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    Interaction structures as predictors of outcome in a naturalistic study of psychodynamic child psychotherapy
    (Routledge Journals, Taylor & Francis Ltd, 2020) Halfon, Sibel; Goodman, Geoff; Bulut, Pelinsu
    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.
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    Session Adherence to Prototypical Psychotherapy Process as a Correlate of Outcome in a Naturalistic Study of Child Mentalization-Informed Psychodynamic Play Therapy
    (Educational Publishing Foundation-American Psychological Assoc, 2021) Goodman, Geoff; Halfon, Sibel
    While the adult psychotherapy literature has made great strides to understand the relations between psychotherapy process and treatment outcome, the child psychotherapy literature lags far behind. The first aim of this study was to determine whether mentalization-informed psychodynamic play therapy (PDT) sessions adhered to therapeutic principles comprising this treatment model. The second aim was to assess whether session adherences to prototypical PDT and Reflective Function (RF) process using the Child Psychotherapy Q-Set (CPQ) were correlated with both problem behavior reduction and adaptive functioning after controlling for pretreatment scores. The third aim was to assess whether these correlations depended on problem behavior type (externalizing-only, internalizing-only, externalizing and internalizing), age, or gender. The sample included 95 children (56% male; M age = 6.80) categorized into these 3 types. Three-hundred seventy-nine sessions from different treatment phases were rated using the CPQ. Outcomes were assessed using the Child Behavior Checklist, Teacher Rating Form, Emotion Regulation Checklist, and Children's Global Assessment Scale. Sessions adhered to prototypical RF and PDT process. Session adherences to prototypical RF and cognitive-behavioral therapy (CBT) process were positively correlated with adaptive functioning. Among internalizers, session adherence to prototypical PDT process was negatively correlated with internalizing behavior, while among externalizers, session adherences to prototypical RF and CBT process were negatively correlated with externalizing behavior and emotion negativity. Session adherences to prototypical RF and CBT process were significantly higher for girls than for boys. Two different trajectories of success are proposed for children with externalizing problems. PDT is proposed for children with internalizing problems.