Page 42 - Personality disorders and insecure attachment among adolescents
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Background
Psychotherapeutic practices for youth show a great variety in treatment approaches deriving from different theoretical orientations (Garland, Bickman, & Chorpita, 2010; Weersing, Weisz, & Donenberg, 2002). Although many adolescents benefit from psychotherapy, for others the outcome is discouraging (Garland et al., 2010; Weisz, Jensen-Doss, & Hawley, 2006). Against this background, it is understandable that there is a tendency to search for effective elements of mental care for youth (Garland et al., 2010; Shepherd, Sanders, & Shaw, 2017). Therefore, examining the therapeutic factors related to successful treatment of adolescents may help therapists to optimize the treatment outcomes for this population, particularly for severely disordered groups such as young people with personality disorders. Mixed-method research with adolescents who report on the outcome of their individual treatment can help to provide an understanding of the success factors (Bledin et al., 2016; Chan, Kirkpatrick, & Brasch, 2017). Hence, the aim of this study was to identify such therapeutic factors in ego narratives written without instruction by a high-risk adolescent sample after treatment for a personality disorder, and to relate these to changes in symptoms during treatment.
Although as effective as individual therapy (Hoag & Burlingame, 1997), it is argued that group psychotherapy, with its focus on peer relationships and identity formation, is preferable for adolescents (Chase, 1991). To provide an understanding of clients’ perceptions of the effectiveness of group psychotherapy in general, Corsini and Rosenberg (1955) and later on Yalom (Yalom & Leszcz, 1985) devised the concept of therapeutic factors. The definitions of this concept vary, but typically the term refers to ‘curative factors’ or ‘mechanisms of change that occur through an intrinsic interplay of varied guided human experiences’ (Yalom & Leszcz, 2005). Yalom’s 12 therapeutic factors generated from his questionnaire were as follows: altruism, cohesion, universality, interpersonal learning input and output, guidance, catharsis, identification, family re-enactment, self-understanding, instillation of hope, and existential factors. They are now widely accepted as corresponding to relevant and potent mechanisms that bring about changes through group psychotherapy.
Yalom’s therapeutic factors in group psychotherapy have been studied in different group settings in a dozen studies, using Yalom’s group therapeutic factors questionnaire (Kösters, Burlingame, Nachtigall, & Strauss, 2006; Yalom & Leszcz, 2005). However, until this study, no research had examined reports written by patients about therapeutic factors that contributed to their recovery. In addition, no researchers had focused on identifying therapeutic factors related to inpatient group treatment for adolescents with personality disorders or high-risk adolescents. In self-report studies on Yalom’s therapeutic factors, ‘cohesion’ is considered the central therapeutic factor that facilitates the other factors (Bernard et al., 2008). However, the interplay between all therapeutic factors, and the value placed on each, differs according to the content and purpose of a group (Yalom & Leszcz, 2005). One study on inpatient adolescent group therapy reported that ‘cohesion’,
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