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

Area of Science:

• Psychiatry
• Psychology
• Clinical Psychology

Background:

• Co-occurring personality disorder (PD) and substance use disorder (SUD) present complex treatment challenges.
• Mentalization-based treatment (MBT) is a therapeutic approach designed to improve emotion regulation and interpersonal functioning.
• Understanding patient experiences is crucial for refining MBT for this population.

Purpose of the Study:

• To explore how patients with co-occurring PD and SUD experience MBT.
• To identify specific elements of MBT that patients perceive as useful or less useful.
• To gain insight into the therapeutic mechanisms that contribute to treatment outcomes.

Main Methods:

• Qualitative study employing semi-structured interviews with 13 participants diagnosed with PD and SUD.
• Thematic analysis was conducted using a hermeneutical-phenomenological approach with researcher reflexivity.
• Interviews focused on participants' experiences with MBT elements, transference, and overall therapy perception.

Main Results:

• Key themes included "I am not alone," "Taking blinders off," "Just say it," "The paradox of trust," and "Follow me closely."
• Useful therapist interventions involved addressing the patient-therapist relationship, unspoken feelings, and affect validation/tolerance.
• Group therapy experiences highlighted feelings of sameness with peers and the discovery of different perspectives.

Conclusions:

• Patient experiences align with theoretical models of borderline personality pathology, particularly attachment disturbances and emotional dysregulation.
• Patients emphasize the importance of therapeutic relationship work, explicit discussion of transference/countertransference, emotional validation, and enhanced mentalizing.
• These findings underscore the value of specific MBT components for individuals with co-occurring PD and SUD.