Background
Children requiring hospitalization for psychiatric care have serious disorders, high use of psychotropic medication, and frequent readmissions. The development and implementation of therapies focused on incorporating primary caregivers or attachment figures is necessary for working with children with severe psychiatric disorders. Mentalization or parental reflective functioning (PRF) is the ability of parents to understand their children’s behaviors as an expression of internal emotional states and act accordingly to help them regulate their emotions; in this way mentalizing is a key component of sensitive parenting. Video-assisted therapies have proven to be effective in promoting change in parent–child relationships. The majority of studies have been carried out with mothers of pre-school children and in an outpatient setting. Video intervention therapy (VIT) is a flexible manualized therapy, which allows the intervention to be individualized to the context where it is applied, according to the needs and resources of the people who participate in it. The objective of the study is to evaluate the feasibility and acceptability of applying VIT to improve the PRF of the parents as primary carers of children hospitalized in a psychiatric service.
Methods
This is a pilot randomized, single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 2:1 allocation (with more people allocated to the intervention arm). The intervention consists of four modules; every module has both one video-recorded play session and one VIT session per week. People assigned to the control group will receive treatment as usual plus weekly play sessions. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Evaluation of the caregivers will include assessments of PRF, wellbeing and personality structure; assessments of children will include parent-ratings and clinician-ratings of symptomatology and general functioning. After every video feedback (VF) session, PRF, the caregiver’s wellbeing and children’s general functioning will be reassessed.
Discussion
This study will contribute to the currently scarce evidence on how to provide family attachment-based interventions in a child inpatient psychiatric unit. It will also inform the design and implementation of a future randomized clinical trial.
Trial registration
ClinicalTrials.gov,
NCT03374904
. Registered on 14 December 2017 (retrospectively registered).
Electronic supplementary material
The online version of this article (10.1186/s13063-019-3310-y) contains supplementary material, which is available to authorized users.
Relationships with primary caregivers provide the context for early childhood development, and evaluating those relationships during the early years can detect difficulties that may influence future mental health. Video feedback is a valuable intervention tool in early childhood, both for family relationships and child development. An intervention was implemented using this technique, focused on mother-father-child triads that were experiencing difficulties in social-emotional development. Participants were 80 mother-fatherinfant triads (experimental group, EG=40, control group, CG=40), with children between 1 and 3 years old. Socio-emotional difficulties decreased significantly in the children who received the intervention (Wilks λ=0.930, F (1, 78)=5.907; P=.017). There was also an increase in psychomotor development in communication (Wilks λ=0.948, F (1, 78) =4.284; P=.042) and fine motor skills (Wilks λ=0.875, F (1, 78)=11.185; P=.001) in children in the EG compared with children in the CG.
The present single case study explored and described the intervention process and therapeutic change expression through the Generic Change Indicators model (GCI) aiming to answer the question of “What changes when you change?”. We reasoned that psychotherapy process research in child and dyadic psychotherapy is scarce, as well as needed because it accounts for the content and mechanisms related to the therapeutic change and its association with interventions’ effectiveness.
To explore this possibility, we conducted a single case qualitative study to explore and describe the intervention process through the GCI within a brief intervention mentalization-informed with video-feedback, with a depressive mother and her baby. Specifically, Patient’s ongoing change was determined through the identification of Episodes of Change (EC) and the Moment of Change (MC) that occurs within it. Each MC was then labeled with one of the 19 GCIs.
Results of the single case study showed that the GCI model is a feasible model to observe and comprehend dyadic interventions. GCI were observed from the beginning of the intervention, increasing the hierarchical level of the GCI throughout the intervention, and associated with the video-feedback situation.
To investigate processes of intervention using the methodology here proposed, allows us to understand the intervention not only from a perspective of effectivity and outcomes but considering the ongoing therapeutic change. In this sense, research like this contributes to the growing body of evidence supporting the training and supervision of psychotherapists.
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