Upper Garden VillaRoyal Cornhill Hospital
01224 557398
Who Are We?
Who Is Referred To The Hub Day?Assessment • Childhood Trauma Questionnaire (CTQ)• Personality Questionnaire (PDQ4)• BPD traits/diagnosis
MBT formulation• Understanding effects of past on the present.
Not to re-live it.• Set goals, plan for the future.• Recover a sense of agency.
Pre-HUB Meeting
• Informal 20-30 mins.
• Meet staff
• Department Tour
• Discuss Anxieties
• Hub leaflet
• SCL90
• Talk about formulation / goals
24 weeks
Business Meeting
Morning Group 8 weeks MBT Education
8 weeks SCID 11
8 weeks Mentalization Based Skills
Lunch Time 12.15-13.30
Afternoon Group Mentalization Based Therapy (MBT)
HUB DAY PROGRAMME
Business Meeting
• Not a Therapy Group
• Lasts up to 15 mins
• Brings 2 groups together
• All Hub staff attend
• Any Messages
• Already adopting an MBT stance
• Enforces a pro-social and relational approach.
MBT Education (Morning Group Weeks 1-8)
Week 1 Contracts & Rules of Engagement
Week 2 Mentalization Based Therapy
Week 3 Mentalization and Attachment
Week 4 Emotional Awareness
Week 5 My Intervention Plan
Week 6 Personality
Week 7 Looking after Yourself
Week 8 Communication
S.C.I.D.D. II(Morning Group Weeks 9 -16)
• Structured Clinical Interview for DSM-IV AxisII Personality Disorders (SCIDD – II)
• Diagnostic questionnaire
• Mentaliszing Exercise in group
• Develops the idea of ‘Thinking about thinking’
• Considers feeling states in self and others
• Related behaviours and thoughts.
MBT SKILLS(Morning Group Weeks 17 – 24)
• Mentalizing Based Skills
• Developed from MBT exercises.
• Thinking about future
• Managing endings
• Goals re-examined
• What next?
• Can be patient-led
Lunch Time
• Challenge patients views on social interactions
• ‘Have a go’
• Can be material to use in the afternoon.
• Light hearted, fun, staff join in.
• Last days can be marked by a picnic/cakes.
Afternoon MBT Group
• Runs every afternoon for full 24 weeks.
• 1 1/2 hours long
Aims
To provide a training environment for mentalizing -
In self
In Others
In Relationships
What is Mentalization?
• Understanding misunderstanding
• To see ourselves from the outside and others from the inside
• Shapes our understanding of others and ourselves
• Central to human communication and relationships
• Underpins clinical understanding, the therapeutic relationship and therapeutic change regardless of modality of therapy
Mentalization Based Therapy(MBT)
• Aims to strengthen patients capacity to understand their own and others mental states in attachment contexts in order to address difficulties with -– Affect regulation– Impulse regulation– Interpersonal functioning
All of which contribute to suicide and self harm.
Bateman and Fonagy 2009
Group MBT
• Non – mentalizing patients + (we hope) mentalizing therapist
• Based in the here and now
• Current issues
• Actively promote group interaction
• Intervene when there is an opportunity fro metalizing
Group MBT cont ...• Not waiting to see ‘how the group deals
with it’
• Open questions
• Curiosity
• Stop Rewind Explore
• Simple• Affect focused but remember most
reactions are about survival• Focus on patients mind (not on behaviour)
What Group MBT is not...
• A support group
• Transference relationships
• Metaphor
• Interpretation
Inbetween the ‘HUB’
• Not an out of hours service.
• Patients encouraged to use crisis plans
• Encourage to think about their original formulation goals and what they hope to achieve from the hub.
• On model to make contact in-between hubs if the patient hasn't made contact.
MBT Supervision
MBT Adherence Scale
Straight after HUB programme ends
All therapists from the day attend
Post Hub Interview
• Thinking about the ending is part of the MBT work in the last weeks of therapy.
• 6-8 week allowed before follow-up
• Allows time to process work done
• Can feel rejected and abandoned
• Individual review appointment offered to discuss future.
Research
Ongoing
Pre and Post HUB - SCL90’s
DVD
Questions