Session Adherence to Prototypical Psychotherapy Process as a Correlate of Outcome in a Naturalistic Study of Child Mentalization-Informed Psychodynamic Play Therapy

Abstract

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.