Interaction structures in the psychodynamic therapy of a boy diagnosed with Asperger’s disorder: a single-case study

Abstract

Abstract.It is important to investigate the outcomes of psychotherapy and, especially, its process. Regarding child psychodynamic psychotherapy, available studies are in smaller numbers. Therefore, we still do not fully know the mechanisms of change in treatments with this age group. The Child Psychotherapy Q-Set (CPQ) was designed to analyze the therapeutic process with children. It permits one to identify interaction structures (i.e., repetitive patterns of interaction) and how they change in the course of a treatment. Based on these assumptions, the aim of this study was to identify and to analyze the interaction structures in the psychodynamic therapy of a boy diagnosed with Asperger's disorder and possible changes in his psychic organization. A mixed longitudinal study, based on the Systematic Case Study procedure, was performed. Approximately 30 months of the boy's psychotherapy were analyzed using the CPQ. The Rorschach method was used as the outcome measure. Four interaction structures were identified, using the CPQ: Active, confident and lively child, competing with connected, mentalizing and accepting therapist; Withdrawn and defensive child with uncertain, unresponsive and didactic therapist; Accepting therapist with demanding, provocative and hostile child; and Reassuring, supportive, nondirective therapist with a compliant and not spontaneous child. Two interaction structures varied over time. Some changes in Rorschach variables were detected after two years of treatment.

The therapeutic process of a child diagnosed with disruptive mood dysregulation disorder.

“…In these treatments, when the child was withdrawn, defensive, resistant, distant or aggressive, the therapist seemed more directive, didactic or misattuned. Interestingly, two IS were quite similar in two studies that focused on the psychotherapeutic process of boys with Asperger's disorder: IS 4 (reassuring, supportive, nondirective therapist with compliant and unspontaneous child) in Ramires et al (2015), and IS 1 (reassuring, supportive, nondirective therapist with a compliant, curious child building insight and positive feelings) in Goodman and Athey-Lloyd (2011). A total of nine CPQ items were the same in both of these IS.…”

“…We can observe differences and some similarities in these IS across different dyads and different pathologies. We would not expect the same IS in different child psychotherapies (even with the same age or the same diagnosis), given the uniqueness of each dyad; however, it is interesting to note that for most treatments, positive and negative transference-countertransference matrices were present (Goodman & Athey-Lloyd, 2011;Ramires et al, 2015;Schmidt, 2015). In these treatments, when the child was withdrawn, defensive, resistant, distant or aggressive, the therapist seemed more directive, didactic or misattuned.…”

O Processo Psicoterapêutico Psicodinâmico De Um Menino Com Sintomas Internalizantes: Uma Análise Com Base No Child Psychotherapy Q-Set

“…Sua validade discriminante foi demonstrada em alguns estudos (Goodman, Midgley, & Schneider, 2015;Schneider et al, 2009), assim como a fidedignidade interavaliadores (Carvalho, et al, 2016;Gastaud, Carvalho, al. , 2015;Ramires, Carvalho, Schmidt, Fiorini, & Goodman, 2015;Schneider et al, 2010). Em todos eles, análises independentes de grupos de sessões de psicoterapia de crianças realizadas por avaliadores treinados atingem índices de concordância superiores a 0,70 (correlação intraclasse).…”

Comparando a Psicoterapia Psicodinâmica de uma menina com modelos de Psicoterapia Psicodinâmica e Terapia Cognitivo- Comportamental

“…Esse estudo faz parte de uma pesquisa maior, que visa investigar o processo psicoterapêutico psicodinâmico de crianças em relação aos seus resultados e a protótipos de psicoterapia. O presente recorte foi constituído por um delineamento longitudinal e correlacional (Sampieri, Collado, & Lucio, 2014), baseado no método de Estudos de Caso Sistemático (Edwards, 2007 (Goodman & Athey-Lloyd, 2011;Goodman et al, 2016;Ramires, Carvalho, Schmidt, Fiorini, & Goodman, 2015;Schneider, Midgley, & Duncan, 2010). (Etchegoyen, 2005;Luz, 2015).…”