Mentalization-based treatment for borderline personality disorder in adults and adolescents: For whom, when, and how?

Abstract

Borderline personality disorder (BPD) is common in clinical practice. Psychotherapy is the treatment of choice, and mentalization-based treatment (MBT) is one of the empirically supported treatments that are currently available. For adults, two variants of MBT (MBT day hospital [MBT-DH] and MBT intensive outpatient [MBT-IOP]) have been developed and empirically evaluated. The authors review research on the development, efficacy, and implementation of MBT. In conclusion, the authors focus on the implementation of treatment programs for BPD patients. Although there are now different effective treatments, their implementation in routine clinical practice has proven to be much more complex than initially thought. In addition, treatments such as MBT are multimodal and long term. Both societal pressures to increase the cost-effectiveness of treatments and new theoretical insights into the role of social learning and salutogenesis in the development of BPD force a reconsideration of some assumptions concerning the nature of treatment for individuals with BPD.

“Yes, there is actually hope!”—A qualitative investigation of how patients experience mentalization-based psychoeducation tailored for borderline personality disorder.

“…The established specialized BPD treatments have developed from both psychodynamic and cognitive tradition, but have been modified and adjusted according to the needs of the target group of patients and therapists’ requirements. The approaches include among others, MBT (Feenstra et al, 2017) and transference-focused psychotherapy (Doering et al, 2010), as well as dialectical behavioral therapy (DBT; McMain et al, 2009) and schema-focused therapy (Sempértegui et al, 2013). The treatments provide a clear treatment structure and a content focused on core personality problems and relevant management.…”

“…The treatment is structured by individually formed case formulations, a framework for therapist interventions in individual and group therapies, and specific psychoeducation in an early phase of treatment. Implementation of specialized treatment such as MBT in routine clinical practice may be complex, and reports based on such experiences provide important feedback on feasibility, requirements, and limitations of the model (Feenstra, Luyten, & Bales, 2017). For further refinement of treatment for personality disorder, investigation of factors promoting or challenging the therapeutic process are central.…”

Mentalization‐based treatment or psychodynamic treatment programmes for patients with borderline personality disorder – the impact of clinical severity

“…Evidence base for treatment interventions should include studies of indications and contraindications (Choi-Kain, Albert, & Gunderson, 2016;Feenstra, Luyten, & Bales, 2017;Meuldijk, McCarthy, Bourke, & Grenyer, 2017). The current study is one of few BPD treatment studies focusing on impacts of comorbidity and severity.…”

The So‐Called Borderline Patient: Aetiology, Diagnosis, and Treatment

“…Many of these patients require hours of painstaking treatment in learning and incorporating a degree of impulse control (Masterson & Lieberman, 2004; Sabin et al, 2017; Stone, 2016). These patients often lack the capacity to identify (in themselves and others) discrete affective states, instead of experiencing or perceiving only pleasure or displeasure (Feenstra, Luyten & Bales, 2017; Halpoth et al ., 2019). Until these patients are able to acquire these and other fundamental structural skills, they will be unable to proceed further along the path of ego development.…”