Bridging the Divide Between Psychodynamic and Behavioral Approaches for Children with Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is one of the primary reasons youth are referred to mental health services. Disruptive behavior disorders such as ODD are heterogeneous in their presentation, developmental trajectories, and treatment needs. Given the high attrition rates in child psychotherapy in general, there is a need for a range of interventions tailored to meet the unique needs of each family to help increase familial engagement and positive outcomes for children with ODD. This article outlines composite clinical case material of a child with ODD who was treated with Regulation Focused Psychotherapy for Children (RFP-C), a manualized, psychodynamic intervention for ODD. The case presented is then reconceptualized from a behavioral parent training perspective. This approach uses parent training to encourage positive parenting practices and reduce coercive reinforcement cycles. The case material and its reconceptualization are followed by a discussion of the distinctions between psychodynamic and behavioral approaches to children with ODD. An integrated psychotherapy approach is proposed, and the benefits and challenges of psychotherapy integration are discussed.