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Mentalization-based therapy adherence and competence stimulates in-session mentalization in psychotherapy for borderline personality disorder with co-morbid substance dependence
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Uppsala University, Sweden.
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2017 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 27, no 6, p. 749-765Article in journal (Refereed) Published
Abstract [en]

Objective: To test whether adherence to mentalization-based treatment (MBT) principles predict better patient in-session mentalizing. Methods: Two sessions for each of 15 patients with borderline personality disorder and comorbid substance abuse disorder were rated for MBT adherence and competence. Individual patient statements were rated for Reflective Functioning (RF), therapist statements were rated as demanding RF or not. Data were analysed using multilevel modelling. Results: MBT adherence and competence predicted higher session RF (=.58-.75), even while controlling for pre-treatment RF. In addition, therapist interventions directed toward exploring mental states predicted higher RF of subsequent patient responses (=.11-.12). Conclusions: MBT adherence and competence were significantly related to patient in-session mentalizing, supporting the validity of MBT principles. Results point to the importance of supervision for therapists to become adherent to MBT principles. The small number of patients and sessions limits generalizability of results.

Place, publisher, year, edition, pages
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD , 2017. Vol. 27, no 6, p. 749-765
Keywords [en]
personality disorders; process research; psychoanalytic; psychodynamic therapy; substance abuse
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:liu:diva-143006DOI: 10.1080/10503307.2016.1158433ISI: 000413701000009PubMedID: 27093128OAI: oai:DiVA.org:liu-143006DiVA, id: diva2:1156516
Note

Funding Agencies|Swedish Research Council for Health, Working Life and Welfare [20070457]; Stockholm County Council [20080487]; Karolinska Institutet [20080487]

Available from: 2017-11-13 Created: 2017-11-13 Last updated: 2018-10-24
In thesis
1. Mentalizing: Competence and process
Open this publication in new window or tab >>Mentalizing: Competence and process
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Mentalisering : Som förmåga och process
Abstract [en]

Mentalizing means making sense of oneself and others in terms of mental states, such as thoughts and feelings. The Reflective Functioning (RF) scale is the golden standard in measuring mentalizing. This thesis aimed to explore the concept of mentalizing and its operationalization RF in different contexts and what RF means in human interaction. The first part of the thesis focused on capturing the applicability of RF in difficult situations of adulthood. The concept of mentalizing was studied as a trait capacity (in young criminal offenders and in mothers who reflected upon their relations to their children and upon limit setting in relation to their children). Findings in the first study indicated that mentalizing might be considered to function as a buffer against committing criminal acts. The second study showed that limit setting RF was more predictive of the mothers’ behavior, measured as emotional availability in interaction with their children, than their general RF concerning the child. In the second part of the thesis, mentalizing was investigated in therapy sessions and analyzed as a state and interactional phenomenon. In study III, therapist interventions were studied and found to be related to the degree of mentalizing that occurred in patient statements, implying that interventions that demanded mentalizing predicted higher levels of RF in patient statements. In study IV, a new instrument to investigate dyadic mentalizing (i. e. both patient and therapist together) was tested. In one of the cases studied, higher dyadic RF predicted patient rated symptom relief in the next session, indicating that dyadic RF might be a mechanism of change. In conclusion, the studies of this thesis suggest that mentalizing can be meaningfully viewed both as an individual competence and as an interactional phenomenon and that RF seems to be highly context- and relationship-specific.

Abstract [sv]

Mentalisering är att begripliggöra sig själv och andra utifrån bakomliggande mentala tillstånd såsom tankar och känslor. Det mest använda sättet att mäta mentalisering är Reflective functioning scale (RF-skalan) som appliceras på anknytningsintervjuer. Avhandlingen syftade till att utforska begreppet mentalisering och RF i olika kontexter samt vad RF har för betydelse i mellanmänskligt samspel. Första delen av avhandlingen fokuserades kring att fånga användbarheten av RF gällande svåra situationer i vuxenlivet. Då undersöktes mentaliseringsbegreppet som en förmåga hos individen (hos unga män som satt i fängelse dömda för olika brott och hos mödrar som reflekterade över relationen till sina barn och över gränssättningssituationer i relation till barnen). Resultaten i den första studien indikerade att mentalisering kan fungera som buffert mot att begå brott. Den andra studien visade att förmågan att mentalisera kring gränssättning i högre utsträckning predicerade mödrarnas beteende i form av emotionell tillgänglighet i samspelet med barnet än generell mentaliseringsförmåga kring barnet. I andra delen av avhandlingen undersöktes mentalisering i terapisessioner, alltså som ett interaktionsfenomen. Studie III handlade om att undersöka hur terapeutens interventioner påverkade graden av mentalisering i patientensuttalanden under en terapisession. Resultaten visade att interventioner som direkt uppmanade till mentalisering ledde till högre RF hos patienten, vilket ger stöd för teorin bakom mentaliseringsbaserad terapi. I den sista studien, en fallstudie, prövades ett nytt instrument avsett att bedöma graden av mentalisering hos den terapeutiska dyaden, dvs både terapeut och patient tillsammans. Ett av resultaten var att högre dyadisk RF kunde predicera minskade symtom i nästföljande session, vilket tyder på att dyadisk RF kan vara en terapeutisk mekanism. Sammanfattningsvis pekar den här avhandlingen på att mentalisering bör ses som både en individuell förmåga och ett interaktionsfenomen samt att RF i hög grad är både relations- och kontextspecifikt.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 43
Series
Linköping Studies in Arts and Sciences, ISSN 0282-9800 ; 756Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 211
Keywords
Reflective functioning, dyadic mentalizing, parent-child interaction, therapeutic process, criminal offenders, mentalization-based treatment, mentalizing in action, explicit, implicit, psychotherapy process research, Reflective functioning, dyadisk mentalisering, föräldra-barn-interaktion, terapiprocess, kriminalitet, mentaliseringsbaserad terapi, psykoterapiprocessforskning, implicit, explicit
National Category
Psychology Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-152253 (URN)10.3384/diss.diva-152253 (DOI)9789176851890 (ISBN)
Public defence
2018-11-16, I:101, Hus I, Campus Valla, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-10-24 Created: 2018-10-24 Last updated: 2018-11-09Bibliographically approved

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