Service user experiences of mentalisation-based treatment for borderline personality disorder

Publication Date13 Mar 2017
AuthorDiarmaid Ó. Lonargáin,Suzanne Hodge,Rachael Line
SubjectHealth & social care,Mental health
Service user experiences of
mentalisation-based treatment for
borderline personality disorder
Diarmaid Ó. Lonargáin, Suzanne Hodge and Rachael Line
Purpose Previous research indicates that mentalisation-based treatment (MBT) is an effective therapeutic
programme for difficulties associated with borderline personality disorder (BPD). The purpose of this paper is
to explore service user experiences of the therapy.
Design/methodology/approach Seven adults (five female and two male), recruited via three NHS trusts,
were interviewed. Participants were attending intensive out-patient MBT for BPD between 3 and 14 months.
Data were analysed using interpretative phenomenological analysis.
Findings Participants experienced the group component of MBT as challenging and unpredictable.
They highlighted developing trust as key to benefitting from MBT. This was much more difficult to achieve in
group sessions than in individual therapy, particularly for those attending MBT for less than five or six months.
The structure of MBT generally worked well for participants but they identified individual therapy as the core
component in achieving change. All participants learned to view the world more positively due to MBT.
Practical implications Enhanced mentalisation capacity may help address specific challengesassociated
with BPD, namely, impulsivity and interpersonal difficulties. MBT therapists are confronted with the ongoing
task of creating a balance between sufficient safety and adequate challenge during MBT. Potential benefits
and drawbacks of differing structural arrangements of MBT programmes within the UK are considered.
Originality/value Learning about service user perspectives has facilitated an enhanced understanding of
experiences of change during MBT in addition to specific factors that may impact mentalisation capacity
throughout the programme. These factors, in addition to implications for MBT and suggestions for future
research, are discussed.
Keywords Borderline personality disorder, Qualitative research, Interpretative phenomenological analysis,
Mentalization-based treatment, Service user experiences
Paper type Research paper
Mentalisation- based treatment ( MBT) is a therapeu tic programme dev eloped by Anthony
Bateman and Peter Fonagy to enhance mentalisation capacity in individuals who have been
given a diagnosis of borderline personality disorder (BPD) (Bateman and Fonagy, 1999, 2001,
2003). Mentalisa tion refers to the ab ility to understa nd, question and b e aware of onesown
mental states and tho se of others (Allen et al., 2008). Bateman and Fonagy (2006) theorise that
an impaired ability to mentalise is at the root of many of the core difficulties associated with
BPD such as impulsivity, interpersonal difficulties, and self-harm. The development of
mentalisation capacity is associated with close attachment relationships, and may become
impaired where a lack of safety is experienced in those relationships. For example, a child
who has experienced abuse may be unable to think about the mental states of their abuser.
The resulting impa ired ability to menta lise leads to diffic ulties with futu re attachment
relationships and to further complic ations such as psyc hic equivalence (i .e. the experienc e of
inner states as abs olute representa tions of outer reali ty, sometimes res ulting in paranoi d
hostility), prete nd mode (i.e. inner r eality and outer rea lity are completely separate sometim es
Received 14 April 2016
Revised 7 December 2016
Accepted 19 December 2016
The authors would like to thank
the three NHS Trusts that
facilitated this study, and especially
the MBT teams through which the
study was conducted. In particular
the authors would like to thank
Simon Graham, Keri Stephenson
and Emma Hickey for their support
with recruitment and other areas of
the research. Finally, the authors
are very grateful to those who took
part in the study, for giving their
time and sharing their experiences
with the authors, without whom
this research would not have been
Diarmaid Ó. Lonargáin is a
Clinical Psychologist at
Lancashire Care NHS
Foundation Trust, Preston, UK
and Faculty of Health and
Medicine, Lancaster University,
Lancaster, UK.
Suzanne Hodge is a Lecturer in
Health Research at the Faculty
of Health and Medicine,
Lancaster University,
Lancaster, UK.
Rachael Line is based at
5 Boroughs Partnership
NHS Foundation Trust,
Warrington, UK.
PAG E 16
VOL. 22 NO. 1 2017, pp. 16-27, ©Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-04-2016-0008

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