Psychotherapeutic Process in Adults with Depressive and Anxiety Symptoms Who Report Childhood Maltreatment: A Scoping Review

Abstract

Extensive research exists regarding the impact of childhood maltreatment (CM) on depression and anxiety in adulthood. Still, its effect on the psychotherapeutic process, particularly symptomatic change and working alliance, remains unclear. Evaluating studies on the impact of CM on the psychotherapeutic process can help identify research gaps. This study aimed to conduct a scoping review of studies on the psychotherapeutic process in individual psychotherapy of adults with symptoms of depression and anxiety who report CM. The study followed the JBI Scoping Review Methodology. Searches were conducted in October 2022 across eight databases for peer-reviewed articles, books, and gray literature. Eligible studies examined the psychotherapeutic process in individual psychotherapy of adults with depression and/or anxiety who reported CM. A narrative method was employed to analyze and synthesize the studies. A total of 39 studies were included, consisting of 35 scientific articles and four doctoral dissertations. Most were randomized controlled trials evaluating different psychotherapeutic approaches, primarily cognitive-behavioral, interpersonal, and psychodynamic therapies. Patients with CM responded to psychotherapies for anxiety and depression, but showed higher symptom levels at both the beginning and end of treatment, along with delayed responses. A strong working alliance was essential for outcomes across different psychotherapeutic approaches. Psychotherapies for anxiety and depression in patients with CM should focus on building a strong working alliance and consider additional time for treatment responses. Future psychotherapy research on people with CM should report on the processes, including the working alliance. More studies assessing personality, anxiety, therapists’ perspectives, and employing qualitative methodologies are needed.