Mapping Developmental Assets in Kosovo’s Youth: Insights into the Internal Cohesion Psychotherapeutic Process for Young People Experiencing Anxiety and Depression: A Qualitative Study

Abstract

This study explores anxiety and depression among young individuals in Kosovo, considering socio-political and economic influences. Introducing Positive Youth Development (PYD) as a framework, the study explores its integration with Internal Cohesion Psychotherapy (ICP) to address youth mental health challenges. Empirical evidence underscores ICP’s positive impact on mental health outcomes, emphasizing developmental assets. Thematic analysis of participant narratives reveals six key themes, showcasing ICP’s transformative nature, the critical role of social support networks, values and beliefs, reflections on personal growth, and therapy’s extended impact on relationships. Participants’ stories highlight ICP’s profound influence on personal growth, social relationships, and mental health. The study examines internal and external assets, emphasizing social networks, values, beliefs, and cultural competence. Insights into ICP’s intrapersonal and professional systems reveal developmental assets fostering growth, motivation, and engagement. External assets like empowerment, safety, and service to others, alongside internal assets like commitment to learning, positive values, integrity, and responsibility, contribute to an understanding of factors influencing Kosovo’s young population. In conclusion, the integration of PYD and ICP offers a powerful synergy to address mental health challenges, providing valuable insights into specific developmental assets crucial for optimizing interventions and promoting mental health among young Kosovars.

1. Introduction

Mental health conditions represent a substantial portion of the disease burden affecting young people aged 10–24 years globally [1]. Factors such as academic pressure, social media, economic challenges, and the stigma associated with mental health contribute to the escalating rates of mental health issues among the youth [2].

Adolescence and young adulthood, as a transformative period marked by biological, cognitive, psychological, and social changes, stands out as a challenging phase characterized by historical perceptions of inherent problematic behaviors among individuals [3,4].

In Kosovo, the prevalence of mental health conditions, particularly anxiety and depression, has risen and intensified due to the socio-political and economic challenges faced by the country [5,6]. The aftermath of the Kosovo War and ongoing state-building processes contribute to a complex mental health landscape. Limited access to mental health services and the persistence of stigma further hinder individuals, especially young people, from seeking help [7].

In response to these challenges, Positive Youth Development (PYD) emerges as a framework that not only addresses mental health concerns, but also emphasizes the positive assets and strengths of young individuals [8,9]. PYD recognizes the potential for growth and development in young people when provided with opportunities, support, and resources. The approach aims to foster resilience, competence, and a sense of purpose in youth by focusing on skills, talents, interests, and meaningful connections. In this regard, developmental assets, integral to Positive Youth Development (PYD), exhibit a negative correlation with depression and anxiety in adolescents [10]. These assets, encompassing factors such as social support, positive identity formation, coping skills, autonomy, school engagement, and community connections, act as protective mechanisms against mental health challenges. When young individuals experience strong social bonds, a positive sense of self, effective coping strategies, and engagement in school and community activities, they are less prone to feelings of isolation, inadequacy, and stress that contribute to depression and anxiety [11]. By fostering a holistic foundation for well-being, developmental assets play a crucial role in mitigating the risk of mental health issues during the formative years of adolescence.

This research acknowledges the need for an integrated approach, recognizing the role of psychotherapy in addressing mental health challenges within the PYD framework. Psychotherapy offers a confidential space for young individuals to navigate challenges, develop emotional resilience, and explore their identity [12]. This paper specifically explores the symbiotic relationship between PYD and Internal Cohesion Psychotherapy (ICP) to identify external and internal assets crucial in the psychotherapeutic process for youth struggling with anxiety and depression.

The integration of PYD and ICP is a powerful synergy that places the mental health journey of young individuals at the forefront of comprehensive therapeutic exploration [13]. While PYD emphasizes nurturing strengths and assets, ICP explores an individual’s internal resources and resilience factors. Developed as an integrative psychotherapeutic model, ICP draws from diverse theories and practices, aiming to achieve internal cohesion and effectively treat emotional difficulties such as anxiety and depression [13,14].

Empirical evidence from a study conducted by the author and colleagues underscores the positive impact of ICP on mental health outcomes, with developmental assets playing a crucial role in enhancing the psychotherapeutic process [13]. The implications of these findings contribute to the theoretical understanding of integrating developmental assets into psychotherapeutic interventions, offering practical insights for clinicians to optimize the effectiveness of psychotherapy.

The theoretical foundations of Positive Youth Development (PYD) and Internal Cohesion Psychotherapy (ICP) demonstrate notable similarities, particularly concerning developmental assets and their integration within the psychotherapeutic process. The intrapersonal system of ICP, encompassing self-regulation, self-esteem, and motivation [15] aligns with the concept of internal assets in PYD, emphasizing the importance of nurturing skills and competencies. Similarly, external assets, particularly support from significant others [16], resonate with the interpersonal system of ICP, highlighting the role of healthy relationships in positive development. Both frameworks recognize the multifaceted influences on mental, emotional, and behavioral development in young adults, encompassing intrapersonal and interpersonal relations, and acknowledging the impact of various societal factors [15,17].

While the broader field understands the role of internal and external assets in youth development, this study uniquely explores what are the most prominent internal and external assets in the psychotherapeutic process in treating anxiety and depression among young adults in Kosovo. By identifying specific assets crucial to the therapeutic process, the study seeks to provide meaningful insights into promoting and improving mental health while preventing psychological difficulties among young Kosovars.

2. Materials and Methods

2.1. Participants

This study involved a cohort of 10 participants drawn from a prior study on PYD and ICP [13] (N = 10; mean age = 26.10, standard deviation = 5.28), comprising eight females and two males. These individuals showed symptoms of depression and anxiety disorders and underwent treatment with Internal Cohesion Psychotherapy (ICP). In terms of education, six participants held a bachelor’s degree, three of them held a master’s degree, and one participant had completed secondary education. The participants, residing in diverse regions of Kosovo, received psychotherapy services at the “Empatia” clinic in Prishtina. Eligibility criteria for inclusion involved young adults experiencing symptoms of depression and anxiety, undergoing Internal Cohesion Psychotherapy (ICP) treatment. Eligible participants had completed more than five psychotherapy sessions, each lasting 45–60 min, conducted on a weekly basis. All sessions were conducted in the Albanian language, given that the participants were native Albanian speakers.

2.2. Data Collection

Data collection employed two interviewing protocols. The first, titled “Effectivity of Internal Cohesion Psychotherapy”, explored participants’ perspectives on their psychotherapeutic experiences, overall assessments of psychotherapy effectiveness, and the psychotherapist’s role in addressing issues related to the four ICP systems—intrapersonal, interpersonal, professional, and spiritual—across three time perspectives (past, present, and future). The PYD protocol, adapted from the Search Institute [18] and translated into Albanian through a translation–back translation procedure, included questions on the presence of external assets (support, empowerment, boundaries and expectations, constructive use of time) and internal assets (commitment to learning, positive values, social competencies, positive identity). The entire interview comprised 41 questions related to the effectiveness of internal cohesion psychotherapy and 9 questions focused on developmental assets.

2.3. Procedure

The current research analyzed transcribed interviews as part of our effort to explore both external and internal assets in the context of psychotherapeutic processes. The study received ethical approval from the “Empatia” multidisciplinary clinic’s ethics committee. These interviews originally involved individuals who had undergone Internal Cohesion Psychotherapy (ICP) to address symptoms associated with depression and anxiety disorders. The interviews were initially conducted as a component of a broader study examining the effectiveness of internal cohesion psychotherapy for young clients dealing with depression and anxiety disorders in Kosovo, specifically focusing on the role of developmental assets [13]. The therapy sessions, in which the participants of this study took part, were completed in 2022, while the transcription and coding of findings occurred in 2023. For this particular analysis, we selected the 10 most recent interviews to concentrate on the insights and experiences.

2.4. Ethics

A consent form to participate in the study was first given to participants, from which they were asked to approve their participation in the study. The letter presented all of the information on the realization and purpose of the study, as well as informing them that the collected data for the study would be protected with complete anonymity and used only for the purpose of the study.

2.5. Data Analysis

In this study, we employed thematic analysis to examine the findings from 10 interviews. The analysis followed a deductive semantic/manifest approach, involving the exploration of data based on predetermined themes. Transcripts of audio recordings served as the primary source for analyzing explicit data. The coding process involved highlighting relevant sections of the text, such as phrases and sentences, and organizing them into codes. The coding process yielded six main themes: Experiences within Internal Cohesion Psychotherapy; Personal development and growth within the Intrapersonal System; Social and relational connections within the Interpersonal System; Career and life alignment within the Professional System; Belief, religion and fulfillment within the Spiritual System; and the transformative effects of Internal Cohesion Psychotherapy. Each category encompassed 3 to 12 subcodes, resulting in a total of 50 questions. Each interview transcript underwent individual coding, and all transcripts were utilized for generating summary statistics. The analysis of the interviews was conducted solely through thematic analysis, adhering to the methodological guidelines established by Braun and Clarke [19]. Notably, this process was carried out manually, without the assistance of any specific analytical software.

3. Results

The current study, comprising in-depth analysis of 10 interviews, offers comprehensive insights into the experiences and perspectives of individuals undergoing Internal Cohesion Psychotherapy (ICP) for symptoms related to depression and anxiety disorders in Kosovo. Each of the explored themes contained important information, collectively offering a detailed understanding of participants’ encounters and viewpoints within the psychotherapeutic context. Moreover, our analysis resulted in a detailed map of the presence of developmental assets in the psychotherapeutic process, by better understanding participants’ journey and perspectives regarding the assets and their relevance in their psychological experiences. Through thorough thematic analysis, six distinct themes emerged, each presented in detail in the following sections and capturing the present interaction between internal and external assets with the ICP systems across the past, present and future.

3.1. Theme 1: Experiences within Internal Cohesion Psychotherapy

The interviewees stated that the experience in psychotherapy had been effective for them, leading them to observe positive changes in themselves.

Participant AGAV emphasized this impact, stating, “It had a lot of effect. You know, now, I still think I need therapy, but for a short period of time I have seen a lot of changes in myself”.

The effectiveness of this approach was also proven in the response of the participant AGDZ, as follows: “I feel very good—it’s just like medicine that makes you feel good for 5 min or cures your pain”.

Similarly, participant AGGS showed how this effectiveness was noticed in the very first sessions: “I think that there’s been a very big change. In the first session, when I got out (of the psychotherapy room), I didn’t say “Wow”, nor did I feel like I learned something. The second session was a completely different experience. When I came out of the second session, I felt a little lighter. It seemed as if a certain weight had been lifted from my back, and then I saw that it started to help me. From the third session onwards, I have been very open-minded, and I said that somehow this is helping me”.

The experience in therapy has been described by some participants as helping them to feel more empowered and contributing to an improved mental well-being. Participant DGBS illustrates this by stating how: “Therapy strengthened me, how do I say… one thing I remember from my experience is that when I left therapy, I was feeling better, more empowered—that I can understand what is going on, you know… that one”.

Participant DGSK underscored this impact, stating, “My eyes have been opened, so that I can see things in a different dimension. I used to look at things in a linear manner and I haven’t looked sideways, I haven’t looked, or had a better idea why I’m having anxiety or why I’m having this feeling. Now I see things differently, and for that it has impacted me a lot”.

In some cases, the participants also recounted their early experiences in psychotherapy, as they stated that they did not have a positive impression of psychotherapy until they engaged with the Internal Cohesion Psychotherapy (ICP) approach. Many noted a noticeable shift in effectiveness, and their overall attitudes toward psychotherapy following their experience with ICP.

For example, participant AGMZH shared, “When I came to the first session, I was in a very bad state, deeply disappointed, and had essentially given up on psychologists, having consulted with numerous ones before (…) When I entered the first session (with the ICP approach), it had never happened to me. This (referring to the current psychotherapist) was my fifth psychologist, and it had never happened to divulge everything to a therapist in one session. The comfort that he has offered me and indeed in the first session I have told him everything, and then it was then I realized that help was within reach”.

Similarly, participant AGDK stated that, “From the very first day, (it was) very effective. I mean, I did some sessions with two or three other psychologists, but (…) I wanted to see and experience what another one would be like. I guess it was somehow a way to observe (…) I don’t know what to call it, to make a comparison. But here (referring to the current psychotherapist), this is where I found support”.

The experiences with ICP, and the effectiveness obtained from psychotherapy, were also expressed in VSR’s answer: “I know that there has been progress for myself as well. I know that I am aware of the progress I have had, since I also had anxiety during that period”.

Participant AGVF also stated that, “I have been here with the Doctor (referring to the psychotherapist) for almost two years, and it is interesting how every 6 months or 1 year that perspective is changing. And the words, even though they are the same, have different shades of meaning for me now. Now I can say that I am very satisfied”.

3.2. Theme 2: Personal Development and Growth within the Intrapersonal System

The intrapersonal system of the Internal Cohesion Psychotherapy (ICP) approach has to do with the individual’s relationship with himself, incorporating functions such as self-regulation, motivation, self-esteem, self-confidence, etc.

During the interviews of the participants on this system, the focus was on how the individuals evaluated themselves, their motivation in performing their activities, their approach towards the process of achieving their goals, etc. The discussion was distributed across three different periods of time: the past, the present, and the future, from where we have seen how this therapeutic approach has helped the participants to have a healthier relationship with themselves.

The asset of Personal Power was among the developmental assets identified from this system, for which participant AGAV answered as follows: “Now I am clearer, now I know more what I want, not only for me, but in general I know better what I want. In a way, I think I have grown up and now I know, I take (things) differently. For example, I know something that is good for me, I do it, and when I see that something is not good for me, I pause to think first about the consequences, what could happen, and I assess and evaluate if I can handle this”.

Another asset, self-esteem, was highlighted during participant discussions. AGAV remarked, “If I had to rate myself from 1 to 10, previously it was around 3 or 4, but now it’s at 8 or 9”.

Similarly, AGDZ added, “… now in this period I value myself a little more after therapy. I started to think things more differently, because usually I have never put myself first”.

Regarding self-esteem, AGFH answered that “In general, I can categorize myself as a pleasant person”.

Meanwhile, participant AGGS reported this change as follows: “While I was comparing myself to others, it was causing me a lot of stress, and even more depression. When I started to fight with my previous self, instead of with other people, that’s when I started to change for the first time”. At the same time AGGS said that “I am now very proud of myself. Now I am very proud of where I am, just because of the fact that this change has happened”.

Participants were queried about their approach to setting life goals, and many noted positive changes attributed to therapy in this regard. During the review of these answers, we identified the Sense of Purpose asset, from which the participants answered as follows:

Participant AGGS said that “The will to do (things) has returned, which hasn’t been the case for a long time”.

Participant AGVF shared, “…I don’t have a problem because I set some goals for myself and I know that I want to do something for myself today…”.

Participants attributed this change partially to psychotherapy. For instance, participant AGAV mentioned that “…psychotherapy was one of the reasons why my motivation increased a little”.

3.3. Theme 3: Social and Relational Connections within the Interpersonal System

The interpersonal system focuses on the individual’s relationship with others, including relationships with family members, friends, partners, colleagues, and other important figures.

Regarding this system, just as in the previous topic, the discussion was divided into three different time perspectives, and we could see how the relationships of the participants were in the past, how they evaluated these relationships in the present, as well as what impression they had about the future of those relationships. During the review of the interviews, several developmental assets were identified. Among the aspects mentioned by the young people in regard to this system was the Family Support asset, as participants shared instances of how their family members provided support.

Participant AGDZ expressed, “I am grateful that my parents were close to me (…) they took care of me”.

Regarding this, participant AGGS recounted her experience on how her mother’s support helped her when she was dealing with mental health challenges: “Especially since last year, my mom especially has tried everything, all the methods that she had, or suggestions or what she could physically do for me, she has tried everything”.

Participant AGFH said, “I also had a lot of support from them, maybe since I was the youngest, they supported me a lot. Even today, in fact, I know that they are there if I need something, although the family has grown, things have changed, but the support has remained”.

Among the other identified assets was that of the Other Adult Relationships, through which the participants expressed how the support of other people had affected them.

About this asset, participant AGGS shared how: “With two people that I was very, very close to, I sat down and talked after this change happened, and I explained to them everything that is happening and fortunately for me, they’ve been really understandable and have shown themselves ready to accept this phase of mine”.

Participant DGSK said, “All of my people—when I say “my people”, I’m including my family and friends—who knew that I would come (to therapy), they were completely like, “you’re very, very good, and I can’t wait to see the result of what will be achieved with you”.

Participant AGFH remarked, “It seems that I have a good social circle, I have good company and there is potential to grow. I’m constantly meeting new people.”

Participant AGMZH said, “Yes, I am hoping that I will always have them because they are very good people that I know very well…”.

Another participant, DGSK, reported on how the support of others affected the part when she had to tell her friends how she deals with anxiety. “I hadn’t previously discussed anxiety with them. They knew I experienced anxiety, but then we talked about how anxiety develops, why anxiety is affecting me—when and why it happens. I didn’t have this kind of conversation, now it’s different. Now, it’s more like “Hey, I’m having anxiety”, you know…”.

Another asset that was mentioned was Time at home, about which participant AGFH expressed that, “I appreciate it a lot when I go home. For example, you know, I spent time with my parents (…) now I’ve learned to appreciate this, to cook something together with my mother, to do something together. That is happiness”.

Another asset identified by these young people was Honesty, pertaining to their willingness to tell the truth even when it is difficult to do so. On this part, participant AGVF showed how this had helped her in relation to others: “My relationships are healthier, in some aspects because “You like me or you don’t like me”, this is me, and you have to accept me as I am”.

The role of this asset was also identified in the part where these young people had a conversation with their family members regarding receiving therapy. Participant VSR answered about this part as follows: “I took the courage, I told my parents, I told them that I have scheduled sessions, I’m going to (therapy). Then, like all parents who are more conservative and don’t understand, being afraid, (asking) “why and why”. But I’ve made peace with myself and said “I want to give it a try, why not?”.

Participant AGDZ responded similarly: “When I told my sister, for example, she was very against it, but I said, you know, “I need it, so I’m not listening to anyone.”. Usually I have obeyed other people’s decisions, but I have decided that I must become better”.

Among other developmental assets that were mentioned within this system, the asset of Parent Involvement in schooling was also noted, around which AGGS stated that, “My mother has been extremely involved in my life. The only reason why I performed very well, especially in elementary school, was because my mother took care of me from the day I was born”.

Another development asset that was identified was Positive peer influence, which states how young people’s best friends can model responsible behaviors for them. In this regard, participant AGGS stated that, “It seems to me that living with students has had a great impact on this change in my routine. When you see someone else studying, doing homework, being productive, cleaning, washing. It somehow influences you positively, prompting you to do those things as well…”.

Meanwhile, the importance of having a supportive social circle was also emphasized by participant VSR, who recounted an experience of how his friends had helped him navigate a situation from the past: “…as a child I was bullied by some people older than me in the neighborhood. I don’t know why but I didn’t understand it as a phenomenon. This had a big impact on me, especially on my self-esteem, but it has not affected me to make friends with other people in the future. I believe that those strong social connections with other people have helped me cope with that part. And I can say that I have friends who are good friends, and I don’t differentiate them from the family…”.

3.4. Theme 4: Career and Life Alignment within the Professional System

The professional system of the Internal Cohesion Psychotherapy (ICP) approach has to do with the individual’s relationship with work, school, and overall life goals and academic or work/career performance. During the interview, the participants recounted how this approach had helped them in their approach to work, school, commitments, etc. For instance, AGDZ reflects, “Always, always for the better. At the time when I was very low… I didn’t even want to work, you know, I was just very passive. So, in general, even now that I’m better, I feel much better about myself. It’s a lot of good will… a lot of good ideas, a lot of creativity, and I like this one that has changed for the better…”.

Among the developmental assets mentioned regarding this system was Achievement Motivation. When the participants were asked about their impression of the relationship with work and school in the future, the following answers simultaneously showed a higher motivation.

Regarding this, participant AGDZ said, “…I really like work and it has been an extra motivation because I’ve seen that I have a lot of will for new ideas and… I don’t get lazy at doing things”.

The asset of Positive view of personal future was also mentioned in this system. Regarding this asset, participant AGAV said, “I love my profession very much and I think that in the future, I will be successful”.

Meanwhile, a similar answer came from participant AGMZH, who said, “It is a profession that I love very much and I don’t see myself doing any other profession (…) I hope that everything goes according to plan”.

Another asset that emerged in this system, based on the participants’ answers, was the asset of Creative activities. According to this, participant AGDZ responded, “Now I’m much more motivated. I just want to go out, and not sit at home, and do something new (…) I take a lot of pictures, I have my camera and I just say, okay, I’m going out, I’m buying some things and I’m taking pictures…”.

The important role of this asset was also described in the response of the participant AGFH, who said, “Activities keep me alive, that’s why I think I’ve been motivated. I also want to do the things I want to do, not just because I feel like I have to do them. Inactivity suffocates me”.

In relation to this asset, when asked about the future, participant VSR said that, “I would have found a hobby that could involve many people since I have always liked these things, and these types of hobbies have always made me feel good…”.

Another asset identified within this system was Reading for pleasure, about which participant DGSK stated had undergone a change in her relation to the present time: “Now it’s a different conversation, I like reading a lot”.

The participants reported that discussing their relationships with work, school, and life goals in general, in therapy, resulted in the creation of new perspectives, thus proving the effectiveness of this approach. The participants answered as follows:

“It had a (significant) impact. The narrative was changed to express a very important opinion during a meeting with all the project members. I made a decision that altered the course, and I felt content with it. It was a big step for me”, said participant VSR.

Participant AGGS expressed, “…it was a great relief because it’s very frightening to live like that, without having something to rely on, something you need, because you somehow don’t know what you’re living for. And now, somehow, it has started to return to me. I enjoy attending lectures, and I want to go to university…”

3.5. Theme 5: Belief, Religion and Fulfillment within the Spiritual System

The last system of the Internal Cohesion Psychotherapy (ICP) approach has to do with the individual’s relationship with beliefs and religion. During this part, the discussion included questions about the participants’ perceptions of life and death, the role of their beliefs, and religion, the discussion of which, similarly to the three previous systems, was structured around the individual’s past, present, and future outlook.

An asset identified within this system was the category of Constructive use of time, specifically for the Religious Community asset, where some of the participants spoke about the role of their religion.

Regarding this matter, participant AGFH shared, “…I am a person who believes. I believe in God a lot and that is the connection I have, and it is truly the most valuable”.

Participant VSR answered on how religion played a role in his life by sharing, “Religion has helped me a lot, I know that I went out with a friend and we discussed it, I found myself again in religion”.

Meanwhile, in confronting the fear of death, participant VSR stated, “Religion plays an important role in the connection between life and death. Death doesn’t scare me anymore. It has influenced me not to have the irrational fears I used to have”.

Another asset identified in this system was Positive view of personal future, which simultaneously proved how these participants had begun to have a positive outlook for themselves and their lives in the future. When participants were asked how they saw their life in the future, they answered as follows:

Participant AGMZH said, “…to have the people I love close to me, to be successful. I really hope to create a family of my own and live this life successfully. This is one of the most important things and I am trying to protect it”.

Participant AGAV further added, “I wish to perceive life as something beautiful, something worth waking up for, not merely existing…”.

3.6. Theme 6: The Transformative Effects of Internal Cohesion Psychotherapy (ICP)

During the review of the interviews, the role of therapy was reported to have played an important role in the participants’ mental health, as highlighted in the following responses:

Participant AGFH stated that “Psychotherapy has opened my eyes, because it has shown me that not all things are as you see them”.

Participant AGGS said, “Psychotherapy helped me personally to feel better, which then influenced me to be better in relation to others”.

Participant AGDZ added, “There have been many bad days for me, so much so that I have not been able to sleep, now I sleep very well…”.

Participant DGSK expressed how therapy had helped her in dealing with anxiety: “The moment when anxiety was triggered, I used to think, ‘Okay, it’s not going to disappear. I might have this condition for an indefinite period.’ But now, it’s completely different. I remember the things I learned with the Doctor (referring to the therapist) like focusing on the present moment, practicing breathing exercises. I implement these techniques, and I’m aware that this (anxiety) will subside after 2–3 min. There’s no need for me to panic”.

This positive change in the relationship with oneself has proven to be observable by others as well. Regarding this, participant VSR stated that “A colleague gave me a compliment by saying, ‘Can you tell me how you are so calm, so good? You have a very calm energy around you (…)’ and that’s when I realized that the sessions are having an impact”.

Similarly, participant AGDZ said, “Even my dad told me, ‘It’s nice that now I can talk to you, because you used to be very sensitive, and now I have the courage to tell you things’, and there I noticed that my approach has changed”.

Regarding this, participant AGFH noted that “I am also receiving comments from other people—from those who knew and who didn’t know that something has changed with psychotherapy—and it automatically gives me a boost at work, gives me success in my friendships, and improves my relationship with my sisters and brothers…”.

At the same time, about the role of this approach, it was reported that it also contributed to the spread of mental health awareness, as the interviewees expressed their inclination to recommend this specific psychotherapeutic approach to many other people who might be facing mental health challenges.

Regarding this, AGFH expressed how: “the idea of mental health, to me, is really an alarm, and if I see someone close to me, who I think has such susceptibility, I don’t hesitate to share my experience and encourage them to seek help”.

This type of awareness was reported to have also played a psycho-educational role, especially when it came to dealing with anxiety. Regarding this, participant DGSK expressed how she helped her friend to recognize the signs of anxiety and ways to deal with it: “…she understood that it is anxiety, and it can happen to anyone, (…) She came to the realization that the sensation she previously experienced, which she never disclosed to me, was anxiety. Even now when she experiences anxiety… I try to teach her the things I learned here (in therapy), the work of breathing, about being present now…”.

4. Discussion

As the aim of this study was to explore the most prominent developmental assets in the psychotherapeutic process of treating anxiety and depression among young adults in Kosovo engaged in Internal Cohesion Psychotherapy (ICP) [15], aligning their experiences with the principles of Positive Youth Development (PYD) [20], the thematic analysis of participants’ narratives revealed important insights into various developmental assets across different domains. The findings, as presented above, underscored the profound impact of ICP on personal growth, social relationships, emotional well-being, and mental health in general among the participants. Through thematic categorization, six key themes emerged, each showing distinct aspects of the participants’ developmental journey. These themes, each illustrated in the previous section, included the transformative nature of the psychotherapeutic experience rooted in ICP principles, the critical role of social support networks, the importance of values and beliefs, personal growth reflections, the extended role of therapy in interpersonal relationships and mental health awareness, and the need for cultural competence and awareness [14,21].

The participants’ stories about their experiences with psychotherapy highlighted its transformative impact on their lives. Many shared initial reservations that evolved into positive changes in their mental health, illustrating psychotherapy’s effectiveness in alleviating anxieties, enhancing self-awareness, and building mental resilience [22]. Additionally, their interactions with Internal Cohesion Psychotherapy (ICP) closely aligned with the principles of Positive Youth Development (PYD), demonstrating ICP’s vital role in developing internal assets like social competency, positive values, and a positive identity, crucial for youth development [23].

This narrative connects with broader research on the rise of adolescent depression, underscoring the need for protective measures against the detrimental effects of depression on functionality, risk of suicide, and transition to adulthood. The World Health Organization’s report of a 25% global increase in anxiety and depression during the first year of the COVID-19 pandemic highlights the urgency of effective protective strategies [24]. The five Cs of PYD—Competence, Connection, Confidence, Character, and Caring—are identified as such strategies. While studies show a negative correlation between the first four Cs and depression, they also reveal a positive correlation between Caring and depressive symptoms, suggesting that high empathy and emotional sensitivity may heighten vulnerability to anxiety and depression [25]. These insights emphasize the role of therapeutic interventions like ICP in cultivating internal strengths and resilience, demonstrating their alignment with PYD principles [26,27]. As we focus on the current findings, the importance of social networks and peer relationships becomes clear. Participants shared personal experiences in which support from friends and family boosted their self-esteem and coping mechanisms. VSR’s story of overcoming bullying through social connections emphasizes the critical role that these networks play in fostering resilience and empowerment. Furthermore, it backs up the PYD framework’s emphasis on the importance of positive peer influence and social support in developing adaptive coping strategies and boosting self-esteem in young people [17]. Furthermore, participant narratives highlight the importance of family and friendship circles in promoting emotional well-being and fostering a sense of belonging, which aligns with the PYD framework’s emphasis on cultivating positive relationships and social connections for holistic youth development [2]. The recognition of the vital role that friendship circles, families, and social support networks play in promoting emotional well-being and creating a sense of belonging among participants is also consistent with Durkheim’s concept of Mechanical Solidarity, which emphasizes the role that primary ties play in forming a person’s identity and their community bonds [28].

Through exploration and reflection, insights into the participants’ values and beliefs highlighted their impact on self-identity and social interactions. The interviews delved into the role played by honesty and positive peer influence as fundamental developmental assets that contribute to holistic youth development [2]. Participants’ emphasis on the value of honesty, even during challenging circumstances, resonates deeply with PYD essentials [21]. Further discussions regarding honesty and positive peer influence shed light on the formative role of these assets in shaping self-identity and social behaviors.

Exploring the role of therapy, findings showed the profound influence of therapeutic interventions not only on personal growth but also on the dynamics of interpersonal relationships. Participants’ narratives underscored how enhanced mental well-being resulting from therapy had a ripple effect on their relationships within the family unit, signifying the broader impact of therapeutic interventions [29]. Furthermore, these narratives emphasized the significance of psychological well-being in shaping and enhancing the quality of relationships, a key facet of both PYD and internal cohesion psychotherapy [15,21].

In addition, the exploration of cultural competence and awareness within the participants’ narratives highlighted a profound recognition of societal biases and the imperative need for fostering understanding and tolerance. This also aligns with Durkheim’s assertion regarding the significance of shared values and beliefs in upholding social cohesiveness and solidarity among communities with diverse backgrounds [30]. AGMZH’s acknowledgment of prevailing prejudices and the call for embracing cultural competence underscore the crucial role of youth in challenging and mitigating societal biases and in fostering a more inclusive and tolerant society [21]. These insights also support the evident importance of various developmental assets in supporting the development of young individuals experiencing mental health challenges [14,31,32].

ICP’s examination of the intrapersonal system revealed profound insights into the participants’ self-relationships, spanning aspects such as self-regulation, motivation, and self-esteem across past, present, and future perspectives [15]. The identified developmental assets within this system demonstrated therapy’s impact on personal growth and self-evaluation [15,33]. For example, the asset of “Personal Power” resonated deeply with individuals, reflecting a heightened sense of self-awareness and assertiveness in decision-making. Participants demonstrated increased self-determination and conscious choices, demonstrating therapy’s transformative impact on self-empowerment [15]. Furthermore, the asset of “Self-esteem” underwent a remarkable transformation, as evidenced by narratives in which initial self-evaluation scores significantly improved post-therapy, indicating a significant increase in self-worth. The emergence of the “Sense of Purpose” asset highlighted the impact of therapy on goal-setting and motivation, as seen in the presented narratives, reflecting a renewed sense of purpose attributed to psychotherapy [15,34].

A significant component of ICP is the professional system, which includes an individual’s connection to work, education, and other related activities [15]. Participants revealed the transformative impact of this therapeutic approach on their attitudes and engagement in work-related and educational endeavors throughout the interviews. AGDZ’s narrative reflected a significant positive shift, emphasizing increased motivation and creativity. Their newly discovered proactive approach to work and creative activities represented a significant improvement in their self-perception and enthusiasm. This aligns with the identified developmental asset of “Achievement Motivation,” as evidenced by participants’ optimism for future success and dedication to their professions. Their positive outlooks emphasized the role of developmental assets in fostering enthusiasm and dedication to career goals [17].

Furthermore, “Creative Activities” emerged as a developmental asset in participant narratives. AGDZ’s increased interest in photography and AGFH’s enthusiasm for engaging activities dqwertfgfemonstrated the transformative power of creative pursuits on their motivation and mental well-being. This is consistent with the emphasis on creative activity as a developmental asset and its positive impact on motivation and mental stimulation [17]. Similarly, the asset of “Reading for Pleasure” emerged as a powerful factor in enhancing personal interests, as evidenced by DGSK’s newfound love of reading. This exemplifies reading’s role as a developmental asset in promoting leisure activities that contribute to personal growth and enjoyment [17,30].

Moreover, participants stated that discussing their work and educational relationships during therapy sessions helped them gain new perspectives and make more informed decisions. VSR’s account emphasized the role of therapeutic dialogue in fostering assertiveness and confidence during professional interactions, reinforcing the therapeutic approach’s transformative effect on personal agency and decision-making. AGGS’s testimony emphasized the restoration of purpose and motivation in academic pursuits, demonstrating the therapeutic approach’s role in rekindling enthusiasm and direction in educational endeavors. These accounts correspond to the developmental assets associated with effective decision-making, a sense of purpose, and motivation, highlighting the therapeutic approach’s role in fostering proactive and purpose-driven attitudes in young people [2,15,17].

The aspect of an individual’s relationship with beliefs and religion is extremely important in the context of ICP. The discussions centered on the participants’ perceptions of life and death, their connection to their beliefs, and religious reflections, which were classified as past, present, and future outlooks. The developmental asset of “Constructive Use of Time” emerged clearly within this system in the realm of the “Religious Community”, where participants articulated the role of religion in their lives. AGFH and VSR emphasized the profound connection and solace they found in their beliefs, emphasizing the value and support they derived from them. This is consistent with the developmental asset’s emphasis on the positive impact of constructive engagement in a religious setting [17].

Furthermore, investigating people’s perspectives on life and death revealed another developmental asset: “Positive View of Personal Future”. Participants’ hopes and dreams for the future reflected their newfound optimism and hope. AGMZH’s desire for a fulfilling family life and professional success, as well as AGAV’s desire for a life filled with beauty and meaning, show a shift toward a more optimistic outlook on life trajectories. These responses demonstrate the impact of the developmental asset on fostering hope and envisioning a purposeful and fulfilling future [21]. Additionally, the discussion about overcoming the fear of death highlighted the role of participants’ religious beliefs in providing comfort and relieving anxieties about mortality [15]. The recognition of religion’s influence in reducing irrational fears about death by VSR highlights the importance of faith in coping with existential concerns. This is consistent with the developmental asset’s impact on promoting resilience and providing reassurance in the face of life’s uncertainties [21].

Lastly, empowerment, safety and service to others [21], were some of the other key external assets explored, each with a unique perspective highlighting the complexities of their roles in shaping the lives of Kosovar youth. Internally, the central themes were commitment to learning, positive values, integrity, and responsibility, emphasizing the importance of personal ethics and individual agency in navigating life’s challenges [14,21]. Participants also discussed the importance of resilience, empathy, and optimism in fostering holistic youth development [21]. These nuanced perspectives offer invaluable insights into Kosovo’s developmental context, portraying an in-depth depiction of the various factors influencing the growth and well-being of its young population.

Limitations and Implications

Despite it being one of the very few studies exploring the presence of developmental assets in psychotherapy, this study has its limitations, mainly emerging from the relatively small participant number and the lack of gender matching within the sample. Another important factor is that the selection criteria, which were confined to individuals engaging in Internal Cohesion Psychotherapy (ICP) with more than five sessions completed, had the undeniable potential of restricting the diversity of experiences. Additionally, ICP is a novel eclectic therapeutic approach, which indicates that the study’s outcomes may not be broadly applicable, limiting the generalization of developmental assets’ effects to other psychotherapy modalities. Hence, the conclusions drawn here may not extend universally to diverse psychotherapy practices, limiting the broader understanding of developmental asset impacts.

Furthermore, the qualitative design of the study limited the ability to determine the cause-and-effect dynamics between variables, which limits the investigation of cause-and-effect dynamics in relation to developmental assets and therapeutic outcomes. To address these constraints, subsequent research initiatives should utilize longitudinal mixed-study designs that include multiple time points, ideally before, during, and after therapy. Increasing the number of participant cohorts with gender parity and adding evaluations of alternative psychotherapy modalities would improve the overall comprehension of how developmental assets impact treatment effectiveness.

The findings of this study, however, also have important ramifications for future psychotherapy and mental health research as well as clinical practice, since the developmental assets of Internal Cohesion Psychotherapy (ICP) that have been identified have the potential to be incorporated into therapeutic interventions that target young adults’ anxiety and depression. These resources can be used by therapists to create customized interventions that promote resilience and constructive youth development. Through the identification and integration of these resources into therapeutic frameworks, professionals can improve treatment results and promote holistic development in youth with mental health issues.

Conclusively, these implications underscore the importance of incorporating developmental assets into clinical practice and stress the necessity of additional research to clarify the wider applicability of these assets across various psychotherapeutic modalities [14]. These initiatives could lead to the improvement of therapeutic outcomes, the precision of interventions, and the advancement of youth mental health practices.