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Abstract Background The abandonment of psychotherapeutic treatments is influenced by various factors, including patient characteristics, therapist traits, and the therapeutic relationship. Despite the well-documented importance of these factors, limited empirical research has focused on the role of the therapeutic relationship and the characteristics of therapist-patient dyads in predicting treatment dropout. This study protocol outlines a longitudinal research project aimed at predicting dropout and non-response in psychotherapy for individuals with personality disorders. The research seeks to identify predictive factors related to psychotherapy outcomes, focusing on patient, therapist, and dyadic elements. Specifically, the study will examine the influence of therapist characteristics (e.g., personality traits, countertransference, responsiveness) on treatment outcomes, explore the impact of relational factors (e.g., treatment expectations, epistemic trust, therapeutic alliance) on therapy effectiveness, and assess how the therapeutic alliance within therapist-patient dyads affects the likelihood of dropout and non-response. Methods The longitudinal study will include 100 therapist-patient dyads (200 participants) recruited from various Mental Health Services in Milan, Italy. Validated instruments will be administered to both patients and therapists at four-time points: T0 (baseline), T1 (3 months), T2 (6 months), and T3 (1 year). Data will be collected at baseline and at the one-year mark to evaluate the relationships between therapist, patient, and dyadic factors and treatment outcomes. Discussion Identifying predictive variables associated with high dropout rates can help preempt treatment discontinuation, reducing the financial and operational burdens on mental health services. Understanding these factors will enable the development of targeted interventions to improve treatment engagement and reduce attrition. This approach could enhance outcomes for individuals with personality disorders and lead to more efficient resource allocation and sustainable delivery of mental health care.

Abstract Background Childhood abuse and neglect pose important risk factors for the development of psychopathology during pregnancy. However, only a few studies have assessed the effects of a specific type of abuse during the perinatal period, namely, psychological maltreatment, which includes emotional abuse and neglect. These studies have found that women who have experienced psychological maltreatment exhibit higher levels of antenatal depressive symptoms and greater difficulties forming attachment with their babies than women who have not experienced this kind of adversity. The aim of this study was to examine how emotional abuse and neglect experiences may favor the occurrence of psychological distress in pregnant women, and whether prenatal attachment might explain this association. Methods Participants comprised 128 Italian pregnant women ranging in age from 21 to 46 years (Mage = 33.4; SD = 6.10). Women responded to the following self-report instruments: CECA.Q and CTQ-SF, for the assessment of psychological maltreatment experiences; MAAS, for the evaluation of prenatal attachment; and PAMA, for the assessment of perinatal psychological distress. Results Pearson correlations revealed a positive association between childhood neglect and perinatal psychological distress and a negative association between childhood neglect and prenatal attachment scores. No significant correlations were found for emotional abuse. Perinatal psychological distress was negatively associated with prenatal attachment. Mediation analyses showed significant associations between childhood neglect and the dimensions of perinatal affectivity and prenatal maternal attachment. Prenatal maternal attachment mediated the relationship between neglect and perinatal psychological distress. Conclusions The transition to motherhood is a sensitive period, particularly for women who have experienced abuse and neglect during childhood. These experiences may negatively impact a woman’s disposition to emotionally and behaviorally engage in the formation of a bond with their unborn baby. These results may have important prevention and clinical implications and thus warrant further exploration.

Childhood emotional maltreatment (abuse and neglect) may contribute to the development of internalizing problems in adolescence. However, the mechanisms explaining this association should be examined further. This study explored the mediating role of insecure anxious attachment style in the relationship between emotional maltreatment and internalizing symptoms in a non-clinical sample of adolescents. Analyses were also conducted to determine whether gender moderated the direct and indirect pathways between emotional maltreatment and internalizing problems. We recruited 449 adolescents aged between 14 and 18 years old [(Mage)=16.46, standard deviation (SD)=1.38]. 60.8% of adolescents were female (Mage=16.51, SD=1.43), whereas 39.2% identified as male (Mage=16.39, SD=1.28). Participants completed a survey including socio-demographic information and three selfreport questionnaires: the Childhood Trauma Questionnaire-Short Form, the Attachment Style Questionnaire, and the Youth Self- Report for ages 11-18. Results showed that emotional abuse and neglect were related to internalizing problems both directly and indirectly through anxious attachment style. Girls who experienced higher levels of emotional abuse and who had an anxious attachment style reported more internalizing problems than boys, whereas higher levels of emotional neglect were associated with increasing levels of internalizing problems only for boys. This study expanded our knowledge of the role of anxious attachment in the onset of internalizing problems among adolescents with experiences of childhood emotional maltreatment.

The perinatal period may represent a particularly challenging time for expecting parents. Previous studies have highlighted an association between several perinatal risk conditions (e.g., childhood maltreatment, poor social support, and stress levels) and the development of psychopathological symptoms in pregnant women, especially depression symptoms. The current study examined the effects of psychosocial risk factors (childhood maltreatment, poor social support, and stressful events) on anxiety, depression, perceived stress, irritability/anger, relationship problems, psychosomatic symptoms, specific physiological problems, and addiction/at-risk behaviors. Sixty-one pregnant women (age range = 24–45) participating in a larger study completed questionnaires about childhood maltreatment (CECA Q.), Maternity Social Support Scale (MSSS), questionnaire on stressful events, and the Perinatal Assessment of Maternal Affectivity (PAMA) during their pregnancy. Results from regression analysis indicated that the presence of childhood maltreatment predicted elevated depressive symptoms, elevated irritability and anger, and elevated relationship problems. Further, stressful events in the year prior to pregnancy predicted elevated psychosomatic symptoms during pregnancy. No other significant associations were found. In this study, traumatic childhood events were strongly associated with mental health symptoms during pregnancy. This is an important finding that suggests the importance of screening and targeting psychotherapeutic interventions for vulnerable women during pregnancy.