Page 43 - Personality disorders and insecure attachment among adolescents

Setting The studied facility is named Albatros; it offers a five-day-a-week structured and integrative psychodynamic group psychotherapy programme. Therapy often starts with residential treatment and then becomes day treatment during the treatment process. This intensive group psychotherapy is adapted for adolescents in an MBT programme (Bateman & Fonagy, 2006, 2012; Hauber, 2010) facilitated by a multidisciplinary team trained in MBT. The programme differs from the MBT programme offered for adolescents in England (Rossouw & Fonagy, 2012) using the psychodynamic group psychotherapy approach. The mentalizing focus of the various therapies is the adolescent’s subjective experience of himself or herself and others, and on relationships with group members and staff. Weekly verbal and non-verbal group psychotherapies, such as group psychotherapy, art therapy and psychodrama therapy are offered, combined with individual and family psychotherapy. Rituals form part of the programme – such as a birthday ritual, an old and new year’s ritual, and a farewell ritual. As the therapy programme progresses, each group member is given more responsibility regarding their participation in society and for other group members and group psychotherapy culture. If necessary, medication is prescribed according to protocol by a psychiatrist on the staff. Measures Only participants who completed the treatment programme as planned wrote a farewell letter as part of a ritual at the end of treatment. At the start and end of treatment, the Symptom Check List 90 (SCL-90) (Derogatis et al., 1973) was completed. Farewell letters As part of the farewell ritual, the farewell letter is read to group members, treatment staff and one or two important persons outside of the treatment. No writing instruction was given, but the participants were familiar with the farewell letters of former group members. This familiarity meant that certain standard components appeared in most of the letters. All farewell letters were kept in folders accessible to the patients. SCL-90 The authorized Dutch version of the SCL-90 (Arrindell & Ettema, 2003) is a questionnaire with 90 questions; it uses a 5-point rating scale ranging from 1 (‘not at all’) to 5 (extreme response). The questionnaire assesses general psychological distress and specific primary psychological symptoms of distress during the last week. Outcome scores are divided into nine symptom subscales: 39