Breakthroughs in emotional awareness: Exploring sudden gains in internet-based psychodynamic therapy for depressed...

To explore factors and processes surrounding sudden gains (SGs) in internet-delivered psychodynamic therapy (IPDT) for adolescent depression.

Based on a randomized controlled trial, 22 patients' chat therapy sessions in close connection, both before and after an SG, were analyzed using reflexive thematic analysis, with a focus on the therapeutic process as well as the patients' descriptions of their improvement.

In the majority of cases, SGs in IPDT were preceded by a process that can be summarized in four themes: "I worked hard with the support of my therapist; "I began to understand myself through the self-help materials"; "I applied my new understanding in everyday life"; and "I became more aware of my feelings and less self-critical."

SGs in IPDT seem to be not just statistical phenomena but meaningful psychological experiences, preceded by recurring therapeutic patterns extending over multiple sessions. In this process, engaged work facilitates the acquisition and application of new self-knowledge, leading to significant changes in emotional awareness and self-criticism.