The Mentalisation Switch: Therapist Reflective Capacity and Alliance Dynamics in Digital MCT+ for Bipolar Disorder—A Longitudinal Quantitative Case Series.
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| Title: | The Mentalisation Switch: Therapist Reflective Capacity and Alliance Dynamics in Digital MCT+ for Bipolar Disorder—A Longitudinal Quantitative Case Series. |
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| Authors: | Maluenda‐Gatica, Roberto (AUTHOR), Araya, Christian (AUTHOR), Morán‐Kneer, Javier (AUTHOR), Ríos, Ulises (AUTHOR), Moritz, Steffen (AUTHOR), MacBeth, Angus (AUTHOR) |
| Source: | Clinical Psychology & Psychotherapy. Mar2026, Vol. 33 Issue 2, p1-16. 16p. |
| Subjects: | Diagnosis of mental depression, Bipolar disorder, Psychotherapists, Psychotherapy, Digital technology, Psychological distress, Cognitive testing, T-test (Statistics), Research funding, Data analysis, Questionnaires, Statistical sampling, Reflection (Philosophy), Treatment effectiveness, Quantitative research, Anxiety, Descriptive statistics, Telemedicine, Longitudinal method, Patient-professional relations, Videoconferencing, Quality of life, Case-control method, Statistics, Cognitive therapy, Therapeutic alliance, Individualized medicine, Data analysis software, Psychosocial factors, Evaluation |
| Geographic Terms: | Chile |
| Abstract: | Objective: This study conducted a preliminary naturalistic effectiveness evaluation of Individualised Metacognitive Therapy (MCT+) delivered via videoconferencing for individuals with bipolar I disorder (BD‐I) in a real‐world clinical setting in Chile. It also explored how therapist characteristics—specifically mentalisation capacity—influence the therapeutic alliance in digital psychotherapy. Methods: A longitudinal quantitative case series design was implemented across 14 therapist–patient dyads. Patients received 12 weekly sessions of MCT+ online. Standardised measures assessed anxiety (GAD‐7), depression (PHQ‐9), metacognitive beliefs (MCQ‐30), psychological distress (CORE‐10) and quality of life (WHOQOL‐BREF). Therapeutic alliance was tracked session‐by‐session (WAI‐S). Therapist mentalisation and attachment were evaluated at baseline (MASC‐SP, RFQ‐8, ECR‐12). Changes in outcome measures were analysed using paired t‐tests, effect sizes (Cohen's d), correlations, reliable change indices (RCI) and hierarchical linear modelling (HLM). Results: Across the intervention, there were significant decreases in anxiety (d = 0.64) and improvements in metacognitive beliefs (d = 0.37). Depression showed a modest improvement (d = 0.34), while changes in quality of life were negligible (d = −0.21). Hierarchical modelling indicated a significant interaction between automatic and controlled mentalisation (b = −0.45, p = 0.008), suggesting that flexible adjustment supported therapeutic alliance development. Attachment style showed no significant associations with the alliance (largest unadjusted effect: ρ = −0.54, p = 0.073; all adjusted ps > 0.99). Conclusions: Digital MCT+ showed preliminary effectiveness in reducing anxiety and maladaptive metacognitive beliefs among individuals with BD‐I, with more limited effects on depression and quality of life. Importantly, therapist mentalisation flexibility—the capacity to shift between automatic and controlled modes, or the mentalisation switch—emerged as a central mechanism for alliance building and engagement in digital contexts, highlighting a key target for clinical training and future research. Summary: Digital MCT+ may be a useful adjunctive intervention for individuals with BD‐I, particularly for reducing anxiety and maladaptive metacognitive beliefs.Therapeutic alliance in videoconferencing psychotherapy appears to be shaped not only by technique, but by therapists' capacity to flexibly adjust their mentalising stance.Early alliance building may benefit from intuitive, affectively attuned therapist responses, whereas later phases may require more explicit, reflective mentalisation to support task and goal alignment.Overreliance on both intuitive and highly self‐reflective mentalising simultaneously may hinder relational attunement in digital therapy.Training and supervision in digital psychotherapy should attend not only to therapists' reflective capacity but also to the timing and flexibility with which different mentalising modes are deployed. [ABSTRACT FROM AUTHOR] |
| Copyright of Clinical Psychology & Psychotherapy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
| FullText | Text: Availability: 0 |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 193280249 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: The Mentalisation Switch: Therapist Reflective Capacity and Alliance Dynamics in Digital MCT+ for Bipolar Disorder—A Longitudinal Quantitative Case Series. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Maluenda‐Gatica%2C+Roberto%22">Maluenda‐Gatica, Roberto</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Araya%2C+Christian%22">Araya, Christian</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Morán‐Kneer%2C+Javier%22">Morán‐Kneer, Javier</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ríos%2C+Ulises%22">Ríos, Ulises</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Moritz%2C+Steffen%22">Moritz, Steffen</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22MacBeth%2C+Angus%22">MacBeth, Angus</searchLink> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Clinical+Psychology+%26+Psychotherapy%22">Clinical Psychology & Psychotherapy</searchLink>. Mar2026, Vol. 33 Issue 2, p1-16. 16p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22Diagnosis+of+mental+depression%22">Diagnosis of mental depression</searchLink><br /><searchLink fieldCode="DE" term="%22Bipolar+disorder%22">Bipolar disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Psychotherapists%22">Psychotherapists</searchLink><br /><searchLink fieldCode="DE" term="%22Psychotherapy%22">Psychotherapy</searchLink><br /><searchLink fieldCode="DE" term="%22Digital+technology%22">Digital technology</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+distress%22">Psychological distress</searchLink><br /><searchLink fieldCode="DE" term="%22Cognitive+testing%22">Cognitive testing</searchLink><br /><searchLink fieldCode="DE" term="%22T-test+%28Statistics%29%22">T-test (Statistics)</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis%22">Data analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+sampling%22">Statistical sampling</searchLink><br /><searchLink fieldCode="DE" term="%22Reflection+%28Philosophy%29%22">Reflection (Philosophy)</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Quantitative+research%22">Quantitative research</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Telemedicine%22">Telemedicine</searchLink><br /><searchLink fieldCode="DE" term="%22Longitudinal+method%22">Longitudinal method</searchLink><br /><searchLink fieldCode="DE" term="%22Patient-professional+relations%22">Patient-professional relations</searchLink><br /><searchLink fieldCode="DE" term="%22Videoconferencing%22">Videoconferencing</searchLink><br /><searchLink fieldCode="DE" term="%22Quality+of+life%22">Quality of life</searchLink><br /><searchLink fieldCode="DE" term="%22Case-control+method%22">Case-control method</searchLink><br /><searchLink fieldCode="DE" term="%22Statistics%22">Statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Cognitive+therapy%22">Cognitive therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Therapeutic+alliance%22">Therapeutic alliance</searchLink><br /><searchLink fieldCode="DE" term="%22Individualized+medicine%22">Individualized medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink><br /><searchLink fieldCode="DE" term="%22Psychosocial+factors%22">Psychosocial factors</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation%22">Evaluation</searchLink> – Name: SubjectGeographic Label: Geographic Terms Group: Su Data: <searchLink fieldCode="DE" term="%22Chile%22">Chile</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Objective: This study conducted a preliminary naturalistic effectiveness evaluation of Individualised Metacognitive Therapy (MCT+) delivered via videoconferencing for individuals with bipolar I disorder (BD‐I) in a real‐world clinical setting in Chile. It also explored how therapist characteristics—specifically mentalisation capacity—influence the therapeutic alliance in digital psychotherapy. Methods: A longitudinal quantitative case series design was implemented across 14 therapist–patient dyads. Patients received 12 weekly sessions of MCT+ online. Standardised measures assessed anxiety (GAD‐7), depression (PHQ‐9), metacognitive beliefs (MCQ‐30), psychological distress (CORE‐10) and quality of life (WHOQOL‐BREF). Therapeutic alliance was tracked session‐by‐session (WAI‐S). Therapist mentalisation and attachment were evaluated at baseline (MASC‐SP, RFQ‐8, ECR‐12). Changes in outcome measures were analysed using paired t‐tests, effect sizes (Cohen's d), correlations, reliable change indices (RCI) and hierarchical linear modelling (HLM). Results: Across the intervention, there were significant decreases in anxiety (d = 0.64) and improvements in metacognitive beliefs (d = 0.37). Depression showed a modest improvement (d = 0.34), while changes in quality of life were negligible (d = −0.21). Hierarchical modelling indicated a significant interaction between automatic and controlled mentalisation (b = −0.45, p = 0.008), suggesting that flexible adjustment supported therapeutic alliance development. Attachment style showed no significant associations with the alliance (largest unadjusted effect: ρ = −0.54, p = 0.073; all adjusted ps > 0.99). Conclusions: Digital MCT+ showed preliminary effectiveness in reducing anxiety and maladaptive metacognitive beliefs among individuals with BD‐I, with more limited effects on depression and quality of life. Importantly, therapist mentalisation flexibility—the capacity to shift between automatic and controlled modes, or the mentalisation switch—emerged as a central mechanism for alliance building and engagement in digital contexts, highlighting a key target for clinical training and future research. Summary: Digital MCT+ may be a useful adjunctive intervention for individuals with BD‐I, particularly for reducing anxiety and maladaptive metacognitive beliefs.Therapeutic alliance in videoconferencing psychotherapy appears to be shaped not only by technique, but by therapists' capacity to flexibly adjust their mentalising stance.Early alliance building may benefit from intuitive, affectively attuned therapist responses, whereas later phases may require more explicit, reflective mentalisation to support task and goal alignment.Overreliance on both intuitive and highly self‐reflective mentalising simultaneously may hinder relational attunement in digital therapy.Training and supervision in digital psychotherapy should attend not only to therapists' reflective capacity but also to the timing and flexibility with which different mentalising modes are deployed. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Clinical Psychology & Psychotherapy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1002/cpp.70260 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 16 StartPage: 1 Subjects: – SubjectFull: Diagnosis of mental depression Type: general – SubjectFull: Bipolar disorder Type: general – SubjectFull: Psychotherapists Type: general – SubjectFull: Psychotherapy Type: general – SubjectFull: Digital technology Type: general – SubjectFull: Psychological distress Type: general – SubjectFull: Cognitive testing Type: general – SubjectFull: T-test (Statistics) Type: general – SubjectFull: Research funding Type: general – SubjectFull: Data analysis Type: general – SubjectFull: Questionnaires Type: general – SubjectFull: Statistical sampling Type: general – SubjectFull: Reflection (Philosophy) Type: general – SubjectFull: Treatment effectiveness Type: general – SubjectFull: Quantitative research Type: general – SubjectFull: Anxiety Type: general – SubjectFull: Descriptive statistics Type: general – SubjectFull: Telemedicine Type: general – SubjectFull: Longitudinal method Type: general – SubjectFull: Patient-professional relations Type: general – SubjectFull: Videoconferencing Type: general – SubjectFull: Quality of life Type: general – SubjectFull: Case-control method Type: general – SubjectFull: Statistics Type: general – SubjectFull: Cognitive therapy Type: general – SubjectFull: Therapeutic alliance Type: general – SubjectFull: Individualized medicine Type: general – SubjectFull: Data analysis software Type: general – SubjectFull: Psychosocial factors Type: general – SubjectFull: Evaluation Type: general – SubjectFull: Chile Type: general Titles: – TitleFull: The Mentalisation Switch: Therapist Reflective Capacity and Alliance Dynamics in Digital MCT+ for Bipolar Disorder—A Longitudinal Quantitative Case Series. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Maluenda‐Gatica, Roberto – PersonEntity: Name: NameFull: Araya, Christian – PersonEntity: Name: NameFull: Morán‐Kneer, Javier – PersonEntity: Name: NameFull: Ríos, Ulises – PersonEntity: Name: NameFull: Moritz, Steffen – PersonEntity: Name: NameFull: MacBeth, Angus IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 03 Text: Mar2026 Type: published Y: 2026 Identifiers: – Type: issn-print Value: 10633995 Numbering: – Type: volume Value: 33 – Type: issue Value: 2 Titles: – TitleFull: Clinical Psychology & Psychotherapy Type: main |
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