<i>"Maybe you don’t know what answers I want"</i>: unresolved alliance ruptures preceding dropout in short-term psychoanalytic psychotherapy with depressed adolescents
The therapeutic alliance is a predictor of therapy outcome across treatments with adolescents, with ruptures and unresolved ruptures in the alliance being associated with treatment dropout. This study investigated the psychotherapeutic process in short-term psychoanalytic psychotherapy (STPP) with...
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2025-03-01
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| Series: | Research in Psychotherapy |
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| Online Access: | https://www.researchinpsychotherapy.org/rpsy/article/view/841 |
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| author | Manuela Jose Difronzo Lisa Thackeray Sally O'Keeffe Ana Calderon Nick Midgley |
| author_facet | Manuela Jose Difronzo Lisa Thackeray Sally O'Keeffe Ana Calderon Nick Midgley |
| author_sort | Manuela Jose Difronzo |
| collection | DOAJ |
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The therapeutic alliance is a predictor of therapy outcome across treatments with adolescents, with ruptures and unresolved ruptures in the alliance being associated with treatment dropout. This study investigated the psychotherapeutic process in short-term psychoanalytic psychotherapy (STPP) with five adolescents with moderate/severe depression who had dropped out of STPP in a large randomized controlled trial and reported dissatisfaction with treatment. In each case, sessions were rated as featuring unresolved ruptures with the therapist. This study aimed to explore the processes characterising ruptures preceding dropout using the Adolescent Psychotherapy Q-set (APQ). Data were analysed using descriptive statistics of the APQ coding; a qualitative reading of the transcripts and clinical vignettes was used to illustrate how the APQ findings manifested in practice. Results revealed a weak alliance preceding the adolescent dropping out of therapy, with a mismatch between self-reliant and disengaged adolescents presenting with strong negative affects and therapists seeking to maintain an active exploration of the adolescents’ difficulties. Research and clinical implications are discussed.
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| format | Article |
| id | doaj-art-1e55851f049c47e8b6dbde0af1cd88b9 |
| institution | Kabale University |
| issn | 2499-7552 2239-8031 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Research in Psychotherapy |
| spelling | doaj-art-1e55851f049c47e8b6dbde0af1cd88b92025-08-20T03:26:05ZengPAGEPress PublicationsResearch in Psychotherapy2499-75522239-80312025-03-0128110.4081/ripppo.2025.841<i>"Maybe you don’t know what answers I want"</i>: unresolved alliance ruptures preceding dropout in short-term psychoanalytic psychotherapy with depressed adolescentsManuela Jose Difronzo0Lisa Thackeray1Sally O'Keeffe2https://orcid.org/0000-0002-6713-2898Ana Calderon3https://orcid.org/0000-0002-9984-6940Nick Midgley4Full Member of The Association of Child Psychotherapists, London; National Health Service, LondonChild Attachment and Psychological Therapies Research Unit, Anna Freud, LondonNewcastle University, Newcastle-Upon-TyneFacultad de Psicología y Humanidades, Universidad San Sebastián, SantiagoChild Attachment and Psychological Therapies Research Unit, Anna Freud, London; Department of Clinical, Educational and Health Psychology, University College London The therapeutic alliance is a predictor of therapy outcome across treatments with adolescents, with ruptures and unresolved ruptures in the alliance being associated with treatment dropout. This study investigated the psychotherapeutic process in short-term psychoanalytic psychotherapy (STPP) with five adolescents with moderate/severe depression who had dropped out of STPP in a large randomized controlled trial and reported dissatisfaction with treatment. In each case, sessions were rated as featuring unresolved ruptures with the therapist. This study aimed to explore the processes characterising ruptures preceding dropout using the Adolescent Psychotherapy Q-set (APQ). Data were analysed using descriptive statistics of the APQ coding; a qualitative reading of the transcripts and clinical vignettes was used to illustrate how the APQ findings manifested in practice. Results revealed a weak alliance preceding the adolescent dropping out of therapy, with a mismatch between self-reliant and disengaged adolescents presenting with strong negative affects and therapists seeking to maintain an active exploration of the adolescents’ difficulties. Research and clinical implications are discussed. https://www.researchinpsychotherapy.org/rpsy/article/view/841Adolescent Psychotherapy Q-settherapeutic alliancerupture-repairadolescencedepressiondropout |
| spellingShingle | Manuela Jose Difronzo Lisa Thackeray Sally O'Keeffe Ana Calderon Nick Midgley <i>"Maybe you don’t know what answers I want"</i>: unresolved alliance ruptures preceding dropout in short-term psychoanalytic psychotherapy with depressed adolescents Research in Psychotherapy Adolescent Psychotherapy Q-set therapeutic alliance rupture-repair adolescence depression dropout |
| title | <i>"Maybe you don’t know what answers I want"</i>: unresolved alliance ruptures preceding dropout in short-term psychoanalytic psychotherapy with depressed adolescents |
| title_full | <i>"Maybe you don’t know what answers I want"</i>: unresolved alliance ruptures preceding dropout in short-term psychoanalytic psychotherapy with depressed adolescents |
| title_fullStr | <i>"Maybe you don’t know what answers I want"</i>: unresolved alliance ruptures preceding dropout in short-term psychoanalytic psychotherapy with depressed adolescents |
| title_full_unstemmed | <i>"Maybe you don’t know what answers I want"</i>: unresolved alliance ruptures preceding dropout in short-term psychoanalytic psychotherapy with depressed adolescents |
| title_short | <i>"Maybe you don’t know what answers I want"</i>: unresolved alliance ruptures preceding dropout in short-term psychoanalytic psychotherapy with depressed adolescents |
| title_sort | i maybe you don t know what answers i want i unresolved alliance ruptures preceding dropout in short term psychoanalytic psychotherapy with depressed adolescents |
| topic | Adolescent Psychotherapy Q-set therapeutic alliance rupture-repair adolescence depression dropout |
| url | https://www.researchinpsychotherapy.org/rpsy/article/view/841 |
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