Mentalization-based therapy adherence and competence stimulates in-session mentalization in psychotherapy for borderline personality disorder with co-morbid substance dependence.
To test whether adherence to mentalization-based treatment (MBT) principles predict better patient in-session mentalizing.



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.



MBT adherence and competence predicted higher session RF (β = .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 (β = .11-.12).



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.
a Department of Behavioral Sciences and Learning , Linköping University , Linköping , Sweden.
Clara
C
Möller
a Department of Behavioral Sciences and Learning , Linköping University , Linköping , Sweden.
Linda
L
Karlgren
a Department of Behavioral Sciences and Learning , Linköping University , Linköping , Sweden.
Anton
A
Sandell
a Department of Behavioral Sciences and Learning , Linköping University , Linköping , Sweden.|b Center for Clinical Research Sörmland , Uppsala University , Uppsala , Sweden.
Fredrik
F
Falkenström
a Department of Behavioral Sciences and Learning , Linköping University , Linköping , Sweden.|c Center for Dependency Disorders , Stockholm County Council , Stockholm , Sweden.|d Center for Psychiatry Research Stockholm , Karolinska Institutet , Stockholm , Sweden.
Björn
0000-0003-4313-1011
B
Philips
D000328:Adult; D001883:Borderline Personality Disorder / Q000453:epidemiology / Q000628:therapy*; D002983:Clinical Competence / Q000592:standards*; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D013811:Psychotherapeutic Processes; D064889:Psychotherapy, Psychodynamic / Q000379:methods* / Q000592:standards; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy*; D056345:Theory of Mind; D055815:Young Adult
personality disorders; process research; psychoanalytic/psychodynamic therapy; substance abuse