Tecniche del Trattamento Basato sulla Mentalizzazione in terapie psicodinamiche, cognitive e basate sulla mentalizzazione: uno studio empirico osservazionale

Mentalization is a mental process that enables individuals to implicitly and explicitly understand and interpret their own and other's mental states (Bateman & Fonagy, 2016). While Mentalization-Based Treatment (MBT; Bateman & Fonagy, 2019) was specifically developed to enhance this capacity, its creators acknowledged that therapeutic approaches grounded in theoretical frameworks other than MBT can also foster the improvement of mentalizing abilities. Objective: To investigate, through two studies, which MBT techniques are present in other forms of psychotherapy and how they influence therapeutic processes. Study 1: From a sample of audio recordings of psychotherapy sessions involving patients diagnosed with personality disorders or subclinical personality issues, 75 verbatim transcripts were randomly selected (n = 25 MBT sessions, n = 25 CBT sessions, n = 25 PDT sessions). Each session was independently evaluated by two trained raters using the MBT Adherence and Competence Scale. The results indicated that MBT therapists demonstrated greater adherence to mentalizing techniques, particularly in maintaining a Not-knowing Stance and Identifying non-Mentalizing Modes, compared to CBT and PDT therapists. The theoretical orientation of the therapists was significantly associated with differences in adherence to specific MBT techniques. Additionally, therapist-related effects appeared to influence adherence to mentalizing techniques, although this finding was not statistically significant. Study 2: From a sample of audio recordings of psychotherapy sessions with patients diagnosed with PD or subclinical personality issues, 110 verbatim transcripts were randomly selected (n = 32 MBT sessions, n = 41 CT sessions, n = 37 PDT sessions). Each session was evaluated by two expert raters using the MBT-ACS (Anna Freud Centre, 2020) and the Reflective Functioning Scale (RFS; Fonagy et al., 1998). The results showed that MBT therapists exhibited greater adherence to MBT techniques. Furthermore, the domains of Mentalizing Sessional Structure and Mentalizing Process were significantly associated with improvements in in-session RF. This suggests that certain MBT techniques may have clinically relevant effects even within therapies that are not explicitly MBT. These findings align with evidence challenging the notion that the “active ingredients” of therapy are exclusively those dictated by the theoretical model.