Interaction Structures in Psychodynamic Psychotherapy for Adolescents.

Despite advances in psychotherapy research showing an evidence-base for psychodynamic psychotherapy (PDT) in adolescents, developmentally specific treatment characteristics are under-researched. We aimed to identify interaction structures (IS: reciprocal patterns of in-session interactions involving therapist interventions, patient behaviors, and the therapeutic relationship) and assess associations between IS and outcome. The study cohort comprised 43 adolescents (Mage = 13.02 years) with nonclinical, internalizing, and comorbid internalizing-externalizing problems in PDT. A total of 123 sessions from different treatment phases were rated based on the Adolescent Psychotherapy Q-Set (APQ). Outcome was assessed with the Brief Problem Monitor-Youth (BPM-Y) administered repeatedly over the treatment course. Principal component analysis of APQ items resulted in five IS, named "Negative Therapeutic Alliance", "Demanding Patient, Accommodating Therapist", "Emotionally Distant Resistant Patient", "Inexpressive Patient, Inviting Therapist", and "Exploratory Psychodynamic Technique" (EPT). Multilevel modeling analyses with Bayesian Markov chain Monte Carlo (MCMC) estimations indicated a two-way interaction effect between EPT and problem levels at baseline such that patients with lower problems at baseline showed good outcome in the context of EPT, whereas an inverse relationship was found for patients with higher problems. Findings provide empirical evidence for characteristic components of PDT for adolescents and preliminary answers about who benefits from psychodynamic techniques.

Psychotherapy Dropout: Using the Adolescent Psychotherapy Q-Set to Explore the Early In-Session Process of Short-Term Psychodynamic Psychotherapy.

Research suggests that short-term psychodynamic psychotherapy (STPP) is an effective treatment for depression in adolescence, yet treatment dropout is a major concern and what leads to dropout is poorly understood. Whilst studies have begun to explore the role of patient and therapist variables, there is a dearth of research on the actual therapy process and investigation of the interaction between patient and therapist. This study aims to address this paucity through the utilisation of the Adolescent Psychotherapy Q-set (APQ) to examine the early treatment period. The sample includes 69 adolescents aged 16-18 years with major depressive disorder receiving STPP as part of the First Experimental Study of Transference Work-in Teenagers (FEST-IT) trial. Of these, 21 were identified as dropouts and were compared to completers on pre-treatment patient characteristics, symptomatology, functioning, and working alliance. APQ ratings available for an early session from 16 of these drop out cases were analysed to explore the patient-therapist interaction structure. Results from the Q-factor analysis revealed three distinct interaction structures that explained 54.3% of the total variance. The first described a process of mutual trust and collaboration, the second was characterised by patient resistance and emotional detachment, the third by a mismatch and incongruence between therapist and adolescent. Comparison between the three revealed interesting differences which taken together provide further evidence that the reasons why adolescents drop out of therapy vary and are multidimensional in nature.

Interaction structures as predictors of outcome in a naturalistic study of psychodynamic child psychotherapy.

Objective: The first aim of this study was to identify interaction structures (IS), which refer to clusters of items characterizing the course of psychotherapy in terms of reciprocal interaction patterns between the therapist and the child, secondly to assess their trends over the course of treatment, and finally investigate which IS predict outcome in long-term psychodynamic child psychotherapy.Method: The sample included 52 children with externalizing and internalizing problems. 192 sessions were rated with the use of the Child Psychotherapy Q-Set (CPQ). Outcome was assessed with the Child Behavior Checklist (CBCL) Total Problems, and Children's Global Assessment Scale (CGAS).Results: A principal components analysis resulted in four IS, theoretically named Therapeutic Alliance, Children's Emotion Expression, Child -Centered Technique and Psychodynamic Technique. Multilevel Modeling (MLM) analyses indicated significant linear growth on Psychodynamic Technique. Multiple regression analyses indicated that Psychodynamic Technique positively predicted changes on CBCL Total Problems and CGAS. In contrast, Child-Centered technique negatively predicted change on CBCL Total Problems, however follow up interaction analyses showed that externalizing children who received more Child-Centered technique showed more improvement on this scale.Discussion: Findings point to empirically derived components of psychodynamic child psychotherapy and provide preliminary answers about which aspects may facilitate change.

Interaction structures in the psychodynamic psychotherapy of a patient with chronic diseases and somatic symptoms / Estruturas de interação na psicoterapia psicodinâmica de uma paciente com doenças crônicas e sintomas somáticos

Abstract Objective This study aimed to identify and analyze the interaction structures (ISs) (patterns of reciprocal interaction between the patient-therapist dyad) that characterize the process of a successful long-term psychodynamic psychotherapy (28 months) of a patient with chronic diseases (lupus and fibromyalgia) and somatic symptoms. Methods The 113 sessions were videotaped and analyzed alternately (n = 60) by independent judges using the Psychotherapy Process Q-Set. Inter-rater reliability ranged from 0.60 to 0.90, with a mean of r = 0.71 (Pearson's correlation). Through a principal component exploratory factor analysis, four ISs were identified. Result The patterns of interaction between patient and therapist showed clinical validity (i.e., they were easily interpretable in the context of the case under study). The ISs were non-linear and more or less prominent across different treatment sessions and stages. Some ISs were similar to those in other studies, and others were probably unique to the present process. In addition, some ISs were independent, whereas others were interrelated over time. Conclusion Process studies, such as the present one, seek to address questions about the characteristics of the interaction between patient and therapist as well as to identify particular patterns of interaction that are most prominent with a specific patient at a specific condition or time. Therefore, these studies can provide some support in establishing knowledge for clinical practice, assisting in the training of therapists, as well as in the elaboration of general guidelines for the technical management of patients with specific characteristics.

Resumo Objetivo Este estudo objetivou identificar e analisar as estruturas de interação (interaction structures [ISs]) (padrões de interação recíproca entre a dupla paciente-terapeuta) que caracterizam o processo de uma psicoterapia psicodinâmica de longa duração (28 meses) de uma paciente com doenças crônicas (lúpus e fibromialgia) e sintomas somáticos. Métodos As 113 sessões foram filmadas e analisadas alternadamente (n = 60) por juízes independentes usando o Psychotherapy Process Q-Set. A confiabilidade entre avaliadores variou de 0.60 a 0.90, com média de r = 0.71 (correlação de Pearson). Por meio de uma análise fatorial exploratória do componente principal, foram identificadas quatro ISs. Resultados Os padrões de interação entre paciente e terapeuta mostraram validade clínica (ou seja, foram facilmente interpretáveis no contexto do caso em estudo). As ISs foram não lineares e mais ou menos proeminentes em diferentes sessões e etapas do tratamento. Algumas ISs foram semelhantes às de outros estudos, e outras provavelmente foram exclusivas do presente processo. Além disso, algumas ISs eram independentes, enquanto outras estavam inter-relacionadas ao longo do tempo. Conclusão Estudos de processo como o presente procuram abordar questões sobre as características da interação entre paciente e terapeuta, bem como identificar padrões particulares de interação que são mais proeminentes com um determinado paciente em condições ou momentos específicos. Portanto, esses estudos podem fornecer suporte ao estabelecimento de conhecimentos para a prática clínica, auxiliando na formação de terapeutas, bem como na elaboração de diretrizes gerais para o manejo técnico de pacientes com características específicas.

Estruturas de Interação na Psicoterapia Psicodinâmica de uma Menina com Transtorno de Adaptação / Estructuras de Interacción en la Psicoterapia Psicodinámica de una Niña con Trastorno Adaptativo / Interaction Structures in the Psychodynamic Psychotherapy of a Girl Diagnosed with Adjustment Disorder

Resumo A literatura científica aponta a necessidade de estudos com foco no processo e nos resultados da psicoterapia psicodinâmica de crianças. Além disso, o relacionamento e as estruturas de interação entre terapeuta e paciente têm sido enfatizadas como importante fator de mudança terapêutica. O objetivo desse estudo foi analisar as estruturas de interação na psicoterapia psicodinâmica de uma criança com transtorno de adaptação. Realizou-se um estudo descritivo, longitudinal, baseado no procedimento de estudo de caso sistemático. Os participantes foram uma menina de oito anos e sua terapeuta. As 40 sessões de psicoterapia foram analisadas através do Child Psychotherapy Q-Set (CPQ). Foram identificadas cinco estruturas de interação, com base na análise fatorial de componentes principais com rotação Varimax. Elas descrevem diferentes padrões de interação, com utilização de abordagens suportivas, diretivas e interpretativas. A importância das estruturas de interação como vetor de mudança, variáveis do terapeuta e uma tendência de abordagens integrativas na psicoterapia de crianças foram discutidas.

Resumen La literatura científica indica la necesidad de estudios con foco en el proceso y en los resultados de psicoterapia psicodinámica de niños. Además, la relación y las estructuras de interacción entre terapeuta y paciente se han enfatizado como un importante factor de cambio terapéutico. El objetivo de este estudio fue analizar las estructuras de interacción en la psicoterapia psicodinámica de una niña con trastorno de adaptación. Se realizó un estudio descriptivo, longitudinal basado en lo método de estudio sistemático de casos. Los participantes fueron una niña de ocho años y su terapeuta. Las Cuarenta sesiones de psicoterapia fueran analizadas mediante el Child Psychotherapy Q-Set (CPQ). Fueran identificadas cinco estructuras de interacción, con base en el análisis factorial de componentes principales con rotación Varimax. Estas describen diferentes patrones de interacción, con utilización de enfoques suportivos, directivos e interpretativos. La importancia de las estructuras de interacción como un vector de cambio, las variables del terapeuta y la tendencia de los enfoques de integración en psicoterapia de niños fueron discutidos.

Abstract The scientific literature indicates the need for studies focusing on the process and outcomes of child psychodynamic psychotherapy. In addition, the relationship and the interaction structures between therapist and patient have been emphasized as an important factor of therapeutic change. The aim of this study was to analyze interaction structures in the psychodynamic psychotherapy of a child with adjustment disorder. We conducted a descriptive, longitudinal study based on the systematic case study procedure. The participants were an 8-year-old girl and her therapist. Forty psychotherapy sessions were analyzed using the Child Psychotherapy Q-Set (CPQ). Five interaction structures were identified on the basis of factor analysis of main components with varimax rotation. They describe different patterns of interaction, using supportive, directive, and interpretive approaches. The importance of interaction structures as a vector of change, therapist variables, and the trend toward integrative approaches in child psychotherapy are discussed.