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Tilbury, E. (2019). Short-term psychoanalytic psychotherapy for adolescents with depression. A treatment manual: by Simon Cregeen, Carol Hughes, Nick Midgley, Maria Rhode and Margaret Rustin, London, Karnac Books, 2017, 267 pp., £29.99 (paperback), ISBN: 978-1-78220-352.. Psychoanal. Psychother., 33(2):133-135.
Short-term psychoanalytic psychotherapy for adolescents with depression. A treatment manual: by Simon Cregeen, Carol Hughes, Nick Midgley, Maria Rhode and Margaret Rustin, London, Karnac Books, 2017, 267 pp., £29.99 (paperback), ISBN: 978-1-78220-352.
This book describes Short-Term Psychoanalytic Psychotherapy, which was developed from the research trial Improving Mood with Psychoanalytic and Cognitive Therapies. It offers a manualised, time-limited approach of once weekly therapy, accompanied by parent work and liaison with the adolescent’s network. This represents an important shift within the psychodynamic tradition of longer term therapy, with the potential aim of securing a place in a more business-driven NHS climate, in which time and resources are limited and complexity and demand within CAMHS services have risen greatly.
As with any manualised approach, the suitability criteria are specific. They are severe depression within the context of intergenerational difficulties. Such difficulties might include parental mental health, developmental difficulties, early loss and trauma or compromised patterns of development. It may be that unresolved issues from parents or carers lives are repeated through the lives of the adolescent and entrenched problems ensue. The book offers practical guidance on session length and the duration of treatment, and how to set up the liaison with the network. The focus of the work is on the transference relationship, with the aim of developing understanding of areas of anxiety and phantasy for the adolescent and in particular on bringing issues of loss to the surface, which are presumed to be a key factor in maintaining depression. The clear description of the frame promotes confidence in knowing how to go about setting up the work. The book also considers psychological and developmental theories of depression, and research on depression in adolescents; the latter offers a useful review of the area and provides insights to practitioners working eclectically.
Some of the research provides a strong argument for an intensive psychodynamic approach to treating this group, such as findings on the comorbidity of depression, the complexity of hidden feelings in adolescents, the potential for suicide in adulthood and relapse rates in adolescents over a 5-year period. Twenty-eight sessions, including a thorough assessment and parent work alongside one-to-one therapy for the adolescent, offer an opportunity to get a deep understanding of the fragility and vulnerability of the young person and provide them with a sense of a beginning, middle and end to their treatment.
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