Child psychotherapy theory and practice are not absolutely coincident. Real psychotherapy sessions do not necessarily resemble the ideal prototypes.

Abstract.It is important to investigate the outcomes of psychotherapy and, especially, its process. Regarding child psychodynamic psychotherapy, available studies are in smaller numbers. Therefore, we still do not fully know the mechanisms of change in treatments with this age group. The Child Psychotherapy Q-Set (CPQ) was designed to analyze the therapeutic process with children. It permits one to identify interaction structures (i.e., repetitive patterns of interaction) and how they change in the course of a treatment. Based on these assumptions, the aim of this study was to identify and to analyze the interaction structures in the psychodynamic therapy of a boy diagnosed with Asperger's disorder and possible changes in his psychic organization. A mixed longitudinal study, based on the Systematic Case Study procedure, was performed. Approximately 30 months of the boy's psychotherapy were analyzed using the CPQ. The Rorschach method was used as the outcome measure. Four interaction structures were identified, using the CPQ: Active, confident and lively child, competing with connected, mentalizing and accepting therapist; Withdrawn and defensive child with uncertain, unresponsive and didactic therapist; Accepting therapist with demanding, provocative and hostile child; and Reassuring, supportive, nondirective therapist with a compliant and not spontaneous child. Two interaction structures varied over time. Some changes in Rorschach variables were detected after two years of treatment.

Children's mentalizing capacity may influence the therapeutic process in psychodynamic therapy. The literature points to the need to tailor the therapeutic intervention to the particular configuration of clinical and developmental problems presented by the children and recommends a shift in technique in the case of severely disturbed or traumatized patients with impaired mentalizing capacity. The aim of this study was to explore the therapeutic process in psychodynamic therapy with school-age children with different kinds of difficulties and mentalizing profiles. A longitudinal design based on the systematic case study method was adopted. Three children with different baseline mentalizing capacities and their psychotherapists participated. Two hundred seventy-three psychotherapy sessions were analyzed using the Child Psychotherapy Q-Set (CPQ) in order to identify the relationship patterns between patient and therapist. Different interaction structures were identified.When the child presented with a more developed mentalizing capacity at baseline, the treatment was more similar to a standard psychodynamic approach. When mentalization capacity was impaired, more directive, supportive and empathic interventions were observed. A child's capacity for mentalization appears to impact the therapeutic process, with the adoption of certain therapeutic approaches and specific techniques depending on the child's own baseline capacity to mentalize.

Este estudo teve como foco a análise do primeiro ano do processo psicoterapêutico de uma criança, com base no Child Psychotherapy Q-set (CPQ). O estudo teve delineamento descritivo, longitudinal, adotando-se o procedimento de estudo de caso sistemático. Participaram um menino de sete anos de idade e sua terapeuta. O CPQ foi aplicado em duas sessões do início do tratamento, duas sessões após três meses, duas sessões após seis meses, duas sessões após nove meses e duas sessões após um ano, para identifi car as características do processo psicoterapêutico, ao longo do tempo. Os resultados obtidos revelaram as características dessa psicoterapia, como ela se modifi cou ao longo do tempo e como essas modifi cações podem ser indicativas de evolução do processo terapêutico. As atitudes da terapeuta envolveram, inicialmente, um trabalho interpretativo e, posteriormente mais refl exivo e de apoio. A criança, inicialmente, mostrou-se resistente e com poucos recursos internos, mas, ao longo do tratamento, revelou maior abertura para o trabalho terapêutico, abordando conteúdos signifi cativos em relação à sua problemática. Algumas características da interação terapeuta-paciente foram se tornando mais salientes ao longo do tempo.

En el campo de la investigación en psicoterapia psicodinámica de los niños, una cuestión abierta es cómo evaluar sistemáticamente los cambios y cuálesse consideran fundamentales. No se han llevado a cabo análisis cualitativos acerca de la visión de padres y madres. El objetivo de este estudio fue investigar la percepción de padres y madres sobre los posibles cambios en sus niños durante sus psicoterapias. El estudio tuvo enfoque cualitativo, descriptivo, longitudinal. Los participantes fueron padres y madres de cuatro niños, asistidos en la clínica privada por tres psicoterapeutas treinados em psicoterapia clínica. Ellos respondieron regularmente al cuestionario de pregunta abierta que se centró en los cambios percibidos en el curso del proceso terapéutico. Los resultados  mostraron que los padres han identificado cambios en el curso de la psicoterapia de sus hijos, que ellos no eran lineales y no se limitaron a la mejoría sintomática. También se identificaron cambios en el funcionamiento mental de los niños y su adaptación ala realidad, y en las relaciones interpersonales. Se discutió la importancia de la participación de los padres en la psicoterapia de los niños y el seguimiento de suvisión acerca del proceso terapéutico. Ellos pueden proporcionar feedbacks importantes que contribuyen para el progreso del tratamiento.Palabras clave: psicoterapia y psicoanalítica, cambios, niños.