Regulation focused psychotherapy for children in clinical practice: Case vignettes from psychotherapy outcome studies

There is a need for empirically informed play therapy approaches for children with oppositional and disruptive behaviors. Regulation-focused psychotherapy for children (RFP-C) is a manualized intervention rooted in the longstanding tradition of nondirective, psychodynamic play therapy. It builds on this history by emphasizing concepts drawn from the psychodynamic construct of defense mechanisms and contemporary research on emotion regulation. By using systematic interventions that target children's defense mechanisms against unpleasant feeling states, RFP-C promotes the development of improved implicit emotion regulation capacities and increases children's ability to tolerate painful emotions that were previously masked by the disruptive behaviors. An overview of this play therapy approach, along with several clinical illustrations drawn from a recent pilot study and ongoing randomized controlled trial of RFP-C as a treatment for oppositional defiant disorder, is provided in order to demonstrate some of the principles of defense interpretation, parent work, and addressing the meaning of disruptive behaviors.