Assessing levels of similarity to a

Marina Bento Gastaud; Cibele Carvalho; Geoff Goodman; Vera Regina Röhnelt Ramires

doi:10.1590/2237-6089-2014-0059

Brief Communication

Assessing levels of similarity to a "psychodynamic prototype" in psychodynamic psychotherapy with children: a case study approach (preliminary findings)

Avaliação dos níveis de adesão ao "protótipo psicodinâmico" na psicoterapia psicodinâmica com crianças: um estudo de caso (resultados preliminares)

Marina Bento Gastaud; Cibele Carvalho; Geoff Goodman; Vera Regina Röhnelt Ramires

http://dx.doi.org/10.1590/2237-6089-2014-0059 Trends Psychiatry Psychother, vol.37, n3, p.161-165, 2015

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Abstract

Objective:To analyze the degree of similarity to a "psychodynamic prototype" during the first year of two children's once-weekly psychodynamic psychotherapy.Methods: This study used a longitudinal, descriptive, repeated-measures design based on the systematic case study method. Two male school children (here referred to as Walter and Peter) and their therapists took part in the study. All sessions were video and audio recorded. Ten sessions from each case were selected for analysis in this preliminary study. Trained examiners (randomly selected in pairs) independently and blindly evaluated each session using the Child Psychotherapy Q-Set (CPQ). Experts in psychodynamic therapy and cognitive behavioral therapy from several countries rated each of the 100 CPQ items with regard to how well it characterized a hypothetical ideal session of either treatment modality. A series of paired t tests comparing analogous adherence scores within each session were conducted.Results:There were no significant correlations between time elapsed and adherence to the prototypes. Walter's treatment adhered to both prototypes and Peter's treatment did not adhere to either prototype.Conclusion:Child psychotherapy theory and practice are not absolutely coincident. Real psychotherapy sessions do not necessarily resemble the ideal prototypes.

Keywords

Psychodynamic psychotherapy, children, case study

Resumo

Objetivo: Analisar o grau de adesão a um "protótipo psicodinâmico" durante o primeiro ano de psicoterapia psicodinâmica de duas crianças tratadas uma vez por semana.Método: Trata-se de um estudo longitudinal, descritivo, com desenho de medidas repetidas baseado no método de estudo de caso sistemático. Participaram do estudo dois meninos em idade escolar (aqui referidos como Walter e Peter) e seus terapeutas. Todas as sessões foram gravadas em vídeo e áudio. Foram selecionadas 10 sessões de cada caso para análise neste estudo preliminar. Examinadores treinados (aleatoriamente selecionados em pares) avaliaram de forma independente e cega cada sessão utilizando o Child Psychotherapy Q-Set (CPQ). Especialistas experientes em terapia psicodinâmica e terapia cognitivo-comportamental oriundos de diversos países pontuaram cada um dos 100 itens do CPQ em relação ao grau em que o item caracterizava uma sessão ideal hipotética de cada modalidade de tratamento. Foi realizada uma série de testes t pareados comparando os escores de aderência análogos a cada sessão.Resultados: Não houve correlações significativas entre a passagem do tempo e a aderência aos protótipos. O tratamento de Walter aderiu a ambos os protótipos e o tratamento de Peter não aderiu a nenhum dos protótipos.Conclusão:A teoria e a prática da psicoterapia de criança não são absolutamente coincidentes. Sessões reais de psicoterapia não necessariamente se assemelham aos protótipos ideais.

Palavras-chave

Psicoterapia psicodinâmica, crianças, estudo de caso

References

Midgley N. The "inseparable bond between cure and research": clinical case study as a method of psychoanalytic inquiry. J Child Psychother. 2006;32:122-47.

Rustin M. Reason and unreason: psychoanalysis, science, and politics. 2001.

Schneider C, Midgley N, Duncan A. A "Motion Portrait" of a psychodynamic treatment of an 11-year-old girl: exploring interrelations of psychotherapy process and outcome using the child psychotherapy Q-set. J Infant Child Adolesc Psychother. 2010;9:94-107.

Ablon J, Jones E. How expert clinicians' prototypes of an ideal treatment correlate with outcome in psychodynamic and cognitive-behavioral therapy. Psychother Res. 1998;8:71-83.

Pole N, Ablon JS, O'Connor L. Using psychodynamic, cognitive behavioral, and control mastery prototypes to predict change: a new look at an old paradigm for long-term single-case research. J Consult Psychol. 2008;55:221-32.

Schneider C. The development of the child psychotherapy Q-set. Diss Abstr Int. 2004;65:1039.

Ferro A. Seeds of illness, seeds of recovery: the genesis of suffering and the role of psychoanalysis. 2005.

Boterhoven De Haan KL, Lee CW. Therapists' thoughts on therapy: clinicians' perceptions of the therapy processes that distinguish schema, cognitive behavioural and psychodynamic approaches. Psychother Res. 2014;24:538-49.

Edwards DJA. Collaborative versus adversarial stances in scientific discourse: implications for the role of systematic case studies in the development of evidence-based practice in psychotherapy. Pragmat Case Stud Psychother. 2007;3:6-34.

Efron AM, Fainberg E, Kleiner Y, Sigal AM, Woscoboinik P. A hora de jogo diagnóstica. O processo psicodiagnóstico e as técnicas projetivas. 2003:207-38.

Schneider C, Jones EE. Child psychotherapy Q-set coding manual. Psychodynamic psychotherapy research. 2012:611-26.

Goodman G, Schneider C, Midgley N. Assessing child psychotherapy process in prototype sessions of three evidence-based treatment models: Is mentalization a common process factor?. 2014.

Schneider C, Pruetzel-Thomas A, Midgley N. Discovering new ways of seeing and speaking about psychotherapy process: the child psychotherapy Q-set. Child psychotherapy and research: new approaches, emerging findings. 2009:72-84.

Ablon JS, Marci C. Psychotherapy process: the missing link: comment on Westen, Novotny, and Thompson-Brenner. Psychol Bull. 2004;130:664-8.

Gabbard GO. Psychodynamic psychiatry in clinical practice. 2005.

Serralta FB, Pole N, Tiellet Nunes ML, Eizirik CL, Olsen C. The process of change in brief psychotherapy: effects of psychodynamic and cognitive-behavioral prototypes. Psychother Res. 2010;20:564-75.

Goodman G, Anderson K, Diener MJ. Processes of therapeutic change in psychodynamic therapy of two inpatients with borderline personality disorder. J Psychother Integr. 2014;24:30-45.