Regulation-Focused Psychotherapy for Children (RFP-C) is a short-term, time-limited psychodynamic treatment approach for children with disruptive behavior disorders, including oppositional defiant disorder (ODD), conduct disorder (CD), attention deficit/hyperactivity disorder (ADHD), and disruptive mood dysregulation disorder (DMDD). RFP-C consists of 16 individual play therapy sessions plus 4 sessions with the child's caregiver(s) only. The basis for the therapeutic process in RFP-C is that all behavior has meaning and that some children engage in disruptive behaviors as a way to avoid experiencing painful or threatening emotions such as guilt, shame, and sadness. [1] RFP-C is an alternative to traditional cognitive-behavioral strategies used in the treatment of disruptive behavior, which employ principles of behavior modification as tools to manage behavior. Instead, RFP-C is affect-oriented, and clinicians using RFP-C focus on understanding the child's inner world and subjective experience and communicating this inner experience to the child in a developmentally appropriate way. [2] [3] RFP-C conceptualizes aggressive and antisocial behaviors as products of emotional dysregulation. The goals of the child sessions are to: (1) identify which of the child's emotions are being avoided, (2) understand how the emotion is being avoided and (3) explore why the emotion is being avoided in a maladaptive way. The goals of the caregiver sessions are to (1) obtain clinical background information, (2) develop the therapeutic alliance, and (3) provide psycho-education to aid in caregivers’ understanding of the child's difficulties. The ultimate goal of RFP-C is to help the caregiver and child understand that all behavior, even disruptive behavior, has meaning in the service of emotional and behavioral regulation. This insight leads to a decreased need to act on the distressing emotions (i.e. less need for disruptive behaviors) and an increased ability to tolerate, work through, and talk about the feelings that previously needed to be warded off. RFP-C utilizes a modified version of the Malan triangle of conflict in case conceptualization and in parent work to help support the child's development of more adaptive implicit emotion regulation capacities.
RFP-C was codified in 2016 with the publication of the Manual Of Regulation-Focused Psychotherapy for Children (RFP-C) With Externalizing Behaviors: A Psychodynamic Approach. [4] This short-term psychodynamic psychotherapy has demonstrated evidence in a pilot study [5] , a randomized controlled trial [6] , and an online, school-based program during the COVID-19 pandemic [7] .
Ongoing education and research related to RFP-C is supported by the non-profit, Center for Regulation Focused Psychotherapy which offers online training and consultation, as well as research grants.
Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.
Attachment disorder is a broad term intended to describe disorders of mood, behavior, and social relationships arising from unavailability of normal socializing care and attention from primary caregiving figures in early childhood. Such a failure would result from unusual early experiences of neglect, abuse, abrupt separation from caregivers between three months and three years of age, frequent change or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts resulting in a lack of basic trust. A problematic history of social relationships occurring after about age three may be distressing to a child, but does not result in attachment disorder.
Reactive attachment disorder (RAD) is described in clinical literature as a severe disorder that can affect children, although these issues do occasionally persist into adulthood. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". In the DSM-5, the "disinhibited form" is considered a separate diagnosis named "disinhibited attachment disorder".
Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.
Emotional dysregulation is characterized by an inability in flexibly responding to and managing emotional states, resulting in intense and prolonged emotional reactions that deviate from social norms, given the nature of the environmental stimuli encountered. Such reactions not only deviate from accepted social norms but also surpass what is informally deemed appropriate or proportional to the encountered stimuli.
Emotional and behavioral disorders refer to a disability classification used in educational settings that allows educational institutions to provide special education and related services to students who have displayed poor social and/or academic progress.
Child psychotherapy, or mental health interventions for children refers to the psychological treatment of various mental disorders diagnosed in children and adolescents. The therapeutic techniques developed for younger age ranges specialize in prioritizing the relationship between the child and the therapist. The goal of maintaining positive therapist-client relationships is typically achieved using therapeutic conversations and can take place with the client alone, or through engagement with family members.
Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.
Parent–child interaction therapy (PCIT) is an intervention developed by Sheila Eyberg (1988) to treat children between ages 2 and 7 with disruptive behavior problems. PCIT is an evidence-based treatment (EBT) for young children with behavioral and emotional disorders that places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns.
Emotionally focused therapy and emotion-focused therapy (EFT) are a set of related approaches to psychotherapy with individuals, couples, or families. EFT approaches include elements of experiential therapy, systemic therapy, and attachment theory. EFT is usually a short-term treatment. EFT approaches are based on the premise that human emotions are connected to human needs, and therefore emotions have an innately adaptive potential that, if activated and worked through, can help people change problematic emotional states and interpersonal relationships. Emotion-focused therapy for individuals was originally known as process-experiential therapy, and it is still sometimes called by that name.
Attachment-based psychotherapy is a psychoanalytic psychotherapy that is informed by attachment theory.
Parent management training (PMT), also known as behavioral parent training (BPT) or simply parent training, is a family of treatment programs that aims to change parenting behaviors, teaching parents positive reinforcement methods for improving pre-school and school-age children's behavior problems.
Attachment-based therapy applies to interventions or approaches based on attachment theory, originated by John Bowlby. These range from individual therapeutic approaches to public health programs to interventions specifically designed for foster carers. Although attachment theory has become a major scientific theory of socioemotional development with one of the broadest, deepest research lines in modern psychology, attachment theory has, until recently, been less clinically applied than theories with far less empirical support. This may be partly due to lack of attention paid to clinical application by Bowlby himself and partly due to broader meanings of the word 'attachment' used amongst practitioners. It may also be partly due to the mistaken association of attachment theory with the pseudo-scientific interventions misleadingly known as attachment therapy. The approaches set out below are examples of recent clinical applications of attachment theory by mainstream attachment theorists and clinicians and are aimed at infants or children who have developed or are at risk of developing less desirable, insecure attachment styles or an attachment disorder.
Psychodynamic models of emotional and behavioral disorders originated in a Freudian psychoanalytic theory which posits that emotional damage occurs when the child's need for safety, affection, acceptance, and self-esteem has been effectively thwarted by the parent.
Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in 2006. The goal of TF-CBT is to provide psychoeducation to both the child and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war. More recently, TF-CBT has been applied to and found effective in treating complex posttraumatic stress disorder.
Dynamic deconstructive psychotherapy (DDP) is a manual-based treatment for borderline personality disorder.
Externalizing disorders are mental disorders characterized by externalizing behaviors, maladaptive behaviors directed toward an individual's environment, which cause impairment or interference in life functioning. In contrast to individuals with internalizing disorders who internalize their maladaptive emotions and cognitions, such feelings and thoughts are externalized in behavior in individuals with externalizing disorders. Externalizing disorders are often specifically referred to as disruptive behavior disorders or conduct problems which occur in childhood. Externalizing disorders, however, are also manifested in adulthood. For example, alcohol- and substance-related disorders and antisocial personality disorder are adult externalizing disorders. Externalizing psychopathology is associated with antisocial behavior, which is different from and often confused for asociality.
Malan's triangles – comprising the triangle of conflict and the triangle of persons – were developed in 1979 by the psychotherapist David Malan as a way of illuminating the phenomenon of transference in psychotherapy, both brief and extended.
Social emotional development represents a specific domain of child development. It is a gradual, integrative process through which children acquire the capacity to understand, experience, express, and manage emotions and to develop meaningful relationships with others. As such, social emotional development encompasses a large range of skills and constructs, including, but not limited to: self-awareness, joint attention, play, theory of mind, self-esteem, emotion regulation, friendships, and identity development.
Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.