The Improving Mood through Psychoanalytic and Cognitive-Behavioural Therapy (IMPACT) study was a large-scale randomized controlled trial carried out in the UK, in which young people suffering from depression received either short-term psychoanalytic psychotherapy, CBT, or a brief psychosocial intervention. In terms of quantitative outcomes on depression measures, all three forms of therapy recorded equivalent levels of effectiveness. A distinctive aspect of the study was that clients (and their parents) were interviewed about their experience of therapy. This made it possible to look at what clients thought was helpful or unhelpful in therapy they had received. Although the massive data set collected in this project is still in the process of being published, the articles that have been disseminated so far include analyses of the experiences of clients who benefitted from CBT and the psychosocial interventions (i.e., ‘good outcome’ cases). These clients consistently described two key aspects of therapy that had been particularly important for them. First, they felt that their therapist openly offered them a different way of making sense of their problems – in other words, was willing to share and explain their assumptions about depression, and how and why therapy might help. Second, they experienced their therapists as being open to feedback, and committed to shared decision-making and collaboration. The published articles include many interesting quotes from clients around each of these themes. These elements of therapy – explicit, shared understanding, and shared decision-making – are key aspects of a pluralistic approach. The findings of the IMPACT study suggest that, at least from the point of view of the client, these processes are crucial to success. Although the therapist’s starting point may be quite different – for instance a highly theoretically coherent CBT model or a looser psychoeducational framework – it is the capacity to explain the model in way that makes sense to the client that is important, and to do so in a way that genuinely involves input from the client.
Wilmots, E., Midgley, N., Thackeray, L., Reynolds, S., & Loades, M. (2020). The therapeutic relationship in Cognitive Behaviour Therapy with depressed adolescents: A qualitative study of good‐outcome cases. Psychology and Psychotherapy: Theory, Research and Practice, 93(2), 276-291.
Dhanak, D., Thackeray, L., Dubicka, B., Kelvin, R., Goodyer, I. M., & Midgley, N. (2020). Adolescents’ experiences of brief psychosocial intervention for depression: An interpretative phenomenological analysis of good-outcome cases. Clinical Child Psychology and Psychiatry, 25(1), 106-118.
Keywords: adolescent, collaboration, shared decision-making, shared understanding