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  • Print publication year: 2007
  • Online publication date: August 2009

8 - Borderline personality disorder, day hospitals, and mentalization

    • By Anthony W. Bateman, Consultant Psychiatrist and Psychotherapist Halliwick Unit, Barnet, Enfield, and Haringey Mental Health Trust University College, London, UK; Visiting Professor Halliwick Unit, Barnet, Enfield, and Haringey Mental Health Trust University College, London, UK, Peter Fonagy, Freud Memorial Professor of Psychoanalysis Director Sub-Department of Clinical Health Psychology, Chief Executive Anna Freud Centre, University College London, London, UK
  • Edited by Bert van Luyn, Salman Akhtar, Thomas Jefferson University, Philadelphia, W. John Livesley, University of British Columbia, Vancouver
  • Publisher: Cambridge University Press
  • DOI:
  • pp 118-136


Borderline personality disorder (BPD) is an intriguing condition and a great deal of theory has been applied to understanding its development and its clinical characteristics. Less consideration has been given to research into practical treatment although acronymic approaches with some effectiveness have begun to flourish over the past few years. There are now DBT (Dialectical Behavior Therapy) (Linehan, 1993), MBT (Mentalization-Based Therapy) (Bateman and Fonagy, 2004b), CAT (Cognitive Analytic Therapy) (Ryle, 1997), CBT (Cognitive Behavioral Therapy) (Davidson, 2000), and SFT (Schema-Focused Therapy) (Young, 1990). Others may follow (Gunderson, 2001).

The profile of the disorder has increased both within and without mental health services as a result of the advent of moderately effective treatments. Publication of evidence-based treatment guidelines in the USA raised the profile of BPD further and even though some have claimed the recommendations were premature (Tyrer, 2002) there is little doubt that they marked a turning point in mental health services, placing BPD further up the mental health agenda of priorities. A strategic review of treatment of personality disorder by the Department of Health in the UK (DoH, 2003) also formally marked the end of a neglectful era in the UK. A sad era during which individuals with a primary diagnosis of BPD received inappropriate, inadequate, and reluctant care from disorganized services; a haphazard delivery of services undoubtedly made worse by the curious mixture of reasonable and irrational conduct so common in individuals with severe personality disorders which itself generates confusion amongst those working to help them.

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