“She’s doing this to me on purpose”: the role of parents in psychodynamic treatment of adolescent depression

Parental attitudes toward adolescent depression are often shaped by interpretations of the young person’s behaviour as intentional, provocative, or rejecting. Although empirical research identifies hostile attribution bias as an important mechanism linking parental distress with adolescent maladjustment, it does not fully explain why such interpretations become emotionally compelling for both parents and adolescents. The aim of this paper is to offer a theoretical integration of hostile attribution bias with the psychoanalytic concept of projective identification, in order to explain a question the empirical literature leaves open: why hostile attributions become so emotionally compelling and self-sustaining for parents and adolescents alike, rather than being simply erroneous cognitions that could in principle be corrected with better information. Drawing on psychoanalytic theory, empirical research, and an illustrative clinical vignette, the paper argues that psychodynamically informed parent work is an essential component of treatment. By providing a therapeutic space in which parental emotional experience can be reflected upon rather than enacted, parent work reduces the defensive need for hostile attributions and promotes greater parental reflectivity. This integrative framework extends current understanding of parental hostility in adolescent depression and offers a psychodynamic account of the mechanisms through which work with parents may facilitate therapeutic change.