Pacheco Fiorini, Guilherme; (2024) Time-limited psychotherapy for depressed adolescents: examining cases of therapeutic ‘failure’ and ‘success’. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Time-limited psychotherapies have demonstrated effectiveness in treating adolescents suffering from major depressive disorder (MDD). However, up to a third of young people may still present clinical symptoms after treatment. Considering this background, the present thesis aimed to examine therapy ‘success’ and ‘failure’ with this population. Methods: All data presented in this thesis was derived from a randomised controlled trial, namely the IMPACT study, and its qualitative branch, the IMPACT-ME study. Computational analyses were performed to investigate different trends of symptom change over time among adolescents diagnosed with MDD from baseline to one year after therapy ended. The Adolescent Psychotherapy Q-Set (APQ) was then used to assess patient and therapist in-session interaction, comparing cases of therapeutic ‘failure’ and ‘success’. Lastly, a descriptive-interpretative approach was employed to investigate how young people who remained clinically depressed after therapy, their therapists, and parents made sense of the experience of psychotherapy. Results: This thesis identified that adolescents who started therapy with higher symptom levels were more likely to show poorer outcomes at a one-year follow-up. By analysing transcripts of psychotherapy sessions, it was possible to identify interaction patterns associated with ‘successful’ and ‘unsuccessful’ cases. Finally, by employing qualitative methods, it was found that the understanding of psychotherapy ‘failure’ is nuanced. This included some evidence that adolescents with poor outcomes do not necessarily describe ‘negative experiences’ of psychotherapy. Conclusions: This thesis’ findings highlight the importance of assessing young people’s symptoms at baseline to inform treatment planning and prognosis. They also point to some in-session features that might be associated with therapeutic ‘success’ or ‘failure’, potentially helping clinicians to identify if psychotherapies are on the ‘right track’. The findings also indicate that having a positive experience of therapy does not necessarily reflect ‘effective therapy’ and that the understanding of outcomes may vary across stakeholders.

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