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

Abstract

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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“…6. See for example, (Eppler-Wolff et al, 2020;Jernigan & Daniel, 2011;Ramires et al, 2020;Sapountzis, 2012;Vaughans & Harris, 2016;Warshaw, 2012).…”

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“…APQ studies have shown adequate interrater reliability among coders e.g., [ 10 , 20 ]. The convergent and discriminant validity of the APQ was established by first conducting a Q-factor analysis of STPP and CBT sessions from the IMPACT study [ 13 ]. Psychodynamic and CBT factors diverged meaningfully between the STPP and CBT sessions and correlated significantly with other similar scales.…”

“…The APQ incorporates items that reflect the core issues of the adolescence period [ 10 ], which enables researchers to identify rudimentary, recurring, conscious, and unconscious relational patterns that emerge in treatment between the therapist and patient dyad (i.e., interaction structures (IS)) [ 8 ]. IS have been used to better understand the nature of the therapeutic process by analyzing PDT sessions with adults and children (with the CPQ and PQS, respectively) using single cases, e.g., [ 11 , 12 , 13 ] and cross-sectional studies, e.g., [ 14 , 15 ]. However, very few studies have extracted IS in PDT with adolescents, e.g., [ 10 ] and none of these studies assessed associations with the outcome.…”

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“…Luyten, Campbell, Allison, and Fonagy (2020) Researchers have also begun to explore moderators of the association of session adherence with effective treatment outcomes in children. For example, mentalization level (Ramires et al, 2020) and therapeutic alliance (Halfon, 2021) have been shown to moderate the association between adherence to the PDT session prototype and change in interaction structures and problem behaviors, respectively. The APQ session prototypes are now available to measure session adherence in similar moderator studies.…”