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 affiance 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 affiance, especially for children with noncomorbid problems. Psychodynamic interventions may have an adverse effect if a therapeutic affiance is not established. For children with comorbid problems, keeping the relationship strong is important.