Page 62 - Personality disorders and insecure attachment among adolescents

and Adolescents (TASC/A) is an exception and was designed to be administered to children and adolescents themselves (DeVet, Kim, Charlot-Swilley, & Ireys, 2003; Kazdin, Marciano, & Whitley, 2005; Shirk & Saiz, 1992). The TASC/A was however designed to be administered at only one or two sessions during therapy. The only available child-report instrument that measures the therapeutic relationship during all sessions, is the Child version of the Session Rating Scale (C-SRS) (B. Duncan, Sparks, Miller, Bohanske, & Claud, 2006; B. L. Duncan et al., 2003; Miller & Duncan, 2004). This instrument is designed to be used at the end of every therapy session and the child version of this tool makes it possible to assess the child’s or adolescent’s self-reported relationship with the therapist. Although designed for individual therapy, the instrument can also be used for group therapy. Second, there is also no agreement in the way dropout is defined. The definition varies across studies, and influences which dropout predictors were found per study (De Haan, Boon, De Jong, Geluk, & Vermeiren, 2014; De Haan et al., 2013; Warnick, Gonzalez, Weersing, Scahill, & Woolston, 2012; Zack et al., 2007). In our study therapy dropout had been defined as occurring when a participant discontinued the treatment program before completing the treatment protocol. So only participants completing the treatment program as planned, were considered completers. The aim of our study was to extend and specify insights on the association between the therapeutic relationship and dropout during adolescent group psychotherapy. In accordance with Zack et al. (2007), we measured the therapeutic alliance of each psychotherapy session with the authorized Dutch version of Child-Session Rating Scale (C-SRS) (B. Duncan et al., 2006; Hafkenscheid et al., 2006). Studies evaluating the (C-)SRS have confirmed the psychometric quality and usability of the instrument, and showed an association between the therapeutic relationship and therapeutic change or outcome (Boon, De Boer, & Ravestijn, 2012; Campbell & Hemsley, 2009; B. L. Duncan et al., 2003; Owen, Miller, Seidel, & Chow, 2016b; Sundet, 2012). The association between the C-SRS and dropout has been studied in a sample of ethnic minority youth (De Haan, Boon, De Jong, et al., 2014). It was also shown that the scores on the C-SRS were not influenced by whether the patient knew that the scores would or would not be observed by the therapist, or whether the questionnaires were completed in presence of the therapist, nor were the (C-)SRS scores significantly correlated with a measure of social desirability (Reese et al., 2013). Method Setting The studied facility, a department of De Jutters-Youz, a YMHC centre in The Hague (one of the three main cities of the Netherlands), offers a five days a week structured and integrative 58