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It also explored how therapist characteristics\u2014specifically mentalisation capacity\u2014influence the therapeutic alliance in digital psychotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A longitudinal quantitative case series design was implemented across 14 therapist\u2013patient dyads. Patients received 12 weekly sessions of MCT+ online. Standardised measures assessed anxiety (GAD\u20107), depression (PHQ\u20109), metacognitive beliefs (MCQ\u201030), psychological distress (CORE\u201010) and quality of life (WHOQOL\u2010BREF). Therapeutic alliance was tracked session\u2010by\u2010session (WAI\u2010S). Therapist mentalisation and attachment were evaluated at baseline (MASC\u2010SP, RFQ\u20108, ECR\u201012). Changes in outcome measures were analysed using paired\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests, effect sizes (Cohen's\n                      <jats:italic>d<\/jats:italic>\n                      ), correlations, reliable change indices (RCI) and hierarchical linear modelling (HLM).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across the intervention, there were significant decreases in anxiety (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.64) and improvements in metacognitive beliefs (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.37). Depression showed a modest improvement (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.34), while changes in quality of life were negligible (\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u2009\u22120.21). Hierarchical modelling indicated a significant interaction between automatic and controlled mentalisation (\n                      <jats:italic>b<\/jats:italic>\n                      \u2009=\u2009\u22120.45,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008), suggesting that flexible adjustment supported therapeutic alliance development. Attachment style showed no significant associations with the alliance (largest unadjusted effect:\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u2009\u22120.54,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.073; all adjusted\n                      <jats:italic>ps<\/jats:italic>\n                      &gt;\u20090.99).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Digital MCT+ showed preliminary effectiveness in reducing anxiety and maladaptive metacognitive beliefs among individuals with BD\u2010I, with more limited effects on depression and quality of life. Importantly, therapist mentalisation flexibility\u2014the capacity to shift between automatic and controlled modes, or the\n                      <jats:italic>mentalisation switch<\/jats:italic>\n                      \u2014emerged as a central mechanism for alliance building and engagement in digital contexts, highlighting a key target for clinical training and future research.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cpp.70260","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T15:40:02Z","timestamp":1773934802000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Mentalisation Switch: Therapist Reflective Capacity and Alliance Dynamics in Digital MCT+ for Bipolar Disorder\u2014A Longitudinal Quantitative Case 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Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6227-4451","authenticated-orcid":false,"given":"Ulises","family":"R\u00edos","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine University of Valpara\u00edso  Valpara\u00edso Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0085-1804","authenticated-orcid":false,"given":"Steffen","family":"Moritz","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0618-044X","authenticated-orcid":false,"given":"Angus","family":"MacBeth","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, School of Health in Social Science University of Edinburgh  Edinburgh 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