Pedagogical stance in mentalization-based treatment

J Clin Psychol. 2022 Sep;78(9):1764-1784. doi: 10.1002/jclp.23335. Epub 2022 Mar 8.


Background: A common aspect of evidence-based treatments for people with borderline personality disorder (BPD) is pedagogical interventions and formats. In mentalization-based treatment (MBT) the introductory course has a clear pedagogical format, but a pedagogical stance is not otherwise defined.

Methods: Treatment integrity was quantitatively assessed in a sample of 346 individual MBT sessions. Nine group sessions and 24 individual MBT sessions were qualitatively subjected to interpretative phenomenological analysis (IPA).

Results: The dominating intervention type was MBT Item 16-therapist checking own understanding (31% of the interventions). IPA unveiled the following: (1) a pervasive, but hidden/implicit psychopedagogical agenda, (2) psychopedagogical content seemed precious for the patients, and (3) four tentative strategies for pedagogical interventions in MBT (a) independent reasoning; (b) epistemic trust; (c) mental flexibility; and (d) application of verified insights, knowledge, or strategies.

Conclusion: Development and clarification of the pedagogical stance in MBT could further improve the quality of therapists' interventions.

Keywords: borderline personality disorder; clinical practice guidelines; cultural competence; education and training; evidence-based psychotherapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Borderline Personality Disorder* / therapy
  • Humans
  • Mentalization*
  • Mentalization-Based Therapy
  • Psychotherapy / methods
  • Theory of Mind*
  • Treatment Outcome