Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-21T02:58:06.988Z Has data issue: false hasContentIssue false

Running a mentalization-based treatment (MBT) programme within a public community adult mental health service setting: a feasibility study

Published online by Cambridge University Press:  02 May 2019

D. Beattie
Affiliation:
HSE Kildare/West Wicklow Mental Health Service, Kildare, Ireland
S. Murphy*
Affiliation:
HSE Kildare/West Wicklow Mental Health Service, Kildare, Ireland
S. Jamieson
Affiliation:
HSE Kildare/West Wicklow Mental Health Service, Kildare, Ireland
A. Lee
Affiliation:
HSE Kildare/West Wicklow Mental Health Service, Kildare, Ireland
*
*Address for correspondence: S. Murphy (DClin), HSE Kildare/West Wicklow Mental Health Service, St. Mary’s, Naas, Kildare, Ireland (Email: sile.murphy1@hse.ie)

Abstract

Objectives:

This article aimed to address the feasibility of mentalization-based treatment (MBT) for patients with personality disorder in a non-specialist setting. The development and implementation of an MBT Programme is described.

Methods:

A multidisciplinary Consult Group met to plan the implementation of the programme. Participants attended a psychoeducation group (MBT Introductory Group), then weekly individual and group therapy. Fourteen participants started the full programme with eight completing at least 9 months, complete data are available for five participants who completed 27 months (first cohort) and 21 months (second cohort). Data include quantitative measures and qualitative questionnaires/interviews. All had a diagnosis of personality dysfunction with co-morbid disorder including anxiety/depressive disorder, post-traumatic stress disorder and eating disorder.

Results:

Data on five participants revealed reductions in global level of distress, improvements in psychological well-being, less interpersonal difficulties and better work and social functioning. Qualitative data from feedback questionnaires (n = 18) and in-depth interview (n = 2) are discussed under the themes of mentalizing, treatment feedback/outcomes and group factors. Therapist reflections on the process identify the challenges involved in implementing a specialist psychotherapy programme within a general service and learning points from this are discussed.

Conclusions:

MBT is an acceptable treatment for patients with personality dysfunction. Prior to the implementation of a programme, factors at the therapist, team and organizational level, as well as the wider context, need to be examined. This is to ensure that conditions are in place for proper adherence to the model to achieve the positive outcomes demonstrated in the RCT studies.

Type
Original Research
Copyright
© The Author(s), 2019. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bateman, A, Fonagy, P (1999). Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. American Journal of Psychiatry 156, 15631569.10.1176/ajp.156.10.1563CrossRefGoogle ScholarPubMed
Bateman, A, Fonagy, P (2001). Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. American Journal of Psychiatry 158, 3642.10.1176/appi.ajp.158.1.36CrossRefGoogle Scholar
Bateman, A, Fonagy, P. (2006). Mentalization-Based Treatment for Borderline Personality Disorder: A Practical Guide. Oxford University Press: Oxford.10.1093/med/9780198570905.001.0001CrossRefGoogle Scholar
Bateman, A, Fonagy, P (2008). 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. American Journal of Psychiatry 165, 631638.10.1176/appi.ajp.2007.07040636CrossRefGoogle ScholarPubMed
Bateman, A, Fonagy, P (2009). Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. American Journal of Psychiatry 166, 13551364.10.1176/appi.ajp.2009.09040539CrossRefGoogle ScholarPubMed
Bales, D, Timman, R, Andrea, H, Busschbach, JJV, Verheul, R, Kamphuis, JH (2014). Effectiveness of day hospital mentalization-based treatment for patients with severe borderline personality disorder: a matched control study. Clinical Psychology & Psychotherapy 22, 409417.10.1002/cpp.1914CrossRefGoogle ScholarPubMed
Bales, D, Verheul, R, Hutsebaut, J (2017). Barriers and facilitators to the implementation of mentalization-based treatment (MBT) for borderline personality disorder. Personality and Mental Health 11, 118131.10.1002/pmh.1368CrossRefGoogle Scholar
Bales, D, Timman, R, Luyten, P, Busschbach, J, Verheul, R, Hutsebaut, J (2017). Implementation of evidence-based treatment for borderline personality disorder: the impact of organizational changes on treatment outcome of mentalization-based treatment. Personality and Mental Health 11, 266277.10.1002/pmh.1381CrossRefGoogle ScholarPubMed
Bender, DS, Dolan, RT, Skodol, AE, Sanislow, CA, Dyck, IR, McGlashan, TH, Shea, MT, Zanarini, MC, Oldham, JM, Gunderson, JG (2001). Treatment utilization by patients with personality disorders. American Journal of Psychiatry 158, 295302.10.1176/appi.ajp.158.2.295CrossRefGoogle ScholarPubMed
Blais, MA, Lenderking, WR, Baer, L, deLorell, A, Peets, K, Leahy, L, Burns, C (1999). Development and initial validation of a brief mental health outcome measure. Journal of Personality Assessment 73, 359373.10.1207/S15327752JPA7303_5CrossRefGoogle ScholarPubMed
Carr, A, Keenleyside, M, Fitzhenry, M, Harte, E, White, MD, O’Hanrahan, K, Hayes, J, Cahill, P, Noonan, H, O’shea, H, McCullagh, A, McGuinness, S, Rodgers, C, Whelan, N, Sheppard, N, Browne, S (2015). Personality disorders in an Irish mental health service: the Waterford Mental Health Survey. The Irish Journal of Psychology 36, 311.10.1080/03033910.2016.1138873CrossRefGoogle Scholar
Derogatis, LR (1994). Symptom Checklist-90-R: Administration, Scoring and Procedures Manual. Pearson: Bloomington.Google Scholar
Dyson, H, Brown, D (2016). The experience of mentalization-based treatment: an interpretative phenomenological study. Issues in Mental Health Nursing 37, 586595.10.3109/01612840.2016.1155246CrossRefGoogle ScholarPubMed
Expert Group on Mental Health Policy (2006). A Vision for Change: Report of the Expert Group on Mental Health Policy. The Stationery Office: Dublin.Google Scholar
Fonagy, P, Luyten, P, Moulton-Perkins, A, Lee, Y-W, Warren, F, Howard, S, Ghinai, R, Fearon, P, Lowyck, B (2016). Development and validation of a self-report measure of mentalizing: the reflective functioning questionnaire. PLoS ONE 11(7), e0158678. doi: 10.1371/journal.pone.0158678.CrossRefGoogle ScholarPubMed
Horowitz, LM, Alden, LE, Wiggins, JS, Pincus, AL (2000). Inventory of Interpersonal Problems Manual. The Psychological Corporation: San Antonio.Google Scholar
Johnson, EL, Mutti, M, Springham, N, Xenophontes, I (2016). Mentalizing after mentalization based treatment. Mental Health and Social Inclusion 20, 4451.10.1108/MHSI-11-2015-0042CrossRefGoogle Scholar
Jorgensen, CR, Freudn, C, Boye, R, Jordet, H, Andersen, D, Kjolbye, M (2012). Outcome of mentalization-based and supportive psychotherapy in patients with borderline personality disorder: a randomized trial. Acta Psychiatrica Scandinavica 127, 305317.10.1111/j.1600-0447.2012.01923.xCrossRefGoogle ScholarPubMed
Katsakou, C, Marougka, S, Barnicot, K, Savill, M, White, H, Lockwood, K, Priebe, S (2012). Recovery in borderline personality disorder (BPD): a qualitative study of service users’ perspectives. PLoS ONE 7(5), e36517. doi: 10.1371/journal.pone.0036517.CrossRefGoogle ScholarPubMed
Kvarstein, E, Pedersen, G, Urnes, Ø, Hummelen, B, Wilberg, T, Karterud, S (2015). Changing from a traditional psychodynamic treatment programme to mentalization-based treatment for patients with borderline personality disorder – Does it make a difference?. Psychology and Psychotherapy: Theory, Research and Practice 88, 7186.10.1111/papt.12036CrossRefGoogle Scholar
Laurenssen, EMP, Luyten, P, Kikkert, MJ, Westra, D, Peen, J, Soons, MBJ, van Dam, AM, van Broekhuyzen, AJ, Blankers, M Busschbach, JJV, Dekker, JJM (2018). Day hospital mentalization-based treatment v. specialist treatment as usual in patients with borderline personality disorder: randomized controlled trial. Psychological Medicine 48, 18. doi: 10.1017/S0033291718000132.CrossRefGoogle ScholarPubMed
Mental Health Division, HSE (2017). A national framework for recovery in mental health—A national framework for mental health service providers to support the delivery of a quality, person-centred service 2018–2020. HSE.Google Scholar
Millon, T, Millon, C, Davis, R, Grossman, S (2009). MCMI-III Manual, 4th edn. Pearson Education Inc.: Minneapolis.Google Scholar
Mundt, JC, Marks, IM, Shear, MK, Greist, JH (2002). The work and social adjustment scale: A simple measure of impairment in functioning. British Journal of Psychiatry 180, 461464.10.1192/bjp.180.5.461CrossRefGoogle ScholarPubMed
National Institute for Clinical Excellence (2009) Borderline personality disorder: recognition and management. NICE.Google Scholar
O’Lonargain, D, Hodge, S, Line, R (2017). Service user experiences of mentalization-based treatment for borderline personality disorder. Mental Health Review Journal 22, 1627.10.1108/MHRJ-04-2016-0008CrossRefGoogle Scholar
Orsmond, GI, Cohn, ES (2015). The distinctive features of a feasibility study: objectives and guiding questions. OTJR: Occupation, Participation and Health, 35, 169177.Google ScholarPubMed
Vogt, KS, Norman, P (2018). Is mentalization-based therapy effective in treating the symptoms of borderline personality disorder? A systematic review. Psychology and Psychotherapy: Theory, Research and Practice. doi: 10.1111/papt.12194.Google ScholarPubMed