Aims: The purpose of this study was to explore how mentalization-based group therapy (MBT-G) for patients with borderline personality disorder may be both different and similar to a more traditional psychodynamic group psychotherapy approach. Material and methods: The study is a comparative case-study examining a supposedly representative clinical example of MBT-G and a supposedly representative clinical example of a psychodynamic group (PDG). Both groups were composed mainly of patients with borderline personality disorder. The study used a mixed methodological approach with quantitative research methods, including MBT-G Adherence and Quality Scale and Reflective Functioning Scale (RF-scale), and qualitative content analysis. Results: 1) The MBT-G therapists focused consistently on mental states and emotions. This was reflected both in a significantly higher intervention frequency, and in a higher proportion of theoretically assumed mentalizing-promoting interventions. 2) We observed an increase in mentalizing (defined as RF) among some patients in the MBT-G group. In the PDG session, RF development were less systematic, and had lesser impact. 3) Interventions with ‘demand’ characteristics might play an important role in developing a mentalizing group discourse. 4) In both groups, therapists and patients actively structured the sessions, but the MBT-G session more explicitly engaged in ‘meta’ discussions about it, i.e. discussing whether a topic should or should not be put on the agenda. Conclusion: Despite similarities between the approaches, differences in choice of therapeutic focus and consistency suggest that the two methods engage patients in different therapy processes. The results warrant studies that include more sessions in order to validate or falsify the resulting hypotheses.

In this article we present a video-based explorative study of three consecutive mentalization-based group therapy (MBT-G) sessions at a Norwegian Mental Health Centre. MBT-G has its roots in group analytic psychotherapy, but is modified to avoid the chaotic and destructive processes often encountered in groups consisting of severely personality disordered patients. Among the most notable differences from the Foulkesian group analytic approach are the therapists handling of authority and a ‘not-knowing stance’ (as opposed to an interpretative stance). Contrary to our expectations we found the typical chaotic borderline group processes that MBT-G was designed to avoid. An in-depth examination of the data, employing qualitative Thematic Analysis, revealed that the therapists failed to establish themselves as authoritative leaders of the group and misconstrued the ‘not-knowing stance’. We present transcripts of some typical sequences and discuss their clinical and therapeutic implications.

Foulkes’ concept of the group matrix is foundational for group analysis. However, its content should progress in parallel with new knowledge in areas that concern its essence. Influential authors have recently proposed a ‘tripartite matrix’ as well as constitutive ‘four modalities’ for understanding others. In this article we contend that personality theory has important implications for a modern understanding of the matrix. We have recently formulated a new theory of personality, based on three major constituents: temperament (primary emotions), attachment, and self-consciousness (mentalizing). All communication and relations between humans are coloured by these constituents. Temperament is the term for evolutionary inbuilt motivational systems that provide the basic energy and emotional quality to interpersonal transactions. Attachment is the individual’s unique template for interpersonal relatedness. And, mentalizing refers to the continuous reflection and interpretation of the content and process of intersubjective communication. These constituents likewise underpin and shape the communicative web in groups, the matrix. There is emotional energy in groups, there is preferred and avoided (types of) interpersonal relations, and there are different levels of reflective capacity (mentalizing), both at the level of the individual and the group. The main task of the group conductor is to create a therapeutic social system that in some defined way is different from the matrix of everyday social groups. S/he has to counteract the principle of entropy, a drift in the direction of an ordinary, daily, matter-of-fact discourse, which can take place in any everyday setting. We illustrate our views with a group therapy case where the therapists succeed in creating a highly productive group sequence (matrix), and where the protagonist clearly increases her mentalizing capacity, followed by a sequence (in the same group session) where the therapists abdicate from the role of matrix creators and the group declines to common talk.

A previous study of a MBT group displayed that the therapists failed to establish the group as a training ground for mentalizing. In this study we present a detailed and long transcript of a sequence in a successful MBT group. The therapists’ interventions were rated according to the mentalization-based group therapy adherence and quality scale, performed by the Norwegian MBT Quality Laboratory. The therapists displayed a high adherence to the MBT-G manual and the patients became collectively engaged in exploring and reflecting upon crucial borderline dynamics. The interventions that seemed most important for unfolding of the sequence are carefully spelled out. They have a metacognitive flavour, but are elsewise simple and straight forward. There seems to be nothing essentially new in this MBT-G approach, if one asks for specific ingredients. However, the therapeutic stance is consequently geared towards exploration of mental states, guided by a certain theory. One might say that it represents a more modern mixture of ingredients that are well known in different research and group therapy camps.

This text resembles the introduction I gave at the GASi 48th Winter Workshop 2025, ‘From Theory to Practice: Applications of Group Analysis in Research Field. A multidimensional exploration’. Research implies an empirical stance. I discuss some of its implications for group analysis.

In this article we describe and reflect upon the roots of mentalization-based group therapy (MBT-G) and its relationship to group analysis. The original setting for MBT was psychotherapeutic day hospitals that were strongly influenced by group analytic thinking. The challenges from an increasing number of borderline patients initiated theoretical and therapeutic innovations that separated MBT-G from traditional group analysis who responded differently, e.g. by strengthening its ties to object-relational theories that emphasized innate destructive drives. Since then, the dialogue between the two approaches have been meagre in the UK, but more constructive in e.g. Norway and Germany. We argue that MBT-G needs group analytic competence with respect to basic group dynamics, and that group analysis needs revitalization by the theory of mentalizing. We call for dialogues between the two approaches. The authors belong to both camps and speak with reference to experiences in Norway, United Kingdom, Denmark and Germany.

One of the main challenges in group therapy with drug-addicted patients is collective pseudomentalization, i.e., a group discourse consisting of words and clichés that are decoupled from any inner emotional life and are poorly related to external reality. In this study, we aimed to explore the phenomenology of pseudomentalization and how it was addressed by the therapist in an outpatient group for drug-addicted patients. The group was composed of seven members, and the transcripts of eight audio-recorded sessions (one per month) were rated and studied. The interventions of the therapist were measured with the mentalization-based group therapy (MBT-G) adherence and quality scale by independent raters. Two sessions, one with the highest and one with the lowest adherence, were selected, and the clinical sequences of pseudomentalization were analyzed in a comparative way. The findings revealed that pseudomentalization does occur as a collective phenomenon, akin to "basic assumptions" of Wilfred Bion, which we reconceptualized in this study. Any pseudomentalization seemed to be reinforced by the therapist when she was presenting frequent and long interventions, when abstaining from the management of group boundaries, when providing questions focused more on content than on the mental states of the group members, and when not focusing on emotions. However, the ultimate source of collective pseudomentalization seemed to be the fear of the group members of being overwhelmed by painful emotions, mental confusion, and a loss of identity. The findings also indicated that the principles of MBT-G may be a good antidote to pseudomentalization.

Empirical and theoretical work on revisions of the major diagnostic classification systems. DSM-IV and ICD-10. have revealed a need for a unifying theory of personality and personality disorders. A recent comparison by Gunderson, Masland, and Choi-Kain (2018), of different treatment strategies (and accompanying theories) for borderline personality disorder speaks to the same need. In this article we ask if Otto Kernberg's (2016) outline in his seminal paper "What Is Personality" might be such a common theoretical ground. We perform a critical analysis of Kemberg's contribution and suggest a common theoretical platform that consists of three basic personality constituents: (a) Temperament. (b) Attachment, and (c) Mentalizing/self-consciousness. We agree with Kernberg on the broad conception of temperament and attachment, though we also differ with his outline on some important details. We argue that the third constituent should be grounded in the realm of sociocognitive development. while Kernberg favors superego formation in a more psychoanalytic sense. The tripartite theory of personality that we outline aims to integrate emotional dispositions and personality traits (temperament) with interpersonal relatedness (psychoanalytic approaches) and social cognition, and it is fundamentally rooted in evolutionary reasoning. We discuss the relevance of this model for theoretical integration of the various empirically supported treatment approaches to borderline personality disorder.

This study concerns an innovative group counseling method, the narrative mediation path (NMP), which aims to promote mentalization on underachievement among university students. The study analyzes a single NMP case with the aim of investigating whether a counselor's interventions influence the reflective functioning (RF) of the group members and their academic performance. The transcripts of 9 sessions of a single NMP were rated according to the Reflective Functioning Scale. We used a microgenetic approach to analyze the clinical sequences of the sessions, for which significant changes in the RF were observed. We identified and categorized the types of counselor's interventions that seemed to improve the students' RFs most effectively. Academic performance was measured by the Academic Performance Scale. The results indicated that most of the students improved their level of RF by mentalizing their problem of underachievement while also improving academic performance. The interventions, which reflect both the not-knowing stance and defense interpretations of the counselor, appeared to play a key role in developing the mentalizing capacities. We discuss the relevance of these findings for the more "interpretative" role of clinicians in mentalizing interventions and the need of further studies to determine whether the results are replicable. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Treatment integrity includes adherence to a therapeutic model and competence in delivering interventions. In group psychotherapy research, the association between a clinician's treatment integrity and therapeutic effectiveness has received little attention. However, the issue has recently become a focus of interest for mentalization-based group therapy (MBT-G), and research instruments for studying clinician's treatment integrity have been developed. This pilot study is aimed at analyzing the association between treatment integrity and change in underachieving university students from Italy who received nine sessions of group counseling aimed at promoting mentalization to enhance their academic performance. The effectiveness of the counseling groups was assessed with the Academic Performance Inventory. Transcripts of 18 sessions from two groups were analyzed using: (a) the Innovative Moments Coding System-a reliable method for studying change by tracking narrative innovations along the therapeutic process, and (b) the Mentalization-based Group Therapy Adherence and Quality Scale-assessing 19 types of mentalizing interventions. The results indicate that adherent interventions should be provided with high quality. Good treatment results require techniques consistent with the theoretical model, but also, most importantly, these techniques have to be delivered competently.

This study aims at evaluating the psychometric properties of the antisocial personality disorder (ASPD) criteria in a large sample of patients, most of whom had one or more personality disorders (PD). PD diagnoses were assessed by experienced clinicians using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders , 4th edition, Axis II PDs. Analyses were performed within an item response theory framework. Results of the analyses indicated that ASPD is a unidimensional construct that can be measured reliably at the upper range of the latent trait scale. Differential item functioning across gender was restricted to two criteria and had little impact on the latent ASPD trait level. Patients fulfilling both the adult ASPD criteria and the conduct disorder criteria had similar latent trait distributions as patients fulfilling only the adult ASPD criteria. Overall, the ASPD items fit the purpose of a diagnostic instrument well, that is, distinguishing patients with moderate from those with high antisocial personality scores. Keywords antisocial personality disorder , psychopathy , item response theory , conduct disorder , gender bias

Summary Mentalization-Based Group Therapy (MBT-G) in a Pilot Study of Female Personality Disordered and Substance-Abusing Patients In this article, we summarize the results of a pilot study that investigated the effects of mentalization based treatment (MBT) for female patients with severe personality disorder (PD) and substance use disorder (SUD). We specially emphasize the group component (MBT-G) of the treatment. We describe the principles of MBT-G, the formidable challenges with this patient population, and how the therapists and the MBT team as a whole coped with these challenges. The overall treatment results were very good, both with respect to drug consumption and personality functioning. For most of the patients an extremely destructive lifestyle was profoundly changed.

In this article, we summarize the results of a pilot study that investigated the effects of mentalization based treatment (MBT) for female patients with severe personality disorder (PD) and substance use disorder (SUD). We specially emphasize the group component (MBT-G) of the treatment. We describe the principles of MBT-G, the formidable challenges with this patient population, and how the therapists and the MBT team as a whole coped with these challenges. The overall treatment results were very good, both with respect to drug consumption and personality functioning. For most of the patients an extremely destructive lifestyle was profoundly changed.

In this correspondence we correct some misleading information about mentalization-based treatment in Oslo, Norway.

Mentalization-based treatment (MBT), originally designed for patients with borderline personality disorder (BPD), may be particularly indicated for severe conditions. However, there is limited documentation of how increasing severity of personality disorder (PD) effect outcomes of highly specialized treatments. This study aimed to investigate associations between clinical severity and outcomes for patients in MBT as compared to a psychodynamic group-based treatment programme (PDT). A naturalistic, longitudinal, comparison study. The sample included 345 patients with BPD (PDT n  = 281, MBT n  = 64). The number of diagnosed PDs, PD criteria, and symptom disorders were chosen as baseline indicators of clinical severity. Clinical outcomes (global functioning, symptom distress, interpersonal problems) were repeatedly assessed over three years. Therapists’ fidelity to MBT was satisfactory. Linear mixed models were the applied statistics. In PDT, greater clinical severity was associated with poorer improvement rates. Clinical severity was not associated with significant differences in outcomes for patients in MBT. Differences in outcomes for patients in MBT and PDT increased significantly with higher severity of disorder. Supporting previous research, this study indicates that clinical benefits associated with MBT also apply for BPD patients with severe conditions. The results also suggest that increasing severity was a challenge in PDT.

OBJECTIVE:The relationship between borderline personality disorder (BPD) and bipolar II disorder (BIP-II) is disputed but understudied. Here, we investigated brain glucose metabolism in these patient groups and healthy control subjects (HCs).METHODS:Sixty-five subjects, 22 BPD (19 females), 22 BIP-II (17 females), and 21 HC (14 females), were examined using 2-deoxy-2[18F]-fluoro-d-glucose positron-emission tomography (PET) scanning. Only patients without reciprocal comorbidity were recruited; BPD participants without bipolar spectrum pathology; BIP-II participants without cluster A/B personality pathology. Groups were compared pairwise. Associations with mood state and childhood trauma were analyzed.RESULTS:Both patient groups exhibited hypometabolism compared with HCs in insula, brainstem, and frontal white matter. Additionally, BPD patients showed hypometabolism in hypothalamus, midbrain, and striatum; BIP-II patients in cerebellum. Uncorrected analyses showed cortical areas of higher metabolism in BIP-II than BPD, and associations with clinical variables differed between the groups.CONCLUSION:Reduced metabolism in the insula regions was shown in both disorders, suggesting shared pathophysiological mechanisms. The observed patterns of altered metabolism specific to each patient group, as well as the uncorrected results, may also suggest differential pathophysiology. However, these latter findings must be interpreted cautiously given the non-significant corrected results in the direct comparison between the disorders.