The present study aimed to investigate adolescents’ experiences of a therapeutic inpatient service utilising mentalization-based treatment (MBT) for borderline personality disorder (BPD) features, including deliberate self-harm. A qualitative research approach was chosen and eight adolescents were interviewed on their experiences. Interviews were analysed using interpretative phenomenological analysis (IPA; Smith, Flowers & Larkin, 2009). The analysis resulted in five superordinate themes and 17 corresponding subordinate themes. Adolescents described having felt uncontained, uncontainable and misunderstood, particularly prior to their admission. They talked about a process of seeking containment from others which in some cases led to their admission. Participants described feeling contained and understood in the inpatient service and developing a healthier relationship with self and others. Finally, they talked about their recovery as a long and challenging journey and expressed hope for the future. The study concluded that therapeutic inpatient treatment utilising MBT was experienced as beneficial by adolescents, though methodological limitations were acknowledged. Clinical implications were drawn and recommendations for future research were made.

The objective of this study was to explore personal experiences of change of people diagnosed with borderline personality disorder (BPD) who had partaken in psychological therapy. The aim was to develop the first model of change grounded in service user experience so that this could inform recovery-oriented practice in relation to this client group. A constructivist grounded theory design was chosen. Eight people with a diagnosis of BPD who had completed group-based therapy programmes or were currently attending a peer support group were interviewed about their experiences of change using a semi-structured, open-ended format. An initial model was developed and refined through triangulation with three published accounts of experiences of change in the context of a BPD diagnosis. ‘Discovering “new ways of being” in interpersonal space’ was conceptualised as the core process underpinning pertinent activities and experiences relating to change in people diagnosed with BPD. This interactive, relational process was facilitated in environments that were felt to be both containing and open to conflict. It involved increasing levels of self-disclosure, information exchange, exploration of mental states, experimentation with new behaviours and the consolidation of new ways of being. The core process appeared to extend beyond the therapeutic setting if supported through a relationship with a secure base. Regardless of therapeutic allegiance, effective interventions for people diagnosed with BPD might share a common core change process. Further research is required into change processes in the context of individual psychological therapies and negative therapeutic experiences.

abstract: Family adaptation to child developmental disability is a dynamic transactional process that has yet to be tested in a longitudinal, rigorous fashion. In addition, although children with developmental delays frequently have behavior problems, not enough research has examined possible underlying mechanisms in the relation between child developmental delay, adaptation and behavior problems. In the current study, factor analysis examined how best to conceptualize the construct of family adaptation to developmental delay. Also, longitudinal growth curve modeling tested models in which child behavior problems mediated the relation between developmental risk and indices of family adaptation. Participants included 130 typically developing children and their families (Mental Development Index [MDI] > 85) and 104 children with developmental delays and their families (MDI < 85). Data were collected yearly between the ages of three and eight as part of a multi-site, longitudinal investigation examining the interrelations among children's developmental status, family processes, and the emergence of child psychopathology. Results of the current study indicated that adaptation is best conceptualized as a multi-index construct. Different aspects of adaptation changed in unique ways over time, with some facets of adaptation remaining stable while others fluctuated. Child internalizing and externalizing behavior problems were found to decrease over time for both children with developmental delays and typically developing children. Child behavior problems were also found to mediate the relation between developmental risk and family adaptation for over half of the mediation pathways. Significant mediation results indicated that children with developmental delays showed higher early levels of behavior problems, which in turn was associated with more maladaptive adaptation. These findings provide further evidence that families of children with developmental delays experience both positive and more challenging changes in their families over time. This study implies important next steps for research and clinical practice in the area of developmental disability. / Dissertation/Thesis / Ph.D. Psychology 2011

abstract: The present study examined the relations of children's effortful control (EC), emotion understanding, maladjustment, social competence, and relationship quality with nonparental caregivers in a sample of 30-, 42-, and 54-month olds. EC was measured with mothers' and caregivers' reports, as well as observed behavioral tasks. Emotion understanding was assessed by asking children to identify emotions during a puppet task. Mothers and caregivers also reported on children's problem behaviors and social competence. Caregivers provided reports of the quality of their relationship with children. Results from longitudinal structural equation models indicated that even after controlling for sex, SES, language ability, and previous levels of constructs, emotion understanding predicted EC one year later at 42 and 54 months. In addition, children with higher EC had more positive relationships with caregivers at 42 and 54 months. Although EC and EU were not significantly related to maladjustment and social competence after accounting for within time covariation among constructs and longitudinal stability, marginal findings were in expected directions and suggested that more regulated children with better emotion understanding skills had fewer behavioral problems and were more socially skilled. Findings are discussed in terms of the strengths and limitations of the present study. / Dissertation/Thesis / M.S. Family and Human Development 2012

The present study examined the interactions between early child behavior, early parenting, and early family stress (parent psychopathology, socioeconomic status, and stressful life events) in predicting later Oppositional Defiant Disorder (ODD) symptoms. Participants were 223 three-year-old children and their parents who participated in a four-year longitudinal study. It was predicted that there would be a stronger relationship between children’s early behavior characteristics and later ODD in the presence of less parental overreactivity/negative affect, more paternal warmth, and less family stress and a stronger relationship between early family stress and later ODD in the presence of less parental overreactivity/negative affect and more paternal warmth. Although early child behavior, early parenting, and early family stress were predictive of later ODD, they did not significantly interact in the predicted direction. In fact, contrary to prediction, only one interaction proved to be significant and it was in the unexpected direction: the relationship between early child behavior and later ODD was stronger among parents who displayed more warmth with their three-year-old children.

Early exposure to abuse, neglect, and household dysfunction is linked to long-term detrimental effects on mental and physical health. In the mid-1990s, Kaiser Permanente and the CDC surveyed adults in the community and found a strong and cumulative relationship between the degree of exposure to adverse childhood experiences (ACEs) and risk factors for leading causes of death in adulthood. At present, most research using ACE survey methodology examines community-based adult samples, and populations who experience the greatest number of adversities are largely ignored. An additional factor indicative of household dysfunction that has not been thoroughly explored in the context of ACE survey methodology is foster care placement. Further, little is understood regarding the impact of out-of-home placement on persons with disproportionately high ACE scores and subsequent difficulties with sexual and aggressive behavior. Studies investigating differential risk factors and outcomes could inform prevention, policy, and treatment. As such, the current study seeks to investigate the impact of childhood adversity and out-of- home placement on the onset of aggression and problem sexual behavior using ACE survey methodology in a sample of juveniles receiving residential treatment for sexual misconduct. Data for this study were collected from archival records of children and adolescents who have received sexual offender treatment at a treatment center for male youth (N=120; 88% Caucasian) for periods ranging from one month to more than four years (M=13.68 months, SD=10.96). These participants have a mean age of 14.63 years (SD=1.56; Range: 11 to 17 years) at the time of first admission into the facility. As expected, the adolescents in this study have experienced higher rates of adverse childhood experiences than the general adult population and male adolescents involved in the juvenile justice system previously reported in the literature. Only 2.5% of the current sample experienced no ACEs and 74.2% faced four or more adversities, which is considered to be high risk in the literature. Participants had a mean age at first out-of-home placement of 9 years (SD=5.21) and had an average of 3.7 out-of-home placements at time of admission to the facility. The association of childhood adversities, the number of non-psychiatric out-of-home placements, and age at first out-of-home placement with earlier onset of aggressive and sexual offending behaviors will be investigated using Cox proportional hazard analyses. Behavioral outcomes (e.g., onset of sexual and aggressive behavior problems; substance use; arrest history; and, treatment length) between individuals who were placed in family members’ homes versus those placed in non-familial foster care will also be explored. Implications for prevention and environmental responsiveness will be addressed.

Extant empirical evidence suggests that multiple risk and protective factors implicated in children's development of behavior problems are intertwined. This study, therefore, investigated the relationships among parental depression and anger, attributions of control, discipline, parent-child relationship variables, and children's behavior problems. Results were based on the responses of parents (55 mothers and 13 fathers) with children in Head Start and parents (52 mothers and 4 fathers) with children in Private School settings. All parents had children who ranged in age from 3- to 8-years. Compared to Private School parents, Head Start parents had lower levels of nonviolent discipline, involvement, and autonomy granting and endorsed greater internalizing behavior problems in their children. Significant correlations were found among parent-child relationship characteristics, parental discipline practices, and child behavior problems in both samples. Regression analyses suggested that Private School parents' use of psychological aggression and autonomy granting interact in the prediction of children's internalizing behavior problems. Although Head Start parents' higher attributions of child control for failure predicted lower levels of nonviolent discipline, and Private School parents' use of psychological aggression predicted greater levels of children's externalizing behavior problems, there was no evidence of parental discipline mediating the relationship between parental attributions and children's behavior problems. These findings emphasize the importance of research involving disadvantaged and nondisadvantaged community samples in order to provide a context for understanding how parental discipline and children's behavior problems are related to parent traits and parent-child relationship characteristics.

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