https://doi.org/10.4081/ripppo.2022.649
Antisocial personality disorder in group therapy, kindling pro-sociality and mentalizing
Submitted: June 21, 2022
Accepted: October 3, 2022
Published: November 7, 2022
Accepted: October 3, 2022
Abstract Views: 2836
PDF: 729
HTML: 32
HTML: 32
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Patients with antisocial personality disorder (ASPD) are known for being difficult to treat. Treatment for ASPD is debated and lacking evidence. Among several reasons for treatment difficulties concerning ASPD, negative countertransference in health personnel is one central topic. Mentalization based treatment (MBT) is a reasonable candidate treatment for ASPD. From an ongoing pilot-study on MBT with substance using ASPD patients, we explore therapist experiences. Four experienced MBT therapists together with the principal investigator performed a focus group together. The therapists were themselves involved in performing this study and analyses are made as an autoethnographic study, with thematic analyses as methodological approach. As this study involved a qualitative investigation of own practice, reflexivity of the processes was performed. The aim was to explore in depth: therapist experiences and therapist wellbeing in MBT-ASPD. We found four main themes on therapist experiences: i) gaining safety by getting to know them better; ii) gaining cooperation through clear boundaries and a non-judgmental stance; iii) shifting inner boundaries; and iv) timing interventions in a high-speed culture. These four themes point to different therapist experiences one can have in MBT-ASPD. Our findings resonate well with the clinical literature on ASPD, the findings imply that clinical teams should have a focus on therapist countertransference and burnout, ensure that therapists uphold boundaries and open-mindedness in treatment of ASPD and that therapists experience vitalizing feelings in this line of work.
APA. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Arefjord, N., Morken, K. T. E., & Lossius, K. (2019). Comorbid Substance Use Disorder and Personality Disorder. In A. Bateman & P. Fonagy (Eds.), Handbook of Mentalizing in Mental Health Practice. American Psychiatric Association Publishing.
Bales, D. L., Timman, R., Luyten, P., Busschbach, J., Verheul, R., & Hutsebaut, J. (2017). Implementation of evidence‐based treatments for borderline personality disorder: The impact of organizational changes on treatment outcome of mentalization‐based treatment. Personality and Mental Health, 11(4), 266-277. https://onlinelibrary.wiley.com/doi/abs/10.1002/pmh.1381
DOI: https://doi.org/10.1002/pmh.1381
Bateman, A., Bolton, R., & Fonagy, P. (2013). Antisocial personality disorder: A mentalizing framework. Focus, 11(2), 178-186.
DOI: https://doi.org/10.1176/appi.focus.11.2.178
Bateman, A., & Fonagy, P. (2013). Impact of clinical severity on outcomes of mentalisation-based treatment for borderline personality disorder. The British Journal of Psychiatry, 203(3), 221-227. http://bjp.rcpsych.org/content/bjprcpsych/203/3/221.full.pdf
DOI: https://doi.org/10.1192/bjp.bp.112.121129
Bateman, A., Campbell, C., & Fonagy, P. (2021). Rupture and repair in mentalization-based group psychotherapy. International Journal of Group Psychotherapy, 71(2), 371-392.
DOI: https://doi.org/10.1080/00207284.2020.1847655
Bateman, A., & Fonagy, P. (2016). Mentalization-based treatment for personality disorders - A practical guide. Oxford University Press.
DOI: https://doi.org/10.1093/med:psych/9780199680375.001.0001
Bateman, A. W. (2022). Mentalizing and group psychotherapy: a novel treatment for antisocial personality disorder. American Journal of Psychotherapy, 75(1), 32-37.
DOI: https://doi.org/10.1176/appi.psychotherapy.20210023
Bateman, A., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385.
DOI: https://doi.org/10.1016/S0140-6736(14)61394-5
Bateman, A., Motz, A., & Yakeley, J. (2019). Antisocial personality disorder in community and prison settings. In P. F. Anthony Bateman (Ed.), Handbook of mentalizing in mental health practice - Second edition. American Psychiatric Association Publishing.
Bateman, A., O’Connell, J., Lorenzini, N., Gardner, T., & Fonagy, P. (2016). A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder. 16(1), 304.
DOI: https://doi.org/10.1186/s12888-016-1000-9
Betan, E., Heim, A. K., Zittel Conklin, C., & Westen, D. (2005). Countertransference phenomena and personality pathology in clinical practice: an empirical investigation. American Journal of Psychiatry, 162(5), 890-898.
DOI: https://doi.org/10.1176/appi.ajp.162.5.890
Binder, P.-E., Holgersen, H., & Moltu, C. (2012). Staying close and reflexive: An exploratory and reflexive approach to qualitative research on psychotherapy. Nordic Psychology, 64(2), 103-117.
DOI: https://doi.org/10.1080/19012276.2012.726815
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.
DOI: https://doi.org/10.1191/1478088706qp063oa
Cain, L., Perkey, H., Widner, S., Johnson, J. A., Hoffman, Z., & Slavin-Mulford, J. (2018). You really are too kind: implications regarding friendly submissiveness in trainee therapists. Research in Psychotherapy: Psychopathology, Process, and Outcome, 21(2).
DOI: https://doi.org/10.4081/ripppo.2018.312
Coco, G. L., Tasca, G. A., Hewitt, P. L., Mikail, S. F., & Kivlighan, J. D. M. (2019). Ruptures and repairs of group therapy alliance. An untold story in psychotherapy research. Research in Psychotherapy: Psychopathology, Process, and Outcome, 22(1).
DOI: https://doi.org/10.4081/ripppo.2019.352
Colli, A., Tanzilli, A., Dimaggio, G., & Lingiardi, V. (2014). Patient personality and therapist response: An empirical investigation. American Journal of Psychiatry, 171(1), 102-108.
DOI: https://doi.org/10.1176/appi.ajp.2013.13020224
Esposito, G., Formentin, S., Marogna, C., Sava, V., Passeggia, R., & Karterud, S. W. (2021). Pseudomentalization as a Challenge for Therapists of Group Psychotherapy With Drug Addicted Patients. Frontiers in Psychology, 12.
DOI: https://doi.org/10.3389/fpsyg.2021.684723
Finlay, L. (2003). The reflexive journey: mapping multiple routes. Reflexivity: A practical guide for researchers in health and social sciences, 3-20.
DOI: https://doi.org/10.1002/9780470776094.ch1
Finlay, L., & Gough, B. (2003). Reflexivity: A practical guide for researchers in health and social sciences. John Wiley & Sons.
DOI: https://doi.org/10.1002/9780470776094
Fonagy, P., Yakeley, J., Gardner, T., Simes, E., McMurran, M., Moran, P., Crawford, M., Frater, A., Barrett, B., & Cameron, A. (2020). Mentalization for Offending Adult Males (MOAM): study protocol for a randomized controlled trial to evaluate mentalization-based treatment for antisocial personality disorder in male offenders on community probation. Trials, 21(1), 1-17.
DOI: https://doi.org/10.1186/s13063-020-04896-w
Gazzillo, F., Schimmenti, A., Formica, I., Simonelli, A., & Salvatore, S. (2017). Effectiveness is the gold standard of clinical research. Research in Psychotherapy: Psychopathology, Process, and Outcome, 20(2).
DOI: https://doi.org/10.4081/ripppo.2017.278
Gibbon, S., Khalifa, N. R., Cheung, N. H., Völlm, B. A., & McCarthy, L. (2020). Psychological interventions for antisocial personality disorder. Cochrane Database of Systematic Reviews(9).
DOI: https://doi.org/10.1002/14651858.CD007668.pub3
Goldstein, R. B., Compton, W. M., Pulay, A. J., Ruan, W. J., Pickering, R. P., Stinson, F. S., & Grant, B. F. (2007). Antisocial behavioral syndromes and DSM-IV drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and alcohol dependence, 90(2-3), 145-158.
DOI: https://doi.org/10.1016/j.drugalcdep.2007.02.023
Halkier, B. (2010). Fokusgrupper. Gyldendal Norsk Forlag AS.
Inderhaug, T. S., & Karterud, S. (2015). A qualitative study of a mentalization-based group for borderline patients. Group Analysis, 48(2), 150-163.
DOI: https://doi.org/10.1177/0533316415577341
Karterud, S. (2018). Case formulations in mentalization-based group therapy. Research in Psychotherapy: Psychopathology, Process, and Outcome, 21(3).
DOI: https://doi.org/10.4081/ripppo.2018.318
Kendall, T., Pilling, S., Tyrer, P., Duggan, C., Burbeck, R., Meader, N., & Taylor, C. J. B. (2009). Borderline and antisocial personality disorders: summary of NICE guidance. 338, b93.
DOI: https://doi.org/10.1136/bmj.b93
Kitzinger, J. (1994). The methodology of focus groups: the importance of interaction between research participants. Sociology of health & illness, 16(1), 103-121.
DOI: https://doi.org/10.1111/1467-9566.ep11347023
Kvarstein, E. H., Pedersen, G., Folmo, E., Urnes, Ø., Johansen, M. S., Hummelen, B., Wilberg, T., & Karterud, S. (2018). Mentalization‐based treatment or psychodynamic treatment programmes for patients with borderline personality disorder–the impact of clinical severity. Psychology and Psychotherapy: Theory, Research and Practice, 92(1), 91-111.
DOI: https://doi.org/10.1111/papt.12179
Malterud, K. (2001). Qualitative research: standards, challenges, and guidelines. The lancet, 358(9280), 483-488. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(01)05627-6/fulltext
DOI: https://doi.org/10.1016/S0140-6736(01)05627-6
McGauley, G., Yakeley, J., Williams, A., & Bateman, A. (2011). Attachment, mentalization and antisocial personality disorder: The possible contribution of mentalization-based treatment. European Journal of Psychotherapy & Counselling, 13(4), 371-393.
DOI: https://doi.org/10.1080/13642537.2011.629118
Meloy, J. R., & Yakeley, J. (2010). Psychodynamic treatment of antisocial personality disorder. Psychodynamic psychotherapy for personality disorders: A clinical handbook, 289-309.
Meloy, J. R., & Yakeley, J. (2014). Antisocial personality disorder. In Gabbard's treatments of psychiatric disorders, fifth edition (pp. 1015-1034).
DOI: https://doi.org/10.1176/appi.books.9781585625048.gg69
Newbury-Helps, J., Feigenbaum, J., & Fonagy, P. (2017). Offenders with antisocial personality disorder display more impairments in mentalizing. 31(2), 232-255.
DOI: https://doi.org/10.1521/pedi_2016_30_246
Råbu, M., McLeod, J., Haavind, H., Bernhardt, I. S., Nissen-Lie, H., & Moltu, C. (2021). How psychotherapists make use of their experiences from being a client: Lessons from a collective autoethnography. Counselling Psychology Quarterly, 34(1), 109-128.
DOI: https://doi.org/10.1080/09515070.2019.1671319
Schwartz, R. C., Smith, S. D., & Chopko, B. (2007). Psychotherapists’ countertransference reactions toward clients with antisocial personality disorder and schizophrenia: An empirical test of theory. American Journal of Psychotherapy, 61(4), 375-393.
DOI: https://doi.org/10.1176/appi.psychotherapy.2007.61.4.375
Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., & Callesen, H. E. J. C. D. o. S. R. (2020). Psychological therapies for people with borderline personality disorder. (5).
DOI: https://doi.org/10.1002/14651858.CD012955.pub2
Taubner, S., Hauschild, S., Kasper, L., Kaess, M., Sobanski, E., Gablonski, T.-C., Schröder-Pfeifer, P., & Volkert, J. (2021). Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): protocol of a feasibility and pilot study. Pilot and feasibility studies, 7(1), 1-10.
DOI: https://doi.org/10.1186/s40814-021-00876-2
Taubner, S., White, L. O., Zimmermann, J., Fonagy, P., & Nolte, T. J. J. o. a. c. p. (2013). Attachment-related mentalization moderates the relationship between psychopathic traits and proactive aggression in adolescence. 41(6), 929-938. https://link.springer.com/article/10.1007%2Fs10802-013-9736-x
DOI: https://doi.org/10.1007/s10802-013-9736-x
Trull, T. J., Jahng, S., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010). Revised Nesarc Personality Disorder Diagnoses: Gender, Prevalence and Comorbidity with Substance Dependent Disorders. Journal of Personality Disorder, 24(4), 412-426.
DOI: https://doi.org/10.1521/pedi.2010.24.4.412
Verheul, R. (2001). Co-morbidity of personality disorders in individuals with substance use disorders. European Psychiatry, 16(5), 274-282. http://ac.els-cdn.com/S0924933801005788/1-s2.0-S0924933801005788-main.pdf?_tid=41ff31f6-4e60-11e6-91b2-00000aacb360&acdnat=1469008781_830035e525f2933fe4b93204f0637d57
e1e3-49ab-b7d0-7fbe5cc0ec38&acdnat=1537183582_3add385b9cf2ae105e81770ac55ddc85
Verheul, R., & van den Brink, W. (2005). Causal pathways between substance use disorders and personality pathology. Australian Psychologist, 40(2), 127-136. https://onlinelibrary.wiley.com/doi/pdf/10.1080/00050060500094613
DOI: https://doi.org/10.1080/00050060500094613
Warner, A., & Keenan, J. (2021). Exploring Clinician Wellbeing within a Mentalization-Based Treatment Service for Adult Offending Males with Antisocial Personality Disorder in the Community. International Journal of Forensic Mental Health, 1-11.
DOI: https://doi.org/10.1080/14999013.2021.1983087
Yakeley, J., & Williams, A. (2014). Antisocial personality disorder: new directions. Advances in psychiatric treatment, 20(2), 132-143.
DOI: https://doi.org/10.1192/apt.bp.113.011205
How to Cite
Morken, K. T., Øvrebø, M., Klippenberg, C. ., Morvik, T., & Lied Gikling, E. (2022). Antisocial personality disorder in group therapy, kindling pro-sociality and mentalizing. Research in Psychotherapy: Psychopathology, Process and Outcome, 25(3). https://doi.org/10.4081/ripppo.2022.649
Copyright (c) 2022 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
List of Cited By :
