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Psychotherapy for Borderline Personality Disorder: Mentalization Based Treatment
Borderline Personality Disorder (BPD) is a severe personality dysfunction thought to affect some 2% of the population. The authors of this volume - Anthony Bateman and Peter Fonagy - have developed a psychoanalytically oriented treatment for BPD known as mentalization treatment. With
randomised controlled trials having shown this method to be effective, this book presents the first account of this treatment for BPD.
randomised controlled trials having shown this method to be effective, this book presents the first account of this treatment for BPD.
- GenresPsychologyPsychiatry
408 pages, Paperback
First published April 1, 2004
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Displaying 1 - 2 of 2 reviews
February 19, 2021
This was a professional read to develop my clinical understanding and skills. Fogany and Bateman were recommended by Tom Ryan. This book describes the MBT (Mentalization Based Treatment) for Borderline Personality Disorder (BPD). I found it useful in thinking about the treatment of BPD and provides a good description of how a team might treat BPD. It makes suggestion specifically to clinicians in coping with paranoid and passive aggression, envy, idealization, hate, sexual attraction, love and attachment. The strong feelings and emotions are experienced in treating BPD, not only in the individual experiencing it, but in a therapist treating it. This book will become a reference in future.
It takes a thick skin to apply this treatment with the authors saying that only act of violence towards a person to remove one from receiving MBT. It is not for the faint hearted. It spends a lot of time discussing the management of the self in response of others as it is about management of others. The Mentalization is a requirement for the Therapist as it for the person receiving therapy. I noted that within therapy that role modelling is an important aspect. The therapists will never get it completely correct, which Bateman and Fogany acknowledge that “Borderline patients are not shy about coming forward and pointing out your short comings and failing of treatment” (p 294).
A lot of the leadership strategies were similar to what Jocko Willink discussed in Extreme Ownership. The strategies of leadership seem universal and take time, effort and responsibility. It is not just telling others what to do. You need to ensure people understand the why of the what you are asking them to do, which reminds me of Nietzsche’s “He who has a why to live for can bear almost any how.”
“Psychiatry has been forced into the chronically uncomfortable position of straddling biomedicine and the social sciences and seems always to hunger for relief… [yet] the data simply do not permit a conception of the future centred on a straightforward biomedical answer to the fundamental question of the pathogenesis of major disorders. Indeed, a balanced image of the future contains a growing and equal partnership of the social sciences and molecular biology (p 36). I agree that Psychology/Psychiatry is not a science but has scientific aspects. One needs to be able to cope with the ambiguity of the social sciences. No better example of this is treating BPD.
“We have considered current empirical research on BPD. Major problems remain in relations to defining the condition and identifying related biological and psychosocial correlates. Enormous progress has been made in this field over the past fifteen years. Earlier controversies concerning the legitimacy of the diagnosis and its relationship to other condition appear far less pertinent. It has also become clear that the psychosocial pathways to BPD are extremely complex and there is no one-to-one relationship between particular trauma such as childhood sexual abuse and BPD” (p 56). I think this encapsulates the complexity of BPD. It is specific to the individual and the diagnosis does not tell you a lot about the person with it. I believe it is too broad to be useful. It means everything and nothing at the same time.
“In a recent meta-analysis (Leichsenring and Leibing 2003) psycho dynamic therapy yielded a large overall effect size of 1.46 with effect sizes of 1.08 for self-report measures and 1.79 for observer-rated measures. For cognitive behavioural therapy, the corresponding values were 1.00, 1.20. 0.87. In addition, the effect sizes for psychodynamic therapy indicated term term rather than short term change in PD” (p 57). Working with BPD is the elite level skills for a Mental Health Clinician. It is a highly stigmatised diagnosis within the field that has clinicians. I am glad to see the evidence for what I have come to understand. Relatively superficial strategies such as CBT do not work well for BPD. The issues are much deeper than CBT can delve.
I can recall my first mentor Stuart McDonald talking how he loved working with people with BPD. I recall thinking this was bizarre and that I wanted to get away from them as much as possible. I now realise that is because I was young and limited as a clinician and felt the need to be able to ‘control’ people I worked with. People with BPD have a special ability to make your inadequacies stark. It never feels good to see this reflection in the mirror. All the better to push the person away and make them wrong. Now I am in the second half of my career and always getting closer to the end I can understand why Stuart McDonald felt this way. I no longer feel the need to control anyone (including my kids) and am more able to recognise that I am inadequate. I can stand the mirror being held up to myself and see my imperfect self and accept myself. People with BPD have helped me grow as a person and a clinician, I just wish I could say I had done the same for them. Influence is a better goal than the illusion of control. At best I hope I have influenced people, because they have influenced me.
It takes a thick skin to apply this treatment with the authors saying that only act of violence towards a person to remove one from receiving MBT. It is not for the faint hearted. It spends a lot of time discussing the management of the self in response of others as it is about management of others. The Mentalization is a requirement for the Therapist as it for the person receiving therapy. I noted that within therapy that role modelling is an important aspect. The therapists will never get it completely correct, which Bateman and Fogany acknowledge that “Borderline patients are not shy about coming forward and pointing out your short comings and failing of treatment” (p 294).
A lot of the leadership strategies were similar to what Jocko Willink discussed in Extreme Ownership. The strategies of leadership seem universal and take time, effort and responsibility. It is not just telling others what to do. You need to ensure people understand the why of the what you are asking them to do, which reminds me of Nietzsche’s “He who has a why to live for can bear almost any how.”
“Psychiatry has been forced into the chronically uncomfortable position of straddling biomedicine and the social sciences and seems always to hunger for relief… [yet] the data simply do not permit a conception of the future centred on a straightforward biomedical answer to the fundamental question of the pathogenesis of major disorders. Indeed, a balanced image of the future contains a growing and equal partnership of the social sciences and molecular biology (p 36). I agree that Psychology/Psychiatry is not a science but has scientific aspects. One needs to be able to cope with the ambiguity of the social sciences. No better example of this is treating BPD.
“We have considered current empirical research on BPD. Major problems remain in relations to defining the condition and identifying related biological and psychosocial correlates. Enormous progress has been made in this field over the past fifteen years. Earlier controversies concerning the legitimacy of the diagnosis and its relationship to other condition appear far less pertinent. It has also become clear that the psychosocial pathways to BPD are extremely complex and there is no one-to-one relationship between particular trauma such as childhood sexual abuse and BPD” (p 56). I think this encapsulates the complexity of BPD. It is specific to the individual and the diagnosis does not tell you a lot about the person with it. I believe it is too broad to be useful. It means everything and nothing at the same time.
“In a recent meta-analysis (Leichsenring and Leibing 2003) psycho dynamic therapy yielded a large overall effect size of 1.46 with effect sizes of 1.08 for self-report measures and 1.79 for observer-rated measures. For cognitive behavioural therapy, the corresponding values were 1.00, 1.20. 0.87. In addition, the effect sizes for psychodynamic therapy indicated term term rather than short term change in PD” (p 57). Working with BPD is the elite level skills for a Mental Health Clinician. It is a highly stigmatised diagnosis within the field that has clinicians. I am glad to see the evidence for what I have come to understand. Relatively superficial strategies such as CBT do not work well for BPD. The issues are much deeper than CBT can delve.
I can recall my first mentor Stuart McDonald talking how he loved working with people with BPD. I recall thinking this was bizarre and that I wanted to get away from them as much as possible. I now realise that is because I was young and limited as a clinician and felt the need to be able to ‘control’ people I worked with. People with BPD have a special ability to make your inadequacies stark. It never feels good to see this reflection in the mirror. All the better to push the person away and make them wrong. Now I am in the second half of my career and always getting closer to the end I can understand why Stuart McDonald felt this way. I no longer feel the need to control anyone (including my kids) and am more able to recognise that I am inadequate. I can stand the mirror being held up to myself and see my imperfect self and accept myself. People with BPD have helped me grow as a person and a clinician, I just wish I could say I had done the same for them. Influence is a better goal than the illusion of control. At best I hope I have influenced people, because they have influenced me.
June 28, 2012
Useful and succinct introduction to mentalisation-based therapy for BPD, which I read immediately following the 3 day workshop in Adelaide. It still hasn't sunk in though!
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