Challenges in Mentalization–Based Group Therapy (MBT-G): A Video-based Explorative Case Study

Abstract

This paper presents a video-based explorative case study of therapeutic challenges in mentalization-based group therapy (MBT-G) for patients with borderline-type problems. Employing qualitative methodology, we explored a MBT group as part of routine psychiatric care at a Psychiatric District Centre (naturalistic study). Several phenomena emerged as important in understanding the therapists’ struggle to construe the group in a manner that foster mentalization. First and foremost, the main challenge seemed to be that the therapists did not succeed in establishing the authority needed to break through a strong pseudo-mentalizing group culture, alternating with more chaotic displays of psychic equivalence. This may be understood as a consequence of a misconstrued attempt by the therapists to take on a not-knowing stance, a central principle in MBT. Supposedly, the not-knowing stance towards the inner psyche of the patients interfused with a not-knowing stance towards the therapeutic process as a whole, undermining the authority of the therapists. The seemingly contradicting demands inherent in the MBT-G treatment manual, both being authoritative and taking a not-knowing stance, have not previously been highlighted in the literature. The results point towards the complicated process of transferring scientifically validated treatments to routine clinical practice.