[The working alliance in inpatient treatment for personality disorders and its connection with patient characteristics: an exploratory study]. / De werkalliantie in klinische psychotherapie voor persoonlijkheidsstoornissen en gehechtheid.

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.

A standard set of outcome measures for the comprehensive assessment of oral health and occlusion in individuals with osteogenesis imperfecta.

BACKGROUND: Osteogenesis imperfecta (OI) is a group of inherited connective tissue disorders of varying severity characterized by bone fragility. The primary objective of this international multidisciplinary collaboration initiative was to reach a consensus for a standardized set of clinician and patient-reported outcome measures, as well as associated measuring instruments for dental care of individuals with OI, based on the aspects considered important by both experts and patients. This project is a subsequent to the Key4OI project initiated by the Care4BrittleBones foundation which aims to develop a standard set of outcome measures covering a large domain of factors affecting quality of life for people with OI. An international team of experts comprising orthodontists, pediatric dentists, oral and maxillofacial surgeons, and prosthetic dentists used a modified Delphi consensus process to select clinician-reported outcome measures (CROMs) and patient-reported outcome measures (PROMs) to evaluate oral health in individuals with OI. Important domains were identified through a literature review and by professional expertise (both CROMs and PROMs). In three focus groups of individuals with OI, important and relevant issues regarding dental health were identified. The input from the focus groups was used as the basis for the final set of outcome measures: the selected issues were attributed to relevant CROMs and, when appropriate, matched with validated questionnaires to establish the final PROMs which represented best the specific oral health-related concerns of individuals with OI. RESULTS: Consensus was reached on selected CROMs and PROMs for a standard set of outcome measures and measuring instruments of oral health in individuals with OI. CONCLUSIONS: Our project resulted in consensus statements for standardization oral health PROMs and CROMs in individuals with OI. This outcome set can improve the standard of care by incorporating recommendations of professionals involved in dental care of individuals with OI. Further, it can facilitate research and international research co-operation. In addition, the significant contribution of the focus groups highlights the relevance of dental and oral health-related problems of individuals with OI.

[An inpatient version of mentalisation-based treatment for patients with cluster A personality disorders]. / Klinische variant van mentaliserenbevorderende therapie voor patiënten met cluster A-persoonlijkheidsstoornis.

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.