The pursuit of the randomised controlled trial

The most significant recent development with respect to researching the benefits and outcomes of a time-limited psychotherapy treatment model, is the UK based IMPACT (Improving Mood with Psychoanalytic and Cognitive Therapies) study (Goodyer et al., 2011).

The IMPACT study claims to be the largest comparative randomised controlled treatment trial ever carried out in Britain with a clinical population of 480 adolescents diagnosed with moderate to severe depression. The IMPACT study has taken place across three regions in the UK and in several clinic settings. The IMPACT study and treatment model utilises a manualised psychotherapy treatment programme which consists of 28 sessions for the young person and seven parent sessions. The manualised psychotherapy programme follows on the adolescent depression study initiated by Dr. Judith Trowell et al. (2003; 2007) and by Trowell and Miles (2011).

The full results and interpretations of data for the IMPACT study are still pending. The intention is for the research manual to become a clinical manual utilised by clinicians in child and adolescent mental health services.

However, one of the principal investigators of the trial, Professor Ian Goodyer in his presentation of the preliminary IMPACT findings to an international conference (2014), has referred to less than hoped for positive results overall, particularly with respect to rates of relapse. Goodyer’s conclusions at this review, remain remarkably similar to the initial justification for the research, which is that knowledge about the particular efficacy of different psychological therapies for the treatment of adolescent depression still remain unclear.

Time-limited psychotherapy specifically with adolescents and young people appears to have become the preferred focus of much contemporary research as well as outcome studies and manualised treatments such as the IMPACT study described above. This may be due in part to a belief that adolescents and young people benefit from being seen individually. It may also, however, reflect a need on the part of researchers to find a ‘neater’ more contained subject for the research inquiry that is less ‘contaminated’ by the messiness of parental involvement, as well as other extraneous factors and this is discussed in more detail in the critical evaluation of this research.

Effective time-limited psychodynamic psychotherapy with adolescents is also described by Shefler (2000) who has adapted James Mann’s (1973) model of short-term dynamic psychotherapy. This model delineates an intake period about the presenting problem and the patient’s view of the problem. At the conclusion of this intake process, the therapist formulates the central issue to be explored which comprises recognition of the patient’s abilities and strengths; the main emotional issues in the patient’s life; and finally the self-perception of the patient. In Shefler’s paper, this framework is applied to time-limited therapy with a highly motivated and articulate young adult. The Israeli context of the therapy with its focus on compulsory army service as a rite of passage whilst interesting, has contextual limitations. One would have hoped, for example, for a discussion about how the militarised nature of Israeli life may have an impact in itself, on the course of adolescence and adult identity.

A further time-limited approach to psychodynamic psychotherapy with adolescents has been designed by Briggs and Lyon (2012); Time- limited Adolescent Psychodynamic Psychotherapy (TAPP). This is a 20-session dynamic psychotherapy aimed at young people aged 14-25. The psychodynamic approach is combined with a psycho-social element and focuses on the problems associated with transitions for the young person. TAPP is a manualised therapy, with a protocol that provides a detailed guide for the clinician in order to ensure that the model is adhered to. TAPP is designed to meet the needs of young people with complex presentations including self-harm and suicidal ideation, as well as post-traumatic experiences and anxieties concerning separation. Practitioners follow a training course and must fulfil particular requirements in order to become certified to administer the therapy.

 
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