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