This was the ACP’s first Real Conversations .......conference, which focused on adolescent depression. It saw the coming together of child psychotherapists and a wide range of other mental health professionals for a day to think about the topical issue of adolescent depression. Delegates heard about services around the country offering innovative models of working, all “underpinned by psychoanalytic approaches”.
Dan McQueen, a child, adolescent and adult psychiatrist at the Tavistock and also Cygnet Hospital Ealing, opened with an overview of research into depression. He highlighted how “treatment needs to be focused on causes not symptoms” which, with their “adaptive functions”, can be misleading. He looked, too, at what works for whom, at how psychotherapy has been shown to be most beneficial to depressed patients who have suffered early trauma, more effective for those struggling with feelings of loss and dependency, less so for those with feelings of failure and perfectionism. He noted, also, the importance of patient preference in determining treatment outcomes.
Deborah Marks, consultant psychotherapist at the Orchard Therapy Centre in Leeds, looked at the neuroscience of the adolescent brain and how the language of neuroscience can help build therapeutic alliances. We need to develop a new language when working with adolescents, she said, and explained how the language of neuroscience can help; adolescents quickly understand talk of “fight, flight and freeze”, of why they might sometimes need to “press the pause button”. She described how it is easier to hear “your brain might freeze and stop you getting the help you need” than, “you freeze and stop yourself getting the help you need”. It was also clear, from her presentation, that parents also find it helpful talking about the adolescent brain and how a better understanding can help to reduce their feelings of blame and sense of persecution.
Young people as adolescent patients, also attended the day and spoke bravely and movingly about how they had been helped by Pause, a drop-in service run by Forward Thinking Birmingham (FTB) with a strong emphasis on patient involvement. This is an NHS and Children’s Society initiative and it offers a 7-days-a-week mental health service for 0-25 year olds, designed by young people, to feel more like a “Costa or Apple store” than a clinic. A young person who is an immigrant, spoke about the severe anxiety he had suffered; and a former in-patient described a painful history of family mental health problems and his journey towards recovery. We heard, too, from a previous service user who is now employed by Pause. The youth worker and Participation and Engagement Lead for FTB, Bob Maxfield, said for service user involvement to work it needs to be “meaningful, real and authentic." That means "acting on what service users tell us but being honest with them, too… it can’t just be a tick box exercise”.
Ben Yeo, child and adolescent psychotherapist at Oxleas NHS Foundation Trust, gave a vivid account of work with a depressed adolescent, summarising the Short-Term Psychoanalytic Psychotherapy (STPP) model and how it can help patients with severe and long-term depression. For his patient, and perhaps many STPP patients, important themes around time and boundaries emerged. There was a constant sense of a “ticking clock” but, rather than being a persecutory experience, the therapy gradually came to represent a firm and reliable “father time” for this patient. "Twenty-eight sessions was enough to get stuck in," concluded Yeo, "but not too stuck".
Julia Britton, consultant child and adolescent psychotherapist and director of Open Door, gave an overview of the now 40-year-old London therapy service for young people and its evolving treatment models. She described the pressure from funders in the voluntary sector to come up with new services but also how patients’ individual needs can drive innovation, as seen in Open Door’s Triple Track Treatment model which provides intensive, multi-modal interventions. Together with Anne-Marie Lewis, a counselling psychologist, she described a long-term psychoanalytic psychotherapy case in which the patient was helped to make real progress in her therapy by being given parallel mindfulness and compassion-focused therapy. We heard, too, about Open Door’s soon-to-be-published parent work model.
There was more on parent work from Lynne Conway, principal child and adolescent psychotherapist working for NHS Greater Glasgow and Clyde, who spoke about supporting parents with "a two-way process of holding on and letting go”. Conway described the pressure on therapists to provide a “magic cure” and the feelings of despair when change does not come quickly. But also how working with a trauma framework in mind can help. She quoted another ACP member, Lydia Tischler, explaining that by the time the parents of depressed adolescents are seen in clinics they have often endured considerable levels of fear. Seeking help can feel like a minefield of judgment and criticism with professionals experienced as bringers back of trauma. She spoke about developing a shared language with parents and “finding words to describe their anguish”.
Milly Jenkins, our reviewer adds, "although there was not much overt discussion at the conference about a growing adolescent mental health crisis, this was implicit. But rather than collective hand-wringing, there was a surprisingly hopeful sense of services and treatment models managing to hold on to core values whilst adapting and innovating to meet increasing demand and complexity." One delegate had noted a recurring metaphor in many of the presentations about buildings and architecture, an emphasis on the importance of boundaries and structure for patients but also for solid services to house and hold them in. Jenkins, concludes: "This is not always easy to believe at the moment, but let’s at least hope this is the first of many ACP conferences on adolescent depression where important thinking about 'what works now' can be built on."
The ACP would be interested to hear from young people or their parents, about their expereince of adolescent depression, please get in touch if you have something to share.