Effects of interventions promoting mentalization and interventions disconfirming pathogenic beliefs: A comparative single case study of three patients

Abstract

Design: The effects of two types of interventions were investigated in an explorative single-case study of three patients with chronic depression and/or borderline personality disorder over 20 therapy sessions (sessions 2–11 and sessions 51–60). The ratings of therapeutic interventions that promoted mentalization were based on the concept of mentalization (Bateman & Fonagy), and the ratings of those disconfirming pathogenic beliefs were based on Control Mastery Theory (Weiss & Sampson). The effect of therapeutic interventions (mentalization vs. pathogenic beliefs) was assessed by measuring the level of reflective self-awareness, which was rated using the Experiencing Scale. The therapeutic alliance relationship was examined each session by a questionnaire. Therapy sessions were analysed with two different time series analyses. Each session was rated in five-minute sections.

Results: In the time-series analysis, therapeutic interventions promoting mentalization and those disconfirming pathogenic beliefs correlated significantly with reflective self-awareness for two of the three patients. For one patient, there was no correlation. However, the results in the trend were different. For all patients, reflective self-awareness decreased or remained stable, and therapeutic alliance improved. This needs to be explained.

Conclusions: The significant association between therapeutic interventions and patients’ reflective self-awareness can be understood as a reciprocal causal process that is co-created by the patient and the therapist. The deviating results, especially for the third patient, are discussed.

Keywords:

• mentalization
• Control Mastery Theory
• experiencing
• reflective self-awareness
• single case study
• time series analysis
• therapeutic interventions
• therapeutic alliance
• clinical ratings

PUBLIC INTEREST STATEMENT

In the past, the effectiveness of psychotherapy was shown in hundreds of high-quality psychotherapy outcome studies. The therapeutic alliance has a great impact on whether psychotherapy works or not. However, we do not know how psychotherapy really works. We asked: 1. Does therapist’s promoting mentalization influence patient’s reflective self-awareness? 2. Does therapist’s disconfirming patient’s pathogenic beliefs influence patient’s reflective self-awareness? The results of a single-case study are: In two therapies therapist and patient had a reciprocal influence. We could show the reciprocal influence in five-minute segments by time series analysis. For one patient, there was no influence. For this patient, reflective self-awareness decreased significantly during therapy. The results show the importance of therapeutic alliance and raise new questions.

Cover image

Source: Elisabeth Brockmann, www.Elisabeth-Brockmann.de

Additional information

Funding

This work was supported by the Köhler Stiftung im Stifterverband für die Deutsche Wissenschaft, Germany; Deutsche Gesellschaft für Individualpsychologie, Germany; and Alfred Adler Institut Mainz, Germany.

Notes on contributors

Josef Brockmann

The authors have been working together in this single-case research project for 10 years. This article shows a main result of this project. All authors are psychodynamically oriented psychotherapists with experience in clinical practice and training. J. Brockmann and H. Kirsch are experienced in psychotherapy research for many years. G. Silberschatz has supervised the project since its beginning. He is a well-known psychotherapy researcher of the San Francisco Psychotherapy Research Group (SFPRG) and was president of the Society for Psychotherapy Research (SPR). The authors published another part of the project “Mr K - A successful case of analytic oriented therapy documented empirically: The role of the therapeutic relationship and reflexive self-awareness” in Psychoanalytic Psychotherapy (2017).

Holger Kirsch

The authors have been working together in this single-case research project for 10 years. This article shows a main result of this project. All authors are psychodynamically oriented psychotherapists with experience in clinical practice and training. J. Brockmann and H. Kirsch are experienced in psychotherapy research for many years. G. Silberschatz has supervised the project since its beginning. He is a well-known psychotherapy researcher of the San Francisco Psychotherapy Research Group (SFPRG) and was president of the Society for Psychotherapy Research (SPR). The authors published another part of the project “Mr K - A successful case of analytic oriented therapy documented empirically: The role of the therapeutic relationship and reflexive self-awareness” in Psychoanalytic Psychotherapy (2017).

Katja Dembler

The authors have been working together in this single-case research project for 10 years. This article shows a main result of this project. All authors are psychodynamically oriented psychotherapists with experience in clinical practice and training. J. Brockmann and H. Kirsch are experienced in psychotherapy research for many years. G. Silberschatz has supervised the project since its beginning. He is a well-known psychotherapy researcher of the San Francisco Psychotherapy Research Group (SFPRG) and was president of the Society for Psychotherapy Research (SPR). The authors published another part of the project “Mr K - A successful case of analytic oriented therapy documented empirically: The role of the therapeutic relationship and reflexive self-awareness” in Psychoanalytic Psychotherapy (2017).

Dorothe König

The authors have been working together in this single-case research project for 10 years. This article shows a main result of this project. All authors are psychodynamically oriented psychotherapists with experience in clinical practice and training. J. Brockmann and H. Kirsch are experienced in psychotherapy research for many years. G. Silberschatz has supervised the project since its beginning. He is a well-known psychotherapy researcher of the San Francisco Psychotherapy Research Group (SFPRG) and was president of the Society for Psychotherapy Research (SPR). The authors published another part of the project “Mr K - A successful case of analytic oriented therapy documented empirically: The role of the therapeutic relationship and reflexive self-awareness” in Psychoanalytic Psychotherapy (2017).

Isolde de Vries

The authors have been working together in this single-case research project for 10 years. This article shows a main result of this project. All authors are psychodynamically oriented psychotherapists with experience in clinical practice and training. J. Brockmann and H. Kirsch are experienced in psychotherapy research for many years. G. Silberschatz has supervised the project since its beginning. He is a well-known psychotherapy researcher of the San Francisco Psychotherapy Research Group (SFPRG) and was president of the Society for Psychotherapy Research (SPR). The authors published another part of the project “Mr K - A successful case of analytic oriented therapy documented empirically: The role of the therapeutic relationship and reflexive self-awareness” in Psychoanalytic Psychotherapy (2017).

Monika Zabolitzki

The authors have been working together in this single-case research project for 10 years. This article shows a main result of this project. All authors are psychodynamically oriented psychotherapists with experience in clinical practice and training. J. Brockmann and H. Kirsch are experienced in psychotherapy research for many years. G. Silberschatz has supervised the project since its beginning. He is a well-known psychotherapy researcher of the San Francisco Psychotherapy Research Group (SFPRG) and was president of the Society for Psychotherapy Research (SPR). The authors published another part of the project “Mr K - A successful case of analytic oriented therapy documented empirically: The role of the therapeutic relationship and reflexive self-awareness” in Psychoanalytic Psychotherapy (2017).

George Silberschatz

The authors have been working together in this single-case research project for 10 years. This article shows a main result of this project. All authors are psychodynamically oriented psychotherapists with experience in clinical practice and training. J. Brockmann and H. Kirsch are experienced in psychotherapy research for many years. G. Silberschatz has supervised the project since its beginning. He is a well-known psychotherapy researcher of the San Francisco Psychotherapy Research Group (SFPRG) and was president of the Society for Psychotherapy Research (SPR). The authors published another part of the project “Mr K - A successful case of analytic oriented therapy documented empirically: The role of the therapeutic relationship and reflexive self-awareness” in Psychoanalytic Psychotherapy (2017).