Page 55 - Personality disorders and insecure attachment among adolescents
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members come across to one another, b) their sense of being valued by the group, and c) demanding that patients try out new behaviour, and setting boundaries to acting-out behaviour that undermines change. Replication is necessary to determine the generalizability of these results to other intensive MBT services for adolescents with personality pathology.  Similarly, the large differences in the number of respondents who mentioned a certain therapeutic factor could also be indicative of the individual needs and reflections on what helped during treatment. The study presented here provided insights into the way adolescents with clinically diagnosed personality disorders described their treatment and treatment outcome. The farewell letters highlighted for instance the importance of positive experiences with the group and treatment staff in addition to the treatment of psychopathology. The goal of the inpatient treatment is not only diminishing psychopathology, but also stimulating positive affects and experiences with others through therapeutic factors such as ‘cohesion’ and ‘interpersonal output’. Following this, the question arises whether the interplay of all therapeutic factors and the value placed on them in general might differ not only according to the content and purpose of a group (Yalom & Leszcz, 2005) but also among individual group members. In that case, treatment could focus not only on diminishing symptoms, yet also on optimizing the therapeutic factors that are most important to each individual. Furthermore, writing a farewell letter as part of the farewell ritual at the end of the treatment seemed to stimulate patients’ reflection on their therapeutic process. This can be important to highlight the result obtained through treatment. The validity of using questionnaires with a high-risk adolescent group with varying mental states is questionable. In this study, change in symptom scores on the SCL-90 were used as indicator of therapeutic success. However, according to the treatment staff, all participants in the studied sample finished their treatment successfully. Patients who were not successful were offered a different farewell ritual (without writing a letter) and their data were not included in this study. Therefore, written reflections on the treatment process and progress during treatment could be more indicative of therapeutic recovery than a questionnaire score for these patients. This information could provide important input for treatment staff regarding how to optimize individual therapeutic factors. The importance of individual therapeutic factors could also differ across the phases of the psychotherapy process. For instance, the therapeutic factors of ‘cohesion’ and ‘interpersonal output’ could be especially important for some patients in the first phase of treatment, to help them learn to connect with others. ‘Guidance’ and ‘interpersonal input’ could be important in the second and third phase to work through interpersonal problems. Therefore, written reflections on the treatment process and patients’ progress could provide treatment staff with input on how to optimize the therapeutic factors for an individual in each treatment phase. 51 


































































































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