The experience of adolescents participating in a randomised clinical trial in the field of mental health: a qualitative study

Background This descriptive study aimed to investigate adolescents’ motivations for participating in a randomised controlled trial (RCT), to explore the understanding that the young people had regarding a number of aspects of the trial design, to examine whether or not they found participation in the trial to be acceptable and what affected this, and to identify whether and how the young people felt that their participation in the RCT impacted on their experience of therapy and on therapeutic change. Methods Seventy-six adolescents who were taking part in a large-scale RCT to evaluate the clinical and cost effectiveness of psychological therapies for depression were interviewed at two time-points after completing therapy. The semi-structured interviews, which included a focus on the young people’s experience of the research study, were analysed using framework analysis. Results The vast majority of adolescents found it acceptable to participate in the clinical trial, and many agreed to participate for reasons of ‘conditional altruism’. However consent was often given without great understanding of the key elements of the trial, including the difference between treatment arms and the randomisation process. Although the adolescents were largely positive about their experiences from taking part, the study raises questions about whether clinical outcomes may be influenced by participation in the research elements of the trial. Conclusions Although adolescents are under-represented in clinical trials, those who do participate are generally positive about the experience; however, careful thought needs to be given to key elements of the trial design and the potential impact of the research participation on clinical outcomes

Framework analysis: a worked example of a study exploring young people’s experiences of depression

Framework analysis is an approach to qualitative research which is being increasingly used across multiple disciplines, including psychology, social policy and nursing research. The stages of framework analysis have been described in published work, but the literature is lacking in articles describing how to conduct it in practice, particularly in the field of psychology, where researchers may be working as part of a team. Having used framework analysis on a study exploring adolescents' experiences of depression, we faced various challenges along the way and learned from experience how to use this approach to qualitative analysis. In this reflective article, we describe a worked example of using framework, which we hope will assist other researchers in deciding if this approach is suitable for their own research, and will provide guidance on how one might go about conducting framework analysis when working as part of a research team. We conclude that framework is a valuable contribution to qualitative methods in psychology, offering a pragmatic, flexible and rigorous approach to data analysis

The Journey Through and Beyond Mental Health Services in the United Kingdom: A Typology of Parents' Ways of Managing the Crisis of Their Teenage Child's Depression.

OBJECTIVE: Depression is a common mental illness experienced by young people. Yet we know little about how their parents manage their symptoms at home, and how parents may experience their treatment at child and adolescent mental health services (CAMHS). Thus, the aim of our study was to create a typology of parents' experiences over a 2-year period, beginning with their teenage child's referral to CAMHS in the United Kingdom. METHOD: A total of 85 semistructured interviews were conducted with one or both parents of 28 adolescents at 3 time points, and qualitatively analyzed using ideal type analysis. RESULTS: Three distinct types or patterns of parental experience were identified: the learning curve parents, the finding my own solutions parents, the stuck parents. CONCLUSION: These patterns of parental experience could perhaps provide a basis for clinicians working in CAMHS to reflect on the families that they see and to adapt their ways of working accordingly to best support these families

The adolescent psychotherapy Q-set (APQ): a validation study

This article reports the validation of the Adolescent Psychotherapy Q-set (APQ), a newly developed instrument, adapted from the well-established Psychotherapy Q-Set (PQS) and the Child Psychotherapy Q-set (CPQ). The APQ aims to describe the psychotherapy process in the treatment of adolescents in a form suitable for quantitative comparison and analysis. The validation was conducted with the ratings of 70 audio-recorded youth psychotherapy sessions from a range of therapists, patients, and treatment stages, using two therapeutic approaches (Short-Term Psychoanalytic Psychotherapy and Cognitive Behavioral Therapy). Data analysis included intraclass correlation coefficients, Q-factor analysis, nonparametric mean differences, and Pearson correlations. Results suggest that the APQ has good levels of interrater reliability, is able to identify differences and similarities of two therapeutic approaches, and good convergent and discriminant validity with a widely-used measure of therapist behaviors (the Comparative Psychotherapy Process Scale). The APQ reported good levels of validity and reliability. It is hoped that it will contribute to new ways of investigating the mechanisms of therapeutic change for those working with adolescents

'Interaction structures' between depressed adolescents and their therapists in short-term psychoanalytic psychotherapy and cognitive behavioural therapy

OBJECTIVE:: Identify the core 'interaction structures' between therapists and depressed adolescents within and across two common forms of psychotherapy. METHOD:: A total of 70 audio-recorded psychotherapy sessions representing short-term psychoanalytic psychotherapy (STPP) and cognitive behavioural therapy (CBT) with youth aged 12-18 years old were coded with the Adolescent Psychotherapy Q-set (APQ), a newly developed instrument. Data included different therapist-patient dyads and stages in treatment and were analysed with cluster analysis. RESULTS:: Three distinct interaction structures between therapists and depressed adolescents: two influenced by the therapists' techniques and one more influenced by the young people's attitude to therapy. CONCLUSION:: When there is a collaborative working relationship between therapists and depressed young people, the therapy process is influenced by the therapists' techniques; while when there is a poor working relationship, the techniques used by therapists of different theoretical orientation become more similar with the aim of engaging the young person in the process

Parents' experience of child contact within entrenched conflict families following separation and divorce: a qualitative study

Child contact arrangements with parents following separation and divorce are strongly endorsed for children in both public policy and law where safe, but can be difficult to sustain. Entrenched high-conflict post-separation relationships between parents can cause substantial emotional risks to children as well as impacting severely on parents’ mental health. This paper describes a qualitative study, aimed at examining parents’ experiences of contact arrangements post-separation, undertaken within a mixed methods random allocation study of therapeutic outcomes for parents in entrenched conflict over their children. Two established semi-structured interviews with 22 parents were jointly subjected to thematic analyses. A thematic analysis across interviews revealed three main themes: ‘Dealing with contact evokes extreme states of mind’ for parents; when speaking of contact, the child is ‘everywhere and nowhere’ in the parents’ minds; ‘the hardest thing about contact is dealing with my ex-partner’. These findings indicate the immense strain children and parents are under and shed much light on the desperate states of mind for parents, particularly the anxieties driving relentless child contact disputes. This paper may contribute to the understanding of parents’ experiences of contact arrangements post-separation, potentially providing important information which can inform best practice for professionals working with this population

Beyond a diagnosis: the experience of depression among clinically-referred adolescents

Policy-makers have identified an urgent need to improve our ability to detect and diagnose depression in adolescents. This study aims to explore the lived experience of depression in clinically referred adolescents. 77 adolescents, aged between 11 and 17 with moderate to severed depression, were interviewed as part of a randomised controlled trial, using the Expectations of Therapy interview. Data were analysed qualitatively using framework analysis, with a focus on how the adolescents spoke about their depression. The study identified five themes: 1) Misery, despair and tears; 2) Anger and violence towards self and others; 3) A bleak view of everything; 4)Isolation and cutting off from the world; and 5) The impact on education. Researchers and policy-makers need to develop an understanding of depression grounded in the experiences of adolescents to improve detection and diagnosis of depression

Parents’ understanding and motivation to take part in a randomized controlled trial in the field of adolescent mental health: A Qualitative Study

Background Little is known about why parents agree to take part in randomized controlled trials for adolescent mental health. This study aimed to investigate parents’ perspectives on participating in a trial for psychological treatment of depression. The study explored parents’ motivations, understanding of the trial and perspectives on the acceptability of the trial. Methods Sixty-five parents took part in this qualitative study. Their adolescent children had been randomly allocated to one of three active psychological treatments for depression as part of the IMPACT trial and were interviewed about their experiences of participating in the study. Semi-structured interviews were analysed using framework analysis. Results For seven of the sixty-five parents, their experience of taking part in the trial was not covered in their interview so they were excluded from the analysis. The analysis was therefore based on the data from the parents of 58 adolescents taking part in the trial. The most commonly cited motivation for taking part in the study reported by parents was a desire to help others going through similar difficulties. Parents generally reported finding trial participation acceptable, although there were aspects that some reported finding less acceptable, including randomization and the burden of research assessments. Others spoke positively about the experience of trial participation and found it enjoyable or even therapeutic. Importantly, some did not appear to have a good understanding of the trial design, including randomization and treatment allocation. Conclusions This study indicates that trial participation can be a positive experience for parents, yet it raises concerns about how trialists can ensure that consent is fully informed, given that some parents appeared to have a poor understanding of the trial. Future studies should seek to explore how communication with trial participants can be improved, to ensure that trial participation is fully informed. Patient and public involvement will be crucial in ensuring this communication is accessible to stakeholders

‘Just like talking to someone about like shit in your life and stuff, and they help you’: hopes and expectations for therapy among depressed adolescents

Objective: To explore hopes and expectations for therapy among a clinical population of depressed adolescents. Method: As part of a randomised clinical trial, 77 adolescents aged 11 to 17, with moderate to severe depression, were interviewed using a semi-structured interview schedule. The interviews were analysed qualitatively, using Framework Analysis. Results: The findings are reported around five themes: “The difficulty of imagining what will happen in therapy”, "the 'talking cure'"; “the therapist as doctor”, “therapy as a relationship” and “regaining the old self or developing new capacities”. Conclusions: Differing expectations are likely to have implications for the way young people engage with treatment, and failure to identify these expectations may lead to a risk of treatment breakdown