Our experience of running a psycho education group for Borderline Personality Disorder (MBT-i). Chris Gray Specialist Nurse Practitioner in Psychotherapy Carol Wilson Nurse Therapist Lansdowne Psychotherapy Service Dr Caroline Leeming Consultant Psychiatrist

What is Mentalizing?  Mentalization is a form of imaginative mental activity about ourselves and other people. Namely it involves perceiving and interpreting human behaviour in terms of intentional mental states e.g. needs, desires, feelings, beliefs, goals, purposes and reasons.

Mentalizing and Borderline Personality Disorder  Early attachment relationships are important in the development of mentalizing.  Failures in mentalizing are associated with emotional dysregulation and impulsivity.  These are core features of BPD.

What is MBT  A research based treatment.  Developed and manualised by Anthony Bateman and Peter Fonagy. 3 main parts: 3 main parts:  MBT-i: a 12 week psycho-educational programme on BPD and MBT.  Individual MBT sessions for months.  Group MBT session for 18 months-2 years.

12 week Psycho-education programme  1. What is mentalizing and a mentalizing stance  2. What does it mean to have problems with mentalizing  3. Why do we have emotions and what are the basic types  4. How do we register and regulate our emotions?  5. The significance of attachment relationships  6. Attachment and mentalizing  7. What is a personality disorder? What is Borderline Personality Disorder?  8. On MBT part1  9. On MBT part2  10. Anxiety, Attachment and Mentalizing  11. Depression, Attachment and Mentalizing  12 Summary and feedback

Aim of MBT-i  Inform/educate patients about mentalizing and BPD.  Prepare patients for long term treatment.  Assess patients mentalizing capacities.  Confirm initial assessment and diagnosis of BPD.

Structure and set up of Group  Anthony Batemans’ MBTi structure involves 2 therapists, 6-12 members  12 weeks at 1.5 hours a time and definite or probable diagnosis of BPD.  PowerPoint presentation based on MBTi manual

Group Leaders  Model a metalizing stance  Maintain an “expert” stance regarding knowledge about mentalizing and BPD  Active Role  Importance of following manual closely

Selection of Patients  Patients selected for first MBTi group were all already in MBT treatment, at various stages.  10 patients invited to the first group.  Patients had completed outcome measures, including the PDQ4 which helped confirm the diagnosis of BPD.

Introducing 3rd Group Leader  Chance to give MBT Practitioner a new experience.  Opportunity for another perspective.  Useful experience

Difficulties and what we have learned  Patient suitability for treatment - engagement and ability to tolerate full MBT programme  Patients who score high on the narcissistic and/or anti-social range of the PDQ4 are less likely to benefit from treatment programme.  Implications for treatment – e.g. disruptive in group therapy, pushes arousal of whole group up.

Difficulties and what we have learned  Certain subjects could be triggering for the patients.  Management of this within the constraints of a non treatment group.  Patients can leave the room and return at a later point.

Difficulties and what we have learned  Patient participation encouraged.  Challenge keeping a balance between encouraging quieter members to participate and ensuring other members do not dominate conversations.  Backed up by patient feedback, stating that their experience of sessions are better when everyone contributes.

Changes after patient feedback  Patient feedback forms important in monitoring patients experience of the course.  Useful in deciding on any future changes that would be necessary to do to enhance the patients experience.

Changes after patient feedback  Running time from reduced from 1.5 hours to 1 hour.  Slides were amended before each new group e.g. difficult to understand language.  Utilised the flip chart more.

Drop out rates  Expectation that some patients will fail to complete the group.  Patients offered one further opportunity to attend next group if they drop out during group.  Missing more than 2 sessions compromises patients learning experience and chance of progressing into treatment.

The future?  Aim is for all patients referred for MBT to attend the MBTi group first and run this group on a rolling basis.  Maximising the suitability of patients for the full MBT treatment programme.  Cost effective.