| About the authors | | xvii | |
| Introduction | | xix | |
| | xix | |
| | xx | |
| Core component of treatment |
| | xxi | |
| | xxii | |
| | xxiii | |
| Chapter 1: Epidemiological and etiological research on borderline personality disorder | | 1 | (38) |
| Definition of the problem |
| | 1 | (2) |
| | 2 | (1) |
| | 2 | (1) |
| | 3 | (1) |
| | 3 | (6) |
| | 3 | (1) |
| | 4 | (1) |
| | 5 | (2) |
| | 5 | (1) |
| | 5 | (1) |
| | 5 | (2) |
| | 7 | (1) |
| Dimensional models of BPD |
| | 8 | (1) |
| The natural history of BPD |
| | 9 | (3) |
| The stability of the diagnosis over time |
| | 9 | (1) |
| | 10 | (2) |
| Studies of mechanisms and aetiological factors |
| | 12 | (7) |
| Biological considerations |
| | 12 | (7) |
| | 12 | (1) |
| | 12 | (2) |
| Neurotransmitter abnormality |
| | 14 | (1) |
| | 14 | (1) |
| | 15 | (3) |
| Attention and self-control |
| | 18 | (1) |
| | 19 | (1) |
| | 19 | (15) |
| Theoretical considerations |
| | 19 | (2) |
| | 21 | (2) |
| Parental separation or loss |
| | 21 | (1) |
| | 21 | (1) |
| Abnormal parenting attitudes |
| | 22 | (1) |
| Childhood trauma and maltreatment |
| | 23 | (3) |
| Models of psychosocial aetiology based on neglect and trauma |
| | 26 | (8) |
| | 26 | (1) |
| The stress-diathesis model |
| | 27 | (1) |
| | 28 | (1) |
| Biological pathways of the impact of extreme stress |
| | 29 | (3) |
| Childhood trauma as a risk factor for adverse brain development |
| | 29 | (1) |
| | 30 | (1) |
| | 30 | (1) |
| | 30 | (1) |
| Anterior cingulate dysfunction |
| | 31 | (1) |
| Psychological pathways linking BPD to the impact of extreme stress: the role of affect dysregulation |
| | 32 | (2) |
| | 34 | (3) |
| Theoretical considerations |
| | 34 | (1) |
| Empirical studies using the AAI |
| | 35 | (1) |
| Empirical studies using self-report measures of attachment |
| | 35 | (1) |
| Summary of empirical data |
| | 36 | (1) |
| Problems with a simple attachment model |
| | 37 | (1) |
| | 37 | (2) |
| Chapter 2: Therapy research and outcome | | 39 | (16) |
| | 40 | (10) |
| Psychoanalytic psychotherapy |
| | 40 | (6) |
| Empirical evidence for mentalization-based psychoanalytic treatment |
| | 43 | (1) |
| | 44 | (2) |
| Cognitive analytic therapy |
| | 46 | (1) |
| | 46 | (1) |
| Dialectical behaviour therapy (DBT) |
| | 47 | (2) |
| Therapeutic community treatments |
| | 49 | (1) |
| | 50 | (2) |
| | 51 | (1) |
| | 51 | (1) |
| | 51 | (1) |
| Problems of outcome research |
| | 52 | (3) |
| Randomization and personality disorder |
| | 52 | (3) |
| Chapter 3: Mentalization-based understanding of borderline personality disorder | | 55 | (56) |
| The developmental roots of borderline personality disorder |
| | 55 | (1) |
| The relevance of the attachment theory perspective |
| | 56 | (1) |
| Optimal self-development in a secure attachment context |
| | 57 | (25) |
| Early stages of self-development |
| | 59 | (3) |
| The infant's sensitivity to social contingency |
| | 59 | (2) |
| | 61 | (1) |
| The self as an intentional and representational agent |
| | 62 | (6) |
| Parental mirroring and the development of mental state concepts |
| | 64 | (4) |
| Psychic equivalence and the pretend mode |
| | 68 | (2) |
| | 70 | (5) |
| Reflective function and attachment |
| | 75 | (4) |
| Neurological basis of mentalization |
| | 79 | (3) |
| The impact of an insecure base |
| | 82 | (9) |
| | 82 | (1) |
| | 83 | (2) |
| Enfeebled affect representation and attentional control |
| | 85 | (2) |
| Disorganization of attachment |
| | 87 | (1) |
| Establishment of the 'alien self' |
| | 88 | (2) |
| | 90 | (1) |
| The impact of attachment trauma |
| | 91 | (18) |
| | 92 | (2) |
| Changes to the arousal 'switch' |
| | 94 | (2) |
| Psychic equivalence, shame, and the teleological stance |
| | 96 | (1) |
| Failure of mentalization and the exposure of the 'alien self' |
| | 97 | (7) |
| Interpersonal relating and the transference |
| | 99 | (1) |
| | 100 | (1) |
| | 101 | (1) |
| Impulsive acts of violence |
| | 101 | (2) |
| | 103 | (1) |
| | 104 | (5) |
| | 109 | (2) |
| Chapter 4: Current models of treatment for borderline personality disorder | | 111 | (34) |
| Transference-focused psychotherapy (TFP) |
| | 112 | (7) |
| | 117 | (2) |
| Dialectical behaviour therapy |
| | 119 | (7) |
| | 119 | (2) |
| | 121 | (1) |
| Mentalization and mindfulness |
| | 122 | (2) |
| | 124 | (2) |
| Cognitive behavioural therapy |
| | 126 | (3) |
| Cognitive analytic therapy (CAT) |
| | 129 | (3) |
| | 129 | (1) |
| Reformulation and interpretation |
| | 130 | (2) |
| Psychodynamic-interpersonal |
| | 132 | (2) |
| | 134 | (1) |
| Other North American approaches |
| | 135 | (4) |
| Other European approaches |
| | 139 | (2) |
| Mentalization: The common theme in psychotherapeutic approaches to borderline personality disorder |
| | 141 | (3) |
| | 144 | (1) |
| Chapter 5: Treatment organization | | 145 | (38) |
| | 145 | (1) |
| | 145 | (3) |
| | 146 | (1) |
| | 147 | (1) |
| | 147 | (1) |
| | 148 | (2) |
| | 150 | (6) |
| | 150 | (2) |
| Characteristics of training |
| | 152 | (1) |
| | 152 | (1) |
| The key worker or primary clinician |
| | 153 | (1) |
| The responsible medical officer |
| | 154 | (2) |
| | 156 | (2) |
| | 158 | (17) |
| | 159 | (3) |
| | 159 | (2) |
| Clarification of key problems, as identified by the patient |
| | 160 | (1) |
| Explanation of the underlying treatment approach and its relevance to the problems |
| | 160 | (1) |
| Information about individual and group therapy and how it can lead to change |
| | 160 | (1) |
| An outline of confidentiality |
| | 161 | (1) |
| Clarification of some basic rules |
| | 161 | (4) |
| | 161 | (1) |
| | 161 | (1) |
| | 162 | (1) |
| Stabilizing social aspects of care |
| | 162 | (1) |
| Assuring the possibility of contact with the patient |
| | 162 | (1) |
| | 163 | (1) |
| Defining and agreeing roles of mental health professionals and others involved in the care of the patient |
| | 164 | (1) |
| | 165 | (2) |
| Interpersonal behaviour and intimate relationships |
| | 165 | (1) |
| Previous treatments and their outcome |
| | 166 | (1) |
| Formation of relational and working alliance |
| | 167 | (2) |
| | 167 | (2) |
| Reliability and readiness to listen |
| | 169 | (1) |
| | 169 | (3) |
| | 170 | (2) |
| | 172 | (2) |
| General strategic recommendations |
| | 173 | (1) |
| | 173 | (1) |
| | 173 | (1) |
| | 174 | (1) |
| | 174 | (1) |
| | 174 | (1) |
| | 175 | (4) |
| | 175 | (2) |
| | 177 | (2) |
| | 179 | (1) |
| | 180 | (1) |
| | 181 | (2) |
| Chapter 6: Transferable features of the MBT model | | 183 | (20) |
| | 183 | (4) |
| | 183 | (1) |
| | 184 | (2) |
| | 184 | (2) |
| | 186 | (1) |
| Consistency, constancy, and coherence |
| | 187 | (2) |
| | 187 | (1) |
| | 187 | (1) |
| | 188 | (1) |
| | 189 | (2) |
| | 189 | (1) |
| | 189 | (1) |
| | 190 | (1) |
| | 191 | (1) |
| | 191 | (1) |
| | 191 | (1) |
| | 191 | (1) |
| | 192 | (2) |
| | 192 | (1) |
| | 193 | (1) |
| | 194 | (1) |
| Individual approach to care |
| | 194 | (1) |
| | 194 | (1) |
| | 194 | (1) |
| | 195 | (1) |
| | 195 | (5) |
| | 195 | (1) |
| | 196 | (1) |
| | 196 | (3) |
| Summary of guidelines for psychopharmacological treatment |
| | 199 | (1) |
| Integration of modalities of therapy |
| | 200 | (1) |
| | 201 | (2) |
| Chapter 7: Strategies of treatment | | 203 | (18) |
| | 203 | (2) |
| | 205 | (2) |
| | 207 | (3) |
| Retaining mental closeness |
| | 210 | (2) |
| | 211 | (1) |
| Working with current mental states |
| | 212 | (2) |
| Bearing in mind the deficits |
| | 214 | (2) |
| | 216 | (4) |
| | 217 | (1) |
| Hyperactive mentalization and pretend mode |
| | 218 | (2) |
| | 220 | (1) |
| Chapter 8: Techniques of treatment | | 221 | (48) |
| Identification and appropriate expression of affect |
| | 222 | (30) |
| | 222 | (2) |
| | 222 | (1) |
| General strategic recommendations for identification of affects |
| | 222 | (1) |
| | 222 | (1) |
| | 223 | (1) |
| | 224 | (9) |
| | 224 | (9) |
| | 224 | (1) |
| General strategic recommendations for dealing with problems of impulse control |
| | 225 | (1) |
| Suicide attempts and self-harm |
| | 225 | (1) |
| | 228 | (1) |
| | 230 | (1) |
| | 231 | (1) |
| | 232 | (1) |
| Other challenging affect states |
| | 233 | (19) |
| | 233 | (5) |
| | 233 | (1) |
| General strategic recommendations |
| | 234 | (1) |
| Aggression related to paranoid anxiety |
| | 234 | (2) |
| | 236 | (1) |
| | 237 | (1) |
| | 238 | (2) |
| | 238 | (1) |
| | 239 | (1) |
| | 240 | (2) |
| | 240 | (1) |
| | 241 | (1) |
| | 242 | (2) |
| | 242 | (1) |
| | 243 | (1) |
| | 244 | (3) |
| | 245 | (1) |
| | 246 | (1) |
| | 247 | (3) |
| | 248 | (1) |
| | 249 | (1) |
| | 250 | (2) |
| | 250 | (1) |
| | 251 | (1) |
| Establishment of stable representational systems |
| | 252 | (8) |
| | 252 | (8) |
| | 252 | (1) |
| General strategic recommendations |
| | 253 | (1) |
| Individual and group sessions |
| | 253 | (7) |
| Identifying primary beliefs and linking them to affects |
| | 254 | (2) |
| Identifying and understanding second-order belief states |
| | 256 | (1) |
| Exploring wishes, hopes, fears, and other motivational states |
| | 257 | (1) |
| | 258 | (1) |
| | 259 | (1) |
| Formation of a coherent sense of self |
| | 260 | (3) |
| | 260 | (3) |
| | 260 | (1) |
| General strategic recommendations |
| | 261 | (1) |
| | 261 | (1) |
| | 262 | (1) |
| Development of a capacity to form secure relationships |
| | 263 | (4) |
| | 263 | (7) |
| | 263 | (2) |
| General strategic recommendations |
| | 265 | (1) |
| | 265 | (1) |
| | 266 | (1) |
| | 267 | (2) |
| Chapter 9: Implementation pathway | | 269 | (18) |
| Step 1: Consider the context in which you work, identify your skills and how you practice, and audit your resources |
| | 270 | (2) |
| | 270 | (1) |
| | 271 | (1) |
| | 272 | (1) |
| Step 2: Apply organizational principles |
| | 272 | (6) |
| | 273 | (1) |
| | 274 | (1) |
| | 274 | (1) |
| | 275 | (1) |
| | 276 | (1) |
| | 277 | (1) |
| Step 3: Modify the aims and techniques of your current practice |
| | 278 | (3) |
| Identify iatrogenic aspects of current practice |
| | 278 | (1) |
| Increase mentalization skill set incrementally to replace current iatrogenic techniques |
| | 279 | (2) |
| Step 4: Implement procedures for dealing with challenging behaviours |
| | 281 | (1) |
| Step 5: Constantly evaluate your practice |
| | 281 | (6) |
| | 281 | (1) |
| | 282 | (1) |
| Patient experience of treatment |
| | 282 | (5) |
| Appendix 1: Suicide and self-harm inventory | | 287 | (14) |
| Appendix 2: Training materials | | 301 | (12) |
| Appendix 3: Crisis plan | | 313 | (2) |
| Appendix 4: Rating of MBT adherence and competence | | 315 | (4) |
| Appendix 5: Text of intensive out-patient programme (IOP) leaflet | | 319 | (2) |
| Appendix 6: Admission feedback questionnaire | | 321 | (2) |
| References | | 323 | (50) |
| Index | | 373 | |
