Regulation-focused psychotherapy for children

1. Introduction

Version followed: Hoffman, Rice & Prout (2016), Manual of Regulation-Focused Psychotherapy for Children (RFP-C) with Externalizing Behaviors: A Psychodynamic Approach (Routledge), as operationalised in the authors' pilot and RCT protocol: 16 individual child sessions (twice weekly, about 8 weeks) plus 4 parent meetings, organised in three Steps. The manual itself is not drawn on [uncertain]. This guide rebuilds it from the published protocol table, the manual's table of contents, and the authors' papers and case studies. Routledge's current listing names Prout, Kufferath-Lin, Rice & Hoffman as authors [uncertain: possibly a revised listing or edition].

RFP-C is a manualised, short-term psychodynamic play therapy for children (roughly school age) with oppositional, disruptive, irritable or aggressive behaviour. Its core claim is that disruptive behaviour has meaning: it works as a defence (an avoidant mechanism) that keeps the child from feeling painful emotions such as sadness, shame, guilt, fear or helplessness. In non-directive play, the therapist repeatedly and empathically points out how and when the child avoids these feelings. The child gradually learns that the feelings can be noticed, tolerated and talked about, first with the therapist and then at home and school, so the behaviour is needed less. The authors equate defences with implicit (automatic) emotion regulation. Change is meant to strengthen implicit regulation, not to teach explicit skills such as self-talk or relaxation. Parents are helped to see the behaviour as meaningful, not only as something to control. [source: Routledge book description; Di Giuseppe et al. 2020; Prout et al., APsaA "Introducing RFP-C"; Rice 2016; Rice & Hoffman 2014]

2. Framework

The pilot protocol sequences 4 parent meetings (P1 to P4) and 16 child sessions as follows [source: Prout et al. 2019 pilot supplement, Appendix 1; manual table of contents via Routledge]:

Step	Sessions	Goals	Format
Step 1: Assessment and formulation	P1 (introductory parent meeting); child sessions 1 and 2; P2 (feedback meeting)	Build rapport and alliance with parents and child. Take the history and chief complaints, and stress family and child strengths. Assess the child's defences against painful affect, noting which topics the child avoids. Build an initial formulation using the triangle of conflict. Introduce the idea that behaviour has meaning.	Parent meetings without the child (the APsaA article mentions an initial meeting with parents and child [uncertain]). Child sessions mix structured and unstructured activities.
Step 2: Addressing avoidance	Child sessions 3 to 12 (about 5 weeks, twice weekly); P3 plus ongoing brief check-ins	Keep an unstructured, child-led frame while ensuring safety. Follow play and talk closely. Note and address attempts to avoid disturbing emotions, including within the therapist–child relationship. Help parents build their own scaffolding for the child's distress.	Non-directive play therapy in a playroom. Parent work runs in parallel.
Step 3: Termination	Child sessions 13 to 16 (about 2 weeks, twice weekly); P4 (final parent meeting)	Use the coming separation to work on feelings of loss and rejection. Review gains and note more adaptive coping. Help parents treat the ending as a chance for the child to face hard feelings, and plan responses to future disruptions.	Same playroom format. In non-research practice, leave the door open to return.

Session length: not stated. A standard 45 to 50 minute play session is likely [uncertain].
Total duration: reported as 8 or 10 weeks. The case study gives both figures; 10 weeks includes the parent meetings [source: Brooks et al. 2025; APsaA article].
Criteria for moving between steps: the steps are session-count driven (time-limited), not criterion-based. Move from Step 1 to Step 2 once you have a working triangle-of-conflict formulation and have given the parents feedback. Termination starts at session 13 whatever the progress. The authors note the frame can be adapted to the child and family in practice [source: APsaA article; pilot protocol]. Any clinical criteria beyond this (e.g., extending treatment) are [synthesis].
Training in the trials: an 8-hour workshop with the manual's authors, a competency quiz, and weekly 90-minute group supervision with session-video review [source: Brooks et al. 2025; Di Giuseppe et al. 2020].

3. Guiding principles

[source: Routledge description; APsaA article; Di Giuseppe et al. 2020; Rice 2016; RFP-C Child Psychotherapy Q-Set prototype paper (SPR PDF; authorship not verified); Brooks et al. 2025]

Behaviour has meaning. Treat each tantrum, defiance or disruption as communication that protects the child from a feeling. Ask "what is this protecting against?" before "how do I stop it?"
Address defences, not drives or content. The main technique is to point out how the child avoids a painful feeling. Do not interpret unconscious wishes directly; the authors say this can hinder engagement.
Stay experience-near. Comment only on what has just happened and can be observed in the room (the manual frames defences as an experience-near, observable construct). Avoid deep, distant or historical inferences.
Child-led, unstructured frame. The child chooses the activity. You do not require turn-taking or sharing. Aggressive and regressive play are allowed, within safety limits.
Focus on expressing and tolerating feelings, not managing them. Do not teach coping skills, reward good behaviour, reassure directly, try to change beliefs, or plan behaviour outside the session. These were rated uncharacteristic of RFP-C in the CPQ prototype.
Tolerate strong affect and provocation. Expect challenges to rules, rejection of your comments, and blaming. Stay calm and treat them as defences to understand, not as misbehaviour to correct.
Track disruptions. Changes in topic, tone, affect, posture or play, or sudden breaks in play, are signs that a defence is active. They are your cue to comment.
Repetition builds tolerance. Addressing the same avoidance many times gives gradual exposure to the warded-off feeling. Expect to say similar things often.
The relationship is the vehicle. The child should experience a relationship in which unpleasant feelings are thought about rather than acted on. Avoidance that shows up toward you is central material.
Use your own reactions as data. Your frustration, helplessness or boredom tells you what parents and teachers may feel, and what the child may be placing in you. Regulate these feelings yourself; do not act them out.
Not judgmental, not didactic, no self-disclosure. These items were rated least characteristic of the ideal RFP-C session.
Parents as partners, not targets. Relieve parental blame, build their reflective functioning, and work with the parent and child as a system. Parent work is not individual therapy and not behaviour-management training.
Time-limited ending as therapeutic material. Comment explicitly on session endings, breaks and termination, and use them to work with loss.
Implicit over explicit regulation. Success means the child relies less rigidly on maladaptive defences and shows more tolerance of affect, not that the child has learned a regulation script.

4. Intervention inventory

The inventory below follows the order of the pilot protocol. Items 1 to 4 are Step 1, items 5 to 13 are Step 2 child work, items 14 and 15 are parent work, and items 16 and 17 are Step 3. All therapist language is my own illustrative wording unless it is in quotation marks with a citation. The quoted lines are from trial therapists in published RFP-C cases, not from the founders. The manual's own scripts were not available.

1. Introductory parent meeting (P1)

Purpose / when: First contact, before seeing the child. Builds the alliance, gathers history and introduces the RFP-C frame. [source: pilot protocol; Brooks et al. 2025]
Steps: (1) Hear the chief complaints in the parents' own words, with recent concrete episodes. (2) Ask explicitly about the child's and family's strengths. (3) Take the developmental and psychiatric history. (4) Introduce the core idea that the behaviour may protect the child from feelings that are hard to bear. (5) Introduce the triangle of conflict in simple terms (see item 3). (6) Explain the format: 16 child sessions, twice weekly, 4 parent meetings, brief check-ins, and confidentiality with sharing of themes by the child's permission. (7) Note the parents' own feelings and what they defend against (exhaustion, shame, anger).
Example language (illustrative): "When he explodes, what happened just before? … I'm curious what feeling might have been hard for him right then." / "We'll be looking at the behaviour as a signal, not only as a problem to stop."
Watch for: Parents feeling blamed; frame the work as understanding, not fault-finding. Dropout risk is high in this population [source: Di Giuseppe et al. 2020]. It's working when parents start offering their own guesses about the feelings behind incidents.

2. Initial child sessions (sessions 1–2): assessing defences

Purpose / when: Sessions 1 and 2. Build rapport, introduce the playroom, and find out which feelings the child wards off and how. [source: pilot protocol]
Steps: (1) Explain simply why the child is coming, in non-blaming terms. (2) Offer the room's materials: figures, dolls, art, building toys, some games. The protocol allows a mix of structured and unstructured techniques at this stage, but which specific structured tasks the manual uses is [uncertain]. (3) Follow the child's lead, and note topics the child avoids, abrupt shifts in play or talk, and what preceded each disruption. (4) Note the child's typical defences (e.g., externalising blame, devaluing, denial, turning passive into active, motor discharge, withdrawal into rule-bound games). (5) After the session, draft a triangle-of-conflict hypothesis.
Example language (illustrative): "Your mom and dad told me things sometimes get really hard at home and at school. Here you get to choose what we do, and I'll try to understand what things feel like for you."
Watch for: Over-structuring with board games can lead to silence and blunt the process, as in the unsuccessful "Oliver" case [source: Brooks et al. 2025]. Early anxiety about the room or camera is itself data.

3. Triangle of conflict formulation

Purpose / when: The organising formulation tool, adapted from Malan and McCullough. Built in Step 1, revisited in every parent meeting, and used by the therapist throughout to decide what to address. It also serves as a "transitional object" carrying the therapy's understanding home and to school. [source: Brooks et al. 2025; APsaA article; pilot protocol]
Steps: Map three corners for a recurring episode. (a) Feeling: the painful affect being avoided (sadness, shame, fear, guilt, helplessness, loss). (b) Anxiety: why the feeling cannot yet be tolerated (it feels overwhelming, dangerous or humiliating). (c) Defence: how it is avoided (the disruptive behaviour or subtler avoidance). Write it for 2 or 3 typical situations, such as losing a game, transitions or being told no. Translate it for parents ("what feeling, how avoided, why").
Example language (illustrative, with parents): "When he loses, the feeling underneath might be shame. That's so uncomfortable that he flips the board and blames the game. The flipping keeps the shame away."
Watch for: Keep the formulation provisional and update it from session material. The exact graphic and corner labels in the manual were not seen [uncertain]. The labels above follow standard Malan/McCullough usage.

4. Feedback parent meeting (P2)

Purpose / when: After child sessions 1 and 2. Share the initial conceptualisation and the principle that disruptive behaviour has meaning. [source: pilot protocol; Brooks et al. 2025]
Steps: (1) Begin with the child's strengths seen in session. (2) Present the triangle for one or two of the parents' own examples. (3) Explain that externalising behaviour can be understood as a way of regulating emotion. (4) Invite parents to observe and reflect on triggers before the next meeting, as observers rather than enforcers. (5) Agree on how check-ins will work.
Example language (illustrative): "In the playroom, when something didn't go his way, he quickly changed the game. I think that's a small version of what happens at home: a fast escape from a bad feeling."
Watch for: Parents who hear this as permissiveness. Make clear that limits still matter (see item 15). It's working when parents ask "what was he feeling?" rather than only "how do I stop it?"

5. Maintaining the unstructured, child-led frame with safety

Purpose / when: Throughout Step 2 and Step 3. The frame lets defences show themselves spontaneously. [source: pilot protocol; APsaA article; Brooks et al. 2025]
Steps: (1) Let the child choose and change activities. (2) Do not require turn-taking, sharing or winning-gracefully rules. (3) Allow aggressive and regressive themes in play. (4) Keep the same room, materials and times. (5) Hold the safety limits (item 13). (6) Resist pulling the child toward talking or toward "therapeutic" activities.
Example language (illustrative): "In here you get to decide what we play."
Watch for: A child who uses rule-bound games to stay away from feelings. The commentators on the Oliver case suggested removing board games to encourage imaginative play [source: Kigin & Hembree-Kigin 2025, a PCIT commentary, not an RFP-C author recommendation; treat as [uncertain]]. RFP-C's own stance would be to address the game itself as avoidance (item 7).

6. Tracking disruptions and avoidance

Purpose / when: Continuous, in every child session. This is the observation half of defence work. [source: Brooks et al. 2025; Di Giuseppe et al. 2020; Rice 2016]
Steps: (1) Follow the flow of play and talk moment by moment. (2) Mark disruptions: abrupt changes of topic, tone or activity; play that suddenly stops or turns destructive; affect that doesn't fit the content; motor restlessness; silence; leaving the room; distorted thinking such as blaming or denial. (3) Ask what came just before: a loss, a frustration, a mention of a parent, the end of the session. (4) Match the disruption to a corner of the triangle. (5) Decide whether to comment now (item 7) or wait for a clearer repetition.
Example language: none. This step is silent observation.
Watch for: Over-reading. Comment only on patterns you can point to in the room. It's working when you can predict the child's disruptions from the formulation.

7. Addressing (interpreting) defences: the core technique

Purpose / when: The central intervention of Step 2, repeated many times per session. You point out, empathically and experience-near, how the child just moved away from a painful feeling, and why that feeling may be hard to bear. The child is invited to notice this together with you. [source: Brooks et al. 2025; APsaA article; Rice 2016; Prout et al. 2020 IJPT abstract; CPQ prototype items: points out defences, interprets warded-off feelings, comments on affect shifts]
Steps: The sources do not publish these as discrete numbered steps. The sequence below is a [synthesis] of the published descriptions. (1) Notice the disruption as it happens (item 6). (2) Describe the observable shift in plain words ("you stopped the game right when..."). (3) Wonder about the feeling just before the shift, tentatively. (4) Name the protective function: the behaviour helps the child not feel it. (5) Name why: the feeling seems too big, scary or embarrassing right now. (6) Let play continue. The aim is that play can resume with less need for the defence (Rice 2016), not that the child must talk. (7) Repeat each time the pattern recurs, gradually moving from describing to linking.
Example language: "I wonder if there was something difficult about losing." and "Maybe you're telling me how bad it feels to say goodbye." [source: Brooks et al. 2025, therapist comments in RFP-C cases]. Illustrative: "You threw the cards right after I won. Losing might feel really bad, so bad that it's easier to be mad at the game." / "We were talking about your dad, and then you wanted to race the cars. Maybe thinking about him brings up a sad feeling that's hard to stay with."
Watch for: The authors warn against simple reassurance, cathartic venting, scolding, and direct interpretation of unconscious wishes [source: APsaA article]. Comments should not drift into questions that press for talk or into leading content suggestions. A commentator flagged one trial question as leading [source: Kigin & Hembree-Kigin 2025]. It's working when the child pauses, nods, adds detail, or returns to the avoided theme, and when play becomes less disrupted. Over time the child may name feelings directly (Jack moved from shooting play to saying he had a lot to worry about). Expect rejection of comments ("No!"). That is typical [source: CPQ prototype] and is not a reason to stop.

8. Working within the play (displacement) and joining it

Purpose / when: When feelings are too threatening to address directly, comment through the play characters, or take a role and voice the disowned feeling. Move to direct comments as tolerance grows. [source: Brooks et al. 2025]
Steps: (1) Accept a role the child assigns (victim, opponent, prisoner). (2) In role, give voice to the vulnerable feeling the child is avoiding (fear, helplessness, sadness), not to aggression. (3) Or comment on a character's feelings ("this soldier must be so scared"). (4) When the child seems more able, bridge carefully toward the child ("sometimes kids feel that too"). (5) Go back into displacement if the child disrupts.
Example language: In role, while being "shot": "I can't feel safe at all." After destructive battle play: "Wow, that must be so sad." [source: Brooks et al. 2025, therapist in Jack case]. Illustrative: "The little bear keeps getting left behind. I bet he feels really lonely."
Watch for: Joining aggressive play without commentary can just repeat it. A PCIT commentator raised reinforcement concerns [source: Kigin & Hembree-Kigin 2025]. The RFP-C answer is to keep voicing the vulnerability under the aggression. It's working when play themes evolve (new endings, rescues, sadness appears) rather than looping unchanged.

9. Commenting on affect and mood shifts

Purpose / when: When the child's mood or affect visibly changes, or when a feeling the child treats as unacceptable (anger, envy, excitement) appears. [source: CPQ prototype items 79, 50]
Steps: (1) Name the change you saw. (2) Link it to what just happened. (3) Accept the feeling as understandable, without judging it and without moving to manage it.
Example language (illustrative): "You got really quiet just now." / "You seemed a little jealous when you saw the other kid's drawing on the wall. That's an ok feeling to have in here."
Watch for: Do not slide into coping-skill teaching ("take a deep breath"). This was rated uncharacteristic of RFP-C.

10. Linking feelings to experience

Purpose / when: Later in Step 2, once the child tolerates comments about in-room avoidance. Connect the pattern to events and relationships outside, so the learning carries over to home and school. [source: CPQ prototype item 76; Brooks et al. 2025]
Steps: (1) Use the child's own reports or the parents' (shared with permission). (2) Link an outside incident to the in-room pattern you have already named several times. (3) Keep it brief and tied to feeling, not to behaviour rules.
Example language (illustrative): "Remember how losing at checkers felt in here? Maybe at recess, when you got out, it was the same bad feeling, and pushing was the fast way out of it."
Watch for: Planning behaviour for outside the session is rated uncharacteristic. Link and understand, don't make action plans.

11. Addressing avoidance in the therapist–child relationship (transference)

Purpose / when: When the child's avoidance targets you: ignoring, provoking, controlling, devaluing, refusing to enter, or reacting to breaks and session ends. A dedicated manual chapter covers this. [source: manual ToC ch. 10; pilot protocol; Brooks et al. 2025]
Steps: (1) Notice the repeating pattern with you. (2) Name it as it happens, in the here-and-now. (3) Wonder about the feeling toward you or about being here (fear of failing in front of you, anger about ending, worry about being judged). (4) Relate it to the triangle. (5) Over time, link it to similar patterns with parents and teachers.
Example language: "It's hard to go in the therapy room and talk about difficult things." [source: Brooks et al. 2025]. Illustrative: "Every time I say something about feelings, you turn the music up. Maybe what I say feels like too much right now."
Watch for: Being drawn into power struggles. It's working when the child can tolerate your comments about the two of you and the provocations soften.

12. Using countertransference

Purpose / when: Ongoing self-monitoring, and especially when you feel strong irritation, helplessness, boredom, or pressure to make the child talk. [source: Brooks et al. 2025; CPQ prototype item 24]
Steps: (1) Notice your reaction. (2) Ask whether it mirrors what parents and teachers feel, or a feeling the child is placing in you (e.g., feeling useless). (3) Regulate yourself before intervening. (4) Use the insight to sharpen the formulation and your empathy in parent work. (5) Bring it to supervision; the trials used weekly video-based supervision.
Example language: none. This is internal.
Watch for: Acting out (scolding, pushing for talk). In the unsuccessful case, pressure to elicit speech pulled the therapist away from experience-near work [source: Brooks et al. 2025].

13. Limit-setting for safety, within the play where possible

Purpose / when: When play threatens the child, you, or the room. The frame stays child-led, but safety is held. [source: pilot protocol ("ensuring safety"); Brooks et al. 2025]
Steps: (1) Keep the play going in symbolic form wherever possible. In one case, the therapist showed how a "tasing" game could work without touching the child's body [source: Brooks et al. 2025]. (2) If a limit is needed, state it briefly and calmly, without scolding. (3) Offer a symbolic alternative (hit the bop bag, the figure "gets hit"). (4) Then address the feeling the action was carrying, using item 7. (5) If unsafe behaviour continues, end the activity, or as a last resort the session, matter-of-factly [synthesis]. The manual's exact limit-setting procedure was not seen [uncertain].
Example language (illustrative): "I won't let you hit me for real, but my character can get zapped. … Zapping might be a way to feel really strong instead of small."
Watch for: Limits delivered as punishment, which the CPQ prototype rates as uncharacteristic. It's working when the child accepts the symbolic channel and the affect behind it can be named.

14. Ongoing parent work: check-ins and the P3 meeting

Purpose / when: Brief check-ins during Step 2, plus the third parent meeting around mid-treatment. The aim is to deepen the parents' understanding of the child's hidden feelings and to help them build their own scaffolding for the child's distress. The authors describe this as a longitudinal discussion of reflective parenting and of how the child regulates unpleasant emotions, not as therapy for the parent. [source: pilot protocol; APsaA article; Kufferath-Lin et al. 2021; Brooks et al. 2025]
Steps: (1) Share progress and the child's strengths. (2) Reintroduce the triangle with a fresh home example. (3) With the child's permission, share play themes that show the child's anxieties and triggers. In one case, the father then reduced overstimulation at home, such as the news on TV. (4) Explore the parent's own feelings during incidents (fear, rage, shame) and how these push toward control. (5) Model curiosity, a reflective stance. (6) Encourage parents to put their understanding into words for the child.
Example language (illustrative): "When he slammed the door, what were you feeling? … It makes sense that you'd want it to stop right away. I wonder what he was feeling just before." / "You might try saying, 'I think you were really disappointed,' before talking about the door."
Watch for: Process research found parent sessions sit closer to a CBT prototype than to the RFP-C child prototype [source: Kufferath-Lin et al. 2021]. Expect some practical, supportive content, but keep returning to meaning. It's working when parents report noticing the feeling before reacting.

15. Moving parents toward relationally attuned limit-setting

Purpose / when: When parents rely on punitive or purely contingency-based responses. For example, Jack's parent made him recite reasons for his behaviour, and another parent threatened to remove rewards to get the child into the room, which increased resistance. [source: Brooks et al. 2025]
Steps: (1) Acknowledge the parent's need for order and safety. (2) Keep the limit, but pair it with naming the child's feeling. (3) Drop shaming add-ons such as forced explanations or lectures. (4) Plan with the parent how to respond to the next likely trigger. Steps 2 to 4 are [synthesis], built from the stated aim.
Example language (illustrative): "You can still say no to the tablet. What's new is saying out loud what you think he's feeling: 'You're so mad it's time to stop.'"
Watch for: Parents hearing "understanding" as "no consequences". Say clearly that limits stay.

16. Termination sessions (sessions 13–16) and endings throughout

Purpose / when: Step 3. The approaching end is used to work on loss, rejection and separation, to review gains and to notice more adaptive coping. Commenting on the end of each hour, weekends and breaks is part of the method throughout, but it becomes central here. [source: pilot protocol; Brooks et al. 2025; CPQ prototype items 52, 75]
Steps: (1) Announce the number of remaining sessions clearly at the start of Step 3 and count down each session. (2) Watch for intensified defences around the ending: regression, provocation, "I don't care", turning to performances or games. (3) Address these as avoidance of sadness or anger about ending (item 7). (4) Name gains concretely, in terms of feelings tolerated rather than behaviour only. (5) Note any new, more adaptive coping seen in the room. (6) In the last session, say goodbye explicitly, and in clinical practice leave the door open to return.
Example language: "Seems like it's a bit hard to hear that we have five more minutes left." / "Instead it's easier to keep showing me the trick." [source: Brooks et al. 2025]. Illustrative: "We have three more times together. Some kids feel mad or sad about stopping, and some act like it doesn't matter at all."
Watch for: The return of old symptoms near the end. These are usually an ending reaction, not a failure [synthesis]. It's working when the child can show or name some feeling about the ending.

17. Final parent meeting (P4)

Purpose / when: After or near the end of the child sessions. Consolidate the parents' understanding and plan for the future. [source: pilot protocol; Brooks et al. 2025]
Steps: (1) Help parents see the ending as a chance for the child to face difficult feelings, and prepare them for possible regression at home. (2) Summarise progress, stressing the strengths of the family and child. (3) Plan new responses to future disruptions, using "behaviour has meaning" and the triangle on two or three predicted situations. (4) Leave the door open to return; discuss booster contact if needed.
Example language (illustrative): "If the old outbursts come back in the next few weeks, it may be about missing these sessions. That's a moment to name the feeling."
Watch for: Parents expecting a cure. Frame progress as increased tolerance of feelings.

5. Handling problems

Sources only address some of these problems, mostly through case material [source: Brooks et al. 2025; Kigin & Hembree-Kigin 2025; Kufferath-Lin et al. 2021]. Guidance marked [synthesis] is my own extrapolation from RFP-C principles.

Child refuses to enter the room or to separate. Don't use rewards or threats; in Jack's case these increased resistance. Name the difficulty empathically (item 11), e.g., that it's hard to go in and talk about difficult things [source: Brooks et al. 2025]. If needed, let the parent come in briefly and then fade out [synthesis].
Silent, withdrawn or "stuck" child (sticks to structured games). Don't press for talk; that pressure pulled the trial therapist off experience-near work. Address the game or the silence itself as protection. Change the approach to show you understand talking is hard; in the Oliver case, setting up a new game increased engagement [source: Brooks et al. 2025]. Offer imaginative materials. Consider whether structured games are the main avoidance and comment on that [synthesis].
Aggression toward the therapist. Stay calm. Treat hostile play as a window into fear. Voice vulnerability in role (item 8), hold physical safety (item 13), and then name the feeling [source: Brooks et al. 2025].
Child rejects every comment ("No!", "Stop talking"). This is expected in the prototype and is not a reason to stop. Shorten comments, move into displacement, and comment on the rejection itself ("It feels bad when I notice feelings") [synthesis].
Overwhelm or escalation after a comment. Pull back into the play metaphor. Reduce interpretive depth, back to describing rather than linking. Hold safety. Pace the repetitions; the model relies on gradual exposure [source: Brooks et al. 2025 (gradual exposure); pacing specifics are synthesis].
Recording or observation anxiety. In research settings, camera anxiety led to withdrawal [source: Brooks et al. 2025]. Name it as a here-and-now worry. In practice, explain clearly why recording is used and make it optional where possible [synthesis].
Parent non-adherence (missed meetings, focus only on behaviour control). Parents who stay behaviour-modification focused were linked to the poorer outcome [source: Brooks et al. 2025]. Explore the parent's own feelings and fears behind the control focus. Reduce blame. Offer phone check-ins [synthesis]. Remember the high dropout risk in this population [source: Di Giuseppe et al. 2020].
Missed child sessions / irregular attendance. The twice-weekly rhythm matters for continuity [synthesis]. Treat absences and returns as material about separation (item 16). Agree with parents on a make-up policy at P1 [synthesis].
Ruptures (child feels criticised, therapist loses temper or scolds). Acknowledge your part simply, without self-disclosure. Name what the child may have felt. Return to the frame. Use supervision to process the countertransference (item 12) [synthesis, consistent with the prototype's avoidance of judgmental stance and self-disclosure].
Therapist pulled into teaching, reassuring or rewarding. These are the least characteristic RFP-C behaviours [source: CPQ prototype]. Notice what feeling you are avoiding by doing them, and go back to commenting on defences.
Comorbid ADHD or developmental delay. RFP-C has been framed for ADHD/ODD presentations [source: Di Giuseppe et al. 2020]. Keep comments very short and concrete. Coordinate medication or other services through usual care [synthesis].
Safety, abuse or suicide disclosures. These sit outside the RFP-C protocol. Follow standard child risk assessment and safeguarding procedures. Inform parents or authorities as required, and adapt the treatment frame as needed [synthesis].
Not enough progress at session 16. The research protocol is fixed-length. In practice, review the formulation with the parents, consider extending or re-contracting, and consider adding or referring to parent management training or other services [synthesis; the authors present RFP-C as an alternative or complement to PMT, CBT and medication (Routledge description)].

Sources

Sources: