{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:18:51Z","timestamp":1791566331717,"version":"4.3.4"},"reference-count":51,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Personality &amp;amp; Mental Health"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Though positive effects of mentalization\u2010based treatment (MBT) for patients with severe borderline personality disorder (BPD) are increasingly documented, less is known about the sustainability of specialized treatment standards and the maintenance of positive outcomes over time. This study aimed to investigate the organizational and clinical sustainability of an outpatient MBT program across two successive treatment periods. The study compares outpatients referred to MBT in a tertiary\u2010level, specialist mental health service in 2009\u20132011 (Period I:\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200996) versus 2011\u20132015 (Period II:\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200989). Organizational quality was based on the MBT quality manual (2019). By structured clinical interviews and repeated self\u2010reports, comparisons included baseline characteristics of eligible patients, clinical outcomes during treatment, therapeutic alliance, therapist countertransferences, and treatment adherence. The MBT team, organization, and systems for quality assurance held satisfactory standards and stability across the two time periods largely compatible with manual recommendations. Patient selection to MBT was in accordance with the targeted patient group, admitting poorly functioning young adults with BPD in both periods. Period II included patients with more severe BPD and self\u2010harming behaviors. Clinical improvement rendered effect sizes in the large range irrespective of time period, and overall 70% remission rates of self\u2010harming. Patient\u2010reported alliance to therapists and therapist\u2010reported countertransference responses were stable with satisfactory levels in both periods. Both periods had low rates of drop\u2010out, though higher in Period II. Results support positive effects and sustainability of MBT for poorly functioning BPD patients treated in a tertiary outpatient MBT\u2010unit within a supportive and stable organizational environment.\n                  <\/jats:p>","DOI":"10.1002\/pmh.70036","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T07:52:42Z","timestamp":1755676362000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Sustainability of Mentalization\u2010Based Treatment Programs for Poorly Functioning Patients With Borderline Personality Disorder. Can We Really Keep It Up?"],"prefix":"10.1002","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9221-4249","authenticated-orcid":false,"given":"E.\u00a0H.","family":"Kvarstein","sequence":"first","affiliation":[{"name":"Section for Treatment Research, Dpt for Research and Innovation, Division for Mental Health and Addiction Oslo University Hospital  Oslo Norway"},{"name":"Institute of Clinical Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5849-8539","authenticated-orcid":false,"given":"K.","family":"Bremer","sequence":"additional","affiliation":[{"name":"Section for Treatment Research, Dpt for Research and Innovation, Division for Mental Health and Addiction Oslo University Hospital  Oslo Norway"},{"name":"Institute for Psychology University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4823-0991","authenticated-orcid":false,"given":"\u00c5.\u00a0L.","family":"Baltzersen","sequence":"additional","affiliation":[{"name":"Dpt for Addiction Treatment, Division for Mental Health and Addiction Oslo University Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Ekberg","sequence":"additional","affiliation":[{"name":"Dpt for Addiction Treatment, Division for Mental Health and Addiction Oslo University Hospital  Oslo Norway"},{"name":"Nydalen Mental Health Centre, Division for Mental Health and Addiction Oslo University Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Normann\u2010Eide","sequence":"additional","affiliation":[{"name":"Dpt for Addiction Treatment, Division for Mental Health and Addiction Oslo University Hospital  Oslo Norway"},{"name":"Nydalen Mental Health Centre, Division for Mental Health and Addiction Oslo University Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3633-3117","authenticated-orcid":false,"given":"D.\u00a0A.","family":"Ulvestad","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine University of Oslo  Oslo Norway"},{"name":"Nydalen Mental Health Centre, Division for Mental Health and Addiction Oslo University Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8599-8871","authenticated-orcid":false,"given":"G.","family":"Pedersen","sequence":"additional","affiliation":[{"name":"Section for Treatment Research, Dpt for Research and Innovation, Division for Mental Health and Addiction Oslo University Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4700-0388","authenticated-orcid":false,"given":"T.","family":"Wilberg","sequence":"additional","affiliation":[{"name":"Section for Treatment Research, Dpt for Research and Innovation, Division for Mental Health and Addiction Oslo University Hospital  Oslo Norway"},{"name":"Institute of Clinical Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/00223891.1990.9674088"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpp.1914"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmh.1381"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmh.1368"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2010.01652.x"},{"key":"e_1_2_11_7_1","unstructured":"Bateman A. D.Bales andJ.Hutsebaut.2014. \u201cA Quality Manual for MBT.\u201dhttps:\/\/www.mbtnederland.nl\/wp\u2010content\/uploads\/2020\/06\/A\u2010Quality\u2010Manual\u2010for\u2010MBT\u2010edited\u2010april\u201023rd\u20102014.pdf."},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.copsyc.2017.09.005"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/per0000422"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.160.1.169"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2009.09040539"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.112.121129"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi.18.1.36.32772"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1017\/ipm.2019.7"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-020-02556-6"},{"key":"e_1_2_11_16_1","first-page":"2000","volume-title":"The Brief\u2010Symptom\u2010Inventory\u201018 (BSI\u201018): Administration, Scoring, and Procedures Manuel","author":"Derogatis L. R.","year":"2000"},{"key":"e_1_2_11_17_1","volume-title":"Structured Clinical Interview for DSM\u2010IV (Version 2.0)","author":"First M.","year":"1994"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1037\/pst0000172"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.copsyc.2021.01.002"},{"issue":"5","key":"e_1_2_11_20_1","first-page":"1","article-title":"Development of Therapeutic Alliance in Mentalization\u2010Based Treatment\u2010Goals, Bonds, and Tasks in a Specialized Treatment for Borderline Personality Disorder","volume":"31","author":"Folmo E. J.","year":"2020","journal-title":"Psychotherapy Research"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0036505"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17093170"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/sltb.13044"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi_2018_32_344"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1037\/1082-989X.2.1.64"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/famp.12232"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/1752-4458-6-10"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40479-020-00133-7"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-018-1876-7"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1163347"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmh.1352"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/papt.12036"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-016-0538-z"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1080\/10503307.2023.2279645"},{"issue":"1","key":"e_1_2_11_35_1","first-page":"25","article-title":"Revised Norwegian Version of Inventory of Interpersonal Problems\u2014Circumplex (IIP\u2010C)","volume":"39","author":"Pedersen G.","year":"2002","journal-title":"Tidsskrift for Norsk Psykologforening"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1027\/1015\u20105759\/a000436"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmh.1382"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2006.03.008"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmh.1234"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1080\/08039488.2022.2147995"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/papt.12478"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-006-0020-1"},{"key":"e_1_2_11_43_1","volume-title":"Mini International Neuropsychiatric Interview (MINI)","author":"Sheehan D. V.","year":"1994"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780195152968.001.0001"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmh.1603"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi.2008.22.3.259"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2021.204"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.3109\/09638237.2012.689435"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.202000810"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2008.11.001"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40359-024-01754-1"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/papt.12194"}],"container-title":["Personality and Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmh.70036","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T02:00:38Z","timestamp":1764036038000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pmh.70036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":51,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/pmh.70036"],"URL":"https:\/\/doi.org\/10.1002\/pmh.70036","archive":["Portico"],"relation":{},"ISSN":["1932-8621","1932-863X"],"issn-type":[{"value":"1932-8621","type":"print"},{"value":"1932-863X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,20]]},"assertion":[{"value":"2025-01-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70036"}}