Mentalization-based Treatment Research Articles

Narrative Identity within Mentalization-Based Group Therapy for Adolescents: A Feasibility Study.

Borderline personality disorder (BPD) is characterized by severe disturbances related to understanding oneself and other people and can be reliably detected and treated in adolescence. In this feasibility study, we aimed to focus on the features of, and changes in, narrative identity throughout the course of Mentalization-Based Treatment in Groups (MBT-G) for adolescents with BPD. Six female patients (M = 15.2, SD = 0.75) joined between 16 and 31 (M = 23.83) MBT g sessions. The narrated events within each session across sessions were coded for themes of agency and communion and the narrated reactions were coded for personality functioning. The patients and their parents also completed several self-report measures before and after therapy. Themes of diminished agency and communion were identified, with communion as the dominating theme. When comparing the patients' first five sessions with their last five sessions, there was an increase in themes related to agency and decreased in communion. The narrated reactions were dominated by themes related to thwarted self-functioning and primarily identity, although intimacy was also present. Patients improved in terms of self-reported functioning and internalizing and externalizing behavior before and after end of treatment. The importance of narration in BPD (group) therapy is discussed alongside clinical implications.

Pour une cohabitation pragmatique des modèles théoriques et cliniques : l’exemple du « Good Psychiatric Management » dans le traitement du trouble de personnalité borderline

Borderline personality disorder (BPD) is a common disorder in general and clinical populations and is related to potentially severe medical and socio-professional consequences. Treatment of BPD is based on evidence-based psychotherapies (such as Dialectical Behavioral Therapy, Mentalization-Based Therapy, Schema-Focused Therapy or Transference Focused Psychotherapy), which have been shown effective but are poorly available in France. Pharmacological treatments, which are more easily available, are not effective in treating symptoms of the disorder but can be useful in management of comorbidities. In this context, recently called “generalist” models have been developed, which every well-trained psychiatrist can implement in their daily practice, combining practical elements from evidence-based psychotherapies and elements of pharmacological management of symptoms and comorbidities. The purpose of this article is to present one of these models, the Good Psychiatric Management (GPM) and its basic principles and its applications, and to provide one of the first French-speaking resources about this model. In addition, beyond the practical elements proposed by the GPM, we discuss the deeper question that it raises, namely the question of a pragmatic integration of different theoretical and clinical models. Indeed, the treatment of BPD patients is at the junction of different conceptualizations of mental pathology (psychopathological, neurobiological) and different modalities of practice (psychotherapy, biological psychiatry). In a French context, that sometimes separates these two models, and in our opinion GPM constitutes an example of clinical collaboration which shows the interest of the combined role of psychiatrist-psychotherapist.

The effectiveness of a day hospital mentalization-based therapy programme for adolescents with borderline personality traits: Findings from Touchstone-Child and Adolescent Mental Health Service.

Individuals with borderline personality disorder (BPD) are at a substantial risk of harm to themselves and others, experience high levels of functional impairment and typically are high users of tertiary healthcare to address their mental health concerns. As indicators for BPD typically emerge in adolescence, a day therapy service in Bentley, Western Australia, Touchstone Child and Adolescent Mental Health Service (CAMHS), was developed as an intensive intervention for adolescents with indicators for BPD and its associated symptomology. Touchstone utilizes mentalization-based therapy (MBT) in a therapeutic community setting, where the current study sought to document the anecdotal outcomes using the data provided at Touchstone, to enable a greater understanding of this treatment approach for adolescents with indicators for BPD. Forty-six participants attended the Touchstone programme between 2015 and 2020. The programme involved 6months of MBT (group and individual), occupational therapy, education and creative therapies. Measures of self-injury, mood and emergency department presentations were collected pre- and post-programme. Results indicate that participants show a reduction in non-suicidal acts and thoughts, as well as a reduction in negative moods and feelings from pre-Touchstone to post-Touchstone. There is also a decrease in participant presentation to tertiary emergency departments for mental health concerns. The current study shows evidence for the efficacy of Touchstone as an MBT therapeutic community intervention to reduce symptoms of emerging BPD and effectively reduce presentations to emergency departments for mental health presentations, alleviating pressure on tertiary hospitals and reducing economic impact of adolescents within this demographic.

An evaluation of a pilot psychoeducational group for older adults with complex emotional needs

Older people are less likely to receive psychological treatment than younger adults despite having a high level of need and complexity. This article outlines the design, implementation, and evaluation of a 9-session psychoeducational group for adults with complex emotional needs (CEN), aged 65 and over. The group collated material from Dialectical Behaviour Therapy (DBT), Mentalisation Based Treatment (MBT), Schema Focused Therapy (SFT), Structured Clinical Management (SCM), and Radically Open DBT (RO-DBT). The aim of the group was to collaborate with participants so that they could help us understand the needs and wishes of older people with CEN. We recruited 6 individuals with CEN from the Later Life Community Mental Health Teams in Manchester. We found that all treatment modalities were well received, that participants had an interest in treatments focusing on understanding self and others, and that clients had behavioural deficits relating to emotional overcontrol. We learnt that CEN in later life manifest differently, and as such may require a varied and adaptive response from psychological services to meet the diverse needs that present in this client group.

청소년 자녀를 둔 부모를 위한 정신화 훈련 프로그램 개발 및 효과

This study is intended to develop a mentalization training program for parents with adolescents. Based on mentalization development theory and the mentalization-based treatment for adolescents and families by Fonagy and his colleagues, a program with four stages of understanding the mentalization attitude, practicing explicit mentalization, exploring mentalization inhibitory factors, and reinforcing effective mentalization was developed. 18 parents in G and P cities were recruited; the program was conducted on the experiment group and no treatment was given on the control group. According to analysis, the program had a significant effect on reducing parental non-mentalization and improving emotional regulation and relationships with adolescents, whereas there was no significant effect on certainty, interest and curiosity, which are sub-factors of mentalization. A supplementary analysis of the sessions and comments indicated that the program led parents to perceive their children as separate individuals from themselves.
 And through the process of sensitively recognizing and validating each other's emotional signals, the level of arousal can be appropriately adjusted, so that they can interact without being easily immersed in their own and children's emotions. It leads to a positive virtuous cycle of gaining empathy from children as well as restoring confidence in maintaining close relationships with children.

청소년 자녀를 둔 부모를 위한 정신화 훈련 프로그램 개발 및 효과

This study is intended to develop a mentalization training program for parents with adolescents. Based on mentalization development theory and the mentalization-based treatment for adolescents and families by Fonagy and his colleagues, a program with four stages of understanding the mentalization attitude, practicing explicit mentalization, exploring mentalization inhibitory factors, and reinforcing effective mentalization was developed. 18 parents in G and P cities were recruited; the program was conducted on the experiment group and no treatment was given on the control group. According to analysis, the program had a significant effect on reducing parental non-mentalization and improving emotional regulation and relationships with adolescents, whereas there was no significant effect on certainty, interest and curiosity, which are sub-factors of mentalization. A supplementary analysis of the sessions and comments indicated that the program led parents to perceive their children as separate individuals from themselves.
 And through the process of sensitively recognizing and validating each other's emotional signals, the level of arousal can be appropriately adjusted, so that they can interact without being easily immersed in their own and children's emotions. It leads to a positive virtuous cycle of gaining empathy from children as well as restoring confidence in maintaining close relationships with children.

The impact of a combined mentalisation-based therapy and therapeutic community programme for adolescents with borderline personality disorder traits on service utilisation in Western Australia.

This study assessed the effect of a mentalisation-based therapy (MBT) treatment programme on the utilisation of Western Australian public hospitals for mental health presentations over an 18-month period. Hospital data included the number of visits to the emergency department (ED), the number of inpatient admissions to hospital and length of stay of the admissions. Participants included 76 adolescents aged 13-17 years old, who presented with borderline personality disorder (BPD) traits. The Touchstone treatment programme is a time-limited intensive programme that utilises MBT in the context of a therapeutic community. Hospital data for the participants were collected and analysed from three time points; 6 months prior to attending the programme, during the 6-month programme (active treatment) and 6 months after the programme. Results found a statistically significant decrease in hospital utilisation from pre to post programme, with a decline in ED visits, inpatient admissions and admission length of stay. This study presents promising preliminary evidence for the effectiveness of an intensive MBT programme as an intervention for adolescents with BPD features and has significant implications for the public health system in terms of providing effective community-based treatment for this difficult to treat population as well as reducing pressure on tertiary care.

Mentalizing the therapist - Therapist experiences with short-term mentalization-based therapy for borderline personality disorder: A qualitative study.

Mentalization-Based Therapy (MBT) was originally developed as a structured psychotherapy approach developed to treat borderline personality disorder (BPD) lasting up to 18 months in outpatient settings. However, a short-term (5 months) MBT program has recently been developed. No studies have investigated how MBT therapists experience the shift towards conducting short-term MBT for BPD. The objective of this study was to explore therapist experiences with conducting short-term MBT for outpatients with BPD in the Danish mental health services. Semi-structured qualitative interviews were conducted with seven therapists about their experiences with short-term MBT after a one-year pilot phase. The interviews were verbatim transcribed and analyzed using thematic analysis. The following four major themes from the therapists' experiences with short-term MBT were found in the qualitative analysis: (1) The longer the better, (2) Change processes can be intellectual or experiential, (3) Short-term therapy is hard work, and (4) Termination is more challenging in short-term MBT. Most therapists were overall reluctant towards changing from long-term to short-term MBT. These therapist experiences could inform implementation of short-term MBT in mental health settings in the future.

Dialectical Integration: The Case of Psychoanalysis and Cognitive Behavioral Therapy

Based on Hegel's dialectics, we argue that different psychotherapies considered monolithic such as cognitive behavioural therapy (CBT) and psychoanalysis, even though they hold radically different views on human suffering and therapy's aims, profoundly influence each other. We call this mutual influence dialectical integration (DI). DI is the result of unconscious processes that are activated by antagonism and negation for self‐constitution. In a dialectically formative process, the self‐constitution of CBT and psychoanalysis each is achieved by means of the negation of part of itself, which undergoes alienation in the other, thereby superficially taking the form of a rejection of the other approach. But whenever theoretical or practical lacunae occur in the unfolding of these disciplines, they negate this primary negation and re‐internalize the alienated self‐component. This part does not return in its original—and negated—form, but, through a sublation introducing theoretical and practical development. This is illustrated here by Hartmann's ego psychology, Beck's cognitive theory, Young's schema therapy, and Bateman & Fonagy's mentalization‐based therapy (MBT). We show how these developments incorporate elements of otherness, which are not simply extraneous to the tradition but also part of it. We conclude by showing how DI gives rise to recognition and containment of otherness in both schools.

Holding a foster child’s mind in mind: study protocol for a cluster-randomized controlled trial of mentalization-based therapy (MBT) for foster families

BackgroundChildren in foster care are psychologically vulnerable and show more social, developmental, and behavioral problems than those living with their family of origin. Many foster parents struggle to care for these children, some of whom have experienced severe adversity. Research and theory suggest that developing a strong and supportive foster parent–child relationship is essential for foster children to become more well-adjusted and experience a decrease in behavioral problems and emotional maladjustment. Mentalization-based therapy (MBT) for foster families aims at increasing the reflective functioning of the foster parents, thus promoting the development of more secure and less disorganized child attachment representations, which is subsequently proposed as a factor that reduces behavioral problems and emotional maladjustment in children and promotes their overall well-being.MethodsThis is a prospective cluster-randomized controlled trial with two conditions: (1) the intervention group participating in MBT, and (2) the control group who receive usual care. Participants are 175 foster families with at least one foster child aged 4–17 years with emotional or behavioral problems. The intervention will be offered to foster families by 46 foster care consultants from 10 municipalities in Denmark. The foster care consultants will be randomized to MBT training (n = 23) or usual care (n = 23). The primary outcome is the psychosocial adjustment of the foster child measured by the Child Behavior Checklist (CBCL) as reported by foster parents. Secondary outcomes include child well-being, parental stress, parent mental health, parent reflective function and mind-mindedness, parent/child relations, child attachment representations, and placement breakdown. In order to explore implementation fidelity as well as practitioner experiences, we will administer questionnaires designed for this study and conduct qualitative research exploring the practice of the MBT therapists.DiscussionThis trial is the first experimental study of a family therapeutic intervention based on attachment theory for foster families within the Scandinavian context. This project will contribute with novel knowledge on attachment representations in foster children and the effects of an attachment-based intervention on essential outcomes for foster families and children.Trial registration ClinicalTrials.gov NCT05196724. Registered on January 19, 2022.

Applying principles of mentalizing based therapy to music therapy methods

Mentalizing is the process of making sense of behavior in oneself and in others. Mentalization-based treatment (MBT) is a theoretical framework that is parallel to creative arts therapies in that it seeks to foster co-regulation of affect, improve reflective functioning, and influence adaptive changes in personality by addressing the attachment needs of the client. While there has been a limited amount of investigation on the application of MBT concepts to music therapy, the primary focus has been on musical improvisation, neglecting its application to the other three methods in music therapy (receptive, compositional, re-creational). Here, we provide a review of MBT concepts, an explanation of the therapeutic function of music in mentalizing, and approaches to apply MBT concepts to all four methods of music therapy through fictional vignettes. The ability of music to help people better understand themselves and others suggests that it is a welcome addition to therapy that incorporates the principles of mentalizing.

The first German evidence-based clinical guidelines on borderline personality disorder

IntroductionThough the evidence regarding the psychotherapeutic and drug treatment of borderline personality disorder (BPD) is rapidly accumulating, with more then 120 randomised controlled trial on the clinical treatment being availabe currently, no evidence-based guidelines existed as yet in Germany. This talk will present the first German evidence-based clinical guidelines for BPD.ObjectivesIn this talk the German evidence-based clinical guidelines for borderline personality disorder will be presented, and focuses and important recommendations highlighted.MethodsA diverse, multidisciplinary panel, including members with research and clinical expertise in the treatment and care of individuals with BPD as well as representatives of persons with lived experience and their relatives, has developed the first evidence-based German treatment guidelines for BPD. The Australian NHMRC and the British NICE guidelines were used as source guidelines and adapted, based on the findings of updated literature searches. All recommendations were consented in an independently moderated, formalised consensus process. Special attention was paid to the management of financial and non-financial conflicts of interest.ResultsThe guidelines support the early detection and treatment of BPD and recommend that the diagnosis be made in adolescents from the age of twelve years on. Disorder-specific psychotherapies, i.e. structured psychological therapies that are specifically designed for people with BPD, are recommended as the first-line treatment for BPD. If the primary focus is the treatment of self-harm, Dialectical Behaviour Therapy or Mentalisation-Based Treatment are recommended. Drug treatment should only be considered if in crisis psychological interventions do not suffice and should be withdrawn as early as possible. Besides, drug treatment may only have a role if required for the treatment of comorbid psychic disorders. The guidelines also recommend educating significant others of the person concerned about the disorder and including them in the development of crisis plans. It is also recommended to offer support to relatives, especially if they are children or adolescents. Also, the role of individuals with BPD who are parents is considered, and early support to foster parenting skills and attachment relationships is recommended.ConclusionsThe first evidence-based German guidelines on BPD are now available and will help to ameliorate the health care of persons with a diagnosis of BPD. The publication of an English version is impending.Disclosure of InterestNone Declared

Investigating the Effect of Mentalization-based Therapy (MBT) and Filial Therapy on Interactions of Student with Attention Deficit Hyperactivity Disorder: Parent and Teacher-child Interactions

Investigating the Effect of Mentalization-based Therapy (MBT) and Filial Therapy on Interactions of Student with Attention Deficit Hyperactivity Disorder: Parent and Teacher-child Interactions

A mentalization-based approach to healing children exposed to adverse experiences: Tools for residential care.

It is well documented how adverse childhood experiences can inhibit child development and mentalizing ability and lead to high risk of developmental psychopathology. Mentalization-based treatment (MBT) has been established as an effective approach to treatment for a long range of psychopathologies with both in- and outpatient treatment, yet the evidence base for effective clinical interventions that can help guide professionals working in residential care on how to support the development of neglected and traumatized children is underdeveloped. This article demonstrates a mentalization-based approach to understanding and working with children in residential care, and offers practical models and tools as well as considerations on implementation that are beneficial and easy to apply, demonstrated through cases. The STORM model and "Obtaining Skills" screening tool may be helpful models for professionals addressing mentalization in children while working in challenging environments such as with traumatized and neglected children.

Adapting Short-Term Mentalization-Based Therapy to ICD-11 Personality Disorder in Adolescents.

Following the introduction of the 11th revision of the International Classification of Diseases (ICD-11), adolescents can now be diagnosed with a personality disorder based on severity ranging from mild to moderate to severe. This dimensional model has potential implications for treatment, as it allows clinicians and researchers to search for effective treatments targeting adolescents at different severity levels rather than offering all patients the same treatment. In this conceptual paper, we propose that the short-term mentalization-based therapy (MBT) program, originally developed to treat adults with borderline personality disorder (BPD), has potential clinical advantages for adolescents with ICD-11 personality disorder at the mild to moderate severity level. The short-term MBT program is a 5-month structured treatment approach including individual therapy, combined psychotherapy with the individual therapist also being one of the group therapists, and closed-group therapy to enhance cohesion and a feeling of security. The purpose of this paper is to make a case for the use of this format, as opposed to the traditional long-term MBT format, for adolescents with BPD. Future research should include large-scale randomized clinical trials powered to assess patient-important outcomes.

The effectiveness of the program based on mentalization and mindfulness (mother and child) in behavioral and emotional problems of primary school children

Purpose: The purpose of this study was to investigate the effectiveness of the program based on mindfulness and mindfulness (mother and child) in behavioral and emotional problems of primary school children. Methods: This quasi-experimental research was pre-test-post-test and follow-up with a control group. The sampling method was voluntary. The volunteers of the experimental group were given a pre-test before the implementation of mentalizing interventions, and after the intervention, a post-test and the control group did not receive any intervention, but they also took a pre-test and a post-test. The sample group of first and second year primary school students had behavioral problems. The experimental group was trained in mindfulness sessions in eight sessions (Burdick, 2014). The research tool included the Achenbach-Child Behavior Inventory (Achenbach and Rescorella, 2007). In this research, analysis of variance with repeated measurements and Bonferroni's post hoc test were used to check the difference in means and data analysis was done with the help of SPSS 24 software. Results: The results showed that mentalization-based treatment on children's behavioral problems in the areas of anxiety/depression (F=78.35, P<0.001), withdrawal/depression (F=16.95, P<0.001) P < 0), physical complaints (F=19.65, P<0.001), thinking problems (F = 60.34, P<0.001), law-breaking behavior (F=12.86, P<0.001) and aggressive behavior (F=79.61, P<0.001) were effective. Conclusion: It can be concluded that the program based on mindfulness and mindfulness (mother and child) can be used to reduce the behavioral and emotional problems of primary school children.

Management of suicidal crisis: mentalizing as a team

The hospital management of patients experiencing a suicidal crisis and suffering from a personality disorder is complex for caregivers. The care model must be adapted and applied by a multidisciplinary team. The emotional charge of these crisis situations makes it difficult for caregivers to maintain their ability to treat mental states with curiosity and without necessarily experiencing them as they appear to them. In other words, it could be difficult to mentalize. For example, an expressed desire to die may be much more complex in reality. Mentalizing abilities are challenged differently depending on our role with the patient. In this article we explore the specifics of interdisciplinary crisis work through the lens of mentalization-based therapy.

The effectiveness of mentalization-based therapy on parent-child interaction and parenting stress: a randomized controlled trial study on children with symptoms of tic disorders and their mothers

Aim: The main objective of this research was the effectiveness of mentalization-based therapy on parent-child interaction and parenting stress in a randomized controlled trial study on children with symptoms of tic disorders and their mothers. Methods: The method of the current research was quasi-experimental with a pre-test, post-test and follow-up plan with a control group. The research sample consisted of 30 mothers and their children with symptoms of tic disorders who had referred to counseling centers and clinics in Mako city in the second half of 2022. They were selected as available and randomly divided into two groups. Experiment and control (15 people in each group) were assigned. The experimental group participated in 15 sessions of the mentalization-based therapy group intervention program, and the control group did not receive any intervention. The subjects of both groups answered the questions of the parent-child relationship scale and the short form of the parental stress scale in the pre-test and post-test phases. Data analysis was done using mixed multivariate analysis of variance test. Results: The results of mixed multivariate analysis of variance indicated the effectiveness of mentalizing group therapy on improving the dimensions of parent-child relationship and parenting stress of children (P<0.001). Also, the results showed that mentalization intervention reduces the parenting stress scores of children with tic disorder symptoms (P<0.001). Conclusion: It can be concluded that the therapeutic mentalization group intervention is effective in improving the dimensions of the parent-child relationship and parenting stress of children with symptoms of tic disorder, and this treatment can be used to reduce the psychological problems of children with tic disorder. Symptoms of tic disorder.

Influence of Cultural and Contextual Factors on the Presentation, Risk Factors, and Treatment of Narcissistic Personality Disorder

Background: In spite of personality disorder is a common topic in the field of psychology and psychiatry, there are still very few studies few studies focusing on cultural and contextual factors of Narcissistic personality disorder (NPD).Method: By reviewing the literature about three countries UK, US and China, the precent study sort out the sociocultural and contextual differences of prevalence, presentation, risk factors and treatment of Narcissistic Personality Disorder (NPD).Result: Contextual and cultural factors have great impact on wide range of NPD’s different aspects. For the prevalence rate of three countries, comparing the highest percentage of three data, UK’s NPD prevalence rate is greater than US, and China has the less NPD prevalence rate. Concerning the presentation of NPD, female and male patients present variously. There is no data responding three countries’ patients’ NPD presentation. With regard of different risk factors, biology, psychotherapy and sociocultural are three of the most essential ones. Eventually, the NPD treatments of three different countries shows significant variety, including Chinese treatments related to traditional medicine, British mentalisation-based treatment and most widely used treatment in America--dialectical behavior therapy.

Mentalizing the patient-Patient experiences with short-term mentalization-based therapy for borderline personality disorder: A qualitative study.

Mentalization-based therapy (MBT) is an evidence-supported psychotherapy approach for borderline personality disorder (BPD) that has been implemented in mental health services worldwide. Originally, MBT was developed as an 18-months program for BPD. However, a short-term (5 months) MBT program has been developed. Research into patient experiences with long-term MBT for BPD is scarce, and no studies have investigated patient experience with short-term MBT for BPD. The objective of this study was to explore patient experience with short-term MBT for BPD in the Danish mental health services. Semi-structured qualitative interviews were conducted with 12 outpatients diagnosed with BPD, who attended short-term MBT for 5 months. The interviews were verbatim transcribed and analyzed using thematic analysis with double coding. The analysis resulted in four subordinate themes: (1) Treatment duration - too short or appropriately short?, (2) The group as a "safe space," (3) Bad experiences impacted treatment negatively, and (4) My life has changed for the better. The results suggest that most of the patients were overall satisfied with short-term MBT, which they experienced as having a positive impact on their lives. However, a subgroup of patients wanted more therapy. This study highlighted the strengths and limitations of short-term MBT for BPD as experienced by the patients, and points to barriers in developing service-user informed short-term treatment options for BPD.