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Reading this book has been alternately an exhilarating and a depressing experience. The authors have set out to describe their progress in thinking about, and trying to help, troubled youngsters and their parents over a period of twenty-five years. Dr Masterson had become disillusioned with the results of out-patient therapy for adolescent personality disorders by the late 1980s and had turned to intensive work in a residential setting for individuals presenting borderline disturbances. This volume describes the outcome for 31 youngsters 5 years after discharge from his unit. It is a thoughtful, well-planned account of the treatment, its results and of the underlying theories. I will deal with the sad news first.
Of 59 youngsters treated on the unit 22 were excluded from this survey as they had spent too short a time in treatment, 6 others could not be traced or refused to co-operate, leaving the 31 mentioned above. The mean age at admission was 15.7 (range 13.0 to 18.1). There were 20 girls and 11 boys, a familiar distribution in psychiatric units at this age. All were of at least average ability and 74 per cent were from social classes I and II. The average length of hospitalisation was 14.48 months. At follow-up 5 years later four levels of impairment were noted; 5 minimal, 13 mild, 7 moderate and 6 severe. That is to say that in spite of intensive and expensive treatment 42 per cent continued to have serious trouble. In the 22 excluded from the formal survey only 40 per cent could be traced and ‘the results were disappointing’.
Of the parent couples, 14 improved, 16 showed no change, one couple ‘got worse’. Where, as sometimes happened, only one parent (usually the mother) got better, there was conflict and a risk of divorce.
One should add that the authors compare these discouraging figures with more gloomy ones from a previous study of youngsters treated as out-patients only. In this sample of 43 adolescents, 75 per cent still had moderate to severe impairment at