Background: An important determinant of therapy outcome is the quality of the therapeutic relationship. This study evaluated the association between the client's assessment of first-session... Show moreBackground: An important determinant of therapy outcome is the quality of the therapeutic relationship. This study evaluated the association between the client's assessment of first-session therapeutic relationship (FSTR) and outcome in an intensive treatment for adolescents with personality disorders. Method: Patients (N = 92) were measured weekly during intensive group treatment. The therapeutic relationship was measured with the Child version of the Session Rating Scale (C-SRS) that was completed after each group therapy session by the patient. Outcome was measured with the Child version of the Outcome Rating Scale (C-ORS). Reliable change index (RCI) was calculated for the both instruments to determine significant changes in therapeutic relationship and outcome. Results: A good FRST gave twice as much chance of a significantly better outcome. Especially for those with moderate FSTR, establishing and maintaining a good working relationship during treatment could increase the chances of a good outcome considerably. In contrast, adolescents with low FSTR had little chance of positive outcome regardless of any improvement in the therapeutic relationship. Conclusion: Adolescents assessment of FRST is indicative of the chance of a good outcome. Show less
Objective Dropout rates are a prominent problem in youth psychotherapy. An important determinant of dropouts is the quality of the therapeutic relationship. This study aimed to evaluate the... Show moreObjective Dropout rates are a prominent problem in youth psychotherapy. An important determinant of dropouts is the quality of the therapeutic relationship. This study aimed to evaluate the association between the therapeutic relationship and dropouts in an intensive mentalization-based treatment (MBT) for adolescents with personality disorders. Methods Patients (N = 105) included were either dropouts (N = 36) or completers (N = 69) of an intensive MBT. The therapeutic relationship was measured with the child version of the Session Rating Scale (C-SRS), which was completed by the patient after each group therapy session. For each patient, the treatment termination status (dropout or completer) was indicated by the treatment staff. The reliable change index (RCI) was calculated for the C-SRS to determine significant changes in the therapeutic relationship. Results While both groups started with similar scores on the C-SRS, the scores between dropouts and completers differed significantly at the end of the treatment period. On average, during therapy, an increase was seen in the scores of completers, and a decrease was seen in the scores of dropouts. While dropouts could not be predicted based on the C-SRS scores, a significant decrease (RCI) in C-SRS scores during the last two sessions occurred more often for dropouts than for completers. Conclusion Our findings show that to prevent dropouts, the patient's judgment of the quality of the therapeutic relationship should be monitored continuously, and decreases discussed with the patient and the group. Show less
Hauber, K.; Boon, A.; Kuipers, G.; Vermeiren, R. 2020
The aim of this study in a high-risk adolescent sample with personality disorders receiving intensive mentalisation-based treatment (MBT), was first, to examine deviations in insecure attachment... Show moreThe aim of this study in a high-risk adolescent sample with personality disorders receiving intensive mentalisation-based treatment (MBT), was first, to examine deviations in insecure attachment distribution of the normative pattern, and in borderline personality disorder and other personality disorders; second, to explore whether MBT alters attachment representations and whether these alterations are related to changes in psychological distress. A total of 60 adolescents were investigated pre-treatment for both categorical and continuous measures of the Adult Attachment Interview (AAI). Pre- and post-AAI (N = 33) data were compared with psychological distress measured by the Symptom Checklist-90. While the most disturbed category of insecure attachment, the "cannot classify" category, was overrepresented (46.7%) at pre-treatment, no differences were observed by type of personality disorder. At post-treatment, 48.5% of the participants showed positive change in the attachment representation, and their psychological distress lowered significantly (p = .002). The whole sample demonstrated change towards increased secure attachment (z = -2.85, p = .004). Attachment insecurity was found in all adolescent personality disorders which MBT seemed to be able to alter. However, as we included no control group, we cannot conclude that changes are due to the treatment itself. Show less
The most difficult target group in mental health care for youth, is recognizable from social debates: An alarming example of a suicide or severe non-suicidal self-injury illustrates the... Show moreThe most difficult target group in mental health care for youth, is recognizable from social debates: An alarming example of a suicide or severe non-suicidal self-injury illustrates the vulnerability of these adolescents and underlines a powerless society. Notably, this target group is often excluded from scientific research. Hauber attributes this exclusion on the many psychiatric problems young people face and a rigid classification system. Theoretical models do not accommodate overlapping problems, despite the most serious conditions being characterized by such an overlap. Hauber described the need for a dimensional classification system to enable care providers to assess serious problems, such as an overlap of personality disorder, insecure attachment and non-suicidal self-injury. The influences of puberty, attachment insecurity and the adolescent’s social dynamics should be included in such a model. By having young people reflect in writing on their treatment, relevant information can be obtained to tailor personalized care, and drop-out can be minimized. New developments suggest improving resilience and connection with others, rather than just reducing symptoms. Hauber's research similarly showed the importance of connecting with others to grow emotionally in adolescence. This is a challenge in modern society, with loneliness being the highest mortality risk for humans. Show less
