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With the publication of Manual of Regulation-Focused Psychotherapy for Children with Externalizing Behaviors: A Psychodynamic Approach, Leon Hoffman, Timothy Rice, and Tracy Prout have given us something to think about. They have written a treatment manual accessible to most therapists for a short-term, psychodynamically derived therapy (RFP-C) to help children struggling with externalizing behaviors. As a child analyst practicing for thirty years, I can read this book only through the eyes of my experience; doubtless, then, this essay will convey the bias with which I have approached the treatment of such children. I will first describe what the authors have attempted in this manual, after which I will discuss what I found most useful in their approach and what might be problematic in it.
The book begins with a foreword by Nick Midgley. After placing the manual in context, Midgley notes that RFP-C is designed for the most common referral for outpatient treatment of children, that of externalizing disorders. This would include diagnoses such as Attention Deficit Disorder, Oppositional Defiant Disorder, Conduct Disorder, and the more recently described Dysregulation Disorder. These disorders, understood to be heterogeneous, are often difficult to treat. These children are understood as having “deficits in implicit emotional regulation” (p. xviii), doubtless the result of both genetic and environmental factors. What makes this manual unusual is its insistence that externalizing behaviors are not just to be managed, but to be understood. Symptom resolution will require attending to the function and meaning of the symptom. Thus,