Interaction structures between a child and two therapists in the psychodynamic treatment of a child with borderline personality disorder

Abstract

This study examined the constellation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – that emerged in the psychodynamic therapy (PDT) of a child diagnosed with borderline personality disorder and treated by two doctoral student therapists. Identification of these interaction structures can inform therapists of what might be expected from patients with particular symptom or behaviour patterns and how interactions change over time. This study also examined each session’s adherence to three session prototypes: PDT, cognitive-behavioural therapy (CBT) and reflective functioning (RF) process. The Child Psychotherapy Q-Set (CPQ) is a 100-item instrument that assesses the processes within a single psychotherapy session. Items reflect a wide range of therapist attitudes and behaviours, patient attitudes and behaviours and interactions between therapist and patient. Experts used the CPQ to define PDT, CBT and RF process session prototypes. The results suggested that four distinct interaction structures could be identified and that their constellations differed between the two therapists and also differed over time within each treatment. Therapists were more structured and accommodating early on in their treatments and more interpretive later. Prototypical PDT process was more prominent in the sessions than RF process, which in turn was more prominent than CBT process. Unique therapeutic processes are at work in every dyad, despite holding the patient and theoretical orientation constant. An effective treatment in one dyad might not work in another due to therapist-specific and dyad-specific effects.

Keywords:

• child psychotherapy
• psychotherapeutic processes
• treatment outcomes
• treatment adherence
• naturalistic study
• single-case research

Acknowledgements

This research was supported by a generous grant from the Long Island University Research Fund. The author wishes to thank Jennifer Andersen, Laura Athey-Lloyd, Silvia Fiammenghi, Leah Berger, Dustin Kahoud and Jason Styka for their participation on the coding team, and Nick Midgley and Celeste Schneider for general consultation. Marcia Miller and Valeda Dent provided information resources. Finally, the author wishes to thank the two therapists and patient for their participation in this study.