Limitations and future directions
aggressive behavior
DISORDER, PATHOLOGY, DISORDERS
One major limitation of this study is that randomization and control intervention feasibility could not be investigated. Thus, results cannot be generalized to feasibility of an RCT in this patient group; these aspects should be addressed in future studies and treatment effects piloted. Researchers might consider broadening inclusion criteria in taking a more dimensional approach to personality pathology, which seems sensible considering the often chronic and progredient course of the disorder (cmp. [A second major limitation is the small sample size. While in line with the model, pre-to-post treatment improvements in diagnoses and empathy pathology were observed, small sample size and lack of control group preclude conclusions about possible treatment effects. For future studies, larger sample sizes must be achieved to ensure statistically sound evaluation of effects. Furthermore, alternative research designs may also be considered, such as cohort designs which have been discussed to better fit the investigation of psychotherapy effects in individuals with complex disorders [Parents only inconsistently took part in the scientific assessments. This might be a result of the recommended flexibility in the frequency of family sessions. Yet moreover, it seemed to be indicative for parent ambivalences towards treatment. Active engagement of parents will need to be a goal just as much as of adolescents when aiming for high acceptance of scientific assessments from the parents.Overall, the study provides a sound basis for conducting a consecutive feasibility and pilot RCT and relevant information for conducting a definitive RCT. Active relational engagement seems to be key during very first contacts with the patients. MBT-CD aims at helping therapists in gaining confidence to work with adolescents with CD and taking a non-judgmental, curious stance about their mental states. This aims at allowing adolescents to perceive themselves and others as feeling and thinking human beings and (re)gain control over their aggressive behavior.