Psychodynamic technique and therapeutic alliance in prediction of outcome in psychodynamic child psychotherapy.

Abstract

Objective: This study is the first to investigate the effect of psychodynamic technique (PT), therapeutic alliance, and their interactions with outcome in psychodynamic child psychotherapy. Method: The sample comprised 79 Turkish children (mean age = 6.86 years, 38% girls) with discrete internalizing (22%), discrete externalizing (11%) and comorbid internalizing and externalizing (67%) problems. Independent raters coded 359 sessions from different phases of treatment using the Child Psychotherapy Process Q-Sort for PT and Therapy Process Observational Coding System-Alliance Scale. Problem-assessment measures were collected at intake and every 10th session in treatment using the Children’s Behavior Checklist and Brief Problem Monitor. Results: Multilevel modeling analyses indicated that the PT and therapeutic alliance interacted such that more use of the PT in the context of high therapeutic alliance predicted less problem behaviors, whereas in the context of low therapeutic alliance PT predicted more problem behaviors. This relationship was moderated by problem comorbidity such that for children with comorbid problems, though a strong therapeutic alliance was indicated, an increase in PT use did not have a significant effect. Conclusion: Findings suggest that the use of psychodynamic interventions is indicated in the context of a strong therapeutic alliance, especially for children with noncomorbid problems. Psychodynamic interventions may have an adverse effect if a therapeutic alliance is not established. For children with comorbid problems, keeping the relationship strong is important.

Therapeutic Alliance: A Comparison Study between Adolescent Patients and Their Therapists

“…As expected, we found that the alliance ratings of both adolescents and therapists were quite stable over time. This adds to the previously scarce evidence on the development and change over time of alliance with adolescents [ 25 , 64 ], supports the previous findings that the alliance is formed at an early stage of treatment [ 22 , 30 , 31 ], and raises the importance of focusing on building the relationship at the very beginning of treatment. According to this finding, the alliance measurement timing would not be of great importance in terms of predicting the treatment outcome.…”

Interaction Structures in Psychodynamic Psychotherapy for Adolescents

“…Studies in adults have indicated that the level of insight mediates the associations between interventions and the outcome, but those findings have not been replicated with adolescents [ 52 ]. Other studies with adults and children have suggested that the relationship between the psychodynamic technique and outcome depends upon the strength of the therapeutic alliance (e.g., [ 24 , 52 ]). Future studies should investigate whether the therapeutic alliance moderates the association between technique and the outcome in adolescents.…”

“…Data were collected at the Psychotherapy Laboratory of Istanbul Bilgi University within the framework of a research program that seeks to investigate the process and outcome of PDT in children and adolescents (for details, see [ 24 ]). This study followed a naturalistic process–outcome design.…”

“…The only studies that investigated associations between IS and outcome in crosssectional samples were conducted with children and adults via the use of CPQ and the PQS. Halfon et al (2020) [23] and Halfon (2021) [24] found that, even though the psychodynamic technique IS predicted the outcome, this was moderated by problem type and severity, with children showing externalizing and comorbid psychopathology benefiting more from client-centered and supportive approaches. Similar findings were found with adults.…”

“…The second aim was to assess associations between the IS and outcome. Studies using PQS and CPQ found that even though the psychodynamic technique IS could predict the outcome, this was moderated by symptom severity [ 24 , 25 ]. Therefore, we aimed to test the effect of problem levels at baseline on our second aim.…”