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Development and Validation of the Adolescent Psychotherapy Q-set (APQ)

  • Research Project Team

    • Ana Calderón, PhD
    • Professor Mary Target
    • Nick Midgley, DPsych, PhD
    • Celeste Schneider, PhD


  • Background

    Over the years, psychotherapy research has evolved towards an understanding of the factors that lead to patient improvement (Lambert, 2013).

    Researchers have increasingly recognised that alongside assessing the outcome or effectiveness of various types of treatments, it is important to understand the process of psychotherapy (Midgley, 2009), which has been defined as primarily “the actions, experiences and relatedness of patient and therapist in therapy sessions when they are physically together” (Orlinsky, Rønnestad, & Willutzki, 2004, p. 311).

    But while process research into psychotherapies with adult patients is relatively prolific (Kennedy & Midgley, 2007), there is a clear gap in current knowledge about the processes that take place in psychotherapy with adolescents. This may be due in part to the paucity of tools designed to quantify adolescent psychotherapy process.

  • Aims

    Development and validation of the Adolescent Psychotherapy Q-set (APQ), a Q-set composed of 100 items that describe the psychotherapy process in young people’s treatments in a form suitable for quantitative comparison and analysis. The APQ provides three perspectives, on

    1. The young person's emotional states, attitudes, and behaviour;
    2. The therapist’s actions and attitudes; and
    3. The nature of the interaction of the dyad.

    It is intended to be neutral with respect to any particular theory of psychotherapy (i.e. phanteoretical), and should permit the portrayal of a wide range of events, interventions, and processes in the psychotherapy process.

  • Methodology

    Data derived from a randomised controlled trial (IMPACT study) that compares the efficacy of Short-Term Psychoanalytic Psychotherapy (STPP) and Cognitive-Behavioural Therapy (CBT) for moderate to severe depressed adolescents.

    The validation was conducted with the ratings of seventy audio-recorded psychotherapy sessions with a range of therapists, patients, and treatment stages, from two therapeutic approaches (STPP and CBT).

    Data analysis included Q-factor analysis, intraclass correlation coefficients, cluster analysis, and parametric and non-parametric correlations and comparisons of group means.

  • Results

    Results suggest that the APQ is a valid and reliable instrument.

    Despite being pan-theoretical,

    • it captures differences between therapeutic techniques (STPP, CBT);
    • has the capacity to distinguish between excellent, moderate, and poor levels of therapeutic alliance;
    • and shows good levels of inter rater reliability.

    Results also show that the psychotherapy process of the sessions studied was heavily influenced by the young person’s responsiveness.