Mentalization-based Treatment for Borderline Personality Disorder: A Practical Guide [NOOK Book]

Overview

Mentalizing-the ability to understand oneself and others by inferring the mental states that lie behind overt behaviour-develops during childhood within the context of a secure attachment relationship. It is crucial to self-regulation and constructive, intimate relationships. Failure to retain mentalizing, particularly in the midst of emotional interactions, is a core problem in borderline personality disorder and results in severe emotional fluctuations, impulsivity, and vulnerability to interpersonal and social...
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Mentalization-based Treatment for Borderline Personality Disorder: A Practical Guide

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Overview

Mentalizing-the ability to understand oneself and others by inferring the mental states that lie behind overt behaviour-develops during childhood within the context of a secure attachment relationship. It is crucial to self-regulation and constructive, intimate relationships. Failure to retain mentalizing, particularly in the midst of emotional interactions, is a core problem in borderline personality disorder and results in severe emotional fluctuations, impulsivity, and vulnerability to interpersonal and social interactions. This book is a practical guide about how to treat borderline patients by helping them develop a more robust mentalizing capacity within the context of an attachment relationship.

It is a 'How to Do' book with illustrative clinical examples. It details precisely how to develop and implement treatment and is a companion to the more detailed book Psychotherapy for Borderline Personality Disorder: mentalization based treatment. This user-friendly guide provides the practitioner with everything they need to know about how to practice mentalizing treatment in day-patient and out-patient settings. Enough theory is provided to orientate the clinician and there is step-by-step practical advice on the assessment of mentalizing and interpersonal relationships, how to structure treatment, the use of basic mentalizing interventions and how to apply them, as well as information on what not to do. In addition, a check list to be used in the assessment of mentalizing and a self-rating exercise for practitioners to evaluate their adherence to mentalizing are included.

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Editorial Reviews

Doody's Review Service
Reviewer: Sheila M. Dowd, PhD (Rush University Medical Center)
Description: This guide introduces the concept of mentalization and reviews the application of the therapeutic techniques. It serves as a companion to the original book published in 2004, Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment (Oxford University Press, 2004)
Purpose: The purpose is to provide practitioners with the techniques and steps to treat borderline personality disorder with mentalization-based therapy, which was developed by the authors. This is a very difficult disorder to treat and, in addition to the patient's distress, it can be stressful for the treatment team. This book is successful in presenting an interesting formulation and intervention.
Audience: According to the authors, the book is aimed at those who provide care for these patients including nurses and mental health professionals. They have written it for those less experienced but hope seasoned practitioners will benefit as well. This is the authors' second publication in the area of mentalization-based therapy and they have several articles in the literature.
Features: The book begins by reviewing the mentalization model and how to use this framework to understand borderline personality disorder. It then reviews the intervention, starting with introducing the diagnosis and treatment to the patient. A nice component of the book is that the authors frequently address specific issues related to treating this population. The book then proceeds to review the format of Mentalization-Based Treatment (MBT) in a day hospital or outpatient center, with both individual and group formats. The book concludes with a section of frequently asked questions and an appendix with questionnaires. The authors are quite aware of the struggles and questions likely to come from treatment of patients with borderline personality disorder.
Assessment: Mentalization-Based Treatment builds on existing treatments for borderline personality disorder and this book offers a concise guide that clinicians can use in their practice.
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Product Details

  • ISBN-13: 9780191008092
  • Publisher: OUP Oxford
  • Publication date: 9/14/2006
  • Sold by: Barnes & Noble
  • Format: eBook
  • Sales rank: 1,197,483
  • File size: 572 KB

Table of Contents


Preface     ix
Foreword     xiii
Introduction to mentalization     1
What is mentalizing?     1
Mentalizing and emotional life     3
Related concepts     4
Clinical implications of the focus on mentalization     8
Conclusions     10
Using the mentalization model to understand severe personality disorder     11
Overview of the developmental model     11
Vulnerability factors     11
Activating factors     12
Phenomenology     13
Disorganization of attachment     14
Disorganized attachment and the disorganization of the self: the alien self     15
Controlling internal working model     16
Failure of mentalization in BPD     17
Arousal and the hyperactivation of the attachment system     18
Understanding BPD in terms of the suppression of mentalization model     20
Common themes     20
Self-destructive dysfunctional interpersonal relatedness     25
Suicide     26
Self-harm     27
Impulsive acts of violence     27
Conclusion     28
Changing views of borderline personality disorder     29
Re-mapping the course of borderline personality disorder     29
Changing expectations about the effectiveness of treatment     30
The reality of iatrogenic harm     33
The structure of mentalization-based treatment     37
Trajectory of treatment     37
Initial phase     38
Assessment of mentalization     38
Giving the diagnosis and introducing the approach     39
Opening a 'dialogue about diagnosis'     40
Giving an explanation     41
Psychoeducation     41
An attachment understanding of borderline personality disorder     41
Treatment programme     43
Day hospital programme     44
Intensive out-patient programme     44
Why group work?     45
Contracts     46
Clarification of some basic rules and giving guidance     46
Individual contracts     48
Formulation     49
Review and reformulation     53
Review of medication     53
Crisis pathways     53
Middle phase     55
Final phase     56
Follow-up     58
Out-patient maintenance mentalization      59
Assessment of mentalization     61
Some key principles in the assessment of mentalization     61
The comprehensive assessment of mentalization in an inter-personal context     62
Unstructured and structured methods for eliciting material helpful in the assessment of mentalization     64
What does poor mentalizing look like?     66
What does good mentalization look like?     67
Extremely poor mentalization revealed during the assessment process     69
Generalized versus partial difficulties     70
Slow recovery following context-specific failures of mentalization     71
Pseudo-mentalization     72
Intrusive pseudo-mentalization     73
Overactive form of pseudo-mentalizing     74
Destructively inaccurate pseudo-mentalization     74
Concrete understanding     75
Misuse of mentalization     79
Conclusion     82
Assessment of interpersonal and relational world     83
Patterns of relationships     83
Normal     84
Centralized     85
Distributed     87
Why assess the pattern of relationship?     89
Current and past relationships     89
Therapist stance      93
Mentalizing or not-knowing stance     93
The doing therapist     96
The monitoring therapist     96
The process therapist     99
Principles of interventions     103
General characteristics of interventions     104
Simple and short     105
Affect focused     106
Focus on the patient's mind not on behaviour     107
Relate to current event or activity     108
Clinical pathway for interventions     109
Which intervention when?     111
Basic principles-a clinical example     113
Suicide attempts and self-harm     113
The mentalizing focus and basic interventions     119
Motivation     119
Reassurance, support, and empathy     120
Identifying and exploring positive mentalizing     122
Clarification and affect elaboration     124
Stop and stand-challenge or trip     126
Boundary violation     130
Basic mentalizing     131
Stop, listen, look     132
Stop, rewind, explore     133
Transference tracers     134
Interpretive mentalizing     136
Mentalizing the transference     139
Mentalizing and group therapy     145
Explicit mentalizing     145
Explicit mentalizing group     146
Implicit mentalizing     151
Implicit mentalizing group     152
Explore understanding of each other     155
Frequently asked questions     159
Further reading     169
On mentalizing and MBT     169
On other therapeutic approaches to BPD     169
Appendix     171
Checklist to be used in the clinical assessment of mentalization     171
Categories of mentalizing capacity based on clinical assessment     173
Self rating of MBT adherence     174
References     177
Index     183
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