Meier, Jasmin; (2022) Exploring the therapeutic process in therapies with young people using the Adolescent Psychotherapy Q-set. Doctoral thesis (D.Psych), UCL (University College London).

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Abstract

Background: The Adolescent Psychotherapy Q-set (APQ) is a pan-theoretical empirically validated process measure with potential for statistical analysis describing the unique characteristics of therapy sessions conducted with adolescents. Aims: This literature review aims to examine the development of the APQ and its applications in research and practice to guide future applications. Methods: A literature search on the PsycInfo and UCL Explore search engines and subsequent scanning of search results yielded nine published studies using the APQ. One unpublished study was made available to the author by the measure developer. Process: Studies were critically reviewed one by one paying attention to their research methodology, innovative use of the APQ, and their contributions to the field of adolescent psychotherapy process research. The APQ’s applications in this small body of literature was then evaluated. A review of relevant applications of the APQ’s child and adult equivalents highlighted directions for the APQ’s future potential. Results: Following its empirical validation, the APQ has been applied theoretically, in research of clinical practice, and in supervision. The APQ’s application to create therapy prototypes of therapy modalities has shown its good discriminatory quality and suitability to study treatment adherence. Using the APQ across therapies has shown it can detect important trends in therapy processes across large data sets. The APQ’s applications in single-case studies has shown the measures’ suitability to this research methodology, having already produced important insights in adolescent therapy process research. The review found the APQ to be sensitive to subtle differences in therapeutic techniques and interactions whilst possibly missing non-verbal factors and within-session variability. The APQ’s use of direct observation in real-life clinical settings, suitability for various statistical analyses and triangulation as well as its potential to find process-outcome links in adolescent therapy are clear advantages. Conclusions: Although empirical research conducted with the APQ is in its infancy, its applications so far have shown the versatility of this measure and its potential to add knowledge to the field of adolescent psychotherapy process research. The review highlights important methodological directions for future research, including a move beyond research based on modality prototypes. Part 2: Empirical Research Project What therapy processes precede dissatisfied dropout in STPP for adolescent depression: a single-case qualitative exploration guided by the Adolescent Psychotherapy Q-set Abstract Background: A significant percentage of young people in treatment for depression drop out of psychotherapy, some due to dissatisfaction with the therapy offered. The therapeutic processes preceding dissatisfied dropouts in the adolescent population are insufficiently understood. Aims: The current single-case study aimed to explore the therapeutic process of a 12-session, prematurely-ended therapy with a young person dissatisfied with short-term psychoanalytic psychotherapy (STPP) received for depression. Methods: The Adolescent Psychotherapy Q-set (APQ), an empirically validated process measure, was used in tandem with clinical case analysis to explore the therapy process over time. Results: The analysis of twelve APQ ratings found a productive patient-therapy couple working collaboratively to understand the young person’s experiences and emotions. Following an initial phase of the young person presenting as emotional and vulnerable, she became increasingly ambivalent about partaking in psychotherapy. A lively and argumentative period exploring the young person’s ambivalence and increased sense of well-being culminated in eventual dropout. Conclusion: Even in a strong, collaborative working relationship with an engaged young person, ambivalence around dependency and vulnerability can threaten treatment completion. The APQ is a suitable measure to explore general treatment processes preceding dropout, but its usefulness could be enhanced through systematic methodological pluralism.

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