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16 results

  • Chapter 12 - Mentalizing in Psychiatric Practice

  • from Section 2 - Other Forms of Psychotherapy
  • Edited by Rachel Gibbons, Jo O'Reilly
  • Book:
    Seminars in the Psychotherapies
    Published online:
    27 May 2021
    Print publication:
    10 June 2021, pp 147-160

  • Summary

    The concept of Mentalizing is a recent theoretical development that has made a major contribution to our understanding of, and capacity to clinically work with, patients with a variety of different disorders. This has been particularly significant in the treatment of borderline personality disorder (BPD). Mentalizing draws upon psychoanalytic, cognitive and relational models of psychological functioning, attachment theory and neuroscience. It is central to psychiatric practice for a number of reasons. First it is a transdiagnostic concept and so is applicable to a range of mental health conditions spanning childhood to old age [1]. Second its position as a well-developed component of the literature on neurobiology and higher-order cognition (HOC) gives it a central place in neuropsychiatry and cognitive psychology [2]. The component of HOC that is called mentalizing has the capacity to rearrange processes within the brain and assure ‘business as usual’ notwithstanding adverse conditions.Mentalizing increases resilience to adversity, protecting psychological vulnerable individuals from relapse, and improving therapeutic outcomes [5]. Focussing on mentalizing helps people consider how teams, systems and services interact to facilitate or undermine interventions and the delivery of services; a non-mentalizing team and system has a negative impact on clinical care by creating an environment that impedes the implementation of reliable and responsive pathways to care and the realisation of skillful treatment [6].

  • 13 - Treating personality disorder: methods and outcomes

  • from Part 3 - Specific treatment approaches
    • By Anthony W. Bateman, Consultant Psychiatrist and Psychotherapist, Barnet, Enfield and Haringey Mental Health NHS Trust and St Anne's Hospital, London; Visiting Professor, University College London, UK, Peter Tyrer, Professor of Community Psychiatry, Centre for Mental Health, Imperial College, London, UK
  • Edited by Jaydip Sarkar, Gwen Adshead
  • Book:
    Clinical Topics in Personality Disorder
    Published online:
    02 January 2018
    Print publication:
    01 July 2012, pp 213-233

  • Summary

    Summary The growing demand for effective treatments for personality disorder has not been met adequately by the development of appropriate clinical services. However, there has been a significant shift from the view that personality disorder is untreatable; we do have treatments that have at least some efficacy and a number of countries have issued national guidance on the treatment of some personality disorders. This chapter summarises some of the current evidence regarding which psychological treatments are effective for personality disorder.

    Although every known treatment is used at some time for conditions that are deemed untreatable, almost all of the treatments for personality disorder that carry some element of respectability are included under one of the headings in Table 13.1. In discussing the efficacy of treatments for personality disorders, we have to be aware of the special problems associated with assessment of these conditions:

  • (a) the high level of comorbidity with other disorders, of both personality and mental state (Tyrer et al, 1997);

  • (b) the fluctuating nature of personality status over time, mainly as a consequence of concomitant mood changes (Clark et al, 2003);

  • (c) the need for a long period of observation, preferably at least a year, before a treatment can be said to have been properly evaluated;

  • (d) the recognition that personality disorder is a multifaceted condition that can be influenced in many different ways and fully justifies the use of what are described as ‘complex interventions’ (Campbell et al, 2000) to treat it. Complex interventions lead to complex evaluations and consequent greater difficulty in interpreting results.

    • An important distinction in determining the value of an intervention is whether it has been demonstrated in standard practice or under strict experimental conditions. This was first highlighted by Schwarz & Lellouch (1967) in discussing randomised trials, and it is commonly described as the difference between an explanatory trial, i.e. a trial in which treatments are compared under ideal (experimentally manipulated) conditions, and a pragmatic trial, in which the study is carried out under the conditions normally appertaining to ordinary practice. In the latter type of trial, possible confounders to the intervention may be present, and although they could be removed, to do so would create an artificial environment that would not allow the results to be transferred to ordinary practice.

  • 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
  • Book:
    Severe Personality Disorders
    Published online:
    14 August 2009
    Print publication:
    06 September 2007, pp 118-136

  • Summary

    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.

  • Services for personality disorder: organisation for inclusion

  • Anthony W. Bateman, Peter Tyrer
  • Journal:
    Advances in Psychiatric Treatment / Volume 10 / Issue 6 / November 2004
    Published online by Cambridge University Press:
    02 January 2018, pp. 425-433
    Print publication:
    November 2004
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  • Mental health services are not yet organised to allow patients with personality disorders easy access, and practitioners lack the necessary skills to implement effective treatment. A number of service models have developed, albeit without a clear evidence-base. These include sole-practitioner, divided-functions and specialist-team models. In general, a divided-functions or specialist-team model is probably best for reducing risk and improving outcomes. Both models present difficulties with integrating treatment, but these can be overcome by good communication. Good management of patients requires careful assessment of need and risk, a consistent approach, constancy of staff, team coherence and adequate in-patient support. Not all practitioners can treat patients with personality disorders and the interpersonal skills of the mental health professional may be crucial in maintaining a patient in treatment.

  • Self-help books on deliberate self-harm

  • Anthony W. Bateman
  • Journal:
    The British Journal of Psychiatry / Volume 185 / Issue 5 / November 2004
    Published online by Cambridge University Press:
    02 January 2018, pp. 441-442
    Print publication:
    November 2004
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  • Psychological treatment for personality disorders

  • Anthony W. Bateman, Peter Tyrer
  • Journal:
    Advances in Psychiatric Treatment / Volume 10 / Issue 5 / September 2004
    Published online by Cambridge University Press:
    02 January 2018, pp. 378-388
    Print publication:
    September 2004
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  • There is encouraging evidence that some patients with personality disorder are treatable. Psychotherapeutic interventions show promise, although interpretation of the literature is problematic: the number of patients in most trials is small, outcome measures are questionable, follow-up is limited, and treatments are multifaceted, complex interventions in which the effective components are unclear. The evidence base can be assessed according to efficacy and generalisability, and when both are taken into account the best verification is for psychodynamic therapy. However, there is inadequate evidence to make specific recommendations for any particular therapy.

  • Drug treatment for personality disorders

  • Peter Tyrer, Anthony W. Bateman
  • Journal:
    Advances in Psychiatric Treatment / Volume 10 / Issue 5 / September 2004
    Published online by Cambridge University Press:
    02 January 2018, pp. 389-398
    Print publication:
    September 2004
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  • There is some evidence that antidepressants, particularly the selective serotonin reuptake inhibitors and the monoamine oxidase inhibitors, have some benefits in the management of borderline personality disorder, and lesser evidence (partly because of limited trial data) for the benefits of antipsychotic drugs and mood stabilisers. There is not sufficient distinction between the different personality disorders to recommend that any one disorder should be treated by any one drug, and successful treatment is dependent on careful management, sensitive to the patient's expectations.

  • Effectiveness of psychotherapeutic treatment of personality disorder

  • Anthony W. Bateman, Peter Fonagy
  • Journal:
    The British Journal of Psychiatry / Volume 177 / Issue 2 / August 2000
    Published online by Cambridge University Press:
    02 January 2018, pp. 138-143
    Print publication:
    August 2000
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  • Background

    Psychiatrists have been criticised for failing to develop adequate treatment for personality disorder. Psychotherapeutic treatments are promising, but their effectiveness is uncertain.

    Aims

    To investigate the evidence for effectiveness of psychotherapeutic treatment for personality disorder.

    Method

    Systematic literature review.

    Results

    There is evidence for the effectiveness of psychotherapy for personality disorder. Problems of case identification, comorbidity, randomisation, specificity of treatment and outcome measurement are inadequately addressed. Authors mainly relied on cohort studies. Evidence neither suggests superiority of one type of therapy over another nor indicates which subgroups of patients should be offered psychotherapy as in-patient, day patient, or out-patient.

    Conclusions

    New research strategies are needed to show that personality change is both measurable and clinically meaningful. Effectiveness studies using randomised controlled designs are required. The literature suggests that effective treatment should be long-term, integrated, theoretically coherent and focused on compliance.

  • Borderline states

  • Anthony W. Bateman
  • Journal:
    Bulletin of the Royal College of Psychiatrists / Volume 9 / Issue 12 / December 1985
    Published online by Cambridge University Press:
    02 January 2018, p. 251
    Print publication:
    December 1985
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