Choosing between psychodynamic therapy and family therapy for adolescents

In the current issue of Psychotherapy and Psychosomatics a Group of Greek investigators is reporting on a study exploring the role of self-esteem and social adjustment in children and adolescents. Both these dimensions have been found to enable youths to cope adequately with stressful life situations and act as protective factors against vulnerability to depression.

Treatment was conducted over a 9-month period in 72 patents aged 9-15 years, and consisted of 8-14 weekly 90-min sessions of systems integrated family therapy (FT) with a focus on family dysfunction, but without specific attention to unresolved intrapsychic conflicts and early childhood, or 16-30 weekly 50-min sessions of focused individual psychodynamic psychotherapy (PP) with a focus on interpersonal relationships, life stresses and dysfunctional attachments plus parent sessions (one per two child sessions), focused on the same areas, by a separate case worker.

Results showed a significant improvement in depressive symptoms in both conditions. Also, difficult cases were those who benefited more from both treatments, reaching less burdened cases in terms of social adjustment and self-esteem outcomes at follow up. These findings may reflect the significant role of self-esteem and social adjustment in the course of depression among children with chronic stress. Both dimensions may enable coping with stressful environments, such as parental psychopathology, child maltreatment, family conflict, lack of parental warmth, affect and support.

Additionally, self-esteem and social adjustment may buffer cardiovascular (e.g. heart rate and heart rate variability) and inflammatory (e.g. plasma levels of tumor necrosis factor-α and interleukins) responses to stress, thus protecting against vulnerability to depression. However, the fact that a great variability in the number of sessions has emerged (8-14 for FT vs. 16-30 for PP) raises some concerns about the relative cost-effectiveness of the two treatments. Comparative effectiveness studies on PP or FT and recommended psychological treatments for depression in youth, i.e., cognitive-behavioral therapy and interpersonal psychotherapy, could be considered for future investigation.