Psychotherapy process in regulation focused psychotherapy for children.

Abstract

Understanding psychotherapy process provides a pathway toward understanding the mechanisms of change and therapeutic factors in psychodynamic psychotherapy. This study examines psychotherapy process in Regulation Focused Psychotherapy for Children (RFP-C), a manualized and time-limited psychodynamic treatment designed for children with disruptive behavior disorders. Sixty child psychotherapy sessions, from 20 children (13 male, seven female; M age = 8) diagnosed with oppositional defiant disorder, were coded using the Child Psychotherapy Q-Set. Results indicate that common factors characterized actual sessions of RFP-C to a greater degree than expected, with sessions adhering significantly to the RFP-C, Psychodynamic Therapy, Cognitive-Behavioral Therapy, Child-Centered Play Therapy, and Reflective Function prototypes. Multilevel modeling results suggested a wide range of variability in terms of patient and therapist effects across psychotherapy processes in this child therapy modality. Therapists were more adherent to the cognitive-behavioral prototype when treating children with comorbid attention problems. Adherence to the RFP-C prototype increased over time and multiple regression analyses indicated that adherence to the PDT prototype (b = À.85, p = .024) was predictive of greater symptom reduction. Overall, RFP-C sessions in this study were less adherent to the prototype than expected and psychodynamic psychotherapy process adherence was predictive of symptom improvement. Limitations, directions for future research, and clinical implications are discussed.