Interaction Structures in the Psychodynamic Psychotherapy of a Girl Diagnosed with Adjustment Disorder

Schmidt, Fernanda Munhoz Driemeier; Gastaud, Marina Bento; Ramires, Vera Regina Röhnelt

doi:10.9788/tp2018.2-07en

Cited by 4 publications

(8 citation statements)

References 16 publications

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“…These factors explained 36.9%, 37.3% and 31.9% of the variance of the items in Alice's, Peter's and Walter's treatments, respectively, which is consistent with the literature (Goodman, 2015;Goodman & Athey-Lloyd, 2011;Ramires et al, 2015;Schmidt et al, 2018). The factors were conceptualized as ISs, describing repetitive patterns of interaction between each therapeutic dyad.…”

Section: Resultssupporting

confidence: 85%

“…Forced-choice coding (ipsative) is used, establishing a normal distribution. Several studies have confirmed interrater reliability and discriminant validity of the CPQ (Goodman & Athey-Lloyd, 2011;Goodman, 2015;Goodman et al, 2016;Goodman, Reed, & Athey-Lloyd, 2015;Ramires et al, 2015;Schmidt et al, 2018;Schneider, et al, 2010). The CPQ has been used to identify specific relationship patterns between patient and therapist, or interaction structures (ISs), in a range of diagnoses like Autism Spectrum Disorder (Goodman & Athey-Lloyd, 2011;Ramires, Carvalho, Schmidt, Fiorini, & Goodman, 2015), borderline personality disorder (BPD; Goodman, 2015), disruptive mood dysregulation disorder (DMDD; Ramires, Godinho, & Goodman, 2017), adjustment disorder (AD; Schmidt, Gastaud, & Ramires, 2018), major depressive disorder and generalized anxiety disorder (Schneider, Midgley, & Duncan, 2010), as well as in a study of children with externalizing and internalizing problems (Halfon, Goodman, & Bulut, 2018).…”

Section: Instrumentsmentioning

confidence: 92%

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The Therapeutic Process in Psychodynamic Therapy with Children with Different Capacities for Mentalizing

Ramires¹,

Carvalho²,

Polli³

et al. 2020

Journal of Infant, Child, and Adolescent Psychotherapy

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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.

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Section: Resultssupporting

confidence: 85%

Section: Instrumentsmentioning

confidence: 92%

The Therapeutic Process in Psychodynamic Therapy with Children with Different Capacities for Mentalizing

Ramires¹,

Carvalho²,

Polli³

et al. 2020

Journal of Infant, Child, and Adolescent Psychotherapy

View full text Add to dashboard Cite

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“…Goodman (2015), discussing the interaction structures in the psychodynamic psychotherapy of a girl diagnosed with borderline personality disorder (BPD), found preliminary evidence for the effectiveness of traditional CBT interventions strategies in diminishing the patient's angry, affective displays, replaced later by PDT intervention strategies. Therefore, we observe in the present therapeutic process, as well as in those reported by Goodman (2015); Ramires et al (2015), and Schmidt (2015) common IS in different children's psychotherapies, with different diagnoses, in which a difficult, angry, aggressive or resistant child relates to a directive, didactic, and limit-setting therapist. What could be the common theme in these different children, diagnoses and dyads?…”

Section: Discussionsupporting

confidence: 86%

“…The duration of these psychotherapy treatments varied from 1 year (Schmidt, 2015) to 3 years (Schneider et al, 2010). The frequencies varied from four sessions (Schneider et al, 2010) to one session per week (Goodman, 2015;Goodman & Athey-Lloyd, 2011;Schmidt, 2015). This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

Section: Process and Interaction Structures In Child Psychodynamic Ps...mentioning

confidence: 99%

“…We can observe differences and some similarities in these IS across different dyads and different pathologies. We would not expect the same IS in different child psychotherapies (even with the same age or the same diagnosis), given the uniqueness of each dyad; however, it is interesting to note that for most treatments, positive and negative transference-countertransference matrices were present (Goodman & Athey-Lloyd, 2011;Ramires et al, 2015;Schmidt, 2015). In these treatments, when the child was withdrawn, defensive, resistant, distant or aggressive, the therapist seemed more directive, didactic or misattuned.…”

Section: Process and Interaction Structures In Child Psychodynamic Ps...mentioning

confidence: 99%

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The therapeutic process of a child diagnosed with disruptive mood dysregulation disorder.

Ramires

Godinho²,

Goodman

2017

Psychoanalytic Psychology

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It has been recognized that there is a need to make psychotherapy more effective for children with disruptive symptoms. Many studies on child psychodynamic psychotherapy have indicated its effectiveness, but do not explain how this treatment works. It is not only necessary to understand how it works, but also for which therapist-patient dyads. The Child Psychotherapy Q-Set was designed to describe the therapeutic process with children, and makes it possible 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 analyze the psychotherapeutic process of a school-aged boy who presented with disruptive behavior disorder, identifying the interaction structures in his treatment. A total of 123 sessions of his treatments were analyzed and 4 interaction structures were identified: 2 became more characteristic over the course of treatment, and 2 became less characteristic. They also varied in magnitude. The therapeutic process showed characteristics consistent with the models described as ideal for psychodynamic psychotherapy, the reflective functioning process, and cognitive-behavioral therapy, in this order of significance. The study highlighted the importance of supportive interventions alongside expressive ones in the treatment of children with disruptive behavior disorders. The results also suggested the integrationist nature of most psychotherapies, and the importance of acknowledging and understanding the effective elements, rather than treatment types that can be present within any therapeutic modality.

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Estruturas de interação no tratamento psicodinâmico de uma paciente com Transtorno de Personalidade Borderline

Nardi¹,

Feijó²,

Bittencourt³

et al. 2023

Av. Psicol. Latinoam.

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Estruturas de interação são padrões repetitivos que ocorrem entre terapeuta e paciente, mesmo que não sejam conscientes por ambos. Na pesquisa empírica, elas ajudam a compreender como se estabelece o processo de mudança em psicoterapia. Nesse sentido, esta investigação utilizou 68 sessões de psicoterapia psicanalítica de um caso do uma jovem paciente com Transtorno de Personalidade Borderline (TPB) com o objetivo de identificar as estruturas de interação e sua correlação com o tempo de tratamento. Os dados foram gravados em vídeo e posteriormente codificadas através do Psychotherapy Process Q-Set (PQS), por duplas de juízes treinados na metodologia Q-Sort. A partir desses dados, foi realizada a análise fatorial do tipo Q de componentes principais que indicou quatro estruturas de interação, sendo Fator 1: Colaborativo; Fator 2: Resistência; fator 3: Aliança/Ruptura e fator 4: Apoio/Encorajamento. As estruturas indicaram que a interação se voltou para o trabalho de manutenção da interação colaborativa, através de uma posição empática do terapeuta, direcionado para o reconhecimento dos estados internos do paciente. Apesar do trabalho colaborativo, a resistência também surgiu como um padrão repetitivo. O terapeuta se tornou diretivo com intervenções estruturadas e questionando o paciente, desta forma contribuindo para o desenvolvimento da capacidade de mentalização. Implicações sobre o processo psicoterápico e indicações para estudos futuros são apresentados com o intuito de contribuir na compreensão sobre o tratamento de pacientes com TPB em psicoterapia psicodinâmica.

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Interaction Structures in the Psychodynamic Psychotherapy of a Girl Diagnosed with Adjustment Disorder

Cited by 4 publications

References 16 publications

The Therapeutic Process in Psychodynamic Therapy with Children with Different Capacities for Mentalizing

The Therapeutic Process in Psychodynamic Therapy with Children with Different Capacities for Mentalizing

The therapeutic process of a child diagnosed with disruptive mood dysregulation disorder.

Estruturas de interação no tratamento psicodinâmico de uma paciente com Transtorno de Personalidade Borderline

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