Component of treatment integrity Level of application | Adherence | Competence | Differentiation |
---|---|---|---|
Therapist-micro level | E.g. Not knowing, mentalizing therapeutic stance , main focus is on enhancing mentalizing within the context of attachment relationship, continuously adapting interventions according to mentalizing capacities of the patient, … | E.g. Motivated, professional attitude, feeling responsible, flexible, creative, open minded; being able to deal with crises, in situations under high arousal being able to keep mentalizing stance; team player, being reflective in contact with colleagues about their own mental states,… | E.g. avoiding focus on behavioural expressions and skills; avoid classic use of transference to promote personality change; no use of suicide contracts,… |
Team-meso level | E.g. Continuous efforts to deliver a consistent and coherent treatment and to provide continuity within the treatment; stimulating mentalizing stance within team interactions to help in keeping a mentalizing environment,… | E.g. creating a large enough team to provide consistency and continuity even during holidays or sick leave of team members; well-balanced team with clear roles; at least one team, member should have authority and personality to create and maintain holding environment for the team; organizing a supervisory structure to increase MBT knowledge and competence of all team members and to ensure adequate managing of team processes. | E.g. intervision, supervision, group reflection and consultation, all stimulating mentalizing and aimed at enhancing adherence and competence |
Organization-macro level | E.g. commitment to fully implement MBT; creating support within the whole organization for the new program; maintaining regular contact with important stakeholders; designing a detailed implementation plan,,… | E.g. sufficient budget to be able to implement the program; capacity of management to remain calm even if crises occur at patient level | E.g. implementation of a quality assurance system, including continuous monitoring feedback |