Page 126 - Personality disorders and insecure attachment among adolescents

be that the two problems have no relationship other than that they often occur simultaneously in adolescents with severe psychiatric problems. Another possibility to be considered is that severe psychopathology and puberty negatively affect attachment security and that recovery of severe psychopathology results in more secure attachment. Nevertheless, this study stresses the importance of secure attachment for adolescent mental health. Especially the influence of paternal attachment during adolescence requires further attention, because this study found with great caution that BPD is likely to develop in adolescence in the absence of paternal positive attachment behaviour in combination with the devaluation state of mind towards the father. Changes over time A substantial number of the severely disturbed adolescents in our sample changed positively over the course of intensive MBT. Although MBT was likely of influence, it cannot be concluded that changes are due to the treatment itself. In addition to a decrease in personality pathology and symptomology, attachment insecurity developed for the better as well. The question remains whether intensive MBT contributed to the achieved result; and if that is the case, which element of this treatment had impact? The first hypothesis is that in different ways, the partial hospitalisation was especially relevant for this group of adolescents with overall adolescent developmental problems and their families. Probably, the intensity of being in therapy 24 hours a day, 5 days a week, made the breakthrough of solid, unhealthy patterns possible. Moreover, being away from home increased the likelihood of altering fixed interaction patterns in the family situation and the severely disturbed separation-individuation process. Furthermore, the continuous availability of MBT-trained nursing staff during the partial hospitalisation presumably could have been of influence (Reiner, Bakermans- Kranenburg, Van IJzendoorn, Fremmer-Bombik, & Beutel, 2016). Hypothetically, for some participants an emotional corrective experience occurred in the relationship with the group and treatment staff during the partial hospitalisation, which resulted in a less insecure attachment representation. Second, psychotherapy in a group with a group psychodynamic approach could have contributed to change (Yalom & Leszcz, 2005). The therapeutic factors ‘cohesion’, ‘interpersonal learning output’, ‘guidance’ and ‘identification’ seem to be pre-conditional factors for the predictors found in this study for therapeutic success, namely ‘interpersonal learning input’, ‘self-esteem’ and ‘turning point’. Third, focussing on mentalization in the different therapies in the program may have stimulated a positive outcome by learning clinical adolescents’ effective emotion regulation and interpersonal interaction. Also, the influence of social support from family and friends (van Harmelen et al., 2016) or age-related development may have caused the change. The results of this thesis provide hope for treatment and prospects for the future of adolescents with personality disorders, insecure attachment and NSSI. Though, it cannot be ignored that a small group did not show a change after intensive MBT, and an even smaller group deteriorated. This is no 122