When Adolescents Stop Psychological Therapy
Sally O'Keeffe & 2 others
December 16, 2020
Abstract
The therapeutic alliance predicts dropout from psychological therapy, and ruptures in the therapeutic alliance may also predict dropout, yet there is a dearth of research with adolescents. This study investigated whether markers of rupture–repair in the alliance were indicative of different types of treatment ending in adolescents receiving psychological treatment for depression. Data were from the IMPACT study, a trial investigating the effectiveness of therapies for adolescent depression. Participantswere randomly allocated to receive a brief psychosocial intervention, cognitive– behavioral therapy, or short-term psychoanalytic psychotherapy. The sample (N 35) comprised adolescents who had either completed their treatment (n 14) or dropped out (n 21) according to their therapist. Dropout cases were further classified as dissatisfied (n 14) or got-what-they-needed (n 7) based on posttherapy interviews with the adolescent and therapist. Selected recordings of therapy sessions were rated using the Rupture Resolution Rating System and Working Alliance Inventory (observer version). Therapeutic alliance and rupture–repair during therapy were similar for completers and got-what-they-needed dropouts, whereas dissatisfied dropouts had poorer therapeutic alliance, more ruptures, ruptures that were frequently unresolved, and greater therapist contribution to ruptures. Qualitative analysis of sessions led to the construction of three categories of therapist contribution to ruptures: therapist minimal response, persisting with a therapeutic activity, and focus on risk. Results suggest that ruptures, especially when unresolved, could be warning signs of disengagement and dropout from therapy. Future research shou
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About the Authors
Sally O'Keeffe
Sally O’Keeffe is a Research Fellow in the School of Health Sciences at City, University of London. Sally has worked on clinical trials investigating the effectiveness of psychological interventions, including treatments for depression and self-harm. Sally is particularly interested in the use of mixed methods to explore how interventions work and what works for whom. Sally completed her PhD at University College London (UCL) and the Anna Freud National Centre for Children and Families. She is currently working on a research programme to develop a brief psychological intervention for people presenting to Emergency Departments having self-harmed.
Peter Martin
Peter Martin is Lecturer in Applied Statistics at University College London. One of the joys of being a statistician is that it opens doors to research collaborations with many people in diverse fields. Peter has been involved in investigations in life course research, survey methodology, and the analysis of racism. In recent years his work has focused on health inequalities, psychotherapy, and the evaluation of healthcare services.
Nick Midgley
Nick Midgley is a Child and Adolescent Psychotherapist and a Professor of Psychological Therapies for Children and Young People at University College London (UCL). He is co-director of the Child Attachment and Psychological Therapies Research Unit (ChAPTRe) at UCL / Anna Freud National Centre for Children and Families and has worked on a number of research projects related to psychodynamic and mentalization-based interventions with children and young people, including the IMPACT and IMPACT-ME studies of the treatment of adolescent depression, and the ‘Reflective Fostering Programme’, a group-based programme to support the well-being of children in foster care. He was the winner of the Society for Psychotherapy Research’s Early Career Achievement Award in 2013, and the BACP’s Outstanding Research Award in 2019.
Nick has published widely on child psychotherapy research and practice. His recent books include, Essential Research Findings for Child and Adolescent Counselling and Psychotherapy (Sage, 2017, with Mick Cooper and Jac Hayes) and Mentalization-Based Treatment for Children: a time-limited approach (APA, 2017).
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