Simulation modeling analysis of sequential relations among therapeutic alliance, symptoms, and adherence to child-centered play therapy between a child with autism spectrum disorder and two therapists

Abstract

This study examined the sequential relations among three pertinent variables in child psychotherapy: therapeutic alliance (TA) (including ruptures and repairs), autism symptoms, and adherence to child-centered play therapy (CCPT) process. A 2-year CCPT of a 6-year-old Caucasian boy diagnosed with autism spectrum disorder was conducted weekly with two doctoral-student therapists, working consecutively for 1 year each, in a university-based community mental-health clinic. Sessions were video-recorded and coded using the Child Psychotherapy Process Q-Set (CPQ), a measure of the TA, and an autism symptom measure. Sequential relations among these variables were examined using simulation modeling analysis (SMA). In Therapist 1's treatment, unexpectedly, autism symptoms decreased three sessions after a rupture occurred in the therapeutic dyad. In Therapist 2's treatment, adherence to CCPT process increased 2 weeks after a repair occurred in the therapeutic dyad. The TA decreased 1 week after autism symptoms increased. Finally, adherence to CCPT process decreased 1 week after autism symptoms increased. The authors concluded that (1) sequential relations differ by therapist even though the child remains constant, (2) therapeutic ruptures can have an unexpected effect on autism symptoms, and (3) changes in autism symptoms can precede as well as follow changes in process variables.

Session adherence to prototypical psychotherapy process as a correlate of outcome in a naturalistic study of child mentalization-informed psychodynamic play therapy.

“…It is quite possible that the child's problem behavior levels influenced session adherence to prototypical psychotherapy process as much as session adherence to prototypical psychotherapy process influenced the child's problem behavior levels. For instance, SMA was used to determine that session adherence to prototypical child-centered play therapy process decreased 1 week (numerals should be used with units) after autism symptoms increased in the treatment of a boy with high-functioning autism spectrum disorder (Goodman et al, 2017). Thus, being more adherent to a particular treatment model's process might not enhance a treatment model's effectiveness.…”

“…Following the work of Ablon, Jones, and Fonagy and his colleagues, Goodman et al (2016) developed three session prototypes—PDT, CBT, and reflective function (RF)—for child therapy using the Child Psychotherapy Process Q-Set (CPQ; Schneider, 2004; Schneider & Jones, 2004). The recent development of the CPQ session prototypes has enabled this area of research to flourish, especially through the medium of empirically-informed single case studies (e.g., Goodman, 2015; Goodman et al, 2017; Goodman, Reed, & Athey-Lloyd, 2015; Goodman & Athey-Lloyd, 2011). Only one of these studies (Goodman et al, 2017) used simulation modeling analysis (SMA) to determine the sequential relations between a session prototype and the symptom variables, both measured across sessions.…”

“…The recent development of the CPQ session prototypes has enabled this area of research to flourish, especially through the medium of empirically-informed single case studies (e.g., Goodman, 2015; Goodman et al, 2017; Goodman, Reed, & Athey-Lloyd, 2015; Goodman & Athey-Lloyd, 2011). Only one of these studies (Goodman et al, 2017) used simulation modeling analysis (SMA) to determine the sequential relations between a session prototype and the symptom variables, both measured across sessions.…”

Psychotherapy process in regulation focused psychotherapy for children.

“…Although many CPQ items capture interactional elements of treatment that relate to therapeutic alliance, this study lacked an explicit measure of therapeutic alliance. As therapeutic alliance continues to stand out as the single most important element of psychotherapy process, future RFP-C research would benefit from the use of alliance measures adapted for child patients (see Goodman et al, 2017). Finally, future research with a larger sample could explore the interaction between psychotherapy processes and symptom change.…”

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

“…However, even when treatments adhere theoretically to the same modality, therapeutic process is unique to each dyad, with both therapist and child contributing to unique patterns of interaction that shift over the course of treatment (Goodman, 2015; Goodman & Athey-Lloyd, 2011). There is evidence that there is a dynamic relationship between process variables, therapeutic alliance, and symptoms, such that changes in any of these variables can lead to effects on the others (Goodman et al, 2017).…”