Research digest: expectations and experiences of therapy

Abstract

of Adolescent boys have the highest rates of disengagement and drop out from mental health services. Further, research suggests that when boys do enagage with services, they may value therapies that provide practical strategies rather than those that advocate the exploration of thoughts, feelings, and relationships. Research is therefore needed to gain a better understanding of teenage boys’ experiences of participating in such therapies. This qualitative study aimed to explore the therapeutic experiences of five male adolescents (aged 16 to 18 years) with moderate to severe depression, who engaged in Short-Term Psychoanalytic Psychotherapy (STPP) as part of a randomised controlled trial. Interpretative Phenomenological Analysis of semi-structured interviews was used for an in-depth and idiographic exploration of their experiences. Three themes were identified: ‘Pain in therapy for a worthwhile purpose’, ‘A relationship unlike others: creating a space for reflection’, and “Ending with ‘a little bit of relief and a little bit of hope’”. The findings offer insight into factors that made it possible for these adolescents to engage in and benefit from STPP – a positive therapeutic relationship and gaining self-understanding – and, aspects that hindered their engagement and led to premature endings. This knowledge could inform clinical practice with depressed adolescent boys. Background: Brief psychosocial intervention (BPI) is a treatment for adolescent depression that has recently demonstrated clinical effectiveness in a controlled trial. The aim of this study is to explore experiences of adolescents with major depression receiving BPI treatment in the context of good treatment outcomes. Method: A subsample of five interviews from a larger study of adolescents’ experiences of BPI was purposively selected, focusing on good-outcome cases. Interviews were analysed using interpretative phenomenological analysis to provide a richer understanding of participants’ experiences of overcoming depression in the BPI group. Results: Four central themes were identified: ‘Being heard and feeling safe’, ‘Collaborative working enhancing therapy’, ‘Gaining a different perspective on one’s self and relationships’ and ‘A positive therapeutic relationship’. Conclusion: BPI is a novel approach with promising clinical effectiveness. Utilising adolescents’ experiences has revealed potential psychological mechanisms of good treatment response to BPI. Overall implications for clinical practice with depressed adolescents are discussed. medication-use. Methods: The qualitative study reports data from semi-structured interviews conducted 12-months post-treatment with 12 adolescents who were clinically referred and treated for depression as part of the IMPACT trial. The interviews were analysed using Thematic Analysis. Results: Four themes were identified: ‘a perceived threat to autonomy’, ‘a sign of severity’, ‘a support, not a solution’, and ‘an ongoing process of trial and error’. Conclusions: This study highlights the value of bringing adolescents’ voices into the broader debate on the use of antidepressants in their age group and in the development of future guidelines. Future implications for research and clinical practice are discussed. Patient expectations about therapy have been regarded as a common factor affecting the course and outcome of psychotherapy. However, little is known about the expectations of adolescents. We aimed to explore the therapy expectations of young people (YP) with depression prior to psychotherapy. We conducted semi-structured interviews with six YP (5 female, 15–19 years old) entering psychodynamic outpatient treatment. Interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. The careful analysis of the YPs’ accounts yielded the following four key themes: not knowing but being cautiously hopeful; therapy as a long and difficult process; therapy as a place to understand oneself and to develop; and the importance of the professional and interpersonal skills of the therapist. The findings suggest to foster realistic treatment and outcome expectations while at the same time individual therapists should pay careful attention to the specific expectations that YP bring into therapy. The aim of this study was to explore children’s expectations and experiences of psychodynamic child psychotherapy. Semi-structured interviews were conducted using self-rating instruments, drawing materials and a selection of toys. Ten children aged 6–10 years were interviewed prior to and after treatment (mean number of sessions = 99). The main results showed that most of the children, despite their young age, had the ability to give clinically valuable accounts, verbally or non-verbally, of their problems. A majority of the children expressed positive hopes and expectations about their forthcoming therapy as well as support would you find helpful?” The aim of this study was to investigate the impact of pretreatment expectations on clinical outcomes and engagement in Parent–Infant Psychotherapy (PIP). Sixty-one mothers who were experiencing mental health difficulties and who were receiving PIP with their young infants participated in the study. A mixed-methodology was used to examine participants’ expectations through transformation content analysis of pretreatment interviews; recurring themes were classified and quantified. Further statistical analyses explored relationships between the quantified themes of parental expectations and clinical outcomes and engagement in treatment. No significant correlation was found between expectations and engagement. One of the six clinical outcomes significantly correlated with parental expectations. Improved reflective functioning (RF) was predicted by participants describing expectations of wanting to improve their parent–infant relationship through the treatment, and expressing concerns about discussing their past experiences. These two expectations predicted improvements in RF independently and when combined. These results indicate that PIP may be more effective for some mothers than others and that assessing future clients’ expectations before beginning PIP may be beneficial. discussion, we focus on the respondents’ expectations of therapy, treatment experiences, and sense making regarding recovery. Greater emphasis is currently being placed on user involvement in shaping the delivery of mental health services and the need for increasing the evidence base for psychotherapeutic interventions such as individual psychoanalytic psychotherapy (IPP). This qualitative study reports on the range of experiences of six young people aged between 16 and 21 years in undertaking IPP. Interpretative phenomenological analysis was used to develop an in-depth understanding of their experiences. The themes identified the young people’s initial expectations and concerns about starting psychotherapy, experiences of learning the ropes of therapy and the process and meaning of ending therapy. The affective relationship with the therapist was of particular importance to the young people concerned. Positive experiences of IPP included being listened to and being accepted, and talking and thinking in depth. The power differentials with respect to being a patient were also evident. The paper concludes by suggesting that paying greater attention to young people’s views of psychotherapy may improve their initial engagement and help to develop services in more appropriate ways. Qualitative methodologies provide a useful adjunct to conducting process and outcome research in this context. Background: There is emerging evidence for the effectiveness of psychodynamic psychotherapy for depressive disorders. However, we know less of how this relation-focused therapy mode is experienced and what the patients themselves identify as helpful. Hence, the purpose of this study is to explore adolescents’ experiences of factors promoting improvement in psychodynamic therapy. Methods: Eight female patients participating in a Norwegian study on psychodynamic therapy, the First Experimental Study of Transference Work – In Teenagers (FEST-IT), were included. The participants were offered a total number of 28 sessions. Semistructured qualitative interviews about experiences with therapy were then conducted and analysed with systematic text condensation and hermeneutic interpretation. Results: The analysis revealed four main themes. ‘Exploring oneself’ comprises autonomy and acknowledgement, openness, insight and acceptance of oneself. ‘Therapist relation and characteristics’ includes confidence and trust in and support from the therapist as well as having a trustworthy and experienced therapist. ‘Focusing on everyday life’ includes learning and practical orientation. ‘Time factors’ refers to duration and frequency. Conclusions: Together with a supportive and listening therapist, the adolescents improve by exploring themselves within the frames of a time-limited treatment period. Improvement seems to be experienced through better relations to oneself and to others and by finding one’s place in the family, or at school. Adolescents value problem solving and help with concrete challenges. Hence, therapy should be tailored to the needs of adolescents with depression and incorporate the challenges they face in their everyday life. Background: 16–18-year-old young people experience a relatively high incidence of mental health problems but there is a paucity of research on their experience of mental health services (MHS). Method: To gain understanding of young people’s experiences of 16–18 MHS, we used qualitative Interpretative Phenomenological Analysis. Ten young people in two 16–18 MHS were interviewed about experiences of using MHS. Results: Five superordinate themes emerged from the data analysis, ‘Power Differentials’, ‘Parental Involvement’, ‘Developmentally Attuned Services’, ‘Developing Self-Expressi