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Dixius A, Goth K, Möhler E. [Pilot Evaluation of a New Treatment Concept for Children to Improve Emotion Regulation and Stress Resilience. START-Kids: Stress-Arousal-Regulation-Treatment for Kids]. Prax Kinderpsychol Kinderpsychiatr 2021; 70:679-98. [PMID: 34898413 DOI: 10.13109/prkk.2021.70.8.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Emotional Dysregulation is a frequent challenge in clinical child psychiatric contexts. The Stress-Arousal-Regulation-Treatment for Children aged six to twelve (START-Kids, Dixius u. Möhler, 2021a), was developed as low threshold treatment tool for children with emotional dysregulation. The program is based on principles of dialectic behavioral therapy. The present article focuses feasibility and a first evaluation of this innovative treatment tool for emotionally dysregulated children. 23 child psychiatric patients aged six to twelve years took part in this eight weeks program with two group sessions at 60 min per week. Immediately before and after treatment personality functioning was assessed with the Levels of Personality Functioning Questionnaire LoPF-Q E and OPD-KJ2-SF E. There was no drop-out. Significant positive changes could be found after treatment with regard to therapists' and a trend for parent's ratings. Limitations are small sample size and lack of a treatment-as-usual-control group. START-Kids is an innovative program with high amount of feasibility and a positive influence on aspects of personality functions in children. Future studies, specifically a randomized controlled trial of START-Kids is warranted.
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Bühlmann V, Schlüter-Müller S, Fürer L, Steppan M, Birkhölzer M, Schmeck K, Koenig J, Kaess M, Zimmermann R. Therapists' emotional state after sessions in which suicidality is addressed: need for improved management of suicidal tendencies in patients with borderline personality pathology. BMC Psychiatry 2021; 21:590. [PMID: 34814860 PMCID: PMC8609732 DOI: 10.1186/s12888-021-03549-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 10/07/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patient suicidality is a frequently experienced topic for psychotherapists. Especially adolescents with borderline personality pathology (BPP) often exhibit suicidal tendencies. Previous research which examined therapists' countertransference towards suicidal patients suggested that therapists are negatively affected and distressed by them. We hypothesize that this emotional response of the therapists is related to specific sessions in which suicidality came up as a topic. Accordingly, the objective of this study consists in examining therapists' emotional state on a session level of analysis. METHODS The sample consisted of N = 21 adolescents (age 13-19 years) with BPD or subthreshold BPD. Therapists' emotional states were measured in n = 418 sessions using the Session Evaluation Questionnaire. Principal component analysis was used to reduce dimensionality of the therapist response. The emotional states were compared depending on whether suicidality has been addressed in the session (SS) or not (NSS). RESULTS Two components could be identified. Firstly, therapists were more aroused, excited, afraid, angry and uncertain after SS than after NSS. Secondly, therapists were more aroused, excited, definite and pleased after SS than after NSS. DISCUSSION Suicidality does not always have to be a burden for therapists: Both a "distress" and an "eustress" component occur in this context from which the latter is supposed to help clinicians master a difficult situation. Since countertransference feelings are often not fully conscious, it is necessary to do research on therapists' emotional states after sessions in which suicidality is addressed. This is crucial to both prevent the therapeutic process from being endangered and preserve clinicians' mental health. Clinical implications and limitations are discussed.
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Affiliation(s)
- Vera Bühlmann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Susanne Schlüter-Müller
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Martin Steppan
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Marc Birkhölzer
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
- Juvenile Forensic Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospital, University of Basel, Basel, Switzerland.
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.
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