The design of the MBT‐G adherence and quality scale

Few group psychotherapy studies focus on therapists' interventions, and instruments that can measure group psychotherapy treatment fidelity are scarce. The aim of the present study was to evaluate the reliability of the Mentalization‐based Group Therapy Adherence and Quality Scale (MBT‐G‐AQS), which is a 19‐item scale developed to measure adherence and quality in mentalization‐based group therapy (MBT‐G). Eight MBT groups and eight psychodynamic groups (a total of 16 videotaped therapy sessions) were rated independently by five raters. All groups were long‐term, outpatient psychotherapy groups with 1.5 hours weekly sessions. Data were analysed by a Generalizability Study (G‐study and D‐study). The generalizability models included analyses of reliability for different numbers of raters. The global (overall) ratings for adherence and quality showed high to excellent reliability for all numbers of raters (the reliability by use of five raters was 0.97 for adherence and 0.96 for quality). The mean reliability for all 19 items for a single rater was 0.57 (item range 0.26–0.86) for adherence, and 0.62 (item range 0.26–0.83) for quality. The reliability for two raters obtained mean absolute G‐coefficients on 0.71 (item range 0.41–0.92 for the different items) for adherence and 0.76 (item range 0.42–0.91) for quality. With all five raters the mean absolute G‐coefficient for adherence was 0.86 (item range 0.63–0.97) and 0.88 for quality (item range 0.64–0.96). The study demonstrates high reliability of ratings of MBT‐G‐AQS. In models differentiating between different numbers of raters, reliability was particularly high when including several raters, but was also acceptable for two raters. For practical purposes, the MBT‐G‐AQS can be used for training, supervision and psychotherapy research.     

Large variations of global functioning over five years in treated patients with personality traits and disorders

The aim of this study was to examine the long-term course of global functioning in patients with personality disorders (PD) and investigate predictors of variation. The Global Assessment of Functioning (GAF) was repeated over five years in 352 patients with PDs of varying severity, all treated in psychotherapeutic day hospitals. Growth models were used for statistical analysis. Large variations in the long-term course of global functioning were evident in this clinical sample. At five-year follow-up, 46% reached a GAF-score above 60 with a mean GAF-score of 71. Their linear change-rate over the five years was estimated to be 4.4 GAF points per year. The average five-year GAF-score for the remaining subgroup (54%) was 50 and their linear yearly change-rate was 0.8 GAF points. Greater relief of symptom distress and interpersonal problems was typical of patients with functional improvement. The number of avoidant PD criteria was associated with slower functional change.