Mentalization-Based Therapy Skills Training and Borderline Personality Disorder by Dan Warrender

I recently completed my MSc Nursing at the University of Aberdeen. This involved undertaking a research project which was directly influenced and inspired by my area of practice as a staff nurse. Working in acute mental health can be challenging for staff, but also for patients, none more so than people with a diagnosis of borderline personality disorder (BPD). People with BPD constitute an estimated prevalence of 20% within inpatient settings, with crisis presentations often involving suicidal and self-harming behaviour. Whilst admission to inpatient services is done primarily with a view to assessing and containing risk of harm, the acute mental health environment can present further challenges as patients can paradoxically deteriorate in hospital. Understanding BPD can be simply described as ‘understanding misunderstanding’. People with BPD often have significantly unstable interpersonal relationships as they can assume other peoples mental states and misconstrue their intentions. These misunderstandings are often triggers to manifestations of crisis. In this way, people with BPD are incredibly fragile, and admission to 28 bedded mixed sex wards, with different staff on opposing shift patterns provides ample opportunity for misunderstanding. This entails a situation where a patient may be admitted on the basis of one crisis, only to experience further crises within the hospital environment. Mentalization-Based Treatment Skills Training (MBT-S) is a two day workshop which teaches mental health staff nurses about BPD and it’s development, before moving on to a role-play based skillset which promotes empathy and exploration of thoughts and feelings. The aim of mentalization is to increasing the patient’s ability for self-reflection and awareness of other peoples mental states. MBT-S was first introduced to staff nurses in Royal Cornhill Hospital in June 2013. My study utilised 2 focus groups to assess staff nurse perceptions of the impact MBT-S had on their practice, with the findings capturing 7 key areas.

  • Common Sense Approach
  • Consistency of Approach
  • Empathy
  • Flexibility
  • Empowerment of Staff
  • Tolerating Risk
  • Limitations

Staff found MBT-S to be a common-sense approach which allowed a consistency of approach between themselves and colleagues. There was also increased empathy towards patients as a result of an increased understanding regarding the nature of BPD. MBT-S had a flexible use in structured sessions or ‘off the cuff’ instances and staff felt empowered to make real visible changes in patients mental states. Staffs ability to tolerate risk was also increased, this avoided unnecessary use of constant observations and the mental health act through an increased ability to make changes through MBT-S based discussion. Limitations were not around MBT-S, but around the limited opportunity to engage with patients in incredibly busy environments.

Although a small scale study, this piece of work has significant implications for practice given the prevalence of people with BPD and the associated challenges admissions can involve. Now in a post at RGU as a lecturer in mental health, I am committed to continuing my research, and increasing awareness and understanding of BPD as a condition which can improve with the correct approach.

Dan Warrender

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