Sabrina Udwin ’24F is a doctoral candidate at the Ferkauf Graduate School of Psychology.
She is a psychology extern at New York City Health & Hospitals, Queens Hospital, in the Pediatrics Department.
She has co-authored literature on Regulation Focused Psychotherapy for Children (RFP-C).
Dr. Tatianna Kufferath-Lin ’21F is a postdoctoral fellow at IMPACT Psychological Services in Mamaroneck, New York, where she provides assessment, consultation and therapy to children, families and adults.
She is a graduate of Ferkauf, where her doctoral research focused on psychotherapy process in parent sessions of Regulation-Focused Psychotherapy for Children (RFP-C).
Together, they participated in “How Does Clinical Research Inform Psychoanalytic Approaches to Child Treatment?,” a one-day online videoconference hosted by the International Psychotherapy Institute on Nov. 4, 2021. They were part of a panel discussion on the topic, “Regulation Focused Psychotherapy for Children with Externalization Disorders: A Psychodynamic Approach.”
They have also had a paper accepted in the Journal of Infant, Child and Adolescent Psychotherapy, where they present detailed case material (with consent and assent from the family) of a fully online treatment during the pandemic, including drawings done on Zoom and excerpts from the chat feature that illustrate psychotherapy process in online child work.
YU News caught up with them to talk about their work and its implication as the pandemic continues to shape the therapeutic relationship.
Congratulations on your participation in the panel discussion and on the acceptance of the paper. How would you answer the question posed by the panel, “How Does Clinical Research Inform Psychoanalytic Approaches to Child Treatment?”, especially for someone who is not in the profession?
Udwin: This presentation was used to contextualize a case study within the Regulation Focused Psychotherapy for Children (RFP-C) research study to understand how treatment occurs in practice.
To date, the extant literature on telepsychotherapy has not included many strategies for effective telepsychotherapy with youth and families.
This unique case adds evidence in support of the value of an online play-based treatment for children with behavioral issues and their families.
The paper, and other clinical research projects, aims to fill a gap in the literature by illustrating a case in which a manualized psychodynamic intervention, originally created with an in-person context in mind, was effectively delivered online with positive outcomes.
Kufferath-Lin: Psychoanalytic and psychodynamic approaches to child therapy are those that take into account the influence of unconscious feelings, wishes and conflicts on our behavior. They tend to emphasize the relationship between a client and therapist as well as the effect of a person’s past on their present.
With children, psychodynamic approaches are often play-based and less structured than other approaches, such as cognitive behavioral therapy (CBT). While there is a substantial amount of case literature and qualitative research on psychoanalytic approaches to child therapy, it has lagged behind other approaches, such as CBT, in demonstrating its efficacy in other ways, such as through randomized controlled trials (RCTs).
More recently, psychoanalytic and psychodynamic researchers have put an increased emphasis on adding to the evidence base for psychodynamic psychotherapy through RCTs and other forms of clinical research. This type of research is valuable for many reasons. It can help to validate and operationalize techniques that psychodynamic clinicians have used for many decades. It can also alert us to new techniques and settings for treatment (such as teletherapy) and give us an idea of which treatments work for which clients, and under what circumstances.
Why is this discussion important?
Udwin: The COVID-19 era has required mental health professionals to make an abrupt transition to online treatment. Many therapists lamented the loss of the physical space for play therapy. There is an urgent need for therapeutic approaches that can effectively be adapted to teletherapy and address the ever increasing needs of families.
The drawings presented in this case convey the ability for us to stay connected and for play to still be effectively charged even in the online remote space.
Additionally, this discussion is important as my colleagues and I anticipate that online psychotherapy may be a big part of the clinical world in the future, a critical aspect being its ability to provide greater access to socially and economically diverse communities.
Kufferath-Lin: This discussion is important because there can be the impression that psychoanalytic and psychodynamic approaches are not “evidence-based.” In fact, there’s a growing and diverse body of research in support of the efficacy of these approaches.
It’s important to bridge the gap between research and practice so that psychoanalytic/dynamic therapists can make informed decisions about client care because they‘re aware of the evidence for the techniques they are using. On the other side, researchers need to know how their work realistically translates to the therapy room, and having this discussion can help them become aware of that.
How does the work presented in your paper fit into this conversation about approaches to child treatment?
Udwin: The work demonstrates the value of a psychodynamic approach to disruptive behavior that demonstrates how we can target behavior problems not only from managing behavior but also through a reflective approach that addresses painful feelings. Support of this approach and published research also provides increased choice for parents and can help clinicians engage more families in treatment. The work also shows adaptability of play therapy interventions even in the time where we are transitioning to remote work.
Kufferath-Lin: Our paper presents a detailed case study of one client who participated in a recent RCT of Regulation Focused Psychotherapy for Children (RFP-C), a short-term psychodynamic treatment for children with oppositional defiant disorder (ODD). RFP-C is a manualized treatment, meaning that the treatment has pre-defined stages and instructs the clinician to intervene in specific ways. RCTs often involve dozens (or more) participants and give us a “big-picture” view of treatment efficacy. Our paper presents an opportunity to understand how a manualized treatment (which can sometimes be seen as rigid or impersonal) is fleshed out in relationship with an actual client. It also demonstrates how our interventions can be adapted to new contexts since the therapy took place entirely online.
What was one thing you discovered in your study that surprised you or made you go “hmmm”?
Udwin: The thing that stood out about this case, being the only start-to-finish RFP-C online case, was how well the child responded and used technology features to aid in treatment progress and how easily the manualized treatment could be translated online. Our biggest “ah-ha” moment was our sparked interest and belief in the possible opportunities to translate manualized evidence-based treatments to online therapy more concretely in the future.
More specifically regarding our ability to use the online space to identify defenses, this case study demonstrated how defenses emerge even online. In a physical space, the patient might run out of the room when faced with a difficult emotion and in this case, the patient retreated instead technologically by turning off her video camera and using the chat function.
Kufferath-Lin: I think it was fascinating to see how this play-based treatment evolved in an online context. When we think of “play therapy,” we often think of a kid in a therapy room with a bunch of toys.
The client in our paper really adapted to the online context by utilizing tools like the chat feature and the whiteboard on Zoom to connect with and communicate with the therapist, even though they were not in the same room. As a therapist, it reminds me that online work is not so different from what we do in person while also showing me how teletherapy can expand our understanding of communication and play in the therapy context.
What are your next steps in terms of your studies and your career?
Udwin: Next year, I will be in my fourth year of the Ferkauf Psychology School-Clinical doctorate program. My research dissertation project is centered on a pilot text-based support program for parents of infants in the Neonatal Intensive Care Unit. Upon graduation, I plan to work in the New York area in hospital or clinic settings treating children, adolescents and families. I also look forward to contributing to the child and adolescent literature base and to present in panels and at conferences in the future.
I’d also like to take this opportunity to thank my supervisors for their guidance, encouragement and support.
Kufferath-Lin: I graduated from Ferkauf earlier this year and am currently completing my postdoctoral training. Through my involvement with RFP-C research, I’ve become really interested in contributing to the evidence base for psychoanalytic/dynamic treatments. I’m particularly interested in parent work and want to continue to study the component of RFP-C that involves communicating and working with parents. I want to learn which interventions can help parents of children with ODD better understand their children’s emotions and behaviors, and whether work with parents can also improve children’s outcomes.