Mentalization-Based Treatment for Personality Disorders: A Practical Guide

Mentalization-Based Treatment for Personality Disorders: A Practical Guide

Mentalization-Based Treatment for Personality Disorders: A Practical Guide

Mentalization-Based Treatment for Personality Disorders: A Practical Guide

Synopsis

Mentalizing - the ability to understand oneself and others by inferring mental states that lie behind overt behaviour - develops within the context of attachment relationships. It is crucial to self-regulation and constructive, intimate relationships, both of which are impaired in personality disorders because of sensitivity to losing mentalizing at times of anxiety and attachment stress. Loss of mentalizing leads to interpersonal and social problems, emotional variability, impulsivity, self-destructive behaviours, and violence. This practical guide on mentalization-based treatment (MBT) of personality disorders outlines the mentalizing model of borderline and antisocial personality disorders and how it translates into clinical treatment. The book, divided into four parts - the mentalizing framework, basic mentalizing practice, mentalizing and groups, and mentalizing systems - covers the aims and structure of treatment, outlines how patients are introduced to the mentalizing model so that their personality disorder makes sense to them, explains why certain interventions are recommended and others are discouraged, and systematically describes the process of treatment in both group and individual therapy to support more stable mentalizing. People with personality disorders commonly have comorbid mental health problems, such as depression and eating disorders, which complicate clinical treatment. Therefore, the book advises the clinician on how to manage comorbidity in treatment. In addition, mentalizing problems in families and social systems, for example, schools and mental health services are also covered. A families and carers training and support guide is provided as families and others are often neglected during the treatment of people with personality disorder. The book is a valuable guide for all mental health workers on how to effectively treat personality disorders.

Excerpt

The aim of our first “practical guide” to mentalization-based treatment (MBT) was to provide an understandable, accessible, and comprehensive account of MBT as used in daily clinical practice. We hoped that the book, in conjunction with only limited additional training, would make clinicians feel confident that what they were about to deliver in clinical practice was MBT, or at least resembled MBT. But over the past few years it has become apparent that we were not specific enough about some of the core components of the model, perhaps because we ourselves were unclear about some of the essential and less essential aspects of MBT; hence, the need for a completely new book. in addition, the theoretical underpinnings of MBT, the structure of treatment, and some of the interventions recommended to promote mentalizing needed clarifying. We hope that this new practical guide elucidates some of the more confusing aspects of MBT.

More importantly, there was an urgent need for a new practical guide because MBT has changed over the past decade; the model and its clinical application are continually being informed by new understanding generated from research. Indeed, MBT “looks” distinctly different now compared to a decade ago, and no doubt it will be different again in another decade. But we hope that the core components we describe here will remain as the foundation stones for further developments. in our attempt to summarize the model more accurately the book has become longer, but we hope this will not put off interested readers.

MBT has been more successful than we ever anticipated, perhaps more so than it deserves. It was initially developed for borderline personality disorder but is now used to treat patients with a range of disorders. We do not cover the adaptations for different disorders in this book, with one exception, MBT for antisocial personality disorder. This book contains an outline of the manual currently being used as the basis for a research trial of MBT for antisocial personality disorder. Other adaptations, for example, MBT for people with eating disorders, substance abuse, depression, and adolescents who self-harm, are outlined in an earlier publication (Bateman & Fonagy, 2012).

The popularity of MBT requires some explanation. First, clinicians easily understand the ideas underpinning the model and recognize that promoting mentalizing is something they are already doing in their clinical work. So it has given a clearer framework to their clinical interventions. Second, it has broad . . .

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