Assessing mentalization in practice: Reliability of the mentalization-based treatment research adherence and...

Area of Science:

• Psychiatry
• Psychotherapy Research
• Clinical Psychology

Background:

• Mentalization-Based Treatment (MBT) requires robust fidelity assessment for accurate delivery and efficacy validation.
• Existing adherence measures for MBT have shown psychometric and conceptual limitations.
• There is a need for a reliable instrument aligned with contemporary MBT principles.

Purpose of the Study:

• To introduce and evaluate the psychometric properties of the Mentalization-Based Treatment Research Adherence and Competence Scale (MBT-RACS).
• To assess the inter-rater reliability of the MBT-RACS for both group and individual MBT sessions.
• To provide a reliable tool for research and clinical supervision in MBT.

Main Methods:

• The MBT-RACS was used to rate 126 recorded MBT sessions (104 group, 22 individual).
• Seventeen trained coders evaluated the sessions for adherence and competence using the MBT-RACS.
• Inter-rater reliability was calculated using intraclass correlation coefficients (ICCs).

Main Results:

• The MBT-RACS demonstrated strong overall inter-rater reliability across most domains for both group and individual sessions.
• High ICCs were observed for total adherence: .84 for group sessions and .95 for individual sessions (two coders).
• Reliability exceeded that typically reported for comparable adherence assessment instruments.

Conclusions:

• The MBT-RACS exhibits robust reliability, supporting its use in research and clinical supervision.
• Its format, focusing on broader, clinically meaningful domains, may enhance rating consistency.
• The scale contributes to methodological rigor, quality assurance, and effective MBT training and implementation.