Page 19 - Personality disorders and insecure attachment among adolescents

Methods Setting The present study was conducted from January 2008 until December 2014 at a residential psychotherapeutic institution for adolescents in the urban area of The Hague in the Netherlands. This facility offers a five days a week intensive MBT with partial hospitalisation for adolescents between the ages of 16 to 23 years with personality disorders. This structured and integrative psychodynamic group psychotherapy programme is manualised, adapted to adolescents (Bateman & Fonagy, 2006, 2012; Hauber, 2010) and facilitated by a multidisciplinary team trained in MBT. The major difference with the MBT programme for adolescents in England (Rossouw & Fonagy, 2012) is the psychodynamic group psychotherapy approach. The mentalizing focus of the different therapies in the programme is on the adolescent’s subjective experience of himself or herself and others and on the relationships with the group members and therapists. The programme offers weekly verbal and non- verbal group psychotherapies, such as group psychotherapy, art therapy and psychodrama therapy, in combination with individual and family psychotherapy. The average duration of treatment is one year with a maximum of 18 months. Commonly, the treatment starts with hospitalisation and continues as day treatment later on during the programme. Medication is prescribed if necessary by a psychiatrist working in the therapy programme, according to protocol. Referrals come non-systematically from other mental health professionals from within and outside our mental health care institution. Subjects In total, 115 adolescents with clinically diagnosed personality disorders were studied with a mean age at the start of treatment of 18.2 (SD = 1.6, range = 15-22; females 80.9%). Most of the participants had other comorbid axis-I disorders (mood disorder 58%; anxiety disorder, including PTSD 31%; eating disorder 13%; ADHD 8%; substance dependence 7%; dissociative disorder 3%; and obsessive compulsive disorder 2%). The average duration of treatment was 277.8 days (SD = 166.1, range = 3-549), with an average of 186.1 days (SD = 146.1) of hospitalisation. Intelligence was estimated based on the level of education and was average to above average. All patients followed the treatment on a voluntary basis and were fluent in the Dutch language. Of the 115 adolescents who were included in this study, 13 were considered treatment dropouts because they withdrew or were sent away before their treatment duration exceed the diagnostic phase of two months (61 days) (A. M. de Haan, A. E. Boon, J. T. V. M. de Jong, M. Hoeve, & R. R. J. M. Vermeiren, 2013; Swift & Greenberg, 2014). These 13 dropouts did not differ 15