Personality syles, depressive disorders and therapist responses in adolescent psychotherapy: A PDM-2 empirically oriented and clinically meaningful investigation.

Introduction: The assessment of personality pathology and depressive disorders in adolescence is very challenging due to the high prevalence and comorbidity of these psychopathological conditions in young people. This study explored the relationship among personality patterns, depressive disorders, and therapists’ responses in adolescent treatment according to the PDM-2 diagnostic framework. Method: Fifty clinicians completed the Psychodiagnostic Chart-Adolescent, the Shedler-Westen Assessment Procedure-II for Adolescents and the Therapist Response Questionnaire for Adolescents to provide a comprehensive assessment of psychological functioning and countertransference responses of an adolescent patient in their care. Results: Four emerging personality profiles related to depressive pathology in adolescence were identified: depressive/introjective, anxious–avoidant, emotionally dysregulated, and narcissistic. The latter two subtypes significantly correlated with a borderline personality organization, whereas the others showed a trend toward significance with a neurotic level of personality organization. Moreover, adolescents presenting with emotionally dysregulated and narcissistic personality patterns tended to evoke negative emotional reactions characterized by anger, irritation, worry, and sense of inadequacy. Patients with depressive/introjective pattern elicited less intense and negative countertransference reactions, whereas patients with anxious–avoidant pattern tended to evoke protective reactions in their clinicians. Conclusions: The study extends knowledge on emerging personality patterns related to depressive disorders in adolescents, and provides a nuanced view of countertransference reactions evoked by these patients in psychotherapy. Therapists should use the information derived from the therapeutic relationship to generate clinically meaningful diagnosis and promote treatments tailored on adolescents’ psychological functioning.