Scientific publications

Below, you'll find a list of our major scientific publications, complete with engaging summaries and links to quizzes. Feel free to explore and have fun. If you're currently working on a master's thesis, don't hesitate to reach out to us to discuss the possibility of collaborating. Our research interests span the fields of organizational psychology and classical clinical research.

First we will summarize our five most important, and impactful articles, in the order I personally rank them.

1. Battles of the Comfort Zone

Folmo, E. J., Karterud, S. W., Kongerslev, M. T., Kvarstein, E. H., & Stänicke, E. (2019). Battles of the Comfort Zone: Modelling Therapeutic Strategy, Alliance, and Epistemic Trust—A Qualitative Study of Mentalization-Based Therapy for Borderline Personality Disorder. Journal of Contemporary Psychotherapy, 1–11. https://doi.org/10.1007/s10879-018-09414-3

Summary

The article discusses how therapeutic strategies, alliance (the relationship between the therapist and the patient), and epistemic trust (a belief in the therapist's knowledge and understanding) interact in mentalization-based therapy (MBT) for borderline personality disorder. The study used interpretive phenomenological analysis (IPA) to examine four individual MBT sessions and found that when therapists were able to identify and investigate maladaptive patterns, challenge the patient, and bring them out of their comfort zone, it facilitated the therapeutic alliance and process. On the other hand, when therapists were brought out of their own comfort zone and tried to repair the relational atmosphere by being supportive, the therapeutic alliance was weak and progress was not observed. The study suggests that a clear therapeutic strategy and the ability to challenge the patient's comfort zone can foster the therapeutic process, and that epistemic trust may develop as a result of a steadfast focus on tasks and goals in therapy.

The concept of "battles of the comfort zone" refers to the idea that therapists need to be willing and able to challenge their clients' dysfunctional behaviors, even if doing so temporarily disrupts the therapeutic relationship. This is seen as an important part of the therapeutic process, as it can help clients to confront and change their problematic patterns of behavior.

We also discuss the role of epistemic trust in therapy, stating that it may develop as a result of a focus on tasks and goals. This suggests that when therapists are able to consistently and competently guide clients towards specific therapeutic goals, it can help to build trust and strengthen the therapeutic alliance.

Finally, we propose that when therapists are able to challenge problematic patterns and maintain a clear therapeutic strategy, it can facilitate the therapeutic process by helping clients to make progress towards their goals. Overall, these takeaways highlight the importance of therapists being able to effectively manage the therapeutic relationship and guide clients towards change.

You can find a quiz about this article here.

2. Pedagogical stance in mentalization-based treatment

Folmo, E., Langjord, T., Myhrvold, N. S., Stänicke, E., Lind, M., & Kvarstein, E. H. (2022). Pedagogical stance in mentalization-based treatment. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.23335

Summary

This article investigated the role of pedagogical interventions in mentalization-based therapy (MBT) for individuals with borderline personality disorder (BPD). The study used both quantitative and qualitative methods to examine the prevalence and quality of pedagogical interventions in MBT, as well as their potential impact on treatment outcomes. The study found that the most frequently used intervention in MBT was "monitoring understanding," and that sessions with higher global ratings tended to have a broader range of satisfactory interventions. However, the study also found that therapists often had an indirect pedagogical stance, which may have led to missed opportunities for pedagogical interventions and a lack of clarity in the therapeutic process. The authors suggest that further research is needed to explore the role of pedagogical interventions in MBT and to develop guidelines for their use in the treatment of BPD.

You can find a quiz about this article here.

3. Development of therapeutic alliance in Mentalization-based treatment

Folmo, E. J., Stänicke, E., Johansen, M. S., Pedersen, G. A. F., & Kvarstein, E. H. (2020). Development of therapeutic alliance in Mentalization-based treatment – goals, tasks and bond in a specialized treatment for borderline personality. Psychotherapy Research. https://doi.org/10.1080/10503307.2020.1831097

Summary

This study tested the model presented in Battles of the Comfort Zone (suggesting that a focus on tasks and goals should be a better predictor of outcome than bond). It investigated the development of the therapeutic alliance in mentalization-based treatment (MBT) therapies for borderline personality disorder (BPD). The sample included 155 patients in an MBT program, and clinical outcomes were based on the Global Assessment of Functioning (GAF) scale. The sample was divided into two subgroups according to GAF levels at the end of treatment (cutoff = 60). The therapeutic alliance was assessed using the Working Alliance Inventory, which measures goals, bonds, and tasks, and was assessed repeatedly over 36 months. The results showed that initial levels of goals, bonds, and tasks did not differ by subgroup, but change over time did differ significantly by subgroup. In the good outcome subgroup, ratings of goals, bonds, and especially tasks increased significantly over time. In the poor outcome subgroup, paranoid personality disorder was associated with poorer alliance development over time. These findings suggest that good outcome therapies are characterized by a process where the therapeutic alliance grows over time, and that an explicit focus on tasks in therapy may be particularly helpful for patients with high levels of mistrust. Additionally, the results of this study suggest that comorbid mood disorders may negatively impact the collaborative starting point of therapy in patients with BPD, but that this negative effect is not enduring over time. Overall, this study highlights the importance of carefully maintaining the therapeutic alliance in the treatment of poorly functioning patients with BPD, including a longer-term process of attachment and bonding, as well as keeping the goals of therapy understandable, current, and updated, and making the therapeutic work, progress, and challenges relevant and explicit.

You can find a quiz about this article here.

4. Metaphors in Mentalization-Based Treatment

Folmo, E.J., Langjord, T., Myhrvold, N.C.S., Lind, M. (2021). Metaphors in Mentalization-Based Treatment: Reintroducing the Language of Change in “Plain Old Therapy”. Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-021-09512-9

Summary

This article discusses the potential benefits and limitations of using metaphors in Mentalization-Based Treatment (MBT) for Borderline Personality Disorder. The article argues that, when responsively tailored by the therapist, metaphors can be a powerful tool for building trust and facilitating change in patients with BPD. The use of metaphors in MBT can help to challenge patients without being too confrontational, make unconscious patterns conscious, and facilitate the development of a sense of agency. They can also serve as internalized mentors, providing guidance and wisdom to patients as they work to change maladaptive patterns of behavior and emotion. However, it is important for therapists to be mindful of the potential risks of using metaphors, as they can be confusing for patients with low mentalizing abilities, and to use them responsively and thoughtfully in order to maximize their effectiveness. The article also emphasizes the importance of maintaining an alliance with the group and developing epistemic trust in other patients in MBT, and suggests that the use of wisdom or teaching stories and metaphors can be helpful in this process.

You can find a quiz about this article here.

5. The design of the MBT‐G adherence and quality scale

Folmo, E. J., Karterud, S. W., Bremer, K., Walther, K. L., Kvarstein, E. H., & Pedersen, G. A. (2017). The design of the MBT‐G adherence and quality scale. Scandinavian journal of psychology, 58(4), 341–349. https://doi.org/10.1111/sjop.12375

Summary

The Mentalization-based Group Therapy Adherence and Quality Scale (MBT-G-AQS) is a tool designed to measure the adherence and quality of mentalization-based group therapy (MBT-G), a treatment approach for Borderline Personality Disorder (BPD). The aim of the present study was to evaluate the reliability of the MBT-G-AQS by having it used to rate 16 videotaped therapy sessions from 8 MBT groups and 8 psychodynamic groups by 5 raters. The results showed high to excellent reliability for global ratings of adherence and quality for all numbers of raters, with particularly high reliability when using several raters. The mean reliability for individual items on the scale was also good, particularly when using multiple raters. These results suggest that the MBT-G-AQS can be a useful tool for training, supervision, and research on MBT-G.

You can find a quiz about this article here.

Other publications

The absence of a publication on my top five list does not necessarily mean that it is of poor quality or lacks impact. In fact, the first article on this list has been cited by 56 other articles, demonstrating its high level of quality and impact.

Mentalization-based treatment in groups for adolescents with borderline personality disorder

Beck, E., Bo, S., Jørgensen, M. P., Gondan, M., Poulsen, S., Storebø, O. J., Andersen, C. F., Folmo, E., Sharp, C., Pedersen, J., & Simonsen, E. (2019). Mentalization-based treatment in groups for adolescents with borderline personality disorder: a randomized controlled trial. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.13152

Summary

The results of this study suggest that group-based Mentalization-Based Treatment (MBT) may not be as effective as treatment as usual (TAU) in the treatment of adolescents with Borderline Personality Disorder (BPD). There were no significant differences between the two groups in terms of primary or secondary outcomes, and a higher percentage of patients in the MBT group terminated treatment prematurely compared to the TAU group. Possible explanations for this include that group-based MBT may not be suitable for adolescents with high levels of psychopathology and low levels of social functioning, the wave effect of premature termination may be more prominent in groups of patients with BPD and adolescents who are sensitive to peer influences, and barriers to implementation of MBT may have affected the effectiveness of the treatment. Further research is needed to better understand the factors that may impact the effectiveness of group-based MBT for adolescents with BPD.

Borderline Personality Disorder (BPD) is a severe mental disorder characterized by symptoms such as marked affective instability, behavioral impulsivity, elevated aggression, difficulties in interpersonal relationships, and self-harm. BPD is typically diagnosed in adolescence and is associated with a high level of psychiatric comorbidity and persistent functional disability. Mentalization-Based Treatment (MBT) is a structured, evidence-based psychotherapeutic program that is first-line treatment for BPD. While the efficacy of MBT for BPD has mainly been tested with adults, no randomized controlled trial (RCT) has examined the effectiveness of MBT in groups (MBT-G) for adolescent BPD. In this RCT, 112 adolescents with BPD or BPD symptoms were randomized to receive a 1-year MBT-G program or treatment as usual (TAU). The primary outcome was the score on the Borderline Personality Features Scale for Children (BPFS-C), and secondary outcomes included self-harm, depression, externalizing and internalizing symptoms, caregiver reports, social functioning, and borderline symptoms rated by blinded clinicians. The results showed that there was no significant difference between the MBT-G group and the TAU group in terms of the primary or secondary outcomes. Additionally, 29% of participants in both groups achieved remission, and 29% of the MBT group completed less than half of the sessions compared to 7% of the control group. These findings suggest that there is no indication of superiority for either therapy method and that retention problems need to be addressed in order to improve the effectiveness of early intervention for adolescent BPD.

Quiz

1. What is Borderline Personality Disorder (BPD)?
   A) A severe mental disorder characterized by symptoms such as marked affective instability, behavioral impulsivity, elevated aggression, difficulties in interpersonal relationships, and self-harm
   B) A mild mental disorder characterized by symptoms such as marked affective stability, behavioral impulsivity, elevated aggression, difficulties in interpersonal relationships, and self-harm
   C) A severe mental disorder characterized by symptoms such as marked affective instability, behavioral impulsivity, elevated aggression, difficulties in interpersonal relationships, and self-control
   D) A mild mental disorder characterized by symptoms such as marked affective stability, behavioral impulsivity, elevated aggression, difficulties in interpersonal relationships, and self-control
   
   
2. What is Mentalization-Based Treatment (MBT)?
   A) A structured, evidence-based psychotherapeutic program that is first-line treatment for BPD
   B) A structured, evidence-based psychotherapeutic program that is second-line treatment for BPD
   C) An unstructured, evidence-based psychotherapeutic program that is first-line treatment for BPD
   D) An unstructured, evidence-based psychotherapeutic program that is second-line treatment for BPD
   
   
3. What was the primary outcome in this study?
   A) The score on the Borderline Personality Features Scale for Children (BPFS-C)
   B) The score on the Depression Scale for Children (DSC)
   C) The score on the Externalizing Symptoms Scale for Children (ESSC)
   D) The score on the Internalizing Symptoms Scale for Children (ISSC)
   
   
4. What was the main finding of this study?
   A) Group-based MBT was superior to TAU in the treatment of adolescents with BPD
   B) Group-based MBT was not superior to TAU in the treatment of adolescents with BPD
   C) Group-based MBT was superior to TAU in some outcomes, but not others, in the treatment of adolescents with BPD
   D) Group-based MBT was not superior to TAU in any outcomes in the treatment of adolescents with BPD
   
   
5. Why may group-based MBT not be suitable for adolescents with high levels of psychopathology and low levels of social functioning?
   A) Group-based MBT may create states of affective dysregulation and nonmentalizing in these adolescents
   B) Group-based MBT may not be able to provide moment-to-moment coregulation of affect for these adolescents
   C) Group-based MBT may not be able to address the specific needs of these adolescents
   D) All of the above

Correct answers

1. A) A severe mental disorder characterized by symptoms such as marked affective instability, behavioral impulsivity, elevated aggression, difficulties in interpersonal relationships, and self-harm 
2. A) A structured, evidence-based psychotherapeutic program that is first-line treatment for BPD
3. A) The score on the Borderline Personality Features Scale for Children (BPFS-C) 
4. B) Group-based MBT was not superior to TAU in the treatment of adolescents with BPD 
5. D) All of the above

Personality and the group matrix

Karterud, S., Folmo, E., & Kongerslev, M. T. (2019). Personality and the group matrix. Group Analysis. https://doi.org/10.1177/0533316418824210

This article was inspired by a discussion I had with Sigmund Karterud in the summer of 2018, when I had the privilege to visit Kari Lossius and Sigmund in Bergen. During this visit, Sigmund was inspired by a movie (along with his reading of Steven Pinker) in which Brian Cox explains the concept of entropy, leading him to conceptualize psychotherapy in terms of entropy.

The concept of the group matrix is a central idea in group analysis, a form of psychotherapy that focuses on the interactions and dynamics within a group. The group matrix refers to the relationships and communication that exist between people who are united for some purpose. This can include both the foundation matrix, which is based on common biological and cultural factors, and the dynamic matrix, which is influenced by the specific needs and context of the group. Some authors have proposed a tripartite matrix, including the foundation matrix, the dynamic matrix, and the personal matrices of individual group members. Others have proposed four modalities of experience that shape the group matrix: affective, behavioral, cognitive, and symbolic. The main task of the group therapist, or conductor, is to create a therapeutic social system that is different from the matrix of everyday social groups, in order to facilitate personal growth and development. This can involve increasing the reflective capacity, or mentalizing, of group members and counteracting the principle of entropy, which can lead to a decline in productive communication.

The temperament-attachment-mentalizing (TAM) theory of personality is a new theory that suggests that personality is comprised of three major constituents: temperament, attachment, and mentalizing. Temperament is the evolutionary oldest part of personality and refers to the primary emotions that drive behavior and motivate action. These primary emotions include SEEKING, FEAR, RAGE, LUST, SEPARATION DISTRESS, CARE, and PLAY. Attachment is influenced by the primary emotions of FEAR and SEPARATION DISTRESS and refers to the individual's unique template for interpersonal relatedness, which is shaped by early experiences. Mentalizing, or the ability to understand oneself and others as psychological beings with intentions, develops within the context of attachment relationships and involves the internalization of cultural achievements and codes. The TAM theory suggests that these three constituents are dynamically interrelated and that the development of mentalizing is influenced by both evolutionary and socio-cultural processes. This theory has implications for understanding group dynamics, as temperament, attachment, and mentalizing all shape communication and relationships within a group.

The article further elaborates on the concept of the group matrix in group analysis and the importance of considering personality factors in understanding group dynamics. The temperament-attachment-mentalizing (TAM) theory of personality suggests that personality is comprised of three major constituents: temperament, attachment, and mentalizing, which are all important in shaping communication and relationships within a group. The text also addresses the issue of whether group analysis is primarily a treatment for patients or a method for enhancing the quality of life for middle-class individuals. It suggests that group analysis can be both, but it is important for the field to maintain its effectiveness as a clinical modality for treatment-seeking patients. The text also discusses the importance of infusing psychotherapy groups with energy, structure, and rules in order to resist the principle of entropy and maintain a productive matrix. Finally, the text emphasizes the role of the group therapist in creating and shaping the group matrix in order to facilitate personal growth and development.

Quiz

1. What is the main focus of group analysis in psychotherapy?
   A) Individual behavior and cognition
   B) Group dynamics and interactions
   C) Family dynamics and relationships
   D) Cognitive-behavioral techniques
   
   
2. What are the three major constituents of the temperament-attachment-mentalizing (TAM) theory of personality?
   A) Temperament, attachment, and self-esteem
   B) Attachment, self-esteem, and social rank
   C) Temperament, attachment, and mentalizing
   D) Mentalizing, conscientiousness, and effortful control
   
   
3. According to the TAM theory, what is the role of mentalizing in personality development?
   A) It is the most important factor in personality development
   B) It develops within the context of attachment relationships and involves the internalization of cultural achievements and codes
   C) It is the result of early experiences and shapes the individual's attachment pattern
   D) It is influenced by both evolutionary and socio-cultural processes
   
   
4. What is the role of the group therapist in group analysis?
   A) To facilitate personal growth and development by creating and shaping the group matrix
   B) To provide individual counseling to group members
   C) To lead group members through structured exercises and techniques
   D) To facilitate communication and understanding between family members
   
   
5. What is the principle of entropy in group analysis?
   A) The tendency of groups to become more productive over time
   B) The tendency of groups to drift towards an ordinary, matter-of-fact discourse
   C) The tendency of groups to become more hierarchical and authoritarian over time
   D) The tendency of groups to become more chaotic and disorganized over time

Correct answers

1. B) Group dynamics and interactions
2. C) Temperament, attachment, and mentalizing
3. B) It develops within the context of attachment relationships and involves the internalization of cultural achievements and codes
4. A) To facilitate personal growth and development by creating and shaping the group matrix
5. B) The tendency of groups to drift towards an ordinary, matter-of-fact discourse
   
   

Mentalization‐based treatment or psychodynamic treatment programmes for patients with borderline personality disorder

Kvarstein, E. H., Pedersen, G., Folmo, E., Urnes, Ø., Johansen, M. S., Hummelen, B., ... & Karterud, S. (2018). Mentalization‐based treatment or psychodynamic treatment programmes for patients with borderline personality disorder–the impact of clinical severity. Psychology and Psychotherapy: Theory, Research and Practice. https://doi.org/10.1111/papt.12179

Summary

Mentalization-based treatment (MBT) is a type of psychotherapy specifically designed for people with borderline personality disorder (BPD). It is a long-term, structured treatment that combines individual and group therapy and psychoeducation, and aims to improve patients' ability to mentalize, or understand and interpret their own and others' thoughts and feelings. This study aimed to investigate the relationship between clinical severity and outcomes for patients in MBT compared to a psychodynamic group-based treatment program (PDT). The study found that in PDT, greater clinical severity was associated with poorer improvement rates. However, clinical severity was not associated with significant differences in outcomes for patients in MBT. The results also suggest that increasing severity was a challenge in PDT, while MBT may be particularly beneficial for severely disordered BPD patients.

This study found that MBT may be particularly effective for patients with severe BPD and comorbid avoidant and possibly paranoid PD traits. It compared MBT to PDT and found that clinical severity was not associated with significant differences in outcomes for patients in MBT, but it was associated with poorer improvement rates in PDT. The study suggests that MBT may be more indicated for patients with severe disorder than PDT and that patients with severe psychopathology can have a treatment potential given appropriate health service organization. It also suggests that MBT's structured and specialized approach may lead to better treatment adherence and may be more effective at addressing the complex and severe mentalization deficits and attachment disturbances often present in patients with severe BPD.

It seems that mentalization-based treatment may be particularly helpful for patients with severe borderline personality disorder, as it appears to be more effective at addressing the complex mentalization deficits and attachment disturbances that often accompany severe BPD. It also appears to be more successful at retaining patients with severe BPD in treatment, which may be due to its structured and specialized approach. On the other hand, the study found that increasing severity was a challenge in the psychodynamic group-based treatment program, and that clinical severity was associated with poorer improvement rates in this treatment. Overall, the study suggests that mentalization-based treatment may be a particularly useful option for patients with severe BPD and may lead to improved outcomes compared to other treatments.

Quiz

1. What is the main aim of mentalization-based treatment (MBT)?
   A) To improve patients' ability to mentalize
   B) To reduce symptom distress and interpersonal problems
   C) To increase global functioning
   D) All of the above

2. What was the design of the study mentioned in the article?
   A) Randomized controlled trial
   B) Case-control study
   C) Naturalistic, longitudinal, comparison study
   D) Meta-analysis

3. What was the sample size of the study?
   A) 21 patients
   B) 103 patients
   C) 345 patients
   D) 509 patients

4. In the study, what was associated with poorer improvement rates in the psychodynamic group-based treatment program (PDT)?
   A) Greater clinical severity
   B) Higher treatment adherence
   C) Lower drop-out rates
   D) More severe mentalization deficits

5. According to the study, why may mentalization-based treatment (MBT) be particularly effective for patients with severe borderline personality disorder (BPD)?
   A) It has a structured and specialized approach
   B) It focuses on reducing symptom distress
   C) It is more effective at addressing attachment disturbances
   D) All of the above

Correct answers

1. A) To improve patients' ability to mentalize
2. C) Naturalistic, longitudinal, comparison study
3. C) 345 patients
4. A) Greater clinical severity
5. D) All of the above
   
   

Social cognition capacities as predictors of outcome in Mentalization-based treatment

Kvarstein, E. H., Folmo, E., Antonsen, B. T., Normann-Eide, E., Pedersen, G., & Wilberg, T. (2020). Social cognition capacities as predictors of outcome in Mentalization-based treatment (MBT). Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00691

Summary       

This study investigated the relationship between social cognition, specifically theory of mind (ToM), and treatment outcomes in patients with borderline personality disorder (BPD) undergoing mentalization-based treatment (MBT). The study found that higher levels of excessive ToM (hypermentalizing) were associated with better improvement in the treatment alliance and better clinical outcomes over time. In contrast, low levels of accurate cognitive ToM responses and errors of insufficient ToM were both associated with poorer improvement over time. The subgroup with frequent insufficient ToM errors had a larger total number of ToM errors and were more likely to have experienced childhood trauma, have comorbid avoidant personality disorder traits or post-traumatic stress disorder, have received extensive prior treatment, and/or have had treatment irregularity. These findings suggest that social cognition, specifically ToM, may be an important predictor of treatment outcomes in BPD and that patients with lower mentalizing capacity may require more specialized treatment approaches. The clinical implications of these findings include the importance of assessing and addressing ToM skills in the treatment of BPD, and the need for further research on the relationship between social cognition and treatment outcomes in this population.

Quiz   

1. What is the main focus of the study?
   A) The relationship between mentalization and treatment outcomes in BPD
   B) The relationship between social cognition and treatment outcomes in BPD
   C) The relationship between reflective functioning and treatment outcomes in BPD
   D) The relationship between self-report and treatment outcomes in BPD

2. Which of the following is NOT a ToM error type assessed by the MASC test?
   A) Excessive ToM (hypermentalizing)
   B) Insufficient ToM
   C) Accurate cognitive ToM responses
   D) Reflective functioning

3. Which of the following was NOT associated with poorer improvement over time in the study?
   A) Low levels of accurate cognitive ToM responses
   B) High levels of insufficient ToM errors
   C) Comorbid avoidant personality disorder traits
   D) Hypermentalizing

4. What was the main predictor of poorer clinical outcomes over time in the study?
   A) Hypermentalizing
   B) Insufficient ToM errors
   C) Low levels of accurate cognitive ToM responses
   D) Comorbid avoidant personality disorder traits

5. What was NOT a factor associated with the subgroup with frequent insufficient ToM errors in the study?
   A) Childhood trauma
   B) Comorbid avoidant personality disorder traits or PTSD
   C) Extensive prior treatment
   D) Good treatment alliance

Correct answers

1. B) The relationship between social cognition and treatment outcomes in BPD
2. D) Reflective functioning
3. A) Low levels of accurate cognitive ToM responses 
4. B) Insufficient ToM errors 
5. D) Good treatment alliance
   
   

The Group Questionnaire (GQ)—Psychometric properties among outpatients with personality disorders

Pedersen, G., Kvarstein, E. H., Wilberg, T., Folmo, E. J., Burlingame, G. M., & Lorentzen, S. (2021). The Group Questionnaire (GQ)—Psychometric properties among outpatients with personality disorders. Group Dynamics: Theory, Research, and Practice. Advance online publication. http://dx.doi.org/10.1037/gdn0000176

Summary       

The aim of this study was to examine the psychometric properties of the Group Questionnaire (GQ), a measure of group psychotherapy process, in a clinical population of patients with personality disorders (PDs). The study included 369 patients with PDs who were attending group psychotherapy in 14 outpatient treatment units in Norway. The GQ is designed to capture the quality of member-member, member-group, and member-leader relationships in group therapy, and is based on concepts of group cohesion and climate, empathy, and alliance. The results of the study replicated the three latent factors of the GQ (positive bond, positive work, and negative relationship), and found that the psychometric integrity of the tripartite relationship structure (member-member, member-group, and member-leader) with eight subfacets was supported. These findings suggest that the GQ can be useful in further research on PD treatment processes and in understanding mechanisms and mediators of change. We suggest that the GQ can be recommended for use in future research and clinical practice with patients with PDs.

Factor analysis is a statistical method used to identify underlying patterns in a dataset by examining the relationships between variables. In this study, we applied factor analysis to test the psychometric properties of the Group Questionnaire (GQ), a tool used to assess the quality of relationships in group psychotherapy. The researchers performed three separate factor analyses to test different models of the GQ. The first model tested the three higher-order dimensions of the GQ (Positive Bond, Positive Work, and Negative Relationship). The second model included eight subfacets that took into account the complex relationship structure of group therapy (leader, group, and members). The third model included the full set of GQ items and the eight subfacets. The results of the factor analyses supported the validity of the GQ as a measure of group relationships in psychotherapy for patients with personality disorders. The findings also provided evidence for the incremental validity of the individual subscales of the GQ, and suggested that the GQ can be useful in future research on the treatment processes and mechanisms of change in personality disorders.

Quiz

1. What is the main aim of the study?
   a) To examine the relationship between social cognition and treatment outcomes in patients with borderline personality disorder
   b) To investigate the psychometric properties of the Group Questionnaire (GQ) in a clinical population of patients with personality disorders
   c) To understand the mechanisms and mediators of change in personality disorder treatment
   d) To assess the quality of relationships in group psychotherapy for patients with personality disorders

2. What is the Group Questionnaire (GQ)?
   a) A tool used to measure social cognition in patients with borderline personality disorder
   b) A measure of group psychotherapy process that captures the quality of member-member, member-group, and member-leader relationships
   c) A tool used to understand the mechanisms and mediators of change in personality disorder treatment
   d) A measure of the quality of relationships in group psychotherapy for patients with social anxiety disorder

3. How many factor analyses were performed in the study?
   a) One
   b) Two
   c) Three
   d) Four

4. What did the results of the factor analyses suggest about the validity of the Group Questionnaire (GQ)?
   a) The GQ is not a valid measure of group relationships in psychotherapy for patients with personality disorders
   b) The GQ can be useful in understanding the mechanisms and mediators of change in personality disorder treatment c) The GQ is a valid measure of group relationships in psychotherapy for patients with personality disorders and provides evidence for the incremental validity of its individual subscales
   d) The GQ is a valid measure of group relationships in psychotherapy for patients with social anxiety disorder

5. What is factor analysis?
   a) A statistical method used to identify patterns in a dataset by examining the relationships between variables
   b) A tool used to measure social cognition in patients with borderline personality disorder
   c) A measure of group psychotherapy process that captures the quality of member-member, member-group, and member-leader relationships
   d) A method of understanding the mechanisms and mediators of change in personality disorder treatment.

   Correct answers

1. b) To investigate the psychometric properties of the Group Questionnaire (GQ) in a clinical population of patients with personality disorders
2. b) A measure of group psychotherapy process that captures the quality of member-member, member-group, and member-leader relationships
3. c) Three
4. c) The GQ is a valid measure of group relationships in psychotherapy for patients with personality disorders and provides evidence for the incremental validity of its individual subscales
5. a) A statistical method used to identify patterns in a dataset by examining the relationships between variables
   
   

The mentalization-based therapy adherence and quality scale (MBT-AQS)

Simonsen, S., Juul, S., Kongerslev, M., Bo, S., Folmo, E., & Karterud, S. (2018). The mentalization-based therapy adherence and quality scale (MBT-AQS): Reliability in a clinical setting. Nordic Psychology, 1–12. https://doi.org/10.1080/19012276.2018.1480406

Summary    

This study aimed to investigate the inter-rater reliability of the Mentalization-Based Therapy Adherence and Quality Scale (MBT-AQS) in a clinical setting. The MBT-AQS is a tool used to measure the treatment integrity of individual mentalization-based therapy (MBT), a manualized treatment for borderline personality disorder that is also potentially effective for the treatment of other disorders such as eating disorders and antisocial personality disorder. The study found that experienced MBT therapists in a clinical setting can generally achieve high levels of reliability on the MBT-AQS. However, the study also identified challenges to reliability on the item level, including low frequency of certain items, ambiguity in some constructs, and low therapist quality. The study suggests that refining the manual and making it more specific could help address these challenges to reliability. The study also found that raters had higher reliability when rating sessions with high adherence and quality, and that low therapist quality was associated with low reliability of ratings. These findings have implications for the use of the MBT-AQS for educational and supervisory purposes. The study recommends that the MBT-AQS be used in combination with other methods of evaluating treatment integrity, and that further research be conducted to examine the sources of unreliability on the item level.   

Quiz   

Question 1: What is the Mentalization-Based Treatment Adherence and Quality Scale (MBT-AQS) used for?

A) To measure the treatment integrity of individual mentalization-based therapy (MBT)
B) To assess the effectiveness of MBT for treating eating disorders
C) To evaluate the competence of MBT therapists
D) To assess the adherence of MBT therapists to the treatment protocol

Question 2: What are the three major components of MBT as described in the article?

A) Psychoeducation, individual psychotherapy, and group psychotherapy
B) Psychoeducation, individual counseling, and group counseling
C) Individual psychotherapy, group psychotherapy, and pharmacotherapy
D) Individual counseling, group counseling, and pharmacotherapy

Question 3: Which of the following is NOT a challenge to the reliability of the MBT-AQS identified in the study?

A) Low frequency of certain items
B) Ambiguity in some constructs
C) High therapist quality
D) Low therapist quality

Question 4: What did the study find about the association between therapist quality and reliability of ratings on the MBT-AQS?

A) High therapist quality was associated with low reliability of ratings
B) Low therapist quality was associated with low reliability of ratings
C) High therapist quality was associated with high reliability of ratings
D) There was no association between therapist quality and reliability of ratings

Question 5: What is the main recommendation made by the study for improving the reliability of the MBT-AQS?

A) Using the MBT-AQS in combination with other methods of evaluating treatment integrity
B) Refining the manual and making it more specific
C) Using the MBT-AQS only for educational and supervisory purposes
D) Conducting more research to examine the sources of unreliability on the item level

Correct answers

1. A) To measure the treatment integrity of individual mentalization-based therapy (MBT)
2. A) Psychoeducation, individual psychotherapy, and group psychotherapy
3. C) High therapist quality
4. B) Low therapist quality was associated with low reliability of ratings
5. B) Refining the manual and making it more specific
   
   

EDITOR

I currently serve as an editor for the research topic "Self-Understanding and Other-Understanding in Personality Pathology" on Frontiers: https://www.frontiersin.org/research-topics/40931/self-understanding-and-other-understanding-in-personality-pathology. This is a unique opportunity to delve into the role of self and other understanding in personality pathology and contribute to the field through the publication of relevant research.

Borderline personality disorder traits and mentalising ability

Grealy, M. K., Godfrey, E., Brady, F., O’Sullivan, E. W., Carroll, G. A., & Burke, T. (2022). Borderline personality disorder traits and mentalising ability: The self-other social cognition paradox. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.1023348

Summary

This study investigated whether borderline personality disorder (BPD) traits influence performance on specific elements of social cognitive tasks, specifically positive and negative valence, in a sample of community-based typical controls. The study found a statistically significant relationship between elevated BPD traits (specifically affect instability) and improved performance on mentalizing tasks. These findings are consistent with previous research suggesting that some individuals with high BPD traits may have enhanced ability to infer mental states and intentions of others, though may have an incongruent self-impression of their social cognitive abilities. The study also found a negative association between high affect instability and the perspective taking sub-scale of the Interpersonal Reactivity Index, suggesting that some individuals with high BPD traits may have difficulty in considering the perspective of others. The study's results provide support for the idea that some aspects of hyper-mentalizing may be considered a core feature of BPD. These findings suggest that the assessment of social cognitive processes, such as the ability to recognize and interpret mental states and emotions, may be helpful in understanding and supporting individuals with BPD and/or high BPD traits. Further research could explore the relationship between BPD traits and social cognition in more depth and examine potential interventions to improve social cognitive abilities in this population.

Mentalizing the patient–Patient experiences with short-term mentalization-based therapy for borderline personality disorder

Hestbæk E, Hasselby-Andersen M, Juul S, Beier N and Simonsen S (2022) Mentalizing the patient–Patient experiences with short-term mentalization-based therapy for borderline personality disorder: A qualitative study. Front. Psychiatry 13:1088872. https://doi.org/10.3389/fpsyt.2022.1088872

Summary

Mentalization-based therapy (MBT) is a structured psychotherapy approach that was developed specifically for patients with borderline personality disorder (BPD). BPD is a severe mental disorder characterized by emotional dysregulation, impulsivity, and interpersonal dysfunction. MBT aims to promote patients' capacity to mentalize, or reflect upon and understand their own and others' mental states, which is thought to be impaired in individuals with BPD. MBT has been shown to have long-lasting effects on patients with BPD, but is often delivered in different formats and durations due to long waiting lists for treatment. This study aimed to explore the experiences of 12 patients with BPD who received short-term MBT (5 months) in Danish mental health services. The study found that most of the patients were satisfied with the short-term MBT, which they perceived as having a positive impact on their lives. However, a subgroup of patients wanted more therapy. The study highlights the strengths and limitations of short-term MBT for BPD as experienced by patients and points to barriers in developing service-user informed short-term treatment options for BPD.

This study explored the experiences of 12 patients with BPD who received short-term mentalization-based therapy (MBT, 5 months) in Danish mental health services. The results suggest that most of the patients were satisfied with the short-term MBT, which they perceived as having a positive impact on their lives. However, a subgroup of patients wanted more therapy. The study highlighted the strengths and limitations of short-term MBT for BPD as experienced by the patients, and points to barriers in developing service-user informed short-term treatment options for BPD. Factors that facilitated or hindered improvement were identified, including initial skepticism about the treatment duration, ambivalence about ending therapy, the importance of the group as a "safe space", and negative experiences impacting treatment negatively. The study suggests that improved dialogue in the preparation phase of short-term treatments and a mentalization-based approach to terminating therapy may be helpful in addressing these issues. Future research could further investigate patient experiences of short-term MBT for BPD, as well as the effectiveness of different treatment durations for this population.

BOOKS

We are pleased to present our book on the Nordic model of MBT, which is written in Norwegian. You can find more information about the book, including how to access a digital or physical copy, by following the link below:

MBT Mentaliseringsbasert terapi

Karterud, S., Folmo, E., Kongerslev, M. (2020). MBT Mentaliseringsbasert terapi. Gyldendal. https://www.gyldendal.no/faglitteratur/medisin/psykiatri/mbt-mentaliseringsbasert-terapi/p-824006-no/

Sigmund Karterud, Espen Folmo, and Mickey Kongerslev, in collaboration with Finn Skårderud and Bente Sommerfeldt, present a four-minute film about their new comprehensive textbook on Mentalization-Based Therapy (MBT):

In addition to being an evidence-based treatment for emotionally unstable personality disorder, MBT is also a therapeutic form that can serve as a universal key in the therapist's intervention repertoire, as well as a solid foundation for anyone who practices "Plain Old Therapy". MBT encompasses both group, individual, and environmental therapy, and the understanding framework behind the model is essential for those who want to prevent (such as teachers, preschool teachers, and parents), or those who work with different forms of insecure attachment (child welfare, special education teachers). The textbook covers an overall personality theory based on temperament, attachment, and mentalization (TAM model), which there has been a great need for. The book is also aimed at all practitioners of MBT in various places in Scandinavia. Åse-Line Baltzersen advocates for the importance of treating personality disorders in the film. This book is in Norwegian only, and outlines what can be denoted "Nordic MBT". The book is published by Gyldendal, and can be found here:

https://www.gyldendal.no/faglitteratur/medisin/psykiatri/mbt-mentaliseringsbasert-terapi/p-824006-no/

Below are some factors that have been linked to positive outcomes for Borderline Personality Disorder (BPD) patients. These are some examples of the various treatment approaches that have been shown to be effective for BPD patients:

1.    A positive therapeutic alliance between the patient and therapist, which has been shown to be important for treatment engagement and improved outcomes (Folmo et al., 2020). A strong therapeutic alliance is essential for the patient's engagement and participation in therapy, and it has been linked to better treatment outcomes.

2.    Early identification and intervention for BPD, as early treatment may prevent the development of more severe symptoms and improve long-term outcomes (Leichsenring et al., 2011). Early identification and intervention can help prevent the development of more severe symptoms and improve long-term outcomes.

3.    Dialectical behavior therapy (DBT) which is an evidence-based treatment that focuses on teaching patients specific skills to help them manage their emotions and behavior (Linehan, 1993). DBT is an evidence-based treatment that has been found to be effective in reducing symptoms of BPD, such as suicidal behavior, self-harm, and emotional regulation problems.

4.    Mentalization-based treatment (MBT) which is an evidence-based treatment that focuses on helping patients understand and process their thoughts and emotions in a healthy way (Karterud et al., 2020). MBT is an evidence-based treatment that focuses on helping patients understand and process their thoughts and emotions in a healthy way, which is essential for improving emotional regulation and reducing symptoms of BPD.

5.    Family-based interventions (FBT) which focuses on involving family members in therapy and addressing patterns of communication and interactions within the family system that may be contributing to the patient's symptoms (Soloff, 1990). Family-based interventions have been found to be effective in addressing patterns of communication and interactions within the family system that may be contributing to the patient's symptoms, and in involving family members in therapy.

6.    Enhancing patients' understanding of core aspects of personality disorder through psychoeducation has also been linked to positive outcomes for BPD (Zanarini et al., 2018). Psychoeducation is an important aspect of treatment, as it helps patients understand the underlying causes of their symptoms and how to manage them effectively.

It is important to note that treatment for BPD is complex and multifaceted, and different factors may be more or less important for different individuals. The best treatment approach is determined on a case-by-case basis, taking into account the patient's unique needs and circumstances.

Our most recent book, published in Norwegian, concerns Mentalization-based treatment (MBT), a specific talking cure where the active ingredient (mentalizing) is boldly proposed as “the most fundamental common factor among psychotherapeutic treatment” (Allen et al., 2008, p. 1). Consequently, MBT is a good candidate for a universal therapy, and a craft any ambitious/aspiring clinician should carefully consider as part of their therapeutic repertoire.

References

Allen, J. G., Fonagy, P., & Bateman, A. W. (2008). Mentalizing in clinical practice. American Psychiatric Pub.

Folmo, E. J., Stanicke, E., Johansen, M. S., Pedersen, G., & Kvarstein, E. H. (2020). Development of therapeutic alliance in mentalization-based treatment-Goals, Bonds, and Tasks in a specialized treatment for borderline personality disorder. Psychother Res, 31(5), 604-618. https://doi.org/10.1080/10503307.2020.1831097

Karterud, S., Folmo, E., & Kongerslev, M. (2020). Mentaliseringsbasert terapi MBT. Gyldendal Akademisk.

Leichsenring, F., Leibing, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. Lancet, 377(9759), 74-84. https://doi.org/10.1016/S0140-6736(10)61422-5

Linehan, M. (1993). Cognitive-behavioral Treatment of Borderline Personality Disorder. Guilford Press.

Soloff, P. H. (1990). Borderline disorders. In Handbook of Outpatient Treatment of Adults (pp. 309-332). Springer.

Zanarini, M. C., Conkey, L. C., Temes, C. M., & Fitzmaurice, G. M. (2018). Randomized Controlled Trial of Web-Based Psychoeducation for Women With Borderline Personality Disorder. J Clin Psychiatry, 79(3). https://doi.org/10.4088/JCP.16m11153

 

SUPERVISOR (MASTER'S THESES)

Are you considering pursuing a Master's degree in psychology and looking for a meaningful project to work on? I invite you to reach out to me to discuss potential topics for your thesis at the Psychological Institute. Not only can a Master's thesis be a valuable opportunity to delve into a clinically relevant topic, but it can also serve as a stepping stone for a research career. While we are open to exploring a range of options, it would be especially advantageous if you are interested in publishing an English-language article based on your thesis. As such, it is strongly recommended that your thesis be written in English. Below are some examples of Master's theses that I have previously supervised.

Den terapeutiske relasjonen i DBT og MBT

Garred, S., Gough, E. M. (2021). Den terapeutiske relasjonen i DBT og MBT [Unpublished master’s thesis, University of Oslo]. https://www.duo.uio.no/bitstream/handle/10852/87426/1/Hovedoppgave_Den-terapeutiske-relasjonen-i-DBT-og-MBT_Elina_Susanne.pdf

Summary

Chronic Feelings of Emptiness’ – a Useful Criterion in the Diagnosis of Borderline Personality Disorder?

Stølsnes, M. (2021). ‘Chronic Feelings of Emptiness’ – a Useful Criterion in the Diagnosis of Borderline Personality Disorder? [Unpublished master’s thesis, University of Oslo]. https://www.duo.uio.no/bitstream/handle/10852/86649/thesis.pdf

Summary

This thesis focused on the topic of chronic feelings of emptiness and its relationship to borderline personality disorder (BPD). The study used data from the Norwegian Network for Personality Disorders and included 1702 patients with various personality disorders who were diagnosed using the DSM-IV and assessed according to LEAD principles. The study found that chronic feelings of emptiness occurred almost twice as often in patients with BPD compared to those with other personality disorders, and that chronic emptiness was a more robust indicator of BPD in men than in women. Chronic emptiness was also found to be correlated with neuroticism. The study concludes that chronic feelings of emptiness may be a hallmark of BPD, but can also be observed in other personality disorders.

An article will be publised based on this master thesis.

The cultural change narrative as a core component of therapeutic change

Sundal, T., Tobiassen, A. H. (2022). The cultural change narrative as a core component of therapeutic change [Unpublished master’s thesis, University of Oslo]. https://www.duo.uio.no/bitstream/handle/10852/86649/thesis.pdf

Summary

This study aimed to investigate the similarities and differences in the change narratives provided by Mentalization-based treatment (MBT) and Dialectical behavior therapy (DBT) for patients with borderline personality disorder (BPD), and how these narratives reflect the rationale, explanations, and procedures of the treatments. A qualitative analysis of seven interviews with three informants who received MBT and four informants who received DBT was conducted using an interpretative phenomenological analysis (IPA). The results showed that the change narratives described by the informants reflected the treatment they received, with DBT informants highlighting explicit learning of a provided approach with predictable and safe therapists, and MBT informants emphasizing a long-lasting process of exploring to create procedural learning with therapists who followed their lead. The study also found that the change narratives provided by MBT and DBT reflect the different rationale, explanations, and procedures of the treatments, and suggests that further research could explore how these differences may impact therapeutic outcomes. Additionally, the results showed that the DBT informants emphasized explicit learning and the use of skills, while the MBT informants focused on an implicit process of change and the development of a mentalizing stance. The study concludes that the change narratives provided by MBT and DBT for patients with BPD reflect the specific ingredients and techniques of the treatments, and suggests that further research could explore how these differences in change narratives may impact therapeutic outcomes.

An article will be publised based on this master thesis.

Personality coaching—unlocking subjectivity with «universal» methods

Vinge, A. (2022). Personality coaching—unlocking subjectivity with «universal» methods. [Unpublished master’s thesis, University of Oslo]

Summary

This is a study that investigates the experiences of nine leaders and managers who participated in coaching using a specific method and coach. The study uses the qualitative method of Interpretative Phenomenological Analysis to analyze data collected from interviews with the participants. The results suggest that the participants' general high level of interpersonal trust facilitated the establishment of a personal bond with the coach and increased their engagement in the tasks and goals of the coaching. The participants also emphasized the importance of belief in and acceptance of the coaching method, and described how the coach's competent application of a personality framework increased their awareness of themselves, others, and their social reality. The study concludes that psychotherapy research and coaching research could learn from each other, and that integration work appears to be an ongoing process during and after coaching.

The major findings of this text are that the coaching method used in this study was successful in increasing the participants' awareness of themselves, others, and their social reality, and that the establishment of trust with the coach and belief in and acceptance of the method were important factors in the success of the coaching. The study also found that learning experiences between sessions and after the coaching facilitated the integration of the personality framework and that integration work appears to be an ongoing process during and after coaching. It is suggested that psychotherapy research and coaching research could learn from each other.

An article will be publised based on this master thesis. 

MASTER'S THESES AND DOCTORAL DISSERTATION

I have successfully completed two master's theses, one at the University of Oslo and one at INSEAD.

1. Transference of tacit knowledge in organizations - lessons from psychotherapy

Transference of tacit knowledge in organizations - lessons from psychotherapy (INSEAD)

Summary

The transfer of tacit knowledge in organizations is a complex and dynamic process that involves the creation of an environment that promotes learning and co-creation of knowledge. It requires the development of effective communication and listening skills, as well as the ability to facilitate interactions and facilitate the co-construction of knowledge. The role of the leader or mentor is crucial in this process, as they have the ability to create a culture that promotes learning and encourages open communication and the sharing of knowledge. It is important for leaders to be aware of their own biases and limitations and to approach the transfer of knowledge with an open and inquisitive attitude. The use of methods from pedagogy and psychotherapy, such as the development of a working alliance and the use of empathetic listening, can be helpful in facilitating the transfer of tacit knowledge. Ultimately, the success of the transfer of tacit knowledge depends on the willingness of all parties involved to engage in an open and honest dialogue and to co-create new knowledge together.

Quiz

2. Affective Activation but not Insight Predicts Sense of Self in Short-Term Dynamic Psychotherapy

Affective Activation but not Insight Predicts Sense of Self in Short-Term Dynamic Psychotherapy: A Single-case Study (UiO)

Summary

The purpose of this study is to examine the therapeutic process and effects of Affect Phobia Therapy (APT), a type of psychotherapy that emphasizes the exploration and restructuring of emotions, in the treatment of a patient diagnosed with cluster C personality disorder. The study uses a single-case observational design, examining video recordings of the therapy sessions and using a quantitative observer-rated assessment tool, the Achievement of Therapeutic Objectives Scale (ATOS), as well as qualitative descriptions of the micro-processes and general information about the psychotherapeutic practice. The study aims to shed light on the mechanisms of change in APT and address the ongoing debate in the field of psychotherapy research about the effective components of psychotherapy and the lack of identified robust mechanisms of change. The study also discusses the importance of affect in psychotherapy and the tension between the widespread belief that emotional exploration is therapeutic and the lack of empirical support for affect-focused therapies showing better outcomes than those that are not affect-focused. The study also discusses the role of insight and mentalization in the therapeutic process and their potential as process variables that can predict positive treatment outcomes.

Psychotherapy research is the study of the effectiveness and mechanisms of change in psychotherapy, which is a type of treatment that aims to help individuals address and resolve emotional, behavioral, and mental health problems. While it is well established that individual psychotherapy is effective, there is still debate about which specific forms of therapy are the most effective and why they work. Meta-analyses of psychotherapy have not consistently shown one type of therapy to be more effective than another, and there have been few robust mechanisms of change identified. Clinical significance refers to a treatment's ability to meet standards of efficacy set by various stakeholders, and is different from statistical significance, which is based on statistical analysis. There is a need for more research on non-responders, or patients who do not benefit from treatment, as well as on identifying predictors of treatment outcomes.

It seems that there is evidence to support the idea that affect-focus, or the exploration and regulation of emotions, can be therapeutic in various forms of psychotherapy. However, there is also research to suggest that affect-focus may not necessarily be a necessary component of successful therapy, and that the therapeutic relationship and alliance may be more important factors in determining treatment outcomes. There is also some debate about whether cognitive or affect-focused approaches are more effective, with some research suggesting that a combination of both may be most beneficial. Additionally, the concept of mentalization, or the ability to reflect on and understand one's own and others' mental states, has been found to be important in the therapeutic process and may be related to affect focus and insight. Overall, it seems that the role of affect and emotion in psychotherapy is complex and multifaceted, and more research is needed to fully understand the relationship between affect focus and therapeutic outcomes.

DOCTORAL DISSERTATION

My doctoral dissertation can be downloaded here:

Measuring MBT – A marriage of the common and specific psychotherapy factors

Summary

This thesis covers a wide range of topics and is recommended for clinicians, researchers, and readers interested in the cultural aspects of borderline personality disorder (BPD). The introduction and discussion provide valuable insights and are particularly worth reading for those interested in the therapeutic alliance and common factors in the treatment of BPD.

The main objective of this research was to examine the role of the therapeutic alliance in the treatment of borderline personality disorder (BPD), a severe mental health condition that is traditionally difficult to treat and characterized by both self and relational pathology. The therapeutic alliance is a central issue in therapy and a key factor in the treatment of BPD patients. However, there is limited research on the therapeutic alliance in this population, and the impact of the alliance on patients with personality disorders (PDs) has been shown to be six times higher than for other patient groups. The research also aimed to establish reliable integrity measures for mentalization-based treatment (MBT), an evidence-based treatment for BPD. The study used a variety of methods, including generalizability theory, purposeful sampling, and linear mixed models, to examine the reliability and effectiveness of MBT and the development of the therapeutic alliance over time in MBT for BPD patients. The results showed that MBT is a reliable and effective treatment for BPD, and that the therapeutic alliance is a key factor in the success of MBT for BPD patients. The study also found that aspects of the therapeutic alliance, such as goals, tasks, and bonds, develop over time in MBT and that these changes are associated with clinical outcomes. Overall, the research suggests that the therapeutic alliance is a crucial factor in the treatment of BPD and that it is important to consider the role of the therapeutic alliance in the development and implementation of evidence-based treatments for BPD.

The thesis discusses the importance of the therapeutic alliance and epistemic trust in the treatment of BPD using MBT. Epistemic trust refers to the ability to trust someone else's knowledge about the world, which is an essential part of the "strong alliance" in therapy. The text suggests that in order to foster epistemic trust, therapists should provide new and corrective experiences and offer direct feedback to their clients. MBT emphasizes the teaching aspect of therapy and focuses on fostering a not-knowing exploration, in which the patient learns how to learn and trusts their new knowledge at a deeper level. The text also discusses the role of countertransference in the therapeutic relationship, and how the therapist's own feelings and reactions can impact the alliance. It is suggested that therapists should be able to tolerate the patient's negative emotions and thoughts, and be able to withhold their own opinions and solutions in order to allow the patient to understand and change. Overall, the text emphasizes the importance of the therapeutic alliance and epistemic trust in the treatment of BPD and suggests that incorporating pedagogy and strategies to foster these elements can be effective in improving outcomes for BPD patients.

This dissertation discusses the importance of providing a sense of understanding and agency in the treatment of BPD. It suggests that helping patients feel understood and having a sense of agency is a powerful and essential part of psychotherapy, and can lead to the restoration of feelings of selfhood. The text also emphasizes the importance of the therapist adopting a not-knowing or inquisitive stance, in which they listen to the patient and communicate a sense of respect and interest in what the patient has to say. This can help enhance the patient's sense of being understood. The text also discusses the importance of the therapist having a greater understanding of the patient's problem, in order to be able to guide them towards a more accurate understanding of reality and help them find the path from error to truth. Overall, the thesis emphasizes the importance of providing a sense of understanding and agency in the treatment of BPD and suggests that adopting a not-knowing stance and having a deeper understanding of the patient's problem can be effective in improving outcomes for BPD patients.

One strength of the research is that it used a variety of methods, including generalizability theory and linear mixed models, to examine the reliability and effectiveness of MBT and the development of the therapeutic alliance over time in MBT for BPD patients. However, there are several limitations to the generalizability of the findings. For example, the study only rated a small number of treatment sessions per therapist, which could artificially increase inter-rater conformity. Additionally, the raters were not blinded to the treatment modality, so the observed differences between therapies cannot be exclusively interpreted as reflecting the discriminant validity of the scale. There are also limitations to the study's use of the Working Alliance Inventory (WAI), as two different versions of the WAI were used, which may have affected the alliance ratings. Finally, the study was conducted in a specialized clinic, which may limit the generalizability of the findings to other treatment settings. Despite these limitations, the research suggests that the therapeutic alliance is a crucial factor in the treatment of BPD and that it is important to consider the role of the therapeutic alliance in the development and implementation of evidence-based treatments for BPD.

GOOGLE SCHOLAR

Here is my Google Scholar profile.

Researchers: Colin Egan & Espen Folmo in New York.


SELECTED PRESENTATIONS

“Minding mentalizing in assessment and treatment of personality disorder”. ISSPD PERSONALITY DISORDER  CONGRESS 2021 – The 17th World Congress. Oslo, Norway, October 2021.

“Faglig bakteppe”, Personlighetskonferansen 2019 Terapeutiske strategier: Veiviser i sårbart terreng. Oslo, Norway, November 2019.

“Battles of the comfort zone: a model of therapeutic strategy, technique, alliance, and epistemic trust”. 49th Annual Meeting of the Society for Psychotherapy Research. Amsterdam, the Netherlands, June 2018.

“Adherence and quality in Mentalization-Based Treatment (MBT)”. 4th International Congress on Borderline (ESSPD). Vienna, Austria, September 2016.

“Can mentalization-based group sessions be reliably assessed? October 2015”. The XIV International Society for the Study of Personality Disorders (ISSPD). Montreal, Canada, October 2015.

“What qualifies as very good versus poor mentalization-based treatment (MBT)?” The XIV International Society for the Study of Personality Disorders (ISSPD). Montreal, Canada, October 2015.

“MBT kvalitetslaboratorium. Hvordan kan terapier kvalitetssikres?” NASJONAL KONFERANSE OM PERSONLIGHETSPSYKIATRI - forebygging, behandling og oppfølging. Oslo, Norway, October 2015.