NHS Grampian development of MBT interventions for people with BPD. Dr Linda Treliving, Consultant psychiatrist in psychotherapy, Head of GSPS, Chair of SPDN. Local context. NHS Grampian Psychological therapies steering group, a multidisciplinary committee
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Dr Linda Treliving,
Consultant psychiatrist in psychotherapy,
Head of GSPS, Chair of SPDN
GSPS service provision is focussed on Tier 3 and 4 complexity of patients.
Mental Health in Scotland with BPD
A Guide to delivering evidence-based Psychological
Therapies in Scotland
General approach and management 1. with BPD
General approach and management 2 with BPD
General approach and management 3 with BPD
1. to be well structured;
2. to devote considerable effort to enhancing compliance;
3. to have a clear focus,
4. to be theoretically highly coherent to both therapist and patient,
5. to be relatively long term;
6. to encourage a powerful attachment relationship
between therapist and patient,
7. to be well integrated with other services available to the patient.
health teams.(250 -300 per year)
discuss with referrer or make further enquiries.
Patient sent an
90-item self-report checklist measures psychological distress
Symptom measures of :
Global severity index : (GSI)
Number of symptoms reported combined with the intensity of perceived distress – best single indicator of current level of distress
Positive symptom distress index: (PSDI)
Average level for the symptoms that were endorsed – measure of symptom intensity
Positive symptom total: (PST)
Number of symptoms endorsed (regardless of level
of distress) - a measure of symptom breadth
SOM O-C IPS DEP ANX HOS PHANX PARID PSY GSI PSDI PST
Patient sent an
Criterion 14 a The care record shows:• the diagnosis or diagnoses• information on how the diagnosis or diagnoses was reached following evidence based guidelines or established diagnostic criteria where available.• confirmation that the diagnosis or diagnoses has been explained to the service user and informal carer.
• post-diagnosis support is offered.
Borderline personality disorder.
b. Group therapy
Longer term therapy (1-2 years))
managing self harm
A new word for an ancient concept
Implicitly and explicitly interpreting the actions of oneself and other as meaningful on the basis of intentional mental states
(e.g., desires, needs, feelings, beliefs, & reasons)
BPD is conceived of as a disorder in the self
structure brought about through
environmentally induced distortion of
psychological functioning, which decouples
key mental process necessary for
interpersonal and social function
The mediator between the genotype and the phenotype is the attachment process
Bulletin of the Menninger Clinic (2003) , 67,3:pp187-211
……when alone feels unsafe and vulnerable
because of the proximity of a torturing and
destructive representation from which he or
she cannot escape because it is
experienced from within the self.
Patients with BPD react in desperate
manner to changes in relationships with
clinging, apparent aggression, cries of
abandonment, refusal to separate and
acts of self harm.
Lack of Mentalisation attachment process
Stability is maintained through ;
- mental isolation not knowing,
- acts of aggression justified by perceived threat,
- inaccurate representations of interpersonal interactions,
- projective mechanisms that force mental states onto the other and thus prevent its genuine perception
…adults who act violently, impulsively,
inconsistently and with emotional
volatility show reduced mentalising
capacities and are protecting an
unstable sense of self.
The overall goals of treatment are to stabilise the
A Mentalising Stance attachment process
This is an ability to continually question the
internal mental states both within the patient
and the therapist
in our relationship that may justify the current state?