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Schema therapy for violent PD offenders: a randomized clinical trial

Background. Violent criminal offenders with personality disorders (PD’s) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs. Methods. We compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms. Results. Patients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes – rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms – and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*- time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*- time: t(1387) = −2.85, p = 0.005). Conclusions. These findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community

Heterogeneity in Response during Multisystemic Therapy: Exploring Subgroups and Predictors

Multiple studies have shown that Multisystemic Therapy (MST) is, at group level, an effective treatment for adolescents showing serious externalizing problem behavior. The current study expands previous research on MST by, first, examining whether subgroups of participants who respond differently to treatment could be identified. Second, we investigated if the different trajectories of change during MST could be predicted by individual (hostile attributions) and contextual (parental sense of parenting competence and deviant and prosocial peer involvement) pre-treatment factors. Participants were 147 adolescents (mean age = 15.91 years, 104 (71%) boys) and their parents who received MST. Pre-treatment assessment of the predictors and 5 monthly assessments of externalizing behavior during treatment took place using both adolescent and parents’ self-reports. Six distinct subgroups, showing different trajectories of change in externalizing problem behavior during MST, were identified. Two of the 6 trajectories of change showed a poor treatment response, as one class did not change in externalizing problem behavior and the other class even increased. The remaining 4 trajectories displayed a positive effect of MST, by showing a decrease in externalizing behavior. Most of these trajectories could be predicted by parental sense of parenting competence. Additionally, lower involvement with prosocial peers was a predictor of the group that appeared to be resistant to MST. Adolescents do respond differently to MST, which indicates the importance of personalizing treatment. Protective factors, such as parental sense of parenting competence and prosocial peers, seem to require additional attention in the first phase of MST.

There is no blank slate

Art therapy for psychosocial problems in children and adolescents

Background: Art therapy (AT) is frequently offered to children and adolescents with psychosocial problems. AT is an experiential form of treatment in which the use of art materials, the process of creation in the presence and guidance of an art therapist, and the resulting artwork are assumed to contribute to the reduction of psychosocial problems. Although previous research reports positive effects, there is a lack of knowledge on which (combination of) art therapeutic components contribute to the reduction of psychosocial problems in children and adolescents. Method: A systematic narrative review was conducted to give an overview of AT interventions for children and adolescents with psychosocial problems. Fourteen databases and four electronic journals up to January 2020 were systematically searched. The applied means and forms of expression, therapist behavior, supposed mechanisms of change, and effects were extracted and coded. Results: Thirty-seven studies out of 1,299 studies met the inclusion criteria. This concerned 16 randomized controlled trials, eight controlled trials, and 13 single-group pre–post design studies. AT interventions for children and adolescents are characterized by a variety of materials/techniques, forms of structure such as giving topics or assignments, and the use of language. Three forms of therapist behavior were seen: non-directive, directive, and eclectic. All three forms of therapist behavior, in combination with a variety of means and forms of expression, showed significant effects on psychosocial problems. Conclusions: The results showed that the use of means and forms of expression and therapist behavior is applied flexibly. This suggests the responsiveness of AT, in which means and forms of expression and therapist behavior are applied to respond to the client's needs and circumstances, thereby giving positive results for psychosocial outcomes. For future studies, presenting detailed information on the potential beneficial effects of used therapeutic perspectives, means, art techniques, and therapist behavior is recommended to get a better insight into (un)successful art therapeutic elements.

Perceived effects of drama therapy in people diagnosed with personality disorders: A qualitative study

Arts and psychomotor therapies are often part of the multidisciplinary treatment for people diagnosed with Personality Disorders (PDs). Drama therapy is aimed at promoting emotion regulation and strengthening of interpersonal skills. The added value of drama therapy has not been sufficiently examined and available studies only provide indirect client reports. Hence, we focus on what people with PDs perceive as effects of drama therapy. This qualitative study followed the Grounded Theory Approach utilising indepth, semi-structured interviews in a natural drama therapy context. Interviews were held with 19 people diagnosed with PDs, who were purposefully sampled. They were recruited from five treatment centres, with five drama therapists involved. Interviews were transcribed verbatim and analysed using a three-step approach: open, axial, and selective coding. Open coding resulted in 93 codes. In the coding process, four overarching themes came to the fore: allowing playfulness and its inherent benefits, connecting the inner and outer emotional world, understanding of maladaptive coping styles, and intrapersonal and interpersonal behavior change. The perceived effects as reported by people diagnosed with PDs provide information about what drama therapy means to them, in their daily lives and which aspects of the treatment were most valuable to them. This study contributes to the necessary underpinning of drama therapy.

Maladaptive behavior in relation to the basic psychological needs of students in secondary education

Much research has been done into the relationship between students’ motivation to learn and their basic psychological needs as defined by the self-determination theory (autonomy, competence, relatedness). However, few studies have explored how these psychological needs relate to different types of maladaptive behavior in the classroom. To prevent or remedy such behavior, more insight into its relationships is required. The present study attempted to determine the relationship between maladaptive behavior of secondary school students (grades 8 and 9) and the degree to which both teachers and peers address their needs for competence, autonomy, and relatedness. Results show significant, negative correlations between maladaptive student behavior in the classroom and the extent to which students’ basic psychological needs are met by teachers and fellow students. Both teachers and fellow students play a role in students’ maladaptive behavior toward school and withdrawn behavior. When it comes to unfriendly behavior, the perceived support of teachers appears to be particularly relevant, while the role of peers is an important factor in delinquent behavior.