Abstract
BackgroundReports on problems encountered in the implementation of complex interventions are scarce in psychotherapy literature. This is remarkable given the inherent difficulties of such enterprises and the associated safety risks for patients involved.Case descriptionA case study of the problematic implementation process of Mentalization- Based Treatment for Adolescents (MBT-A), a new therapy for 14 to 18 year old youngsters with severe personality disorders, is presented. The implementation process is described and analyzed at an organizational, team and therapist level.Discussion and evaluationOur analysis shows that problems at all three levels contributed and interacted to make the implementation cumbersome and hazardous.ConclusionThe implementation of complex psychotherapeutic programs for difficult patients could benefit from a structured attention to processes at multiple levels. We therefore propose a new comprehensive heuristic model of treatment integrity. This new model includes organisational, team and therapist adherence to the treatment model as necessary components of treatment integrity in the implementation of complex interventions. The application of this new model of treatment integrity potentially increases the chance of successful implementations and reduces safety risks for first patients enrolling in a new program.
Highlights
Reports on problems encountered in the implementation of complex interventions are scarce in psychotherapy literature
We propose a new comprehensive heuristic model of treatment integrity. This new model includes organisational, team and therapist adherence to the treatment model as necessary components of treatment integrity in the implementation of complex interventions. The application of this new model of treatment integrity potentially increases the chance of successful implementations and reduces safety risks for first patients enrolling in a new program
Several studies support the effectiveness of various psychosocial interventions for borderline personality disorder (BPD) in adults, including Mentalization-Based Treatment (MBT) [1], Dialectical Behaviour Therapy (DBT) [2], Schema-Focused Therapy (SFT) [3], TransferenceFocused Psychotherapy (TFP) [4], Systems Training for Emotional Predictability and Problem Solving (STEPPS) [5] and Cognitive Behaviour Therapy (CBT) [6]
Summary
Reports on problems encountered in the implementation of complex interventions are scarce in psychotherapy literature. Several studies support the effectiveness of various psychosocial interventions for BPD in adults, including Mentalization-Based Treatment (MBT) [1], Dialectical Behaviour Therapy (DBT) [2], Schema-Focused Therapy (SFT) [3], TransferenceFocused Psychotherapy (TFP) [4], Systems Training for Emotional Predictability and Problem Solving (STEPPS) [5] and Cognitive Behaviour Therapy (CBT) [6] These results have typically been obtained under optimal (experimental) conditions, including extensive supervision, adherence monitoring, and above average organizational about problems and the lessons learned has been a successful strategy to increase safety [8,9]. The strongly adapted program runs much smoother, while the favourable outcomes seem at least maintained, if not further improved
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