Page 70 - Personality disorders and insecure attachment among adolescents
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These results indicate that an improving therapeutic relationship during the course of therapy is associated with adherence to therapy, while a decreasing quality of the therapeutic relationship during the course of therapy is associated with the patient ending therapy prematurely. Our study showed that the rather short instrument (C-SRS), which can be easily applied in clinical practice and which is completed by adolescent patients themselves, is a valuable instrument for measuring the quality of the therapeutic relationship.
A significant decrease in the therapeutic alliance in the last three sessions was a predictor of dropout. For dropouts such a decrease occurred in 38.9% of the cases, for completers the was 7.2%. Because such a significant decrease in therapeutic group alliance occurred during the treatment process in 14.3% of all cases, only with hindsight it was clear that such decrease has led to dropout. To prevent dropout out of therapy this means that every substantial decrease in C-SRS score is worthwhile discussing. In this study, some participants spoke of being satisfied with the session, while on the C-SRS they rated the therapeutic alliance of that same session as low. By using the C-SRS, such unspoken inconsistency can be recognized, understood and worked through in the next session and thereby outcomes can be improved (Norcross & Lambert, 2018). In case the drop has to do with something that occurred in the working alliance with the therapists and/ or the group members, differences in perspective and thoughts, beliefs, wishes and feelings can be explored and validated (Bateman & Fonagy, 2012). In this way group psychotherapy is a shared attentional process which strengthens mentalizing capacities and interpersonal functioning.
Limitations of this study must be mentioned. First limitation is that it is not clear if these results found in a sample of high risk adolescents can be generalized to group psychotherapy with other patients with personality pathology and patients with other pathology. Second limitations is that Axis-I disorders were left out due to the practical consideration of not overloading patients with assessment instruments. Nevertheless, the C-SRS can help psychotherapists to timely intervene when breaks occur in the therapeutic alliance with adolescents with personality pathology that may lead to dropout.
References
Armbruster, P., & Kazdin, A. E. (1994). Attrition in child therapy. In T. H. Ollendick & T. J. Prinz (Eds.), Advances in clinical child psychology (Vol. 16, pp. 81-108). New York: Plenum.
Bateman, A., & Fonagy, P. (2006). Mentalization based treatment for borderline personality disorder: A practical guide. Oxford, UK: Oxford University Press.
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