Page 123 - Personality disorders and insecure attachment among adolescents
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four new factors were identified, although in different rates compared to studies using self-report questionnaires. The therapeutic factors ‘cohesion’, ‘interpersonal learning output’, ‘guidance’ and ‘identification’ were mentioned by nearly all participants and are therefore considered important for recovery in adolescents with personality pathology. These therapeutic factors seem to be a precondition for the factors that were correlated with therapeutic success, namely the factors ‘interpersonal learning input’, ‘self-esteem’ and ‘turning point’, though it is not clear whether these factors led to this change. For that reason, it is suggested with great caution that clinicians in an intensive group psychotherapy practice among adolescents with personality disorders should focus on—next to the common therapeutic factors—a) how the group members come across to one another, b) the sense of value for the group, and c) trying out new behaviour and setting boundaries for behaviour that undermines change. However, it would be premature to connect firm clinical implications to these findings. Further prospective research is necessary to determine the generalisability of these results to other intensive MBT services for adolescents with personality pathology. Furthermore, the question arises whether the interplay between all therapeutic factors and the value placed on them in general differs not only according to the content and purpose of a group (Yalom & Leszcz, 2005) yet also in individual group members. In that case, treatment could focus not only on diminishing symptoms but also on optimising important therapeutic factors for that individual. Further research seems important for treatment in general and for personalisation of treatment.
In Chapter 4, the association between the therapeutic relationship and dropout in an intensive MBT treatment for adolescents with personality disorders was evaluated. Patients (N=105) included were both dropouts and completers of intensive MBT treatment. The therapeutic relationship was measured with the Child version of the Session Rating Scale (C-SRS) that was completed after each group therapy session by the patient. For each patient, the treatment termination status (dropout or completer) was indicated by the treatment staff. It was found that both groups began with similar scores on the C-SRS; although on average as treatment progressed, the scores of completers increased from the start to the end of therapy, while the scores of dropouts decreased during therapy. At the end of the treatment period the scores differed significantly between dropouts and completers. A significant decrease in C-SRS scores between consecutive sessions was common for all patients, though a significant decrease in C-SRS scores during the last two sessions occurred more often for dropouts. The conclusion was drawn that a substantial reduction of the rated quality of the therapeutic relationship during the course of therapy increases the risk of premature termination. As a consequence, the patient’s judgement of the quality of the therapeutic relationship should be monitored and discussed with the patient and the group. Doing so could improve the therapeutic relationship and decrease the risk of dropout.
The primary objective of Chapter 5 was to examine adolescent attachment insecurity in adolescents with personality pathology. The first aim of this study was to examine deviations in
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