Response to Maria Papadima’s commentary on MacKean et al. (2023) and Midgley et al.’s (2021) Papers about an Internet-Based Psychodynamic Treatment

We welcome a chance to respond to Maria Papadima’s commentary on the papers by MacKean et al. (2023) and Midgley et al. (2021). Papadima raises some important questions about how we understand the apparent increase in adolescent mental health difficulties, and the way in which psychoanalytically-trained child psychotherapists can respond to potential innovations or new developments in mental health support.

Although Papadima makes some positive comments on the internet-based psychodynamic treatment (iPDT) that was described in our pilot study (Midgley et al., 2021), she raises a number of concerns, including:

1. whether iPDT should be considered a ‘psychotherapy’, or whether it is better defined as an ‘online course’ or ‘online educational approach’;

2. whether we consider that it is a therapy or not, and if so, should it be considered a psychodynamic approach, or a more generic model of building skills in emotional awareness; and

3. whether iPDT is a potentially valuable addition to what child mental health services can offer, or whether there is a risk of blurring the line between treatment for those with a clinical diagnosis of depression, and those who are dealing with milder problems with mood, which can be managed through support and psychoeducation; and if so, whether introducing iPDT risks undermining the recognition of need for highly specialist, qualified psychotherapists.

These are all important and valid concerns, which we will try to respond to in turn.

Although there is no single, commonly accepted definition of psychotherapy, Wampold and Imel (2015) define psychotherapy as a primarily interpersonal treatment that is a) based on psychological principles; b) involves a trained therapist and a client who is seeking help for a mental disorder, problem, or complaint; c) is intended by the therapist to be remedial for the client’s disorder,