Mentalization-based-treatment techniques across psychodynamic, cognitive and MBT therapies

This study examined whether therapists from orientations that do not explicitly target mentalizing-namely psychodynamic therapy (PDT) and cognitive behavioural therapy (CBT)-use interventions consistent with Mentalization-Based Treatment (MBT), and how their use compares with MBT-oriented therapy.

Seventy-five verbatim transcripts were randomly selected from audio-recorded psychotherapy sessions involving patients with personality disorders or subclinical personality difficulties. Therapist orientation was determined by self-identification (MBT = 25, CBT = 25, PDT = 25). Sessions were independently rated using the MBT Adherence and Competence Scale (MBT-ACS) and the Reflective Functioning (RF) Scale.

MBT-consistent techniques were observed in PDT and CBT sessions, though at lower levels than in MBT. MBT therapists showed higher MBT-ACS scores, particularly in maintaining a not-knowing stance and identifying non-mentalizing modes. Across orientations, higher MBT-ACS scores were associated with lower mean session-level RF, but also with greater within-session RF increases.

Mentalizing-oriented techniques appear across therapeutic orientations and may represent trans-theoretical process elements. Their association with both lower average RF and greater within-session change suggests they may be more frequently used in clinically challenging moments, supporting the restoration or enhancement of mentalizing.