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

Abstract

It has been recognized that there is a need to make psychotherapy more effective for children with disruptive symptoms. Many studies on child psychodynamic psychotherapy have indicated its effectiveness, but do not explain how this treatment works. It is not only necessary to understand how it works, but also for which therapist-patient dyads. The Child Psychotherapy Q-Set was designed to describe the therapeutic process with children, and makes it possible 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 analyze the psychotherapeutic process of a school-aged boy who presented with disruptive behavior disorder, identifying the interaction structures in his treatment. A total of 123 sessions of his treatments were analyzed and 4 interaction structures were identified: 2 became more characteristic over the course of treatment, and 2 became less characteristic. They also varied in magnitude. The therapeutic process showed characteristics consistent with the models described as ideal for psychodynamic psychotherapy, the reflective functioning process, and cognitive-behavioral therapy, in this order of significance. The study highlighted the importance of supportive interventions alongside expressive ones in the treatment of children with disruptive behavior disorders. The results also suggested the integrationist nature of most psychotherapies, and the importance of acknowledging and understanding the effective elements, rather than treatment types that can be present within any therapeutic modality.

Mentalization in Child Psychodynamic Psychotherapy

“…() demonstrated the discriminant validity of CPQ when comparing sessions between two models of psychotherapy, PP and CBT. In addition, several studies have confirmed the interrater reliability obtained with the procedure (Goodman & Athey‐Lloyd, ; Goodman et al ., ; Ramires et al ., , ). In all of them, independent analyses of different sets of child psychotherapy sessions (ranging from 9 to 123 sessions) conducted by trained coders have reached agreement indices above 0.70 (intraclass correlation).…”

“…The interrater reliability, in all sessions, ranged from 0.62 to 0.81 (mean 0.73). These results are similar to previous studies (Goodman, ; Goodman et al ., ; Ramires et al ., , ). Subsequently, the means of the CPQ assessments were calculated to generate the composite score that was used in the subsequent analyses.…”

“…Some studies have used the prototypes developed to evaluate the psychotherapeutic process with children (Gastaud et al ., ; Goodman & Athey‐Lloyd, ; Ramires, Godinho & Goodman, ). All of them evidenced in common an increase in similarity to the RF prototype over time; that is, to the extent that therapist interventions and child behaviour were closer to the model of therapy based on the development of mentalization capacity, reflecting a more engaged and deep posture of reflection between the dyad and achieving more effective results at the end of treatment, which corroborated the hypothesis that mentalization is a common factor of effective treatments.…”

Development of Brazilian prototypes for child psychodynamic psychotherapy and cognitive-behavioral therapy

“…19 Therefore, the objective of this study was to develop Brazilian PDT and CBT prototypes for children with ID and ED. The following hypotheses were tested: 1) expert clinicians should exhibit a high degree of agreement regarding the conceptualization of sessions for children with ID and ED within their respective theoretical approaches; 2) based on the consideration that the Q methodology could differentiate the PDT and CBT prototypical processes in various previous studies 4,8,21 and that the children's psychopathological conditions impact the therapeutic process and the degree of similarity to the prototypes, 13,14 it was expected that the expert clinicians' ratings would generate four distinct factors, differentiating both theoretical approaches for both types of diagnoses.…”

The impact of parental participation in the child's psychoanalytic therapeutic process

“…A tradução e adaptação do instrumento seguiram as diretrizes propostas por Juliane Callegaro Borsa, Bruno Figueiredo Damásio e Denise Ruschel Bandeira (2012). A fidedignidade interavaliadores obtida com o CPQ vem sendo confirmada por vários estudos brasileiros (Carvalho, Godinho & Ramires, 2016;Gastaud, Carvalho, Goodman & Ramires, 2015;Ramires, Carvalho, Schmidt, Fiorini & Goodman, 2015;Ramires, Godinho, Carvalho, Gastaud & Goodman, 2017;Ramires, Godinho & Goodman, 2017). Em todos eles, análises independentes de grupos de sessões de psicoterapia de crianças (variando de 20 a 160 sessões nos estudos) realizadas por avaliadores treinados têm atingido índices de concordância superiores a 0,70 (correlação intraclasse).…”