Interaction structures between a child and two therapists in the psychodynamic treatment of a child with Asperger's disorder

Abstract

Leading the charge to link intervention research with clinical practice is the development of process research, which involves a detailed analysis of specific therapeutic processes over the course of treatment. The delineation of interaction structures -repetitive patterns of interactions between patient and therapist over the course of treatment -can inform therapists of what may be expected from patients with particular patterns of symptoms or behaviours in their clinical practice and how interactions change over time. Using the Child Psychotherapy Q-Set, this study aims to compare the different interaction structures that emerged in the two-year psychotherapy of a six-year-old child conducted, for one year each, by two doctoral-student therapists in a university-based community mental health clinic. The study allows for exploration of the independent role of the therapist in the psychodynamic therapy of a child diagnosed with Asperger's disorder. The results suggest that four distinct interaction structures between child and therapist could be identified in this psychotherapy and that the interaction structures differed between the two therapists and also differed over time within each treatment. The implications of these findings for training and clinical practice are discussed.

Interaction Structures in the Psychodynamic Psychotherapy of a Girl Diagnosed with Adjustment Disorder

“…Some are indicative of a clearly positive transferencecountertransference matrix, such as IS 1, while others denote a negative transference-countertransference matrix, such as ISs 3 and 4. These fi ndings are similar to those of other studies of ISs in child psychodynamic therapy, which also identifi ed positive and negative transferencecountertransference matrices (Goodman, 2015;Goodman & Athey-Lloyd, 2011;Ramires et al, 2015).…”

“…Goodman (2015) and Goodman and Athey-Lloyd (2011) showed that the therapist contributes to interaction patterns. In their respective studies, they analyzed the sequential treatment of a child by two different therapists and found that each therapist made an independent contribution to the conformation of these structures, the magnitude of which differed between therapists.…”

“…This concept is framed within a line of thought that emphasizes interaction as the driving force behind therapeutic change, whereby interpersonal factors and the patient-therapist dyad may help the patient resume emotional development. Jones (2000) argues that only research into these specifi c interaction processes will be able to identify the ingredients that produce therapeutic change, and that gaining insight into these structures can help psychotherapists in clinical practice; therapists with such knowledge can know what to expect from patients experiencing certain symptoms and exhibiting certain behaviors, and understand how interactions may change over time (Goodman & Athey-Lloyd, 2011).…”

“…Its discriminant validity has been established (Goodman, Midgley, & Schneider, 2015;Schneider et al, 2009), as has inter-rater reliability (Goodman & Athey-Lloyd, 2011;Goodman et al, 2015;Ramires et al, 2015;Schneider, 2004;Schneider et al, 2010). In all of these studies, independent analyses of child psychotherapy sessions by trained raters have achieved agreement coeffi cients above 0.70 (intraclass correlation).…”

Psicoterapia de Crianças: Desenvolvimento da Versão em Português do Child Psychotherapy Q-Set

“…O CPQ tem sido utilizado em estudos desenvolvidos nos Estados Unidos e Inglaterra, visando explorar em profundidade a natureza do processo terapêutico e sua relação com o resultado (Schneider, Midgley, & Duncan, 2010;Schneider et al, 2009), a elaboração de protótipos da psicoterapia de crianças (Goodman, Midgley, & Schneider, 2016) e a identificação e análise das estruturas de interação no processo terapêutico (Goodman & Athey-Lloyd, 2011). As análises qualitativas e quantitativas possibilitadas pelo procedimento assim como a investigação do processo ao longo do tempo no interior de cada psicoterapia e entre diferentes tratamentos são recursos que oferecem importantes e inéditos vértices de observação.…”