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Assessment and Treatment of Attachment-Related Aspects in Adolescents with Personality Disorders In recent years the relevance of attachment-related aspects in psychotherapy research has increased. This approach offers an opportunity to test the effectiveness of specific psychotherapeutic procedures for personality disorders in adulthood. Although there are a number of novel psychotherapeutic interventions for personality disorders that were adapted for adolescents, there is still a lack of research on studies that consider attachment-related characteristics. The present study demonstrates attachment-related aspects in a large sample of in-patient adolescents with personality disorders. Therapeutic implications of these findings will be outlined and discussed in the context a new attachment-based intervention tool. This tool might be particularly useful to help patients facing individual aspects of their attachment trauma and to develop more adaptive emotion regulation strategies in interpersonal contexts.

Attachment Based Short Intervention During Inpatient Treatment of Adolescents In clinical attachment research the established and economic Adult Attachment Projective Picture System (AAP) has been increasingly used in the past few years to assess the attachment representations in adults and recent studies demonstrated sufficient validity for assessing attachment representations in adolescents. Apart from coding attachment classifications, the AAP provides useful and clinically valid information concerning attachment related defences, aspects of capacity to act and synchrony in relationships and emotion regulation strategies with respect to attachment related traumatic experiences. These valuable aspects with respect to individual resources led to the conceptualization to implement the AAP in the therapeutic setting as a feedback tool. In this pilot case we report on an adolescent patient in an inpatient setting. The therapist received an individualized feedback on the patients' AAP to focus on specific attachment related themes used as a short intervention respective an add-on treatment. This paper presents the first results of this new approach by demonstrating the potential therapeutic effects and process of therapy.

AIT (Adolescent Identity Treatment) - an Integrative Treatment Model for the Treatment of Personality Disorders Personality disorders are patterns of maladaptive personality traits that have an impact on the individual throughout the life span. Borderline Personality Disorder (BPD) is a very severe, but treatable mental disorder. Identity disturbance is seen as the central construct for detecting severe personality pathology - and, most notably, borderline personality disorder - in adults and adolescents. Crises in the development of identity usually resolve into a normal and consolidated identity with flexible and adaptive functioning whereas identity diffusion is viewed as a lack of integration of the concept of the self and significant others. It is seen as the basis for subsequent personality pathology, including that of borderline personality disorder. Although BPD has its onset in adolescence and emerging adulthood the diagnosis is often delayed. In most cases, specific treatment is only offered late in the course of the disorder and to relatively few individuals. Adolescent Identity Treatment (AIT) is a treatment model that focuses on identity pathology as the core characteristic of personality disorders. This model integrates specific techniques for the treatment of adolescent personality pathology on the background of object-relation theories and modified elements of Transference-Focused Psychotherapy. Moreover, psychoeducation, a behavior-oriented homeplan and intensive family work is part of AIT.

This presentation describes the development of attachment between adopted children and their adoptive parents with a focus on the particular issues seen in international adoptions. The questions of settling in, trauma in the country of origin, and the motivations of the adoptive parents will be discussed. Diagnosis and various psychopathological manifestations will be examined, as will outpatient and inpatient modes of therapy. The treatment of children of various ages will be covered along with the necessity for intensive counseling and psychotherapy for the adoptive parents. This will enable the parents to work through early trauma, which will give them and their adopted child the basis for developing healthy attachment patterns. This in turn will enable the child to mature and integrate into society. Possibilities of prevention are discussed. Many of the approaches discussed here regarding attachment and adoption may be applied to foster children and their foster parents.

Insecure attachment and deficits in self-regulation as personality traits are risk factors for the development of psychopathological symptoms from infancy on. This study examines differences in attachment and personality in late childhood, comparing children from non-clinical families, from a child guidance center, and child psychiatry units with in-patient care. Children's attachment representations, their attachment behavior strategy, reported distressing parental behavior, their emotional openness, and attachment coherency were assessed with the Late Childhood Attachment Interview (LCAI). Ego-resiliency, ego-undercontrol, field-independence, aggressiveness, and anxiety were assessed by means of the California Child Q-Sort. The results show clear attachment differences, with the child guidance group showing more attachment insecurity in the LCAI compared to the control group, and the psychiatric in-patient group even more attachment insecurity, more distressing parenting from both mother and father, and more attachment disorganization than the other two groups. Whereas children from the child guidance center and the child psychiatry unit did not differ in personality, both groups were significantly different from the control group in all personality dimensions. The results suggest that personality differences may be a risk factor for behaviour problems, however problem severity and the choice of the treatment institution seem to be influenced by attachment security.

Attachment research has deepened our understanding of the essential continuities and discontinuities of psychological development from childhood to adolescence and to adulthood. This paper considers the relevance of ambivalent-preoccupied attachment, one of the two types of insecure attachment, for understanding emotional vulnerability during adolescence. How current social and economic conditions have exacerbated the effects of ambivalent-preoccupied attachment in the attainment of the developmental tasks of adolescence is considered. By describing three clinical vignettes clinical recommendations are given.

A single case study is presented from a feasibility study on social, psychic and neurobiological causes of violence in adolescence focusing on right-wing extremist and xenophobic youth. Results from psychological assessments and a structured biografical reconstruction are analyzed. The case illustrates a typical developmental path of a right-wing, xenophobic and violent male adolescent who experienced early and repeated exclusion and social marginalization. Results from psychological testing demonstrated additional developmental risk factors, such as disorganized attachment representations and low mentalizing abilities. A depth-hermeneutic analysis ofa sequence during the attachment interview as well as a reflection of the research setting further illustrates how experiences of exclusion are re-enacted by a combination of fear of abandonment and aggression.

A tendency to pass on traumatic experiences from one generation to the next can be observed in family systems. This continuity manifests itself very differently, e. g. in posttraumatic stress disorders, anxiety disorders, mood disorders, aggressive behavior, social withdrawal or health risk behaviors in the second or third generation. Besides physiological mechanisms (e. g. levels of cortisol) psychosocial "mediators" as attachment security, emotional regulation and availability, parenting style as well as family dynamic processes like family secrets, communication deviances and resulting disturbances of mentalization, disturbances of interpersonal boundaries, conflicts of loyalty and delegation are of relevance. A case example and considerations of resilience processes are given as well.

The power of imagination refers to the ability of obtaining mental access to an inner world of vision and potential in which change can be believed to be possible. The ability to create inner pictures is dependent on a capacity for symbolisation which is often impaired in deprived or traumatised children and adolescents or those with attachment disorders. Psychotherapy should help foster the ability to create inner pictures, while at the same time remembering that the work of integrating wishes and visions into the real life structure of patients presents a special therapeutic challenge.

The rise in "hyperkinetic disorder" diagnoses is not based on better but rather on less precise diagnoses. As a rule the co-morbidities as mentioned in ICD-10 like emotional disorders, commitment disorders and social behaviour disorders, are the real clinical pictures accompanied by such symptoms as inattentiveness, hyperactivity and impulsiveness. These are disorder pictures based possibly on unconscious areas of conflict which can be managed by psychoanalytic treatment. However, this involves considerable treatment challenges taking into account that there are some major difficulties: Children showing said disorder pictures have not only symbolizing disorders but mostly also playing disorders. They experience playing not symbolically, no longer mainly "as if" and taking place in a space between imagination and reality. Their play may easily turn into concreteness or reality and get out of control all of a sudden. In addition, children and young people with externalizing disorders constantly attack basic conditions and seek to destroy them. Verbal intervention frequently does not reach the patients. Counter transferences are very difficult to bear and to control, and the tendency of psychotherapists to join in is strong. It is therefore of great importance to work on the ability of symbolization and mentalization, on relationship and transference, simultaneously however on frame and structure, with reliability and regularity of the settings. Analytic therapies as well as therapies founded on depth psychology may be indicated, possibly supplemented by parallel medication; at the beginning a particularly careful diagnosis should be made.

Based on clinical experiences, results of the Frankfurt Prevention Study and arguments taken from a current interdisciplinary dialogue between psychoanalysis and neurobiology the authors discuss that Attention Deficit Hyperactivity Disorder (ADHD) always has to be understood as a product of complex interactions of (mostly unconscious) idiosyncratic, biographical, relational, institutional, societal as well as neurobiological, neurophysiological, and genetical factors. This is one reason why the authors think that psychoanalysis with its unique conceptualizations to understand psychic realities as products of such a complex intertwining of unconscious and reality factors, taking into account biological as well as societal roots of human behavior, could be regarded as one of the best available psychotherapeutic approach nowadays which is capable to deal theoretically and therapeutically with children suffering from ADHD. Psychoanalysis offers an alternative (with longlasting positive results) to exclusive treatments with psychostimulants. This thesis is discussed by short case studies illustrating 7 subgroups of children with very different inner conflicts and fantasies all being subsumed under the ADHD diagnosis in DSM-IV.

This article deals with methods and instruments used to identify high risk parents and early developing risks of infants and young children during the pre- and postnatal period in order to develop early intervention strategies based on early diagnosis in the context of parent-child-relationship. The specific experiences of our research approaches, funded by the German ministry of education and research (BMBF) from 2003 to 2007 at the University of Applied Sciences in Potsdam in cooperation with the parent counselling centre "Vom Säugling zum Kleinkind" are reflected. An interaction and communication focused strategy was developed to help to identify early development risks and resources in the parent-infant-relationship at the age of 0-3 years. After testing the diagnostical approach of this social-emotional development screening (SEE-0-3) in a current evaluation study on a high-risk-population, it was integrated as one module of early diagnosis into the early intervention program "STEEP--Steps toward effective and enjoyable parenting" which is based on the attachment theory. Using a concrete case it will first be discussed which kind of approaches to becoming parents with high risk factors can be developed on the basis of attachment reflecting acting and second which possibilities an interaction and video based concept could offer in the field of early diagnosis and intervention with families of infants and young children.

The author describes the course of an adolescent psychotherapy with guided affective imagery (Leuner 1985) using the therapeutic material of a 15 year old female adolescent with a severe depression und automutilative behaviour. She considers this therapeutic method as very useful especially for severely disturbed adolescents, because the method enhances the creativity of the patient and enables him to express traumatizing experiences in a symbolical form thus facilitating their integration.

The paper explores the meaning of childrens' pictures as a symbol for growing autonomy. The psychotherapy of a 7-years old turkish boy, who came to treatment with a destroyed identity, will be described. The parents failed to support the boy's development by adequate mothering. The aggressive symptomatic as it emerged at the beginning of the psychotherapy is shown in a shipwreck. During therapy he succeeds to develop age-appropriate autonomy that is shown in a series of drawings.

Self-Psychology, as a segment of contemporary psychoanalysis, can claim merit as to having included the vastly accrued body of knowledge of pertinent fields of the human sciences into their clinical reasoning. This, in turn, has set forth a rebound effect which eventually has contributed to Psychoanalysis' still ongoing exodus from its long-lasting "splendid isolation". By presenting selected findings pertaining to attachment- and neuroscientific trauma-research, the author aims at hypothesizing with reference to the interface of early ontogenic attachment disorganization, onset of dissociative disorders and graded traumatic impact. Finally, in considering clinical relevance of the data, the author opts for composite strategies i.e. measures embedded in an overall psychodynamic treatment stance inclusive of occasional employ of EMDR and hypnotherapeutic interventions.

Early maltreatment of children can lead to severe disorders in the regulation of behaviour and affect, alterations in awareness and distorted perception. In development-oriented psychotherapy, therapeutic interventions which are directed to regulating processes, decentration or mentalization, desomatization and symbolization of enacted messages play a central role. The results of early traumatization and of therapeutic interventions are portrayed, examining the multi-dimensional diagnosis and therapy of a dangerously aggressive 12-year-old boy as an example. From this, it becomes clear how, through new experiences with regulating others, he gradually surfaces from a world of annihilation and destruction and learns to survive and to live.

What is the significance of theory of attachment for practical remedial therapeutics? It is a current and intensive debate on this issue in the socio-psychological field of work. The intention of the article is to make public the possible applications of attachment theory. To start with, fundamental assumptions of attachment theory will be introduced (following J. Bowlby 1975), then the role of attachment processes in problematic human relationships will be described. The author will attempt to make clear how fundamental remedial-therapeutic concepts of actual treatment can be deduced from the considerations, theory of attachment makes, and how this can be practically applied, illustrated by a case study from actual remedial-therapeutic work with a girl with psycho-social behavioural difficulties and her mother. Thus, the author tries to show a highly promising way from theory of attachment to attachment therapy.

Deriving from an integrative psychoanalytic concept for single grownup patients treatment in a psychotherapeutic clinic based on the integrative model of P. Janssen the author tries to apply this model and to expand it to the treatment of families in a similar context. This setting mainly relies on three columns: 1. the psychoanalytic group therapy of the parents (or the mother resp. father), 2. the psychoanalytic psychotherapy of the child (resp. children) and 3. the psychotherapy sessions with the family, resp. the single therapy sessions of the grown up patients. This clinical model offers the opportunity to distinguish between accompanying children and children as patients in a stricter sense. The psychodynamic processes of transference, countertransference and resistance are integrated in and by regular team sessions. This paper discusses the parallel processes in the different applied therapeutic methods and their positive mutual influences on each other centered around a detailed case vignette of a family (a mother with two boys) that underwent psychotherapeutic treatment in the described manner for 12 weeks.