How effective are long-term psychoanalytic treatments in adolescents? A comparison between the evaluations of the patients, their parents and their therapists

Seiffge-Krenke, I. (2010). „Beyond efficacy“: Welche Faktoren beeinflussen die Effizienz analytischer und tiefenpsychologisch fundierter Therapien bei Jugendlichen? {"Beyond efficacy": Which factors influence the effectiveness of psychoanalytic and psychodynamic therapy of adolescents?}. Forum der Psychoanalyse, 26, 291-312.
Seiffge-Krenke, I., & Nitzko, S. (2011). Wie wirksam sind analytische und tiefenpsychologisch fundierte Langzeitpsychotherapien bei Jugendlichen? Ein Vergleich der Einschätzung von Patienten, ihren Eltern und Therapeuten {How effective are psychoanalytic and psychodynamic long term therapies in adolecents? Comparing the ratings by patients, their parents and therapists}. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 39, 253-264.

Brief summary of the studies

In the evaluation of psychotherapy outcome with children and adolescents, studies are lacking which analyze psychotherapy outcome from the perspective of different persons involved in this process. In the above studies, treatment efficacy of  30 and 28  long-term treatments with adolescents (mean age 13 years) is presented from the perspective of the afflicted adolescent, his or her parents and his or her therapists. In general, in a study of 30 long-term patients, psychodynamic therapy (mean 97 hours) was effective in reducing symptomatology, both from the perspective of therapist, adolescents and their parents, but the level of change differed significantly. In a second study, the design was further differentiated into a therapy group (n = 28) and a waiting group (n = 32), which did not differ in relevant features such as SES, marital status of the parents, age, gender, and diagnosis of the child. The sample was drawn from an outpatient unit with prevailing internalizing disorders (50.0 %); externalizing disorders (24%), personality disorders (18%) and somatoform disorders (5%) were less frequent. The treatment was psychodynamic therapy with a mean frequency of 89 hours (70 hours for individual treatment of the adolescent and 19 hours for accompanying work with parents).

Assessment were made 3 times over 1.5 years, at the  beginning of the treatment (mean 7 hours), after 40 hours and at the end of the treatment (mean 68hours).For assessments of parents and child, comparable instruments ( YSR and CBCL) were applied.  In the therapy group, the therapists reported a strong reduction in symptomatology (both on a psychic and a somatic level). Therapists further perceived a significant reduction in communicative disturbances of the patient with parents, siblings and friends over time. At the beginning of the treatment, adolescents reported higher symptom levels than their parents. Further, adolescents and their parents reported a significant reduction in symptomatology  over time.  However, parents perceived less change in symptomatology, compared to their children. The diagnosis (internalizing vs. externalizing disturbances) had no impact on the evaluation of treatment effectiveness of adolescents and parents. The quality of the therapists’ work with parents did not impact psychotherapy outcome. Correlations between parents and adolescent  were low (r = .113; ns for internalizing and r = .239;ns for externalizing symptoms) over time.

Conclusions

Earlier studies also have shown low cross- informant correlations between adolescents and their parents regarding the assessment of symptomatology, due to changes in disclosure behavior. Both studies highligh that parents underestimate the severity of symptomatology in their child and also did not perceive as much change during therapy as therapists and children did. Therefore, particularly during the adolescent years of a patient, psychotherapy should include the different perspectives of all persons involved.

Contact

Prof. Inge Seiffge-Krenke

Psychologisches Institut, Abteilung Entwicklungs- und Pädagogische Psychologie, Johannes Gutenberg-Universität,55009  Mainz, Germany.

E-mail: seiffge-krenke@uni-mainz.de