Group psychotherapy with borderline patients is an activity that is fraught with ominous apprehension and it is perhaps for this reason that little research has been done in the field. The aim of the present studies was to map out the area and to test some basic hypotheses about patient and therapist behaviour during the therapy process. Two therapy groups of carefully diagnosed clinical borderline patients were studied by means of video-technique during a therapy process of 20 months. Special technical arrangements and ethical agreements were elaborated for the research. Outcome data was collected concerning the patients’ self-image, symptom-level and personality structure. A follow-up was done 2-3 years after therapy on functional level, capacity for work, medication and need of further treatment. As expected a high drop-out rate occurred. Within a year 40% of the patients had left, and within 20 months 60%. Drop-out was not found possible to predict before the period of therapy commenced but early drop-outs were generally younger and in a more acute state of distress than late drop-outs. In order to study the therapy process two major perspectives were elaborated and operationalized: 1) classification of focus and depth of therapists’ interventions and 2) relational capacity of the patient (Borderline Relatedness). In contrast to remainers, late drop-outs were found most sensitive to disturbances in the frame of therapy (group instability) and were considered prone to interact malignantly with the therapists, eventually leading to drop-out. As to outcome and follow-up, late drop-outs were characterized by the poorest outcome all over, while early drop-outs and remainers were generally more stabilized although the early drop-outs seemed more dependent on medication for their functioning. By means of a principal components analysis the large amount of outcome data was condensed to two important factors: 1) symptom and functional level and 2) direction of anger. Thus, it was found that an important feature of a positive outcome was the ability to function at work and in social life and to direct anger outwards, not just towards oneself, thus protecting and idealizing important others, as was often the case with these patients before treatment. Taken together, the results point to the need for more precise and sensitive diagnostic methods and outcome criteria both to predict and to evaluate therapeutic outcome. To minimize drop-out and negative therapeutic reaction the research speaks in favor of further studying the therapist-patient interaction during the group therapy process and to evaluate the relative importance of therapist interventions and non-specific curative factors. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1989, härtill 4 uppsatser.</p> / digitalisering@umu.se

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Inledning: Anknytningsbaserad familjeterapi (ABFT) syftar till att stärka relationen mellan ungdomar och föräldrar genom att bearbeta ungdomens känslor kopplade till anknytningsbrott i relationen. Denna studie fokuserar på det terapeutiska arbetet med känslor. Frågeställning: Vilka terapeutinterventioner kan man urskilja som bidrar till att ungdomar uttrycker känslor i ABFT? Metod: I denna kvalitativa fallstudie har ett urval sessioner av en videofilmad ABFT observerats och analyserats med avseende på hur ungdomens känslomässiga nivå förändras och vilka terapeutinterventioner som föregår förändringen. Resultat: Då terapeuten frågar eller uppmanar ungdomen att berätta om förberedda sårbara teman för föräldrar och samtidigt uppmanar föräldrarna att fråga och spegla empatiskt, stiger den känslomässiga nivån förutsatt att uppmaningarna är kopplade till ungdomens mer eller mindre implicita känslor. Känslor uttrycks i lägre grad vid individuella samtal med ungdomen. Diskussion: De enskilda interventionerna uppfattades inte vara det viktigaste för arbetet med fördjupning av känslor i denna terapi. Snarare var det att skapa ett gemensamt mål för arbete kring de känsloladdade teman som formulerats i terapin vilket är i linje med terapins intentioner. Studiens resultat kan sägas understryka vikten av väl genomarbetade allianssamtal med såväl ungdom som föräldrar för att möjliggöra känslomässiga uttryck hos ungdomen tillsammans med föräldrar. / Introduction: The goal of Attachment-based family therapy (ABFT) is to create a stronger attachment between adolescents and their parents through youth disclosure of emotions related to attachment failures. The focus of this study is on the therapeutic work with emotions. Research question: Which therapist interventions contribute to the emotional expression of the adolescent in ABFT? Method: In this qualitative case-study a number of videotaped sessions of an ABFT have been observed and analyzed in order to determine which therapist interventions precede emotional arousal. Results: When the therapist asks or encourages the adolescent disclosure of the well prepared core conflict themes, and at the same time supports the parents in empathic responses and questions, it is possible to see an increase in youth emotional arousal as long as the interventions involves the adolescents more or less implicit emotions. There was almost no emotional arousal in the sessions where the adolescent was alone without parents. Discussion: Most important for an increase in emotional arousal was not single therapist interventions, but instead the collaborative work with the family to create a shared goal for the therapy centered on the emotionally loaded core conflicts. The results seem to underline the importance of thoroughly worked throw alliance sessions with both parents and adolescent.