{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:52:03Z","timestamp":1791525123343,"version":"4.3.4"},"reference-count":115,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005366","name":"Universitetet i Oslo","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005366","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Few studies have investigated the therapeutic alliance in treatment of patients with borderline personality disorder (BPD), particularly regarding alliance in group psychotherapy. This study aimed to investigate the development of therapeutic alliance in a 3-year outpatient mentalization-based treatment (MBT) program for BPD combining individual and group psychotherapy, and to examine whether reflective functioning (RF) predicted alliance development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Patients with BPD or significant sub-threshold borderline personality pathology were included, with baseline data from 47 patients and longitudinal data from 42. Baseline assessment comprised diagnostic interviews, self-report measures, and interview-based measures of RF. Patient-reported alliance was assessed every 6 months using the Working Alliance Inventory (subscales Bond, Task and Goal) for individual psychotherapy and the Group Questionnaire (domains Positive Bond, Positive Work and Negative Relationship with their respective subscales) for group psychotherapy. Main statistical method was linear mixed models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In individual psychotherapy, initial alliance levels were satisfactory across all subscales. Over the course of treatment, the Bond level remained stable, whereas Task and Goal showed small but statistically significant increases. In group psychotherapy, Positive Bond was high initially and stable during treatment. For the Positive Work domain and its two subscales, initial levels were below the satisfactory range. During treatment, there was a small but significant increase in agreement on tasks and goals with the other group members but not with the therapists. For the Negative Relationship domain and its three subscales, all estimates except one were within the satisfactory range initially. Initial level of the subscale Group Members was outside the satisfactory range, indicating somewhat strained relationships with the other group members. Longitudinally, there were no improvements for the domain or subscales. RF at baseline had no significant effect on the therapeutic alliance in either treatment modality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study demonstrates overall satisfactory levels of therapeutic alliance in an MBT program for BPD but also indicates specific alliance-related challenges in the group psychotherapy component. Initial level of RF may not affect the therapeutic alliance in MBT treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration (if applicable)<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>\n                      ID NCT04157907.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1919516","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:34:20Z","timestamp":1791524060000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Therapeutic alliance and predictive validity of reflective functioning in conjoint mentalization-based treatment for borderline personality disorder"],"prefix":"10.3389","volume":"17","author":[{"given":"Dag Anders","family":"Ulvestad","sequence":"first","affiliation":[{"name":"Clinic for Group Therapies and Personality Disorders, Division of Mental Health and Addiction, Nydalen District Psychiatric Center, Oslo University Hospital","place":["Oslo, Norway"]},{"name":"Institute of Clinical Medicine, University of Oslo","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elfrida Hartveit","family":"Kvarstein","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, University of Oslo","place":["Oslo, Norway"]},{"name":"Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Ekberg","sequence":"additional","affiliation":[{"name":"Clinic for Group Therapies and Personality Disorders, Division of Mental Health and Addiction, Nydalen District Psychiatric Center, Oslo University Hospital","place":["Oslo, Norway"]},{"name":"Quality Laboratory of Psychotherapy, National Advisory Center for Substance Use and Addictive Disorders, Severe Concurrent Mental Health Disorders and Personality Disorders, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peder Ludvig","family":"S\u00e6tre","sequence":"additional","affiliation":[{"name":"Clinic for Group Therapies and Personality Disorders, Division of Mental Health and Addiction, Nydalen District Psychiatric Center, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geir","family":"Pedersen","sequence":"additional","affiliation":[{"name":"Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Wilberg","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, University of Oslo","place":["Oslo, Norway"]},{"name":"Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1037\/gdn0000135","article-title":"Alliance in group therapy: a meta-analysis","volume":"25","author":"Alldredge","year":"2021","journal-title":"Group Dyn. Theory Res. Prac"},{"key":"B2","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.comppsych.2015.05.016","article-title":"Is reflective functioning associated with clinical symptoms and long-term course in patients with personality disorders?","volume":"64","author":"Antonsen","year":"2016","journal-title":"Compr. Psychiatry"},{"key":"B3","volume-title":"Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th Edn","year":"2013"},{"key":"B4","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.jbtep.2016.04.006","article-title":"Skills use and common treatment processes in dialectical behaviour therapy for borderline personality disorder","volume":"52","author":"Barnicot","year":"2016","journal-title":"J. Behav. Therapy Exp. Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1111\/j.1600-0447.2010.01652.x","article-title":"Treatment completion in psychotherapy for borderline personality disorder: a systematic review and meta-analysis","volume":"123","author":"Barnicot","year":"2011","journal-title":"Acta Psychiatr. Scand"},{"key":"B6","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1111\/papt.12362","article-title":"Patient experiences of therapy for borderline personality disorder: commonalities and differences between dialectical behaviour therapy and mentalization-based therapy and relation to outcomes","volume":"95","author":"Barnicot","year":"2022","journal-title":"Psychol. Psychother. Theory Res. Prac"},{"key":"B7","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1037\/cou0000844","article-title":"Patient experiences of long-term psychodynamic psychotherapy for mood and personality disorders: a systematic review and meta-aggregation of qualitative studies","volume":"73","author":"Barrett","year":"2025","journal-title":"J. Counsel. Psychol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1080\/00207284.2020.1847655","article-title":"Rupture and repair in mentalization-based group psychotherapy","volume":"71","author":"Bateman","year":"2021","journal-title":"Int. J. Group Psychother"},{"key":"B9","doi-asserted-by":"crossref","DOI":"10.1093\/med:psych\/9780199680375.001.0001","volume-title":"Mentalization Based Treatment for Personality Disorders: a Practical Guide","author":"Bateman","year":"2016"},{"key":"B10","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1037\/a0038457","article-title":"The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder","volume":"52","author":"Bedics","year":"2015","journal-title":"Psychotherapy"},{"key":"B11","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1097\/00131746-200503000-00002","article-title":"The therapeutic alliance in the treatment of personality disorders","volume":"11","author":"Bender","year":"2005","journal-title":"J. Psychiatric Prac"},{"key":"B12","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1037\/h0085885","article-title":"The generalizability of the psychoanalytic concept of the working alliance","volume":"16","author":"Bordin","year":"1979","journal-title":"Theory Res. Prac"},{"key":"B13","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1037\/0736-9735.25.1.47","article-title":"Mentalization in adult attachment narratives: reflective functioning, mental states, and affect elaboration compared","volume":"25","author":"Bouchard","year":"2008","journal-title":"Psychoanal. Psychol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1490056","DOI":"10.3389\/fpsyt.2024.1490056","article-title":"Countertransference, alliance, and outcome in the treatment of patients with personality disorder: a longitudinal naturalistic study","volume":"15","author":"Breivik \u00d8vsteb\u00f8","year":"2024","journal-title":"Front. Psychiatry"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e301751","DOI":"10.1136\/bmjment-2025-301751","article-title":"How epistemic trust, mistrust and credulity relate to mental health, personality pathology, treatment engagement and relationship in psychotherapeutic and psychiatric settings","volume":"29","author":"Br\u00f6cker","year":"2026","journal-title":"BMJ Mental Health"},{"key":"B16","first-page":"71","article-title":"\u201cCohesion in group psychotherapy,\u201d","volume-title":"Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients","author":"Burlingame","year":"2002"},{"key":"B17","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1037\/pst0000173","article-title":"Cohesion in group therapy: a meta-analysis","volume":"55","author":"Burlingame","year":"2018","journal-title":"Psychotherapy"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1176\/appi.ajp.2008.07081360","article-title":"Mentalization: ontogeny, assessment, and application in the treatment of borderline personality disorder","volume":"165","author":"Choi-Kain","year":"2008","journal-title":"Am. J. Psychiatry"},{"key":"B19","volume-title":"Statistical Power Analysis for the Behavioral Sciences, 2nd Edn","author":"Cohen","year":"1988"},{"key":"B20","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1176\/appi.ajp.2013.13020224","article-title":"Patient personality and therapist response: an empirical investigation","volume":"171","author":"Colli","year":"2014","journal-title":"Am. J. Psychiatry"},{"key":"B21","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1080\/15248371003699969","article-title":"Twelve frequently asked questions about growth curve modeling","volume":"11","author":"Curran","year":"2010","journal-title":"J. Cogn. Dev"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1002\/cpp.2888","article-title":"Predictors of psychotherapy dropout in patients with borderline personality disorder: a systematic review","volume":"30","author":"de Freixo Ferreira","year":"2023","journal-title":"Clin. Psychol. Psychother"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e70080","DOI":"10.1002\/cpp.70080","article-title":"Dropout in psychotherapy for personality disorders: a systematic review of predictors","volume":"32","author":"De Salve","year":"2025","journal-title":"Clin. Psychol. Psychother"},{"key":"B24","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1080\/00332747.2019.1610295","article-title":"Effects of therapeutic alliance and metacognition on outcome in a brief psychological treatment for borderline personality disorder","volume":"82","author":"Dimaggio","year":"2019","journal-title":"Psychiatry"},{"key":"B25","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1037\/int0000243","article-title":"\u201cYes, there is actually hope!\u201d\u2014a qualitative investigation of how patients experience mentalization-based psychoeducation tailored for borderline personality disorder","volume":"31","author":"Ditlefsen","year":"2021","journal-title":"J. Psychother. Integr"},{"key":"B26","first-page":"3","article-title":"The session rating scale: preliminary psychometric properties of a \u201cworking\u201d alliance measure","volume":"3","author":"Duncan","year":"2003","journal-title":"J. Brief Ther"},{"key":"B27","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1037\/ccp0000055","article-title":"Reflective functioning as predictor of working alliance and outcome in the treatment of depression","volume":"84","author":"Ekeblad","year":"2016","journal-title":"J. Consult. Clin. Psychol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1016\/j.psc.2018.07.008","article-title":"Community and clinical epidemiology of borderline personality disorder","volume":"41","author":"Ellison","year":"2018","journal-title":"Psychiatr. Clin. North Am"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1001\/jamanetworkopen.2020.19686","article-title":"Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic","volume":"3","author":"Ettman","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"B30","doi-asserted-by":"publisher","first-page":"824","DOI":"10.3389\/fpsyg.2018.00824","article-title":"Exclusion-proneness in borderline personality disorder inpatients impairs alliance in mentalization-based group therapy","volume":"9","author":"Euler","year":"2018","journal-title":"Front. Psychol."},{"key":"B31","volume-title":"Structured clinical interview for DSM-5 clinical version (SCID-5-PD)","author":"First","year":"2016"},{"key":"B32","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1192\/bjp.bp.113.143842","article-title":"Transference-focused psychotherapy for borderline personality disorder: change in reflective function","volume":"207","author":"Fischer-Kern","year":"2015","journal-title":"Br. J. Psychiatry"},{"key":"B33","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1037\/pst0000172","article-title":"The alliance in adult psychotherapy: a meta-analytic synthesis","volume":"55","author":"Fluckiger","year":"2018","journal-title":"Psychotherapy"},{"key":"B34","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1111\/sjop.12375","article-title":"The design of the MBT-G adherence and quality scale","volume":"58","author":"Folmo","year":"2017","journal-title":"Scand. J. Psychol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1080\/10503307.2020.1831097","article-title":"Development of therapeutic alliance in mentalization-based treatment\u2014goals, bonds, and tasks in a specialized treatment for borderline personality disorder","volume":"31","author":"Folmo","year":"2021","journal-title":"Psychother. Res"},{"key":"B36","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1037\/a0036505","article-title":"The role of mentalizing and epistemic trust in the therapeutic relationship","volume":"51","author":"Fonagy","year":"2014","journal-title":"Psychotherapy"},{"key":"B37","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1037\/per0000113","article-title":"Translation: mentalizing as treatment target in borderline personality disorder","volume":"6","author":"Fonagy","year":"2015","journal-title":"Pers. disord"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1017\/S0954579409990198","article-title":"developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder","volume":"21","author":"Fonagy","year":"2009","journal-title":"Dev. Psychopathol"},{"key":"B39","volume-title":"Reflective Functioning Manual: Version 5 for Application to Adult Attachment Interviews","author":"Fonagy","year":"1998"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1037\/t02879-000","author":"George","year":"1985","journal-title":"The Adult Attachment Interview"},{"key":"B41","doi-asserted-by":"publisher","first-page":"443","DOI":"10.4081\/ripppo.2020.443","article-title":"Italian adaptation of the Group Questionnaire: validity and factorial structure","volume":"23","author":"Giannone","year":"2020","journal-title":"Res. Psychother"},{"key":"B42","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1007\/s10879-022-09531-0","article-title":"Framework for MBT formulations: the narrative formulation and MBT passport","volume":"52","author":"Grove","year":"2022","journal-title":"J. Contemp. Psychother."},{"key":"B43","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1080\/10503300500352500","article-title":"Development and validation of a revised short version of the working alliance inventory","volume":"16","author":"Hatcher","year":"2006","journal-title":"Psychother. Res"},{"key":"B44","volume-title":"Multilevel and Longitudinal Modeling with IBM SPSS","author":"Heck","year":"2010"},{"key":"B45","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1037\/1082-989X.2.1.64","article-title":"Application of random-effects pattern-mixture models for missing data in longitudinal studies","volume":"2","author":"Hedeker","year":"1997","journal-title":"Psychol. Methods"},{"key":"B46","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1080\/00207284.2025.2499046","article-title":"Alliance and cohesion predicting outcome in group psychotherapy: a structural equation model meta-analysis","volume":"76","author":"Henderson","year":"2026","journal-title":"Int. J. Group Psychother"},{"key":"B47","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1037\/a0022186","article-title":"Alliance in individual psychotherapy","volume":"48","author":"Horvath","year":"2011","journal-title":"Psychotherapy"},{"key":"B48","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1521\/pedi.2025.39.3.223","article-title":"Internal structure and consistency of the level of personality functioning scale-brief form: a systematic review and meta-analysis","volume":"39","author":"Hualparuca-Olivera","year":"2025","journal-title":"J. Personal Disord"},{"key":"B49","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10503307.2023.2226812","article-title":"Observer-based and computerized measures of the patient's mentalization in psychotherapy: a scoping review","volume":"34","author":"H\u00fcwe","year":"2023","journal-title":"Psychother. Res"},{"key":"B50","volume-title":"IBM SPSS Statistics for Windows, 30th Edn","year":"2024"},{"key":"B51","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/s12671-018-0969-1","article-title":"Mentalizing imagery therapy: theory and case series of imagery and mindfulness techniques to understand self and others","volume":"11","author":"Jain","year":"2020","journal-title":"Mindfulness"},{"key":"B52","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1037\/pst0000139","article-title":"Developing a therapeutic relationship monitoring system for group treatment","volume":"55","author":"Janis","year":"2018","journal-title":"Psychotherapy"},{"key":"B53","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1080\/10503307.2020.1871525","article-title":"Predictors of dropout among adolescents with borderline personality disorder attending mentalization-based group treatment","volume":"31","author":"J\u00f8rgensen","year":"2021","journal-title":"Psychother. Res"},{"key":"B54","volume-title":"Manual for Mentaliseringsbasert Gruppeterapi (MBT-G)","author":"Karterud","year":"2012"},{"key":"B55","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1177\/0533316415577339","article-title":"On structure and leadership in mentalization-based group therapy and group analysis","volume":"48","author":"Karterud","year":"2015","journal-title":"Group Anal"},{"key":"B56","doi-asserted-by":"publisher","first-page":"318","DOI":"10.4081\/ripppo.2018.318","article-title":"Case formulations in mentalization-based group therapy","volume":"21","author":"Karterud","year":"2018","journal-title":"Res. Psychother"},{"key":"B57","volume-title":"Manual for gruppekurs om personlighet og personlighetsforstyrrelser","author":"Karterud","year":"2019"},{"key":"B58","volume-title":"Manual for mentaliseringsbasert terapi (MBT) og MBT vurderingsskala: versjon individualterapi","author":"Karterud","year":"2010"},{"key":"B59","volume-title":"Mentaliseringsbasert terapi (MBT)","author":"Karterud","year":"2020"},{"key":"B60","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/B978-0-12-813521-1.00003-5","article-title":"\u201cChapter 3 - case formulations in mentalization-based treatment (MBT) for patients with borderline personality disorder,\u201d","volume-title":"Case Formulation for Personality Disorders","author":"Karterud","year":"2019"},{"key":"B61","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1080\/10503307.2012.708795","article-title":"The MBT adherence and competence scale (MBT-ACS): development, structure and reliability","volume":"23","author":"Karterud","year":"2013","journal-title":"Psychother. Res"},{"key":"B62","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.cpr.2013.12.003","article-title":"Reflective functioning: a review","volume":"34","author":"Katznelson","year":"2014","journal-title":"Clin. Psychol. Rev"},{"key":"B63","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1037\/pst0000245","article-title":"Reflective functioning, psychotherapeutic alliance, and outcome in two psychotherapies for bulimia nervosa","volume":"57","author":"Katznelson","year":"2020","journal-title":"Psychotherapy"},{"key":"B64","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1037\/ccp0000760","article-title":"Reflective functioning and its potential to moderate the efficacy of manualized psychodynamic therapies versus other treatments for borderline personality disorder","volume":"91","author":"Keefe","year":"2023","journal-title":"J. Consult. Clin. Psychol"},{"key":"B65","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1037\/ccp0000674","article-title":"In-session reflective functioning in psychotherapies for borderline personality disorder: the emotion regulatory role of reflective functioning","volume":"89","author":"Kivity","year":"2021","journal-title":"J. Consult. Clin. Psychol"},{"key":"B66","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"Koo","year":"2016","journal-title":"J. Chiropr. Med"},{"key":"B67","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1037\/per0000555","article-title":"Using case formulation for prediction of the therapeutic alliance in treatment for borderline personality disorder","volume":"14","author":"Kramer","year":"2023","journal-title":"Pers. Disord. Theory Res. Treat"},{"key":"B68","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1007\/s10879-024-09630-0","article-title":"Working alliance instability in the inpatient treatment of borderline personality disorder","volume":"54","author":"Kratzer","year":"2024","journal-title":"J. Contemp. Psychother."},{"key":"B69","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med"},{"key":"B70","doi-asserted-by":"publisher","first-page":"317","DOI":"10.7326\/0003-4819-146-5-200703060-00004","article-title":"Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection","volume":"146","author":"Kroenke","year":"2007","journal-title":"Ann. Intern. Med"},{"key":"B71","volume-title":"The Group Questionnaire: A New Measure of the Group Relationship","author":"Krogel","year":"2008"},{"key":"B72","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1080\/10503307.2012.729868","article-title":"The group questionnaire: a clinical and empirically derived measure of group relationship","volume":"23","author":"Krogel","year":"2013","journal-title":"Psychother. Res"},{"key":"B73","doi-asserted-by":"publisher","first-page":"e70036","DOI":"10.1002\/pmh.70036","article-title":"Sustainability of mentalization-based treatment programs for poorly functioning patients with borderline personality disorder. can we really keep it up?","volume":"19","author":"Kvarstein","year":"2025","journal-title":"Pers. Mental Health"},{"key":"B74","doi-asserted-by":"publisher","first-page":"691","DOI":"10.3389\/fpsyt.2020.00691","article-title":"Social cognition capacities as predictors of outcome in mentalization-based treatment (MBT)","volume":"11","author":"Kvarstein","year":"2020","journal-title":"Front. Psychiatry"},{"key":"B75","doi-asserted-by":"publisher","first-page":"1163347","DOI":"10.3389\/fpsyt.2023.1163347","article-title":"Improvement of personality functioning among people treated within personality disorder mental health services. a longitudinal, observational study","volume":"14","author":"Kvarstein","year":"2023","journal-title":"Front. Psychiatry"},{"key":"B76","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1037\/int0000101","article-title":"The first sessions of psychotherapy: a qualitative meta-analysis of alliance formation processes","volume":"28","author":"Lavik","year":"2018","journal-title":"J. Psychother. Integr"},{"key":"B77","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1002\/wps.21156","article-title":"Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies","volume":"23","author":"Leichsenring","year":"2024","journal-title":"World Psychiatry"},{"key":"B78","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1080\/10503301003636696","article-title":"Conflict begets conflict: executive control, mental state vacillations, and the therapeutic alliance in treatment of borderline personality disorder","volume":"20","author":"Levy","year":"2010","journal-title":"Psychother. Res"},{"key":"B79","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1037\/ccp0000735","article-title":"The alliance-outcome association in group interventions: a multilevel meta-analysis","volume":"90","author":"Lo Coco","year":"2022","journal-title":"J. Consult. Clin. Psychol"},{"key":"B80","article-title":"\u201cHelping alliances in psychotherapy,\u201d","volume-title":"Succesful Psychotherapy","author":"Luborsky","year":"1976"},{"key":"B81","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1146\/annurev-clinpsy-071919-015355","article-title":"The mentalizing approach to psychopathology: state of the art and future directions","author":"Luyten","year":"2020","journal-title":"Annu. Rev. Clin. Psychol"},{"key":"B82","doi-asserted-by":"publisher","first-page":"102380","DOI":"10.1016\/j.cpr.2024.102380","article-title":"The role of mentalizing in psychological interventions in adults: systematic review and recommendations for future research","volume":"108","author":"Luyten","year":"2024","journal-title":"Clin. Psychol. Rev"},{"key":"B83","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1093\/ptr\/9.4.424","article-title":"The effects of the therapeutic alliance on the outcomes of individual and group psychotherapy with borderline personality disorder","volume":"9","author":"Marziali","year":"1999","journal-title":"Psychother. Res"},{"key":"B84","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.comppsych.2004.08.007","article-title":"Reliability and validity of the work and social adjustment scale in phobic disorders","volume":"46","author":"Mataix-Cols","year":"2005","journal-title":"Compr. Psychiatry"},{"key":"B85","doi-asserted-by":"publisher","first-page":"949326","DOI":"10.3389\/fpsyg.2022.949326","article-title":"Investigation of causes of ceiling effects on working alliance measures","volume":"13","author":"Meier","year":"2022","journal-title":"Front. Psychol"},{"key":"B86","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1002\/cpp.658","article-title":"Working alliance inventory-short revised (WAI-SR): psychometric properties in outpatients and inpatients","volume":"17","author":"Munder","year":"2010","journal-title":"Clin. Psychol. Psychother"},{"key":"B87","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1192\/bjp.180.5.461","article-title":"The work and social adjustment scale: a simple measure of impairment in functioning","volume":"180","author":"Mundt","year":"2002","journal-title":"Br. J. Psychiatry"},{"key":"B88","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1521\/pedi.2023.37.5.633","article-title":"The role of epistemic trust in mentalization-based treatment of borderline psychopathology","volume":"37","author":"Nolte","year":"2023","journal-title":"J. Personal Disord"},{"key":"B89","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1176\/appi.psychotherapy.20230032","article-title":"Novel approach to examining working alliance instability during psychotherapy for borderline personality disorder","volume":"77","author":"Notsu","year":"2024","journal-title":"Am. J. Psychother."},{"key":"B90","doi-asserted-by":"publisher","first-page":"2944","DOI":"10.1080\/09638288.2018.1563833","article-title":"Reducing ceiling effects in the working alliance inventory-rehabilitation dutch version","volume":"42","author":"Paap","year":"2020","journal-title":"Disabil. Rehabil"},{"key":"B91","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1037\/gdn0000176","article-title":"The group questionnaire (GQ)\u2014psychometric properties among outpatients with personality disorders","volume":"27","author":"Pedersen","year":"2023","journal-title":"Group Dyn. Theory Res. Prac"},{"key":"B92","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.eurpsy.2017.12.028","article-title":"Revised manual for the global assessment of functioning scale","volume":"51","author":"Pedersen","year":"2018","journal-title":"Eur. Psychiatry"},{"key":"B93","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1080\/08039488.2022.2147995","article-title":"The Norwegian network for personality disorders \u2013 development, contributions and challenges through 30 years","volume":"77","author":"Pedersen","year":"2022","journal-title":"Nordic J. Psychiatry"},{"key":"B94","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1080\/10503307.2013.801001","article-title":"Predictors of psychotherapy alliance in borderline personality disorder","volume":"23","author":"Richardson-Vejlgaard","year":"2013","journal-title":"Psychother. Res"},{"key":"B95","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1002\/(SICI)1097-4679(200002)56:2<233::AID-JCLP9>3.0.CO;2-3","article-title":"Resolving therapeutic alliance ruptures: diversity and integration","volume":"56","author":"Safran","year":"2000","journal-title":"J. Clin. Psychol"},{"key":"B96","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1080\/10503300512331327083","article-title":"Building an alliance: early therapy process and the client\u2013therapist connection","volume":"15","author":"Sexton","year":"2005","journal-title":"Psychother. Res"},{"key":"B97","volume-title":"Mini International Neuropsychiatric Interview (MINI)","author":"Sheehan","year":"1994"},{"key":"B98","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780195152968.001.0001","volume-title":"Applied Longitudinal Data Analysis","author":"Singer","year":"2003"},{"key":"B99","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1016\/S0006-3223(02)01324-0","article-title":"The borderline diagnosis I: psychopathology, comorbidity, and personaltity structure","volume":"51","author":"Skodol","year":"2002","journal-title":"Biol. Psychiatry"},{"key":"B100","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med"},{"key":"B101","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1192\/bjp.2021.204","article-title":"Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis","volume":"221","author":"Stoffers-Winterling","year":"2022","journal-title":"Br. J. Psychiatry"},{"key":"B102","doi-asserted-by":"publisher","first-page":"CD012955","DOI":"10.1002\/14651858.CD012955.pub2","article-title":"Psychological therapies for people with borderline personality disorder","volume":"5","author":"Storebo","year":"2020","journal-title":"Cochrane Database Syst. Rev"},{"key":"B103","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1521\/pedi_2018_32_391","article-title":"Predictors of dropout from a 20-week dialectical behavior therapy skills group for suicidal behaviors and borderline personality disorder","volume":"34","author":"Stratton","year":"2020","journal-title":"J. Personal Disord"},{"key":"B104","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1007\/s00406-023-01655-1","article-title":"Societal costs of personality disorders among treatment-seeking patients in Norway: the relative contribution of specific DSM-5 categories","volume":"274","author":"Sveen","year":"2024","journal-title":"Euro. Arch. Psychiatry Clin. Neurosci"},{"key":"B105","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1037\/a0029138","article-title":"Internal structure of the reflective functioning scale","volume":"25","author":"Taubner","year":"2013","journal-title":"Psychol. Assess"},{"key":"B106","doi-asserted-by":"publisher","first-page":"1380532","DOI":"10.3389\/fpsyt.2024.1380532","article-title":"Minding mentalizing - convergent validity of the mentalization breakdown interview","volume":"15","author":"Ulvestad","year":"2024","journal-title":"Front. Psychiatry"},{"key":"B107","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1080\/08039488.2022.2123040","article-title":"borderline focused reflective functioning measure - interrater reliability of the mentalization breakdown interview","volume":"77","author":"Ulvestad","year":"2023","journal-title":"Nord. J. Psychiatry"},{"key":"B108","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1037\/gdn0000237","article-title":"The group questionnaire: a psychometric investigation of the Dutch adaptation among patients with personality disorders","volume":"29","author":"van den Heuvel","year":"2025","journal-title":"Group Dyn. Theory Res. Prac"},{"key":"B109","doi-asserted-by":"crossref","first-page":"334","DOI":"10.4324\/9780203582015","volume-title":"The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work, 2nd Edn","author":"Wampold","year":"2015"},{"key":"B110","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1002\/pmh.1434","article-title":"The level of personality functioning scale-brief form 2.0: update of a brief instrument for assessing level of personality functioning","volume":"13","author":"Weekers","year":"2019","journal-title":"Personal Ment. Health"},{"key":"B111","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1002\/pmh.1570","article-title":"Normative data for the LPFS-BF 2.0 derived from the Danish general population and relationship with psychosocial impairment","volume":"17","author":"Weekers","year":"2023","journal-title":"Personal Ment. Health"},{"key":"B112","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1002\/jclp.70000","article-title":"Burden of disease of borderline personality disorder: a comprehensive evaluation of quality of life and societal cost of illness","volume":"81","author":"Wibbelink","year":"2025","journal-title":"J. Clin. Psychol"},{"key":"B113","doi-asserted-by":"publisher","first-page":"1732940","DOI":"10.3389\/fpsyt.2026.1732940","article-title":"Effectiveness of mentalization-based therapy and dialectical behavior therapy for cluster B personality disorders: a naturalistic study of service utilization and treatment dropout","volume":"17","author":"Yin","year":"2026","journal-title":"Front. Psychiatry"},{"key":"B114","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.16m11153","article-title":"Randomized controlled trial of web-based psychoeducation for women with borderline personality disorder","volume":"79","author":"Zanarini","year":"2018","journal-title":"J. Clin. Psychiatry"},{"key":"B115","first-page":"369","article-title":"Current concepts of transference","volume":"37","author":"Zetzel","year":"1956","journal-title":"Int. J. Psychoanal"}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1919516\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:34:26Z","timestamp":1791524066000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1919516\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":115,"alternative-id":["10.3389\/fpsyg.2026.1919516"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1919516","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"article-number":"1919516"}}