Antisocial personality disorder in group therapy, kindling pro-sociality and mentalizing

Submitted: June 21, 2022
Accepted: October 3, 2022
Published: November 7, 2022
Abstract Views: 3079
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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.



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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. DOI:
Bateman, A., Bolton, R., & Fonagy, P. (2013). Antisocial personality disorder: A mentalizing framework. Focus, 11(2), 178-186. DOI:
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. DOI:
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:
Bateman, A., & Fonagy, P. (2016). Mentalization-based treatment for personality disorders - A practical guide. Oxford University Press. DOI:
Bateman, A. W. (2022). Mentalizing and group psychotherapy: a novel treatment for antisocial personality disorder. American Journal of Psychotherapy, 75(1), 32-37. DOI:
Bateman, A., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385. DOI:
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:
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:
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:
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101. DOI:
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:
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:
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:
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:
Finlay, L. (2003). The reflexive journey: mapping multiple routes. Reflexivity: A practical guide for researchers in health and social sciences, 3-20. DOI:
Finlay, L., & Gough, B. (2003). Reflexivity: A practical guide for researchers in health and social sciences. John Wiley & Sons. DOI:
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:
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:
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:
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:
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:
Karterud, S. (2018). Case formulations in mentalization-based group therapy. Research in Psychotherapy: Psychopathology, Process, and Outcome, 21(3). DOI:
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:
Kitzinger, J. (1994). The methodology of focus groups: the importance of interaction between research participants. Sociology of health & illness, 16(1), 103-121. DOI:
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:
Malterud, K. (2001). Qualitative research: standards, challenges, and guidelines. The lancet, 358(9280), 483-488. DOI:
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:
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:
Newbury-Helps, J., Feigenbaum, J., & Fonagy, P. (2017). Offenders with antisocial personality disorder display more impairments in mentalizing. 31(2), 232-255. DOI:
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:
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:
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:
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:
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. DOI:
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:
Verheul, R. (2001). Co-morbidity of personality disorders in individuals with substance use disorders. European Psychiatry, 16(5), 274-282.
Verheul, R., & van den Brink, W. (2005). Causal pathways between substance use disorders and personality pathology. Australian Psychologist, 40(2), 127-136. DOI:
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:
Yakeley, J., & Williams, A. (2014). Antisocial personality disorder: new directions. Advances in psychiatric treatment, 20(2), 132-143. DOI:

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).

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