Changes in mentalization in patients with personality disorders during sequential brief-Adlerian psychodynamic psychotherapy: The role of therapists' technique and countertransference.

Personality disorders Pub Date : 2024-04-04 DOI:10.1037/per0000659

Andrea Ferrero, Giulia Gagliardini, Barbara Simonelli, Simona Fassina, Silvana Lerda, Salvatore Gullo, A. Colli

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Abstract

Mentalization, that is the capacity to understand our and others' behaviors in terms of intentional mental states, represents one of the core features of personality disorders (PDs) and can be related to therapists' countertransference (CT) and interventions. AIMS The aim of the present work was to study the relationship between therapists' technique, therapists' CT, and patients' mentalization, in a sample of patients with PDs undergoing a 40-session program of sequential brief-adlerian psychodynamic psychotherapy, a psychodynamic therapeutic model specifically developed for the treatment of PDs in public mental health services. METHOD Eighty-seven patients with PD and their therapists completed ratings of mentalization (mentalization imbalances scale and reflective functioning questionnaire), CT (therapist response questionnaire), and therapists' intervention (comparative psychotherapy process scale) at five different time points (Sessions 5, 10, 20, 30, and 40). RESULTS Results showed that patients' mentalizing problematics decreased over time. Moreover, we found a reduction of therapists' disengaged CT, and an increase in positive CT over time. Regarding therapists' techniques, psychodynamic-interpersonal interventions were on average higher than cognitive-behavioral, but both techniques were used increasingly over time. Our results also showed significant and clinically coherent interactions between therapist's CT and techniques and between patient's mentalization imbalance and therapist's response. Our results highlighted the importance of early stages in therapy, since the most significant relationships between the various process variables (patient's mentalizing imbalances, therapist's techniques, and emotional responses) are observed between t₁ and t₂, corresponding to the initial phases of the treatments. Clinical implications will be discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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人格障碍患者在连续简短的阿德勒心理动力学心理治疗过程中的心智变化：治疗师的技术和反移情的作用。

心理化，即从有意的心理状态来理解我们和他人行为的能力，是人格障碍（PDs）的核心特征之一，可能与治疗师的反移情（CT）和干预有关。目的：本研究的目的是研究治疗师的技术、治疗师的反移情（CT）和患者的心理化之间的关系，研究对象是正在接受 40 个疗程的简短-阿德勒心理动力学连续治疗的人格障碍患者。方法87名帕金森氏症患者及其治疗师在五个不同的时间点（疗程5、10、20、30和40）完成了对精神化（精神化失衡量表和反思功能问卷）、CT（治疗师反应问卷）和治疗师干预（心理治疗过程比较量表）的评分。结果显示，随着时间的推移，患者的精神化问题有所减少。此外，随着时间的推移，我们还发现治疗师的 "脱离性 CT "有所减少，而 "积极性 CT "有所增加。在治疗师的技术方面，心理动力-人际干预平均高于认知行为干预，但随着时间的推移，这两种技术的使用都在增加。我们的研究结果还显示，治疗师的 CT 与治疗技术之间，以及患者的心理失衡与治疗师的反应之间，都存在着明显的、临床上一致的相互作用。我们的结果凸显了治疗早期阶段的重要性，因为在治疗的初始阶段（t₁和 t₂），各种过程变量（患者的心理化失衡、治疗师的技术和情绪反应）之间的关系最为显著。本文将讨论其临床意义。(PsycInfo Database Record (c) 2024 APA, 版权所有）。

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Personality disorders

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