Short-term psychoanalytic psychotherapy with a depressed adolescent with borderline personality disorder: an empirical, single case study

While clinical descriptions of psychotherapy with depressed adolescents with traits of borderline functioning exist, they are not yet supported by empirically-grounded research. This single-case study aims to identify meaningful therapist-patient interaction in the course of short-term psychoanalytic psychotherapy with an adolescent girl who meets diagnostic criteria for both Borderline Personality Disorder (BPD) and Major Depressive Disorder (MDD). Twenty-eight sessions of psychotherapy were coded, using the Adolescent Psychotherapy Q-Set. Five interaction structures were identified, which were distinguished by the nature of the adolescent's emotional expression during sessions, and how the therapist responded to the young person. Exploration of the clinical and theoretical meaning of these interaction structures suggests that core elements of a young person's depression and borderline functioning can be identified in sessions, and that the therapeutic process overall shows some significant departures from some of what is usually recognised as a typical psychoanalytic approach. The paper discusses whether these changes in technique can be understood as responses to the clinical challenges associated with working with adolescents with borderline features.