Pseudomentalization as a Challenge for Therapists of Group Psychotherapy With Drug Addicted Patients

Abstract

One of the main challenges in group therapy with drug-addicted patients is collective pseudomentalization, i.e., a group discourse consisting of words and clichés that are decoupled from any inner emotional life and are poorly related to external reality. In this study, we aimed to explore the phenomenology of pseudomentalization and how it was addressed by the therapist in an outpatient group for drug-addicted patients. The group was composed of seven members, and the transcripts of eight audio-recorded sessions (one per month) were rated and studied. The interventions of the therapist were measured with the mentalization-based group therapy (MBT-G) adherence and quality scale by independent raters. Two sessions, one with the highest and one with the lowest adherence, were selected, and the clinical sequences of pseudomentalization were analyzed in a comparative way. The findings revealed that pseudomentalization does occur as a collective phenomenon, akin to “basic assumptions” of Wilfred Bion, which we reconceptualized in this study. Any pseudomentalization seemed to be reinforced by the therapist when she was presenting frequent and long interventions, when abstaining from the management of group boundaries, when providing questions focused more on content than on the mental states of the group members, and when not focusing on emotions. However, the ultimate source of collective pseudomentalization seemed to be the fear of the group members of being overwhelmed by painful emotions, mental confusion, and a loss of identity. The findings also indicated that the principles of MBT-G may be a good antidote to pseudomentalization.

Antisocial personality disorder in group therapy, kindling pro-sociality and mentalizing

“…Inderhaug & Karterud ( 2015 ) has written well about pseudomentalizing in groups, they suggested that therapist failed to manage authority and overplayed the not-knowing position as an explanation for chaotic group sessions. Esposito and colleagues ( 2021 ) have made an important contribution to the understanding of pseudomentalizing in groups with substance addicted patients, where they suggest that there are three types of pseudomentalizing where the intrusive type is perhaps what is most recognizable in our study. The intrusive pseudomentalizing appears certain about mental states and lacks any connection between thoughts and feelings (Esposito et al ., 2021 ).…”

“…Is a high tempo and the party like quality of the dialogue an example of pseudomentalizing, the antisocial version? Pseudomentalizing has been described as potentially very destructive in group therapy (Esposito et al ., 2021 ). Therapists often have problems with discovering when pseudomentalizing is present, they lack authority to steer the group away from pseudomentalizing and furthermore, we assume that a pseudomentalistic dialogue does not have the potential to produce change.…”

“…The intrusive pseudomentalizing appears certain about mental states and lacks any connection between thoughts and feelings (Esposito et al ., 2021 ). Since pseudomentalizing does not appear in all group sessions, the therapeutic style (MBT-adherence) probably matters in generating a mentalizing dialogue (Esposito et al ., 2021 ). The high tempo described from the therapists in this study suggests that they struggle with chaotic group sessions, and we suspect that pseudomentalizing is the dominant mental stance in the patients in these moments.…”

“…Esposito and colleagues (2021) have made an important contribution to the understanding of pseudomentalizing in groups with substance addicted patients, where they suggest that there are three types of pseudomentalizing where the intrusive type is perhaps what is most recognizable in our study. The intrusive pseudomentalizing appears certain about mental states and lacks any connection between thoughts and feelings (Esposito et al, 2021). Since pseudomentalizing doesn't appear in all group sessions, the therapeutic style (MBT-adherence) probably matters in generating a mentalizing dialogue (Esposito et al, 2021).…”

The relationship between treatment integrity and outcome in group psychotherapy: A systematic review

“…However, this is of fundamental importance in the study of integrity. It is possible, in fact, that more informative results emerge from studies that focus on the reciprocity of variables (Webb et al, 2010), since adherence and competence could show a greater impact on the outcome precisely in the interaction with other aspects of the process and with the characteristics of patients and therapists themselves (Esposito et al, 2021(Esposito et al, , 2022. In the current review, only three In this regard, it is important that researchers report in their studies not only effect sizes of the treatment but also effect sizes of the relationship between treatment integrity and outcome.…”