Background: Until now few studies have proven that an attachment style can be changed in the course of psychotherapy and that the attachment style has an impact on the therapy outcome. In particular, there is a lack of studies about these relationships in long-term psychoanalytic psychotherapy with children and adolescents. Sampling and Methods: Seventy-one children with mental disorders receiving long-term outpatient psychodynamic psychotherapy were assessed 4 times using the Heidelberg Attachment Style Rating for Children and Adolescents. The measurements were conducted at the beginning of treatment, at the 25th treatment session, at the end of treatment and 1 year after the completion of treatment. Results: The results showed a significant change in attachment style during treatment. The proportion of children and adolescents with a secure attachment style increased from 23% to 63%. There was no significant difference in the attachment style between patients with good and poor treatment outcome, but a significant relationship between secure attachment and the number of treatment sessions could be demonstrated. Conclusions: A reorientation towards a secure main attachment style over the course of psychotherapy is possible. However, attachment style seems to be not a moderator but a mediator for the outcome of psychoanalytic psychotherapy in children and adolescents.

In several studies, the association between attachment style and psychotherapy outcome has been shown for adults. The aim of the present study was to examine the association between attachment style and outcome of short-term psychodynamic psychotherapy for children and adolescents. 71 children and adolescents with a mental disorder receiving out-patient short-term psychodynamic psychotherapy were studied. Attachment style was assessed with the Heidelberg Attachment Style Rating for Children and Adolescents (HASR-CA). Therapy outcome was measured using the Severity of Impairment Score for Children and Adolescents (SIS-CA). It could be shown that good outcome in therapy is significantly more frequently associated with a secure attachment style than with an insecure attachment style. No significant changes in attachment security were observed during treatment. Thus, attachment style is a good predictor of a successful short-term psychodynamic psychotherapy for children and adolescents and therefore is an important criterion for the differential indication for psychodynamic therapies.

Shame and guilt feelings play a pivotal role in the aetiology and maintenance of a number of psychological disorders as well as in the development and regulation of moral behaviour. Despite intensive theoretical treatments of this topic, there have been few empirical studies to date, chiefly because of the lack of appropriate measuring instruments. The purpose of this study was the psychometric evaluation of the German version of the Test of Self-Conscious Affect for Children and Adolescents (TOSCA-C/A). The psychometric properties of this instrument were evaluated using a non-clinical sample of N = 505 children and adolescents aged between 8 and 18 years and a clinical sample of N = 50 children and adolescents. The individual scales proved reliable. There were many indications of the validity of the scales. We conclude that the German version of the TOSCA-C/A is the basis for the further investigation of self-conscious affects such as guilt and shame in children and adolescents.

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