Page 58 - Personality disorders and insecure attachment among adolescents

This study is unique in that rather than using a questionnaire that asked about every therapeutic factor of Yalom, as occurs in most studies, therapeutic factors were detected from the farewell letters. It is conceivable that those therapeutic factors that were barely evident in this study might have been more strongly observed through a questionnaire. For instance, ‘identification’, in the sense of participants mentioning that group members and team members had served as an example for new behaviour, was not mentioned. Four therapeutic factors were encountered in addition to those of Yalom, namely ‘self-esteem’, ‘turning point’, ‘resilience’ and ‘epistemic trust’. Two out of the three therapeutic factors that were related to the reduction of symptoms, namely ’self-esteem’ and ‘turning point’, were newly identified therapeutic factors. Whereas the groups studied by Yalom were mostly weekly outpatient groups, the facility studied in this research offered a five-day intensive group psychotherapy programme with continuous availability of MBT-trained nursing staff. Therapeutic method and treatment staff likely influence therapeutic factors and factor rankings. However, it remains unclear whether differences in intensity, treatment staff availability, and patient groups were related to the new therapeutic factors. Nevertheless, it seems advisable for adolescent clinical practice to demand that patients try out new behaviours and to set boundaries to acting-out behaviour that undermines psychotherapy. Future research is needed to examine whether the new factors are indeed therapeutic factors.
Limitations of this study should be mentioned. First one may wonder if the identified therapeutic factors were implied as important for recovery in their therapeutic interventions by the treatment staff and copied by the writers. It seems likely that the treatment staff would provide role models regarding attitudes and rules of engagement. For example, some adolescents seemed to have used psychological language in their letters. The question here is whether the contents of those letters resembled the patient’s own reality, or rather reflected the desire to please the group and treatment staff. The second shortcoming of this study is the limited generalizability of the results due to the use of inpatients at a single facility, and the small sample. Despite these limitations, the study remains valuable because little prior research had been done regarding personality disorders among adolescents (Courtney-Seidler et al., 2013; Hutsebaut et al., 2013; Sharp et al., 2016).
References
Arrindell, W. A., & Ettema, J. H. M. (2003). SCL-90: Manual for a Multidimensional Psychopathology Indicator (2nd ed. ed.). Amsterdam, The Netherlands: Pearson.
Bateman, A., & Fonagy, P. (2006). Mentalization based treatment for borderline personality disorder: A practical guide. Oxford, UK: Oxford University Press.
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