Regulation Focused Psychotherapy for Children (RFP-C) with Externalizing Behaviors: Comparing the Successful Case of "Jack," and the Unsuccessful Case of "Oliver"

Regulation Focused Psychotherapy for Children (RFP-C) is a manualized, time-limited, psychodynamic approach for children who experience challenges with emotion regulation and demonstrate externalizing behavior problems (Hoffman et al., 2016). In research settings, it takes place over ten weeks and includes 16 sessions with the child and four with the child’s parents. This protocol can be extended or modified in regular clinical practice. The current study utilized a dual case study method to analyze pretreatment and post-treatment measures and compare psychotherapy outcomes and process in RFP-C between a successful and an unsuccessful case. Data examined included (a) quantitative outcome measures; (b) case conceptualizations and clinical vignettes drawn from review of session videos; (c) post-treatment interviews with parent, child, and therapist; and (d) psychotherapy process codings of child and parent sessions. These data were employed to (a) identify differential psychotherapy processes; (b) assess parental defense mechanisms; (c) assess parental attachment classifications; and (d) evaluate therapist countertransference ratings. Results indicated that many variables contributed to successful versus unsuccessful treatment outcomes, including but not limited to (a) the child’s spontaneity; (b) the child’s active participation and emotional expression throughout treatment; (c) themes of child play; (d) the therapist’s countertransference; (e) the child and parental defense mechanisms; and (f) the parental attachment styles. Taken together, findings from this study contribute to the literature on therapeutic outcomes for children and families and highlight some of the essential characteristics of successful psychotherapy process. Limitations of the study and directions for future research are also discussed.