Prozess des Mentalisierens in einer mentalisierungsbasierten Langzeittherapie für Borderline-Persönlichkeitsstörungen

Observer-based and computerized measures of the patient's mentalization in psychotherapy: A scoping review

OBJECTIVE

In recent decades, mentalizing has found its permanent place both in therapeutic practice and in psychotherapy research. Inconsistent results and null results are often found. Therefore, the different methodological approaches should be examined in more detail. A scoping review was conducted to provide an overview of the approaches that measure the patient's mentalizing ability based on therapy sessions or in the course of psychotherapy.

METHOD

For the scoping review, a literature search was conducted in four databases. A total of 3217 records were identified.

RESULTS

We included 84 publications from 43 independent studies. Most studies used the Reflective Functioning Scale and applied the scale to therapy sessions or the Adult Attachment Interview. The other identified approaches used a computerized text analysis measure or clinician-report measures. Mostly good psychometric properties of the measures were reported. The Reflective Functioning Scale applied to the Adult Attachment Interview was the only measure that proved to be sensitive to change.

CONCLUSION

More economical variants to the time-consuming Reflective Functioning Scale applied to the Adult Attachment Interview are being developed continuously. In some cases, there is no standardized approach, or the measures are used only sporadically and require further and more comprehensive psychometric evaluations.

Enhancing mentalization by specific interventions within mentalization-based treatment of adolescents with conduct disorder

Objective

Mentalization is discussed as a mechanism of change in psychotherapy due to its positive effects on psychological functioning. In order to specifically apply mentalization-based interventions, a better understanding of the relationship between interventions and in-session mentalization is needed. The study aimed to explore the association between interventions and effective mentalizing.

Method

Fifteen therapy sessions of three therapies with male adolescents with conduct disorder were transcribed and rated with the Reflective Functioning (RF) Scale and a newly developed Mentalization-based Treatment (MBT) intervention coding manual. The coded interventions were categorized into intervention levels according to the MBT manual. Fisher's exact tests were performed to test differences in frequencies of interventions in high-RF sequences (RF score ≥ 4) compared with remaining therapy sequences (RF score ≤ 3).

Results

Specific MBT interventions such as demand questions, affectelaboration, empathic validation, change of subject, challenge, patienttherapist relation and mentalizing for the patient were related to effective mentalizing. Moreover, intervention levels such as supportive & empathic, basic- mentalizing & affect mode and relational mentalizing were positively associated with effective mentalizing.

Conclusion

MBT interventions seem to promote effective mentalizing at various intervention levels. Interventions that enhance effective mentalizing seem to be patient specific. In line with MBT theory, their effect on effective mentalizing might depend on various variables, such as the patients' arousal and pre-mentalizing mode.

[Psychodynamic conflicts: Development of a questionnaire for the assessment by patients and their therapists]

Psychodynamic conflicts: Development of a questionnaire for the assessment by patients and their therapists Abstract. The OPD-CA conflict questionnaire represents a means of recording modes of coping with unconscious conflicts according to the Operationalized Psychodynamic Diagnostics (OPD-CA) for patients and their therapists. To select the items for the conflict questionnaire, we combined the expert ratings and psychometric quality criteria using a sample of 427 adolescents (53.6 % patients) and 44 therapists. The short version contains 28 items, which include 7 intrapsychic conflicts and their active and passive coping modes (total ICC = .855; p < .001). We found expected differences between healthy and clinically abnormal adolescents with a higher level of conflicts among outpatients. A comparison of the therapist's version with two different methods (assessment according to the sheet in OPD-CA and the conflict questionnaire) produced consistent assessments of the same patient both in the expert assessment (total ICC = .861; p < .001) and from the point of view of 52 participants in two OPD-KJ training courses (total ICC = .825; p < .001).

[Changes in the Level of Conflict through Psychodynamic Psychotherapy: The Perspective of Adolescent Patients and their Therapists]

Changes in the level of structure and conflict are, in addition to alleviating of symptoms, central goals of psychodynamic therapies. This study examines this question with a focus on intrapsychic development-impairing conflicts in the sense of the OPD-CA on a sample of 121 adolescents and their 46 therapists. At the beginning, in the middle and at the end of the M = 73.27 hours (SD = 17.40) therapy, they assessed the level of conflict and structure from the patients' and the therapists' perspectives. The results show large effect sizes with regard to the reduction of the overall conflict level from the point of view of the therapists (η2 = .33). While the therapists reported higher initial values in almost all intrapsychic conflicts and significant linear decreases over time, the therapy tended to sensitize the patients to the existence of an intrapsychic development-impairing conflict. With regard to the structural level, which was already quite good at the start of treatment, there were no significant changes over time. However, the overall structural level and the conflict scales contributed to the explanation of the variance in the severity of symptoms at the end of therapy.