“Tricky interactions”: exploring mental health staff responses to stressful interpersonal sequences following mentalizing skills training

Purpose Staff−patient interactions in mental health wards may involve multiple, sometimes contradictory, stressful interpersonal sequences. National guidelines stress the importance for clinicians to have appropriate training to develop: a good understanding of staff−patient interactions; a capacity to step back and reflect. Mentalizing skills training has been proposed to support staff in these two areas. This approach teaches general clinicians core concepts and skills derived from specialist mentalization-based treatment. Earlier mentalizing skills evaluations have lacked ongoing supervision following initial training and used self-report measures only. This study therefore aims to assess the feasibility of implementing mentalizing skills training for staff followed by ongoing supervision, using a researcher-rated measure of staff metacognition (essentially, reflective capacity). Design/methodology/approach In three psychiatric wards, the authors examined staff participation in a two-day mentalizing skills course followed by five-months of supervision. To measure outcomes, the authors used a repeated-measures design (baseline, post-training, five months post-training). They undertook semi-structured interviews (“The Caregiving Interview”) to explore participants’ responses to patients, applying the Metacognitive Assessment Scale (MAS) to assess reflective capacity. Findings Of 54 staff members approached, 43 completed the two-day course. Thirty-one participants attended at least one supervision session; seven participants undertook the protocol-intended five or more sessions. Wilcoxon signed-ranked tests showed moderate improvements in MAS from baseline to post-training (r = 0.31) and five-months (r = 0.36). Originality/value A novel semi-structured interview was developed. The findings extend the literature on mentalizing skills, revealing potential difficulties in engaging staff in ongoing supervision. Despite this attrition, participants’ gains in metacognition appear to be maintained.