Expectations, Interaction and Therapeutic Change in Psychodynamic Child Psychotherapy

This thesis aims to increase the knowledge of courses and processes of change prior to and during psychodynamic child psychotherapy with parallel parent contact. The dissertation examines parents’ and psychotherapists’ stated goals and expectations prior to the child’s psychotherapy, processes of change focusing on the psychotherapeutic encounter between child and psychotherapist, and outcome gauged by standardized measures compared to experienced change regarding the child’s problems. This dissertation also wants to examine different instruments for describing the psychotherapeutic process. Data was collected from systematic case studies, at different times during the course of psychotherapy, with material from different sources, such as child psychiatric assessment before and after conducted psychotherapy, questionnaires, and video taping of therapy sessions. By examining the therapeutic encounter from the perspectives of child, parent and psychotherapist, an image of psychotherapy, which illustrates the complexity of the psychotherapeutic process, was created. The thesis is based on three articles: Study I examines parents’ and psychotherapists’ goals and expectations prior to psychotherapy. Study II is a close study of a video-taped individual therapy, in which the interaction between child and therapist is examined with the rating instrument Child Psychotherapy Q-set (CPQ), the psychotherapist’s description of the psychotherapy’s process, and the self-rating instrument Feeling Word Checklist (FWC-24). Study III examines change in global functioning ability after child psychotherapy. By examining several psychotherapies in order to construct qualitative understanding of low and high change, respectively, in rated global functioning, limitations in the rating instrument Children’s Global Assessment Scale (CGAS) are analyzed. The results point to: 1. The need for a culture of cooperation between family and the one conducting the treatment, where goals are formulated together and in accordance with the family’s frame of reference and life experiences, which can increase the possibility of creating positive expectations, and of adapting treatment to the family in question. 2. Different methods of examining psychotherapy reflect and complete the image of the psychotherapy process. 3. The psychotherapy process’s complexity and the difficulty in describing the effect of therapy with simple measurements or remaining psychiatric symptoms. Positive change in several areas, such as the child experiencing increased independence, gets access to more positive affections, has improved self-esteem and a more optimistic idea of the future, could be described as psychological phenomena and can be difficult to encompass with narrow psychiatric terminology. 4. The intersubjectivity between child and psychotherapist appears essential. The therapist’s attitude and interventions are characterized by creating a steady therapeutic framework for exploring the child’s problems. 5. The importance of the therapist’s meta-competence, i.e., overarching competencies that psychotherapists need to use to guide any intervention, what interventions to use, and when they are suitable. At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 2: Submitted.