Single-session Mentalization-based Treatment Group for Law Enforcement Officers

ABSTRACT

Law enforcement violence has emerged as a leading public health concern, and law enforcement officers are themselves at greater risk for a range of psychiatric disorders. Drawing on the significant empirical support for mentalization-based treatment (MBT), this paper explores the use of MBT as a transdiagnostic psychotherapy for law enforcement professionals. By helping patients to mentalize—that is, to “read,” access, and reflect on mental states in oneself and other people—MBT could be useful as a dual-focus treatment, able to simultaneously impact psychiatric illness among law enforcement officers while also indirectly impacting the problem of law enforcement violence in the broader society. The core psychotherapeutic principles of MBT are reviewed, along with common vulnerabilities in mentalizing likely to arise for law enforcement professionals in the context of high emotional and interpersonal intensity. The authors outline a novel application of MBT which has implications for psychiatric treatment as well as police training: the single-session psychoeducation and psychotherapy group, where law enforcement officers practice both self-reflection and empathy in situations of relational conflict. Utilizing group process from a residential treatment program for first responders with mental health and substance use disorders, a case example is offered to illustrate this intervention.

DISCLOSURE STATEMENT

Anthony W. Bateman receives royalties from books on MBT from American Psychiatric Publishing and Oxford University Press, as well as fees for MBT trainings, outside the submitted work. No other authors have any conflicts of interest to report, or any involvements that might raise the question of bias in the work reported or in the conclusions, implications, or opinions stated.

Notes

¹ While multiple factors contribute to this imbalance, one important contextual factor is the relative prevalence of firearm holding in the United States across civilians, military, and law enforcement domains. From a global perspective, the United States has the largest number of firearms at 398,520,000 holdings, followed far behind by China with 79,170,000 firearms, India with 76,7000,000 firearms, and Russia with 50,330,000 firearms (see Karp, 2018).

² While these findings may bear relevance on LEO performance, it is important to note that pre-employment police evaluation processes are extensive and utilize the most current and comprehensive psychological assessments (Mitchell & Dorian, 2016).

³ At present, scant empirical attention has been paid to the use of group psychotherapy to treat LEOs. For examples of such interventions, developed specifically for LEO populations outside the United States, see Chongruksa et al. (2012) and Vallejo (2011).

⁴ Since this group is facilitated in a psychiatric treatment program that necessarily focuses on patients’ acute psychological and interpersonal challenges, we grant patients considerable autonomy in bringing in scenarios that feel most pressing and personally meaningful to them. While these scenarios often involve interactions at work, they just as regularly involve relationships with friends, family members, and intimate partners. Consistent with the extensive research on the efficacy of MBT, our assumption is that, as patients practice reflecting on emotionally stressful situations in the relatively “cold” context of therapy, these experiences will generalize into greater capacities for reflectiveness in more emotionally “hot” contexts (e.g., arguments with loved ones, critical incidents in the field). However, as discussed later in the “Limitations and Future Directions” section, this assumption remains anecdotal and requires empirical validation for this intervention and patient population.

⁵ Identifying information has been altered to disguise the identity of the patients mentioned in this clinical example. The primary patient has granted written consent for the publication of his case material.

Additional information

Notes on contributors

Robert P. Drozek

Robert P. Drozek is a therapist and supervisor in the Mentalization-based Treatment (MBT) Clinic at McLean Hospital, a teaching associate in psychiatry at Harvard Medical School, and a supervisor of MBT through the Anna Freud Centre in London. Anthony W. Bateman is one of the original developers and researchers of MBT. He serves as a consultant psychiatrist at the Anna Freud National Centre for Children and Families in London, Visiting Professor at University College London, and Honorary Professor in Psychotherapy at the University of Copenhagen. Jonathan T. Henry is the medical director of the Addictions Treatment Program at the Jesse Brown Veterans Administration Medical Center in Chicago, IL. Hilary S. Connery is the medical director of the LEADER Residence at McLean Hospital, an assistant professor of psychiatry at Harvard Medical School, and the clinical director for McLean’s Center of Excellence in Alcohol, Drugs, and Addiction. George W. Smith is the director of Outpatient Group Services at McLean Hospital, a teaching associate in psychiatry at Harvard Medical School, and the clinic director of the Personality Disorders Outpatient Service at McLean. Rachel D. Tester is the program director of the LEADER Residence at McLean Hospital, a residential treatment program that provides comprehensive psychiatric services to male uniformed responders with mental health and substance use disorders.