Interaction Structures in the Psychodynamic Psychotherapy of a Girl Diagnosed with Adjustment Disorder

Schmidt, Fernanda Munhoz Driemeier; Gastaud, Marina Bento; Ramires, Vera Regina Rohnelt

doi:10.9788/TP2018.2-07Pt

Fernanda Munhoz Driemeier Schmidt ^**Mailing address: Casemiro de abreu, 370, apto 402, Bairro Rio Branco, Porto Alegre, RS, Brazil. E-mail: fernandadriemeier@hotmail.com

Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil

http://orcid.org/0000-0003-3072-9671

Marina Bento Gastaud

Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil

http://orcid.org/0000-0002-4040-0995

Vera Regina Rohnelt Ramires

Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil

http://orcid.org/0000-0002-1760-7154

*Mailing address: Casemiro de abreu, 370, apto 402, Bairro Rio Branco, Porto Alegre, RS, Brazil. E-mail: fernandadriemeier@hotmail.com

CPQ Items	Mean	SD
Most characteristic items
31 - T asks for more information or elaboration.	8.28	0.57
6 - T is sensitive to C's feelings.	8.20	0.55
28 - T accurately perceives the therapeutic process.	8.06	0.65
3 - T's remarks are aimed at encouraging C's speech.	7.70	0.79
88 - Material of hour is meaningful and relevant to C's conflicts.	7.56	0.65
76 - T makes links between C's feelings and experience.	7.45	0.78
77 - T's interaction with C is sensitive to C's level of development.	7.35	0.85
23 - Therapy section has a specific focus or theme.	7.25	0.68
86 - T is confident, self-assured [vs. uncertain or unsure].	7.25	0.76
82 - T helps C manage feelings.	7.16	0.98
Least characteristic items
9 - T is nonresponsive [vs. affectively engaged].	1.12	0.25
41 - C does not feel understood by T.	1.62	0.69
40 - C communicates without affect.	1.72	0.48
5 - C has difficulty understanding T's comments.	1.73	0.54
18 - T is judgmental and conveys lack of acceptance.	1.77	0.59
56 - C is distant from his or her feelings.	1.91	0.45
17 - T actively exerts control over the interaction (e.g., structuring, introducing new topics).	1.97	0.86
26 - C is socially misattuned or inappropriate.	2.02	0.47
42 - C ignores or rejects T's comments and observations.	2.15	0.46
58 - C appears unwilling to examine thoughts, reactions, or motivations related to problems.	2.43	0.99

Interaction Structure 1 - Attuned and interpretive therapist with active, expressive, and demanding child. (α = 0.81)
CPQ Items	Factor Loading
28 - T accurately perceives the therapeutic process.	.68
72 - C is active.	.66
29 - The quality of C's play is fluid, absorbed [vs. fragmented, sporadic].	.60
96 - C's parents are a topic of discussion.	-.59
69 - C's current or recent life situation is emphasized.	-.54
46 - T interprets the meaning of C's play.	.54
22 - C expresses fears of being punished or threatened.	-.52
75 - Interruptions, breaks in the treatment, or termination of therapy are discussed.	.50
13 - C is animated or excited.	.50
83 - C is demanding.	.46
90 - C's dreams or fantasies are discussed.	-.45
39 - C is competitive, rivalrous with T.	.45
73 - C expresses fears or displays phobic behavior.	-.43
Interaction Structure 2 - Sensitive and supportive therapist with withdrawn and distant child. (α = 0.85)
CPQ Items	Factor Loading
99 - T offers help or guidance.	.79
12 - T models unspoken or unelaborated emotions.	-.72
77 - T's interaction with C is sensitive to C's level of development.	.62
27 - There is a focus on helping C plan behavior outside the session.	.60
53 - C conveys awareness of own internal difficulties.	-.56
71 - C engages in make-believe play.	-.56
91 - An earlier developmental phase is a topic.	-.54
26 - C is socially misattuned or inappropriate.	-.53
81 - T emphasizes feelings to help C experience them more deeply.	-.52
54 - C is clear and organized in verbal expression.	.51
95 - C's play lacks spontaneity.	.51
44 - C feels wary or suspicious [vs. trusting and secure].	.50
10 - C seeks greater intimacy with T.	-.48
40 - C communicates without affect.	.47
93 - T is neutral.	-.45
47 - When the interaction with C is difficult, T accommodates C.	.42
86 - T is confident, self-assured [vs. uncertain or unsure].	.42
Interaction Structure 3 - Didactic and directive therapist with aggressive and defensive (projective) child. (α = 0.83)
CPQ Items	Factor Loading
34 - C blames others, or external forces, for difficulties.	.69
55 - T directly rewards desirable behaviors.	.68
66 - T is directly reassuring.	.65
85 - C's aggression is directed toward self.	-.63
65 - T clarifies, restates, or rephrases C's communications.	.59
70 - C struggles to control feelings or impulses.	-.56
87 - T informs C of the potential impact of his or her behavior on others (not including T).	.56
84 - C expresses anger or aggressive feelings.	.51
38 - T and C demonstrate a shared vocabulary or understanding when referring to events or feelings.	-.50
97 - T emphasizes verbalization of internal states and affects.	.50
82 - T helps C manage feelings.	-.48
57 - T attempts to modify distortions in C's beliefs.	.46
8 - C is curious.	-.43
51 - C attributes own characteristics or feelings to T.	.41

Interaction Structure 4 - Directive therapist with dependent, resistant, and embarrassed child. (α = 0.78)
CPQ Items	Factor Loading
100 - T draws connections between the therapeutic relationship and other relationships.	-.63
67 - T interprets warded-off or unconscious wishes, feelings, or ideas.	-.62
32 - C achieves a new understanding or insight.	-.57
49 - C conveys or expresses mixed or conflicted feelings about T.	-.53
80 - C behaves in a dependent fashion [vs. insists on independence].	.51
58 - C appears unwilling to examine thoughts, reactions, or motivations related to problems.	.50
92 - C's feelings or perceptions are linked to situations or behaviors of the past.	-.50
9 - T is nonresponsive [vs. affectively engaged].	.49
42 - C ignores or rejects T's comments and observations.	.48
17 - T actively exerts control over the interaction (e.g., structuring, introducing new topics).	.47
61 - C feels shy and embarrassed [vs. un-self-conscious and assured].	.46
74 - Humor is used.	-.45
48 - T sets limits.	.41
59 - C feels inadequate and inferior [vs. effective and superior].	.41
45 - T tolerates C's strong affect or impulses.	-.40
Interaction Structure 5 - Accepting, supportive therapist with anxious child. (α = 0.76)
CPQ Items	Factor Loading
31 - T asks for more information or elaboration.	.57
2 - T comments on C's nonverbal behavior [e.g., body posture, gestures].	-.54
4 - There is discussion of why C is in therapy.	.54
36 - T points out C's use of defenses.	-.51
79 - T comments on changes in C's mood or affect.	-.51
64 - C draws T into play.	-.50
63 - C explores relationships with significant others.	.50
50 - T draws attention to feelings regarded by C as unacceptable [e.g., anger, envy, or excitement].	-.48
52 - T makes explicit statements about the end of the hour, upcoming weekend, or holiday.	.48
43 - T suggests the meaning of the behavior of others.	.42
7 - C is anxious and tense [vs. calm and relaxed].	.42
16 - There is discussion or evidence of bodily functions [e.g., bowel movements].	-.40

[1] *Mailing address: Casemiro de abreu, 370, apto 402, Bairro Rio Branco, Porto Alegre, RS, Brazil. E-mail: fernandadriemeier@hotmail.com

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Interaction Structures in the Psychodynamic Psychotherapy of a Girl Diagnosed with Adjustment Disorder

Abstract