 individuals with principal diagnoses of generalized anxiety disorder, panic disorder, social anxiety disorder, or obsessive-compulsive disorder were randomized to receive a transdiagnostic CBT protocol (the Unified Protocol) or a single-diagnosis CBT protocol corresponding to their principal diagnosis. The Unified Protocol had a lower homework burden than the majority of the single-diagnosis protocols, which varied in degree of assigned homework. Despite this, there were no differences in average homework compliance or quality across principal diagnosis, treatment condition, or their interaction. Homework quality was significantly related to all symptom outcomes (self-reported and clinician-rated anxiety and depressive symptoms, clinician-rated clinical severity). Homework compliance was significantly related to clinician-rated anxiety symptom outcomes. Additionally, greater homework quality and compliance were both significantly associated with increased odds of completing treatment, suggesting homework variables can be useful and easily obtainable predictors of treatment retention.     

Sibling relationships and civic engagement: A longitudinal study of Chinese young adults

This study examined the longitudinal associations of sibling intimacy and conflict with civic attitudes and behaviours among Chinese young adults. At two time points separated by about 12 months, questionnaire data were collected from 272 Chinese college students (mean age at Time 1 = 19.68 years; 69% female), students who studied in Hong Kong and had at least one sibling. Students rated their intimacy and conflict with their siblings and their parents at Time 1, and their civic attitudes and behaviours at both time points. Hierarchical regression revealed that, controlling for demographic characteristics and parent–child intimacy and conflict, sibling intimacy predicted increases in both civic attitudes and behaviours. Sibling conflict was a non-significant predictor, however. Findings highlighted the roles of siblings in understanding civic development in young adulthood and the utility of targeting sibling intimacy as means to foster young adults' positive attitudes to and active participation in civic activities.     

How High Schools Become Empowering Communities: A Mixed‐Method Explanatory Inquiry into Youth‐Adult Partnership and School Engagement

Educational reform efforts emphasize empowerment and engagement, but these concepts are rarely translated into policy or classroom practice. This inquiry explores how schools can become places where students take ownership over their own learning. Phase 1 of this inquiry, a survey of students from diverse high schools, examines pathways to school engagement. Results indicated that youth voice in decision‐making, particularly when the experience is situated within supportive adult relationships and a sense of safety, significantly predicts emotional and cognitive engagement. Phase 2, a case study of an exemplary high school, sought to explain these pathways. Grounded in the theoretical perspectives of “empowered community settings” and “youth‐adult partnership,” analyses highlighted the importance of a shared belief system and core instructional activities that were student‐centered, affirmative, and strength‐based. Within this context, the opportunity role structure allowed students to exercise voice in creating their own educational program. The relational environment offered partnership and safety for academic risk‐taking. Teachers broke down traditional roles and power hierarchies in ways that helped students discover their own sources of engagement. The article identifies ways that community psychologists, as policy framers and as researchers, can help schools become places of empowerment and engagement.     

Efficacy of Dialectical Behavior Therapy for Adolescents in a Partial Hospitalization Program

This study evaluated dialectical behavior therapy for adolescents (DBT‐A) vs. treatment as usual within a 6‐week partial hospitalization program. The 103 adolescent participants (mean age = 15.27 years) were predominantly girls (n = 63, 61%) with a variety of primary mental health diagnoses. Results indicated that DBT‐A was superior for decreasing symptoms of depression and interpersonal sensitivity, but no statistically significant difference was detected for anxiety or hostility. Implications for treating youth with transdiagnostic identities are discussed.