Mentalization-Based Treatment From the Patients’ Perspective – What Ingredients Do They Emphasize?

Abstract

Objective: The aim of this study was to explore how patients with personality disorder (PD) and substance use disorder (SUD) experience mentalization-based treatment (MBT), in particular what they consider useful and less useful elements of the therapy. Method: Semi-structured qualitative interviews with 13 participants were conducted. Participants were interviewed on their experience of the different elements of MBT, their experience of working in the transference, and their view on MBT as a whole. Thematic analyses were performed within a hermeneutical-phenomenological epistemology, with an emphasis on researcher reflexivity. Results: The following themes were found in the material: “I am not alone,” “Taking blinders off,” “Just say it,” “The paradox of trust,” and “Follow me closely.” Three of these themes concerned therapist interventions; these involved addressing the relationship with the patients, addressing negative or unspoken feelings in the sessions, and validating and tolerating patients’ affect. Two themes concerned group therapy experiences; these were the experience of sameness with co-patients in group and the experience of discovering different perspectives in group. Conclusions: Patients’ experiences of useful elements in MBT resonate with theoretical tenets of (borderline) personality pathology, in particular attachment disturbances and emotional dysregulation. Patients highlight what we would label working in the therapeutic relationship, addressing transferential and counter-transferential processes explicitly, emotional validation, and enhancing mentalizing in its own right.

“If you don’t have a word for something, you may doubt whether it’s even real” – how individuals with borderline personality disorder experience change

“…Our findings on normalization also support Morken et al (2019b), who explored how patients with BPD features and substance use experienced mentalization-based treatment, and Farrell et al (2009), who published the first randomized controlled trial on schema therapy groups. Morken et al (2019b) found that by identifying with others with similar problems, patients who had suffered from shame and a sense of being bad achieved a sense of self-worth. After listening to co-patients, they felt normalized and less alone and bad.…”

“We Just Did Not Get on”. Young Adults’ Experiences of Unsuccessful Psychodynamic Psychotherapy – A Lack of Meta-Communication and Mentalization?

“…As a capacity, it is similar to reflective function in mentalization theory (Bateman and Fonagy, 2016). Indeed, patients with personality disorders and low capacity for mentalization have expressed their wish for therapists who communicate clearly in the therapeutic setting (Morken et al, 2019), indicating that patients in the present study would have benefitted from such an approach as opposed to the restrained version of the psychoanalytic stance they described their therapists applied. When not noticing the sudden shifts in mentalization capacity, the therapist underestimates the patient's difficulties which leads to interventions not adjusted to patient's level and needs.…”

Social Cognition Capacities as Predictors of Outcome in Mentalization-Based Treatment (MBT)

“…Several qualitative studies describing change processes among BPD patients have indeed highlighted the subjective impact of new relational experience, practice, and competence ( 47 – 50 ). Positive patient-reported group experiences—learning to gain and lend perspectives are indeed emphasized in a qualitative study of MBT ( 51 ). In our study, patient’s self-report indicated improvement of interpersonal problems among patients with mainly hypermentalizing problems.…”