Page 43 - Personality disorders and insecure attachment among adolescents
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‘universality’ and ‘instillation of hope’ were the most valued therapeutic factors (Chase, 1991). Another study found that inpatients with comorbid personality disorder scored significantly higher on ‘family re-enactment’ and ‘self-understanding’ than patients without comorbid personality disorder, and significantly lower on ‘cohesiveness’ (Sayin et al., 2015). The investigation of unstructured reports of therapy outcomes, written by patients without instruction, might reveal other therapeutic factors or alter the rankings of importance among such factors.
In this mixed-method study, therapeutic factors related to patients’ reported recovery were examined for a high-risk adolescent population who had been clinically diagnosed with personality disorders. As part of a goodbye ritual at the end of an intensive group psychotherapy programme, participants were asked to write a farewell letter to express their thoughts and feelings about the treatment. This letter was read aloud to the group and treatment staff. Using content analysis (Elo & Kyngäs, 2008), these farewell letters were studied to identify the therapeutic factors of Yalom (Yalom & Leszcz, 2005). Guiding questions were, first, which therapeutic factors were mentioned in the letters, and how often; second, which therapeutic factors could be related to a reduction in psychological stress and symptoms during treatment. Based on previous studies, it was expected that first, all of Yalom’s therapeutic factors would appear in the letters guided by the hypothesis that working in a group with peers using a group psychodynamic approach (Yalom & Leszcz, 2005) would provide a positive influence; second, the therapeutic factors of ‘family re-enactment’ and ‘self- understanding’ were expected to be related to significant less psychological stress and symptoms at the end of the treatment following the study of Sayin (Sayin et al., 2015) by subtracting the post-treatment total score on the SCL-90 from the pre-treatment score.
Methods
Participants
The participants were adolescents who had voluntarily been admitted to a partial residential mentalization-based treatment (MBT) facility of a youth psychiatry institution in the urban area of The Hague in The Netherlands. They had clinically diagnosed personality disorders and non-psychotic co- morbidity, and had completed the treatment according to protocol. Referrals came non-systematically from other mental health professionals, both within and outside the mental health care institution.
Between 2008 and 2017, 70 farewell letters were collected along with pre- and post-treatment data from the SCL-90. The adolescents’ mean age at the end of treatment was 18.9 years (SD = 1.7, range = 16–23) and most (88.6%) of the group were female. The average duration of treatment was a year, with a maximum of 18 months. Their intelligence, estimated from their level of education, was
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