Hauber Kirsten, Boon Albert E, Vermeiren Robert
De Jutters, Centre for Youth Mental Healthcare Haaglanden, Dr. Van Welylaan 2, 2566 ER The Hague, The Netherlands.
3Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Leiden, The Netherlands.
Child Adolesc Psychiatry Ment Health. 2019 Jan 10;13:2. doi: 10.1186/s13034-019-0263-6. eCollection 2019.
The aim of this study was to investigate whether therapeutic factors as identified by Yalom and potential additional therapeutic factors could be found in the qualitative individual reports of high-risk adolescents with personality disorders at the end of an intensive group psychotherapeutic MBT programme and whether the therapeutic factors were related to therapy outcomes.
At the end of treatment, 70 adolescents were asked to write a farewell letter. Content analysis of the letters was performed by two independent raters, using the 12 therapeutic factors of Yalom and potential additional therapeutic factors as coding categories. The factors were related to outcome, operationalized as a decrease in psychological symptoms as measured with the Symptom Check List 90 (SCL-90).
All therapeutic factors of Yalom and four new factors were identified in the letters, ranging from 1 to 97%. The factors of 'cohesion' (97%), 'interpersonal learning output' (94%), 'guidance' (98%) and 'identification' (94%) were found in most letters. By contrast, 'universality' (1%), 'family re-enactment' (3%) and 'instillation of hope' (1%) were found in very few letters. The factors 'interpersonal learning input', 'self-esteem' and 'turning point' were significantly associated with therapeutic recovery.
Large presence differences were encountered in therapeutic factors associated with resilience processes and the resolution of psychological distress. Although a relationship was found between certain factors and change in symptoms, it was unclear whether the factors had led to such change. Further research seems important for treatment in general and for the personalization of treatment.
本研究旨在调查在强化团体心理治疗的精神分析性辩证治疗（MBT）项目结束时，能否在人格障碍高危青少年的定性个人报告中找到雅洛姆所确定的治疗因素以及潜在的其他治疗因素，以及这些治疗因素是否与治疗结果相关。
治疗结束时，70名青少年被要求写一封告别信。由两名独立评分者对信件进行内容分析，使用雅洛姆的12种治疗因素和潜在的其他治疗因素作为编码类别。这些因素与结果相关，结果以症状自评量表90（SCL - 90）测量的心理症状减轻来衡量。
在信件中识别出了雅洛姆的所有治疗因素和四个新因素，比例从1%到97%不等。大多数信件中都发现了“凝聚力”（97%）、“人际学习产出”（94%）、“指导”（98%）和“认同”（94%）等因素。相比之下，“普遍性”（1%）、“家庭重演”（3%）和“希望灌输”（1%）在极少数信件中被发现。“人际学习输入”、“自尊”和“转折点”等因素与治疗康复显著相关。
在与恢复力过程和心理困扰解决相关的治疗因素中，存在很大的出现差异。虽然发现某些因素与症状变化之间存在关系，但尚不清楚这些因素是否导致了这种变化。进一步的研究对于一般治疗和治疗的个性化似乎都很重要。
