Aim: Even though there is substantial evidence that play based therapies produce significant change, the specific play processes in treatment remain unexamined. For that purpose, processes of change in long-term psychodynamic play therapy are assessed through a repeated systematic assessment of three children’s “play profiles,” which reflect patterns of organization among play variables that contribute to play activity in therapy, indicative of the children’s coping strategies, and an expression of their internal world. The main aims of the study are to investigate the kinds of play profiles expressed in treatment, and to test whether there is emergence of new and more adaptive play profiles using dynamic systems theory as a methodological framework.Methods and Procedures: Each session from the long-term psychodynamic treatment (mean number of sessions = 55) of three 6-year-old good outcome cases presenting with Separation Anxiety were recorded, transcribed and coded using items from the Children’s Play Therapy Instrument (CPTI), created to assess the play activity of children in psychotherapy, generating discrete and measurable units of play activity arranged along a continuum of four play profiles: “Adaptive,” “Inhibited,” “Impulsive,” and “Disorganized.” The play profiles were clustered through K-means Algorithm, generating seven discrete states characterizing the course of treatment and the transitions between these states were analyzed by Markov Transition Matrix, Recurrence Quantification Analysis (RQA) and odds ratios comparing the first and second halves of psychotherapy.Results: The Markov Transitions between the states scaled almost perfectly and also showed the ergodicity of the system, meaning that the child can reach any state or shift to another one in play. The RQA and odds ratios showed two trends of change, first concerning the decrease in the use of “less adaptive” strategies, second regarding the reduction of play interruptions.Conclusion: The results support that these children express different psychic states in play, which can be captured through the lens of play profiles, and begin to modify less dysfunctional profiles over the course of treatment. The methodology employed showed the productivity of treating psychodynamic play therapy as a complex system, taking advantage of non-linear methods to study psychotherapeutic play activity.
This study investigated therapeutic alliance (TA) trajectories, their demographic and symptomatic predictors, and associations with outcome in psychodynamic child psychotherapy. Method: The sample included 89 Turkish children (M age ϭ 6.87, SD ϭ 2.11, 46% girls) with internalizing (37.11%), externalizing (21.14%), and comorbid (38.20%) problems; 12% of the children were in the nonclinical range. Independent raters coded 328 sessions from different phases of treatment using the Therapy Process Observational Coding System-Alliance Scale. Outcome measures were collected at intake and termination (Children's Behavior Checklist and Teacher Rating Form). Results: Multilevel growth curve modeling indicated that TA showed a quadratic trend (high-low-high) over the course of treatment. The shape-of-change methodology indicated three subgroups following a stable pattern, a slow and an accelerated quadratic TA trajectory. Externalizing problems (teacher report) negatively predicted average TA strength. Boys and children with internalizing problems showed a declining TA trajectory, whereas children with externalizing problems (teacher report) showed an upward TA trajectory. Multivariate multiple regression analyses showed that the average TA (i.e., intercept) and the positive quadratic slope (the high-low-high pattern) positively predicted changes in internalizing and externalizing problems (teacher report). Discussion: This study was the first to show the course of TA development in psychodynamic child psychotherapy, identify a number of child characteristics that facilitate and impede TA. Investigating both the strength and patterns of TA development when examining associations with outcome is important. What is the public health significance of this article?This study suggests the aggressive and impulsive behaviors of children with externalizing problems may pose a challenge to relationship strength and that children with internalizing problems may show a decline in interest and willingness to participate in therapy activities, possibly due to avolition associated with underlying depression. Therapists need to compensate for such challenges with increased TA building strategies to keep the relationship strong. Fostering a more rapid positive change and overcoming TA ruptures is critical for symptomatic improvement.
This article is based on a study of young people and sexuality in Turkey. The focus of this study included messages about sexuality, sexual beliefs, sexual experiences with a view to consent and resistance, religiosity, and certain interrelations therein. A total of 471 students (273 women, M age=20.5 years, and 198 men, M age=21 years) from four different universities in Turkey participated in a survey with measures of restrictive and permissive messages about sexuality received from various sources, beliefs about sexual roles of men and women in relationships, and questions about a range of sexual experiences, including coital and non-coital. The incidence and characteristics of ideal sexual partnership and incidence and dynamics of experiences involving "token resistance" and "consent to unwanted sex" were specifically investigated. The results provided a snapshot of the sexual lives of students in this country at the crossroads of secularism and traditional Muslim mores. Both commonalities and differences were found across gender. Both men and women received more restrictive than permissive messages. The most important message source was same-sex friends for men and parents for women. Men had more dating and sexual partners than women. The correlations of religiosity and messages with sexual experiences and attitudes were mostly in the expected direction. Women were more likely to have a token resistance incidence and both genders were equally unlikely to consent to unwanted sex. The results were discussed in relation to the cultural context and the relevant literature, and recommendations are offered for future research.
Internalizing and externalizing problems have been related to negative emotionality, and affect regulation deficits in several studies. Certain psychodynamic models of treatment use children’s symbolic play activity as a medium to mentalize negative emotions in order to develop children’s affect regulation. However, the complex associations among these constructs and their associations with outcome have not been examined. This study aimed to investigate, first, whether average mentalization practices in treatment, as well as session-to-session expression of negative emotions and symbolic play predict gains in affect regulation and, second, whether changes in these variables are associated with clinically significant change in symptoms and global function. The sample included 40 outpatient children, who underwent long-term psychodynamic treatment. Nine hundred seventy-five sessions were coded for children’s symbolic play, affect expression (anger and dysphoric affect), and affect regulation characteristics, and each treatment was scored for average adherence to mentalizing principles. Time Series Panel Analyses (TSPA) indicated session-to session use of symbolic play predicted gains in affect regulation. A significant 2-way interaction indicated that dysphoric affect expression in high mentalization adherent treatments was associated with higher affect regulation than in low adherent treatments. Partial correlation analyses indicated that mentalization adherence in treatment was associated with symptomatic improvement at trend level of significance, and changes in affect regulation and symbolic play were significantly associated with gains in global function. Findings point to the importance of use of symbolic play, and dysphoric affect expression in the context of mentalization practices for gains in affect regulation and outcome.
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