Page 46 - Personality disorders and insecure attachment among adolescents

anxiety, agoraphobia, depression, somatization, insufficient thinking and handling, distrust and interpersonal sensitivity, hostility, sleeping disorders, and rest. The total score (range 90–450) is calculated by adding the scores of the subscales. The test-retest reliability has been shown to be fair to good (k = 0.62–0.91) (Arrindell & Ettema, 2003).
Procedures
During a 9-year period (2008–2017) all newly admitted adolescents were asked to participate in the study. A verbal description of the treatment protocol was provided to the participants. Then their written informed consent was obtained, according to legislation, namely the institution’s policy and Dutch law (Eurec, 2017). All patients agreed to participate, and in accordance with institutional policy they received no incentives or rewards. The procedures in this study were in accordance with the 1964 Helsinki declaration and its later amendments and comparable ethical standards. According to the treatment protocol, patients who finished treatment as planned were asked to write a farewell letter. The letter was read as part of the farewell ritual.
Analysis
Content analysis
The first author and a senior colleague who is a psychologist were both part of the treatment team
of the researched facility. They familiarized themselves with Yalom’s 12 therapeutic factors on the basis of Yalom’s 60-item group therapeutic-factor list (Yalom & Leszcz, 2005, pp. 62-63). The sample of 70 farewell letters was then examined using content analysis (Braun & Clarke, 2006). This qualitative method of analysis started with the first author reading ten letters while taking notes of themes, therapeutic factors of Yalom, and potential additional therapeutic factors. All sentences in the letters were numbered to compare the results of the coders. Thereafter, seven other farewell letters were coded independently by the two psychologists. All therapeutic factors found, which were not proposed by Yalom, were tracked systematically. The results were discussed regarding the use of the 12 factors and the identification of additional therapeutic factors. The maximum number of factors per sentence was limited to five.
Next, the remaining letters were analysed by the two psychologists, who coded every line for therapeutic factors based on Yalom’s 60-item group therapeutic-factor list and the additional therapeutic factors. The inter-rater reliability was determined by analysing which therapeutic factors
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