An examination of parent sessions in regulation-focused psychotherapy for children.

Abstract

Collateral work with parents is a widely adopted practice within child psychotherapy. Therapeutic process within these parent sessions has not been empirically studied or defined, despite a sizable process-outcome literature in both child and adult individual therapy. This link between research and practice is particularly important among manualized, child-focused treatments, where the proposed therapeutic action and clinical approach to parent work is defined according to distinct theoretical principles. To address this gap in the child treatment literature, the present study used the Psychotherapy Process Q Set to examine the in-session processes of parent sessions from 16 treatments of regulation-focused psychotherapy for children (RFP-C). RFP-C is a manualized, psychodynamic treatment for children with disruptive behaviors that consists of 16 child sessions and four collateral parent sessions. The parent-session process ratings were compared to existing adult therapy prototypes and the RFP-C child session prototype. Results indicated that observer-coded psychotherapy process in RFP-C parent sessions was most similar to a cognitive-behavioral therapy prototype and moderately correlated with both a supportive-expressive psychodynamic psychotherapy and a reflective functioning prototype. Observer-coded parent session process was distinct from the RFP-C child prototype. Limitations and directions for future research and clinical practice are discussed. The findings of this study indicate the need to intentionally examine process in parent sessions, both within RFP-C and across modalities, as these sessions have their own unique mechanisms of therapeutic action that ultimately may be additive with regard to child outcomes. Clinical Impact StatementQuestion: What aspects of psychotherapy process characterize parent sessions in regulation-focused psychotherapy for children (RFP-C)? Findings: RFP-C parent sessions are characterized by supportive and collaborative discussions between therapist and parent that focus on helping the parent to make meaning of their child's disruptive behavior. Meaning: The findings of this study extend process research beyond the traditional therapist-parent dyad, laying the foundation for empirical examination of parent work both within RFP-C and across modalities, including process-outcome research, determination of common factors in parent work, and the use of clinical data to inform and shape manualized treatments. Next Steps: Future studies may compare process in parent work across child-focused treatments, potentially developing tools specifically for this purpose, which then can be related to child outcomes to determine the effective clinical ingredients of collateral work with parents.

Psychotherapy process in regulation focused psychotherapy for children.

“…If one goal of psychotherapy process research is to identify distinctions (rather than commonalities) between treatments, it may be helpful to use a tool like such as Halfon’s (2021) psychodynamic therapy prototype—an approach that excludes common factors components of the treatment—to code child therapy sessions. A study of RFP-C parent sessions, using the PQS, has been published (Kufferath-Lin et al, 2021). A side-by-side comparison of collateral parent work and child psychotherapy sessions would provide more information on the relationship between these processes as well as their respective and combined contributions to treatment outcomes.…”

“…A side-by-side comparison of collateral parent work and child psychotherapy sessions would provide more information on the relationship between these processes as well as their respective and combined contributions to treatment outcomes. Child, parent, and therapist factors all contribute to outcomes in youth psychotherapy (Karver et al, 2005; Kufferath-Lin et al, 2021). Possible areas of future investigation would be to examine specific contributions from each of these stakeholders to the trajectories of successful and unsuccessful cases.…”

Including parents in child treatment is beneficial, so how do we help therapists to work effectively with parents in practice?

“…There are, however, no measures of psychotherapy process designed for parent work, so there is little empirical research in this area. In one study, the developers of Regulation-Focused Psychotherapy for Children, a time-limited psychodynamic intervention, applied a common measure of adult psychotherapy process, the psychotherapy process Q-Set), to parent sessions (Kufferath-Lin et al, 2021). They found that parent sessions in this model were characterized by the dialogue having a specific focus, the parent bringing up significant issues and material, the parent's current or recent life situation is emphasized, and the parent's interpersonal relationships as a major theme (Kufferath-Lin et al, 2021).…”

“…In one study, the developers of Regulation-Focused Psychotherapy for Children, a time-limited psychodynamic intervention, applied a common measure of adult psychotherapy process, the psychotherapy process Q-Set), to parent sessions (Kufferath-Lin et al, 2021). They found that parent sessions in this model were characterized by the dialogue having a specific focus, the parent bringing up significant issues and material, the parent's current or recent life situation is emphasized, and the parent's interpersonal relationships as a major theme (Kufferath-Lin et al, 2021). In terms of the therapist, sessions were characterized by the therapist being sensitive to the parent's feelings, attuned to the parent, and empathic, and the therapist communicating in a clear, coherent style, adopting a supportive stance, asking for more information and elaboration, conveying a sense of nonjudgment, and suggesting the meaning of another's behavior (Kufferath-Lin et al, 2021).…”

“…They found that parent sessions in this model were characterized by the dialogue having a specific focus, the parent bringing up significant issues and material, the parent's current or recent life situation is emphasized, and the parent's interpersonal relationships as a major theme (Kufferath-Lin et al, 2021). In terms of the therapist, sessions were characterized by the therapist being sensitive to the parent's feelings, attuned to the parent, and empathic, and the therapist communicating in a clear, coherent style, adopting a supportive stance, asking for more information and elaboration, conveying a sense of nonjudgment, and suggesting the meaning of another's behavior (Kufferath-Lin et al, 2021). The authors point out that these characteristics overlap with aspects of cognitive behavioral therapy, supportive-expressive therapy, and reflective functioning.…”