Adolescent Identity Treatment

Pamela A. Foelsch, PhD Weill Cornell Medical College, New York-Presbyterian Hospital, Harrison, NY, USA

Prof. Dr. Klaus Schmeck Psychiatric University Hospitals, Basel, Switzerland

Andrés H. Borzutzky Instituto Médico Schilkrut, Santiago, Las Condes, Chile

Helen T. Arena, PhD Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NY, USA

Anna E. Odom, PhD Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NY, USA

Dr. Susanne Schlüter-Müller Practice for Child- and Adolescent Psychiatry and Psychotherapy, Frankfurt, Germany Psychiatric University Hospitals, Basel, Switzerland

1 Introduction 
2 Description of the Disorder
2.1 Terminology and Definition
2.1.2 Definition of Personality Disorders according to DSM--‐IV--‐TR
2.1.3 Transition to DS
M2.2 Epidemiology
2.3 Course and Prognosis
2.4 Diagnostic Procedures and Differential Diagnosis 
3 Theoretical Models and Rationale
3.1 Models of the Disorder
3.2 Neurobiological Vulnerability
3.3 Sequence of Growth and Implications for Continued Development
3.4 Theory Underlying the Individual Psychotherapy
3.4.1 Object Relation Theory
3.4.2 Developmental Theory
3.4.3 Identity
3.5 Theory Underlying the Environmental Interventions 
4 Diagnosis and Treatment Indications
4.1 Structure and Process of the Initial Patient Contact
4.2 Diagnostic Process
4.3 Diagnostic Procedures and Interviews
4.3.1 Psychiatric Diagnosis
4.3.2 Structural Diagnosis
4.3.3 Identity Assessment
4.3.4 Standard Assessment Battery Recommendations
4.4 Treatment Indications and Contraindications
4.4.1 Indications for Adjunctive Treatment
4.4.2 Treatment Refusal
4.4.3 Treatment Contraindications 
5 Treatment
5.1 Aims and Goals
5.1.1 Specific Aim
5.1.2 Planting seeds
5.2 Therapist Variables, Stance, and Attitudes
5.2.1 Considerations….the air within which the treatment thrives
5.2.2 Therapist Characteristics and Attitudes
5.2.3 Therapist Stance
5.2.4 Maintaining Objectivity
5.3 Preparatory Phase and Education
5.3.1 Confidentiality
5.3.2 Shift in Family Dynamic
5.3.3 Treatment Limitations
5.3.4 Role of Family in Treatment
5.3.5 Psychoeducation
5.3.6 Factors that may contribute to treatment interruptions
5.3.7 General Parenting Strategies
5.3.8 Tasks of Adolescence
5.4 Contract Setting
5.4.1 Contracting Phase
5.4.2 Individual Contract
5.4.3 Family Contract
5.4.4 Threats to Treatment
5.5. Strategies for the Treatment
5.5.1 Session Frequency: Individual and Parent/Family
5.5.2 Length of Treatment
5.5.3 Direct Interventions
5.5.4 Dual Treatment Focus: Acute/Focal and Long--‐Term (Structural Change)
5.5.5 Patient Driven versus Model Driven
5.6 Tactics
5.6.1 Maintaining the Treatment Frame
5.6.2 Selecting the Dominant Affect
5.6.3 Regulating Affect in Sessions
5.6.4 Intervention: Tactics
5.6.5 Transference and Countertransference
5.6.6 Modification of Transference Analysis with Adolescents
5.7 Techniques
5.7.1 Channels of Communication
5.7.2 Clarification
5.7.3 The Process of Clarification with Adolescents
5.7.4 Confrontation
5.7.5 InterpretationSummary of Adolescent Specific Techniques
5.8 Working with the Families
5.8.1 Practical issues around treatment
5.8.2 Parent strategy for tolerating negative affect
5.9 Direct Environmental Interventions
5.9.1 Home Plan
5.9.2 Additional Direct Environmental Interventions
5.10 Adjunctive Psychopharmacological Treatment
5.11 AIT Summary 
6 Adolescent Identity Treatment (AIT) Case Illustration
6.1 Initial Evaluation
6.1.1 Structural Interview
6.1.2 Parent/Family Assessment
6.1.2.2 Collateral Sources
6.2 Contracting
6.2.1 Anna’s Motivation for Treatment
6.2.2 Contracting Process
6.3 Treatment:
6.3.1 Anna’s Treatment Course
6.3.2 Implementing Home Plan with Parents
6.3.3 Working Through of Splitting in Self-Representation
6.3.4 Individual Treatment Summary
6.3.5 Parent’s Treatment Course 7Efficacy
7.1 Empirical Support for Efficacy of AIT
7.3 Modifications of Adult Treatment for Adolescents
7.4 AIT in Adolescents
7.4.1 Chart Review Study 8Training and Supervision
8.1 Training