[The working alliance in inpatient treatment for personality disorders and its connection with patient characteristics: an exploratory study]

BACKGROUND

The working alliance between therapist and patient has been investigated frequently, but much less is known about the working alliance in specific patient groups in specific settings.

AIM

To obtain insight into the characteristics of the working alliance in intensive inpatient psychotherapy involving patients with severe personality disorders, and to pay special attention to patient characteristics such as diagnosis and attachment.

METHOD

At the end of the first phase of treatment we collected, on the basis of questionnaires, information about the working alliance and attachment of 60 patients with a severe personality disorders who had received inpatient psychotherapy.

RESULTS

Working alliances with therapist and team were found to be weaker than in outpatient populations; working alliances with the therapist proved to be stronger than working alliances with the treatment team. Cluster C patients developed a better working alliance with the treatment team than did cluster B patients, particularly in the domain of treatment goals. Patients in this study turned out to be attached more anxiously and 'avoidantly' than patients in general outpatient populations; no correlation was found between patients' attachment and the strength of the working alliance. However, when a distinction was made between patients with extreme scores and patients with average scores, results showed that the more anxiously patients felt attached, the higher were their scores for their working alliance with the treatment team.

CONCLUSION

It is more difficult to establish a working alliance with patients who have a severe personality disorder than with patients suffering from a less severe personality disorder. Patients with a severe personality disorder seemed to show a higher degree of anxious attachment and to have a more critical attitude to the working alliance.

[An inpatient version of mentalisation-based treatment for patients with cluster A personality disorders]

BACKGROUND

Despite the severity of their disorder, only a few patients suffering from cluster A personality problems are admitted to mental health care facilities for appropriate treatment. A review of the international literature on the treatment of cluster A patients does not reveal any description of non-pharmaceutical treatment for this group of patients, nor does it mention any research into the effectiveness of treatment for the group.

AIM

To describe the development of a step-down inpatient treatment model for patients suffering from severe cluster A problems.

METHOD

We reviewed the sparse research and the limited reports of clinical experience.

RESULTS

The arguments supporting a step-down inpatient version of mentalisation-based treatment and its application in clinical practice are discussed.

CONCLUSION

A step-down inpatient treatment model has been developed and will be tested in research.

A comparison of curative factors in different types of group psychotherapy

The authors have constructed a Dutch version of Yalom's "Questionnaire for Curative Factors." This Dutch version has been administered to 134 participants of 22 psychotherapy groups in various psychiatric services in the Netherlands. Results concerning validity and reliability of the instrument are presented, as well as concerning the homogeneity of the hypothesized "factors." Differences between types of groups and categories of group members were tested by means of techniques of analysis of variance (ANOVA). Multiple regression analysis was applied in order to detect variables of differential qualities on one or more factors. Only the factor identification, neglected in literature on curative factors, was highly predictable.