CEFS 620 Week 5 Analysis Paper 2 Example

Analysis Paper: How Much Psychotherapy Helps Depressed Adolescents, and How Counselors Can Improve the Odds

The Problem and the Thesis

Depression is among the most common mental health problems of adolescence, and it became more common in the early 2020s. Racine et al. (2021) estimated that about one in four young people worldwide had clinically elevated depressive symptoms during the first year of the pandemic. McWhirter et al. (2017) describe depression and suicidal behavior as central concerns in work with at-risk youth, and Cook-Cottone et al. (2015) stress that counselors must adapt treatment to the developmental level of the young client. This paper analyzes how well psychotherapy works for depressed adolescents and argues that it helps but leaves most young people unimproved, so counselors should strengthen standard therapy with family involvement and use brief, accessible interventions to reach those who would otherwise receive nothing.

How Well Does Psychotherapy Work?

Most meta-analyses of youth depression treatment report effect sizes, which are hard to translate into what a counselor will see. Cuijpers et al. (2023) addressed that problem in a meta-analysis of 40 randomized trials that reported clinical outcomes. Roughly two months in, response had occurred in 39 of every 100 treated young people and 24 of every 100 in the comparison groups, which means about six youths must be treated for one extra response; the gap remained significant at six to twelve months. Clinically significant improvement occurred in 54 percent of youth in therapy and 32 percent of controls, deterioration in 6 percent versus 13 percent, and recovery in 58 percent versus 36 percent.

These figures support therapy, and they are easier to explain to families than effect sizes: roughly one more adolescent recovers for every three or four who receive therapy rather than no therapy. They also carry two warnings. First, more than 60 percent of young people receiving therapy did not respond within the study period. Second, studies with a low risk of bias showed smaller effects, so the most trustworthy trials paint a more modest picture. The honest message for counselors is that psychotherapy helps depressed adolescents, but that a counselor should expect many clients not to respond to a first course of treatment and should plan for that from the start.

Involving the Family

One way to improve outcomes is to involve caregivers. Dippel et al. (2022) reviewed 19 randomized trials and meta-analyzed 17, comparing interventions that involved caregivers or families with similar interventions that did not. They found a small but significant added benefit for family involvement at the end of treatment (d = 0.34). The trials varied widely in how much caregivers were involved and in how outcomes were measured, so the review cannot say which form of involvement works best. Still, the finding fits what the textbooks emphasize about the family as the most important context of a young person's life, and it suggests that bringing parents into treatment, even in limited ways, is worth the effort. In practice, involvement can range from a few sessions teaching parents about depression and how to respond to withdrawal or irritability, to full family sessions that address conflict at home. A counselor can start with the lighter forms, which most families accept, and move to fuller involvement when family conflict appears to be maintaining the adolescent's symptoms.

Reaching Youth Who Receive No Care

A second strategy addresses a different problem: many depressed adolescents never reach a counselor at all. Schleider et al. (2022) tested free online single-session interventions with 2,452 adolescents aged 13 to 16 with elevated depressive symptoms, recruited from all 50 states. Compared with a supportive control, both active interventions, one teaching behavioral activation and one teaching that personal traits can change, reduced depressive symptoms three months later (d = 0.18) and reduced hopelessness. The effects were small, but they came from a single session that cost nothing and required no appointment. For the many adolescents who will not or cannot enter ongoing therapy, such interventions offer a first step.

Weighing the Evidence

The three bodies of evidence differ in strength. The meta-analysis of psychotherapy rests on 40 trials and provides the most reliable estimate of what standard treatment achieves. The family involvement review shows a consistent but small advantage with considerable variation among studies. The single-session trial is large and well controlled, but it is one study with a three-month follow-up. Together they suggest that the best approach combines structured therapy, active family involvement and low-barrier tools that extend care beyond the counseling office.

Implications for Counselors

Counselors working with depressed adolescents should measure progress regularly, so that nonresponse is noticed within weeks rather than months, and should be ready to adjust or intensify treatment when a client is not improving. They should invite caregivers into treatment from the first session, with the adolescent's agreement. They should also know which free, evidence-based online tools they can recommend to young people on waiting lists or to those reluctant to begin counseling. Finally, because deterioration occurred in a minority of treated youth as well as in controls, counselors should screen regularly for worsening symptoms and suicidal thinking, and should have a clear plan for referral to psychiatric care when a client's depression deepens despite treatment. The deterioration figures are a reminder that monitoring is part of treatment, not an administrative task.

A Christian Perspective

The research shows that many young people do not improve quickly, which can discourage both clients and counselors. Writing to the Corinthians, Paul describes being pressed hard yet not crushed and bewildered yet not hopeless (English Standard Version Bible, 2001/2016, 2 Corinthians 4:8). A Christian counselor can bring that kind of hope to an adolescent who has not yet responded, while continuing to search for the approach that will help.

Conclusion

Psychotherapy helps depressed adolescents, but less often than many assume. Involving families adds a modest benefit, and brief online interventions can reach youth who would otherwise receive nothing. Counselors who plan for nonresponse, bring parents in and use every tool available will give more young people a real chance of recovery.

References

Cook-Cottone, C. P., Kane, L. S., & Anderson, L. M. (2015). The elements of counseling children and adolescents. Springer Publishing.

Cuijpers, P., Karyotaki, E., Ciharova, M., Miguel, C., Noma, H., Stikkelbroek, Y., Weisz, J. R., & Furukawa, T. A. (2023). The effects of psychological treatments of depression in children and adolescents on response, reliable change, and deterioration: A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 32(1), 177-192. https://doi.org/10.1007/s00787-021-01884-6

Dippel, N., Szota, K., Cuijpers, P., Christiansen, H., & Brakemeier, E.-L. (2022). Family involvement in psychotherapy for depression in children and adolescents: Systematic review and meta-analysis. Psychology and Psychotherapy: Theory, Research and Practice, 95(3), 656-679. https://doi.org/10.1111/papt.12392

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

McWhirter, J. J., McWhirter, B. T., McWhirter, E. H., & McWhirter, A. C. (2017). At risk youth (6th ed.). Cengage Learning.

Racine, N., McArthur, B. A., Cooke, J. E., Eirich, R., Zhu, J., & Madigan, S. (2021). Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: A meta-analysis. JAMA Pediatrics, 175(11), 1142-1150. https://doi.org/10.1001/jamapediatrics.2021.2482

Schleider, J. L., Mullarkey, M. C., Fox, K. R., Dobias, M. L., Shroff, A., Hart, E. A., & Roulston, C. A. (2022). A randomized trial of online single-session interventions for adolescent depression during COVID-19. Nature Human Behaviour, 6(2), 258-268. https://doi.org/10.1038/s41562-021-01235-0