Journal of Clinical Psychology最新文献

Personality disorders (PD) in adolescents are a significant risk factor in the development and maintenance of eating disorders (ED). Comorbid PD and ED can influence each other and significantly impact on the young person′s well-being, worsening interpersonal relationships and social functioning. Patients with ED often use coping mechanisms related to food and body shape as maladaptive attempts to manage PD-related problems, like negative ideas about self and others. We describe the case of an 18-year-old adolescent presenting with binge eating disorder (BED), stage I obesity, and Avoidant and Obsessive-Compulsive Personality Disorders, treated with Metacognitive Interpersonal Therapy for Eating Disorders (MIT-ED). The patient reported low self-esteem and insecurity about her decision. When her need for autonomy was frustrated, she adopted dysfunctional behaviors such as chasing perfectionistic goals to increase her self-esteem. Further, when criticized feeling useless, she would mitigate her feelings of shame and sadness through social withdrawal and binge eating. Therapy focused on improving awareness of the mental states that contribute to social withdrawal and dysfunctional eating behaviors and to build psychological resources to support self-worth and autonomy. We describe the addition of family therapy to the treatment protocol to address some of the interpersonal and relational dynamics that maintained Asia′s sense of herself as worthless and unable to pursue her own goals. Implications for treating adolescents presenting with comorbid PD and ED are discussed.

Treating personality disorders in adolescents presents a significant challenge, as intense emotions and unstable relationships often lead to early dropout from therapy. This is particularly concerning, given that psychotherapy is the primary treatment for personality disorders and that such a diagnosis is typically associated with severe difficulties daily functioning. The case report of a 16-year-old girl with borderline personality disorder illustrates how a history of trauma and early unstable relationships can contribute to later difficulties in emotion regulation and impair the ability to think clearly under pressure. During group therapy, interpersonal conflicts were resolved as the girl became increasingly able to understand both her own mind and the mind of others. A new conflict arose and intensified when the therapists were required to inform external authorities, highlighting the importance of mentalizing within the team and the advantages of a team-based approach to treating personality disorders, which includes a combined treatment of both individual and group therapy. The case illustration demonstrates how mentalization-based interventions can help rebuild trust and repair misunderstandings in therapy, thereby preventing dropout and illustrating the potential of psychotherapy for these patients. Concrete examples of possible interventions for managing interpersonal conflict in group therapy are provided with the aim of encouraging others to engage in the treatment of personality disorders in adolescence.

In this commentary on the issue of the Journal of Clinical Psychology: In Session dedicated to Deliberate Practice (DP), we highlight commonalities between DP supervision as illustrated in the target papers and Alliance-Focused Training (AFT) and applaud the shift towards more experiential learning. We also note one major difference, namely the absence of Behavioral Rehearsal (BR) in AFT in spite of this being a key element of DP as conceptualised in the Sentio Supervision Model and in the target papers. We then offer some critique of DP as modelled in this issue. We suggest that empirical evidence on what constitutes therapeutic expertise is undeveloped. Consequently, there is a risk of building a super-structure of DP on foundations that still await solid empirical support. We note how DP might be tailored more closely to what is known about therapeutic effectiveness, drawing on process research and Task Analysis. We then suggest that DP may have failed to sufficiently conceptualise the relational nature of therapeutic expertise—different in character to skill training in fields where DP was originally formulated and developed. We argue that processes of interpersonal attunement offer a frame in which parenting skills, developmental psychopathology, the earning of secure attachment both in and outside of therapy, and the safe base of supervision can all be gathered into a unifying paradigm. We end by arguing that the ability to be mindfully present in relationship underpins the experiential depth and skilful responsiveness at the heart of both attachment and successful psychotherapy.

Dampening of positive affect (PA) constitutes a transdiagnostic risk and maintenance factor for affective dysregulation in various psychopathologies, including depression. However, the motives underlying this PA downregulation strategy remain unclear, even though they may be highly relevant for improving traditional psychological treatments. This study examined whether avoidance of negative emotional contrasts (NECs) and diminished preference for positive emotions were predictive of dampening. The latter was operationalised as low pro- and high contra-hedonic emotion regulation (ER) goal endorsement. An adult community sample (N = 159) completed an online survey, and multiple linear regressions were conducted to examine the predictive validity of both factors, after controlling for age, gender, and repetitive negative thinking (RNT). Higher levels of NEC avoidance and higher contra-hedonic ER goal endorsement were consistently found to uniquely predict concurrent dampening levels, above and beyond age, gender and RNT. Crucially, inclusion of both factors in the same regression model still yielded evidence for the unique predictive validity of NEC avoidance. Findings support the possibility that dampening is motivated by NEC avoidance rather than solely by emotional preferences. Study limitations are noted, and implications for future research and clinical practice are discussed.

This commentary, written for Journal of Clinical Psychology: In Session, synthesizes five case-based contributions on psychotherapy for adolescents with personality disorders (PDs). Although PDs often emerge in adolescence, age-adapted treatments remain scarce. Randomized clinical trials are still limited, making carefully constructed case studies important for identifying promising treatments. Three of the featured cases draw on mentalization-based therapy for adolescents, implemented in combined group–individual formats, adapted toward dimensional models of PD, or extended socioecologically to involve wider social networks, such as family, peers, and school systems. The remaining two derive from metacognitive approaches: one applying Metacognitive Interpersonal Group Therapy (MIT) for Adolescents in a case of dependent and borderline PD, and the other applying MIT for Eating Disorders with an adolescent with binge eating disorder and comorbid avoidant and obsessive–compulsive PD. Across studies, four shared priorities emerge. First, the capacity to think, reason, and regulate mental states, defined as mentalizing or metacognition, serves as a central mechanism of change. Second, impairments in self and interpersonal functioning are treated as the core pathology in PDs. Third, therapeutic progress depends on actively engaging the adolescent's broader social context rather than working solely within the therapist–patient dyad. Fourth, comorbidity, whether trauma-related disorders, substance use, eating disorders, or others, should be treated integratively to ensure targeted, personalized treatment. These cases demonstrate that innovation in adolescent PD treatment often begins with single cases. The task ahead is to translate these clinical examples into rigorously tested, developmentally sensitive, and ecologically grounded intervention models that can be applied in early intervention programs.