Mentalizing and Group Psychotherapy: A Novel Treatment for Antisocial Personality Disorder.

Antisocial personality disorder (ASPD) is a common condition associated with interpersonal and social violence, and current treatments are unsatisfactory. Mentalizing, which has developmental roots in attachment processes, offers a framework to reconsider treatment for ASPD, in which dysfunction of the attachment system temporarily inhibits affect regulation and reduces mentalizing abilities, resulting in impulsivity and relational reactivity. Mentalization-based treatment for ASPD (MBT-ASPD), which focuses on the mental and relational processes central to personality disorder rather than on anger management and violent behavior, is a promising intervention. Implemented as a group psychotherapy, MBT-ASPD targets the mentalizing vulnerabilities and attachment patterns of patients by using a semi-structured group process focused on personal formulation and by establishing group values to promote learning from other members and generating "we-ness." The treatment then emphasizes mentalizing in relationships. This article discusses the mentalizing model of ASPD and outlines strategies for MBT-ASPD from a therapy group conducted in Great Britain.

Single-session Mentalization-based Treatment Group for Law Enforcement Officers.

Law enforcement violence has emerged as a leading public health concern, and law enforcement officers are themselves at greater risk for a range of psychiatric disorders. Drawing on the significant empirical support for mentalization-based treatment (MBT), this paper explores the use of MBT as a transdiagnostic psychotherapy for law enforcement professionals. By helping patients to mentalize-that is, to "read," access, and reflect on mental states in oneself and other people-MBT could be useful as a dual-focus treatment, able to simultaneously impact psychiatric illness among law enforcement officers while also indirectly impacting the problem of law enforcement violence in the broader society. The core psychotherapeutic principles of MBT are reviewed, along with common vulnerabilities in mentalizing likely to arise for law enforcement professionals in the context of high emotional and interpersonal intensity. The authors outline a novel application of MBT which has implications for psychiatric treatment as well as police training: the single-session psychoeducation and psychotherapy group, where law enforcement officers practice both self-reflection and empathy in situations of relational conflict. Utilizing group process from a residential treatment program for first responders with mental health and substance use disorders, a case example is offered to illustrate this intervention.

Evaluating "mentalizing positive affect" as an intervention for enhancing positive affectivity in borderline personality disorder using a single-case multiple-baseline design.

Evidence-based treatments for borderline personality disorder (BPD), including mentalization-based treatment (MBT), have not adequately examined changes in positive affect (PA) in the treatment of BPD. Therefore, we developed a new intervention, "mentalizing positive affect," and evaluated its effect on PA, negative affect, BPD severity, ego-resiliency, and quality of life during MBT treatment for BPD. In a single-case multiple-baseline design, 4 female BPD patients received 6 months of individual MBT, after which they were followed up for 2 months. Intensive repeated measurements data were subjected to hierarchical linear modeling to analyze whether the positive intervention was related to changes in self-reported outcome measures. Our results failed to support a co-occurring increase in the reporting of PA related to the "mentalizing positive affect" intervention. However, the slope of PA increased at a quicker rate after the end of treatment, perhaps indicating a delayed treatment effect. "Mentalizing positive affect" was related to a marginally significant decrease in the mean level of BPD severity compared with standard MBT. Moreover, focusing on PA in MBT seemed feasible for maintaining a good working alliance. Our findings call for more research to test interventions aimed at enhancing PA in the treatment of BPD. Such efforts might well involve treatment of longer duration and higher intensity to increase the number of sessions, as well as longer follow-up periods, than we used. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Adversity, attachment, and mentalizing.

The papers in this special issue offer evidence of personality disorder as a dysfunction of higher-order cognition, which is conceptualized variously as a disorder of mentalizing, metacognition, mindfulness, social cognition and reflective function. While there may be differences in the scope of these concepts, they all imply that higher-order mental processing is at the core of personality function. In this commentary, the authors use mentalizing as an umbrella term for these concepts, and argue that it is the complex interaction of adversity, attachment and mentalizing that leads to the characteristic symptoms of borderline personality disorder and other personality disorders. Evidence is provided from the papers in this special issue, comments made on the findings and further avenues for research are recommended.

The MBT Adherence and Competence Scale (MBT-ACS): development, structure and reliability.

The properties of the 17-item Mentalization-Based Treatment Adherence and Competence Scale (MBT-ACS) were investigated in a reliability study in which 18 psychotherapy sessions, comprising two sessions by nine different therapists, were rated by seven different raters. The overall reliabilities for adherence and competence for seven raters were high, .84 and .88 respectively. The level of reliability declined by number of raters but was still acceptable for two raters (.60 and .68). The reliabilities for the various items differed. The MBT-ACS was found to be an appropriate rating measure for treatment fidelity and useful for the purposes of quality control and supervision. The reliability may be enhanced by redefining some items and reducing their numbers.

Psychotherapy for borderline personality disorder: mentalization based therapy and cognitive analytic therapy compared.

Mentalization Based Therapy (MBT) and Cognitive Analytic Therapy (CAT) are among a small number of psychotherapy approaches offering specific methods for the treatment of Borderline Personality Disorder (BPD). They share a number of features, notably both seek to integrate ideas and methods from psychoanalysis and cognitive psychology, pay attention to early attachment experiences and see harsh and inconsistent care, in combination with biological vulnerability, as playing an important part in the genesis of BPD offer treatment based on a developmental understanding of BPD, taking account of recent developments in observational research seek to provide therapy appropriate for use in the public service. These similarities, however, conceal a number of differences in underlying assumptions and emphases and are linked with contrasting therapeutic techniques. In this paper we present a discussion of key features of our models of normal and pathological development and a consideration of the conceptual underpinnings and of how far they are compatible with what is reliably known in the general field of psychology and how far it offers a model accessible to patients and clinician. Where our views diverge significantly, the reader will have some of the evidence on which to make a personal choice.

Mechanisms of change in mentalization-based treatment of BPD.

There are very few less contentious issues than the role of attachment in psychotherapy. Concepts such as the therapeutic alliance speak directly to the importance of activating the attachment system, normally in relation to the therapist in individual therapy and in relation to other family members in family-based intervention, if therapeutic progress is to be made. In group therapy the attachment process may be activated by group membership. The past decade of neuroscientific research has helped us to understand some key processes that attachment entails at brain level. The article outlines this progress and links it to recent findings on the relationship between the neural systems underpinning attachment and other processes such as making of social judgments, theory of mind, and access to long-term memory. These findings allow intriguing speculations, which are currently undergoing empirical tests on the neural basis of individual differences in attachment as well as the nature of psychological disturbances associated with profound disturbances of the attachment system. In this article, we explore the crucial paradoxical brain state created by psychotherapy with powerful clinical implications for the maximization of therapeutic benefit from the talking cure.

Mentalization-based treatment of BPD.

Psychoanalytically oriented partial hospital treatment for BPD has been shown to be more effective than treatment as usual in a randomized controlled trial and over 18 months of follow-up. Focus of treatment, in the context of group and individual psychotherapy, was on increasing the patient's capacity for mentalization, the capacity to think about mental states of oneself and others as separate from, yet potentially causing actions. We summarize the research and outline the essential theoretical and practical components of mentalization-based treatment. Core aspects of treatment include enhancing mentalization, bearing in mind patient deficits, using transference, retaining mental closeness, and working with current mental states. Finally, it is proposed that mentalization is a common theme in psychotherapy of BPD and may explain why different treatments "work."