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Table 1 Multilevel model of treatment integrity including three components of treatment integrity at three levels of application

From: The implementation of mentalization-based treatment for adolescents: a case study from an organizational, team and therapist perspective

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