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Article
Publication date: 6 February 2017

Maria Francesca Freda and Giovanna Esposito

The purpose of this paper is to discuss a reflexive process that makes a distinction between reflection and reflexivity, two processes the authors define according to the…

Abstract

Purpose

The purpose of this paper is to discuss a reflexive process that makes a distinction between reflection and reflexivity, two processes the authors define according to the mentalization construct. Next, it explores how the narrative mediation path (NMP), a novel multimodal counselling method addressed to underachieving college students, promotes reflection and reflexivity by enhancing student ability to mentalize their university experiences.

Design/methodology/approach

The authors conducted an idiographic case study on one of the ten groups of underachieving students who participated in the counselling sessions.

Findings

NMP narrative modes (metaphoric, iconographic, writing, and bodily) promoted reflection, and group-level inter-subjective steps were essential for the development of reflexivity. Furthermore, it was found that in each narrative mode, the students developed reflective and reflexive processes through the attainment of mentalization dimensions.

Practical implications

The adoption of the NMP has some implications for universities. Many underachieving students in higher education often have reflexive difficulties when examining their university experiences, so could be considered average mentalizers who tend to show bias in their university experience signification when under stress. Promoting mentalization development can enable students to use their resources strategically at university and improve their academic performance.

Originality/value

The NMP is innovative because of its multimodality: it employs different modes and media, makes use of both individual and group narrative levels, and is integrated in a single method, which enhances the development of reflexive meaning construction.

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Article
Publication date: 13 March 2017

Diarmaid Ó. Lonargáin, Suzanne Hodge and Rachael Line

Previous research indicates that mentalisation-based treatment (MBT) is an effective therapeutic programme for difficulties associated with borderline personality disorder…

Abstract

Purpose

Previous research indicates that mentalisation-based treatment (MBT) is an effective therapeutic programme for difficulties associated with borderline personality disorder (BPD). The purpose of this paper is to explore service user experiences of the therapy.

Design/methodology/approach

Seven adults (five female and two male), recruited via three NHS trusts, were interviewed. Participants were attending intensive out-patient MBT for BPD between 3 and 14 months. Data were analysed using interpretative phenomenological analysis.

Findings

Participants experienced the group component of MBT as challenging and unpredictable. They highlighted developing trust as key to benefitting from MBT. This was much more difficult to achieve in group sessions than in individual therapy, particularly for those attending MBT for less than five or six months. The structure of MBT generally worked well for participants but they identified individual therapy as the core component in achieving change. All participants learned to view the world more positively due to MBT.

Practical implications

Enhanced mentalisation capacity may help address specific challenges associated with BPD, namely, impulsivity and interpersonal difficulties. MBT therapists are confronted with the ongoing task of creating a balance between sufficient safety and adequate challenge during MBT. Potential benefits and drawbacks of differing structural arrangements of MBT programmes within the UK are considered.

Originality/value

Learning about service user perspectives has facilitated an enhanced understanding of experiences of change during MBT in addition to specific factors that may impact mentalisation capacity throughout the programme. These factors, in addition to implications for MBT and suggestions for future research, are discussed.

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Article
Publication date: 11 September 2017

Bethany Luxmoore and Phil McEvoy

Mentalization is a psychodynamic concept that can help us to understand our emotional responses to others. The purpose of this paper to illustrate how the concept of…

Abstract

Purpose

Mentalization is a psychodynamic concept that can help us to understand our emotional responses to others. The purpose of this paper to illustrate how the concept of mentalization may be applied in dementia care.

Design/methodology/approach

An autoethnographic account of the author’s experiences (first author), working as a project manager in which the author used the concept of mentalization to pay close attention to how the author’s emotional responses to people with dementia influenced thier communicative interactions.

Findings

This paper outlines how the author processed the author’s own internal experiences in both mentalizing and non-mentalizing modes, as the author wrestled with feelings of conscious incompetence. In the non-mentalizing mode, the author was pre-occupied with the author’s own anxieties. The author struggled to relate to or make sense of the experiences of the individuals with advanced dementia that the author engaged with. Moving towards a mentalizing stance helped the author to attune to the embodied experiences of the people with dementia and recognise the reciprocal nature of our communicative interactions.

Originality/value

This paper illustrates the role that mentalization may play in developing natural and authentic strategies to support communicative engagement in dementia care. These strategies may be of potential value to family carers. Family carers who can maintain a mentalizing stance may be more able to respond in empathic, person- centred ways to people who are living with dementia. On the other hand, non-mentalizing responses may be a root cause of mis-understanding and emotional disengagement.

Details

Working with Older People, vol. 21 no. 3
Type: Research Article
ISSN: 1366-3666

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Article
Publication date: 3 November 2009

Anne Van den Berg and Karel Oei

Effective treatment of patients with severe psychopathy is very difficult to achieve. This conclusion may be drawn from an extensive examination into the usage of the term…

Abstract

Effective treatment of patients with severe psychopathy is very difficult to achieve. This conclusion may be drawn from an extensive examination into the usage of the term ‘psychopathy’ in scientific research literature, in theoretical development from various psychological schools of thought, in the practice of therapy and in assessment. The central issue for the authors of this article is the inability of severely psychopathic patients to commit to the patient‐therapist relationship. Attachment theory and mentalisation‐based treatment are used here to define the cause and nature of this inability, which is incurred in very early childhood. These two models can aid in the development of more dynamic definitions of psychopathy, better suited to dynamic therapy formats.The ways in which psychopathy is defined partly account for a number of problems encountered in the practice of therapy. The authors assume that the treatment of psychopathy should be interactional and should match patients' individual levels of psychological development and mentalisation; highly psychopathic patients often perceive others as objects, ie. as part of the context, not as subjects, ie. autonomous personalities.The authors propose to conduct further research in order to verify the validity of their hypothesis. They also put forward a number of suggestions for therapy formats with a view to establishing effective working relationships with psychopathic patients.

Details

Mental Health Review Journal, vol. 14 no. 3
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 14 March 2016

Peter Fuggle, Dickon Bevington, Fiona Duffy and Liz Cracknell

MBIT is a manualised mentalization-based approach to working with hard to reach young people at risk of a wide range of life adversities including severe mental illness…

Abstract

Purpose

MBIT is a manualised mentalization-based approach to working with hard to reach young people at risk of a wide range of life adversities including severe mental illness, substance misuse, family breakdown, school exclusion, offending and homelessness. The on-line manual (www.tiddlymanuals.com) describes how Adolescent Mentalization-Based Integrative Therapy (AMBIT) is a systemic intervention requiring attention to four different domains of intervention simultaneously; much emphasis is placed on the support systems for workers to maintain this balance in what are often chaotic working conditions. The purpose of this paper is to illustrate how these four main components of the AMBIT approach link together in actual clinical practice.

Design/methodology/approach

The authors illustrate the core techniques of the AMBIT approach, namely, “working with your client”, “working with your team”, “ working with your network” and “learning as a team” with a series of case vignettes, demonstrating the inter-relationship of these components rather than seeing them as separate strands.

Findings

A range of mentalization-based techniques such as “thinking together”, mentalized formulation, “disintegration grids” and web-based manualising are described and illustrated in relation to a series of case vignettes in order to address barriers to effective practice. The vignettes emphasise how these components must be linked together and held in balance, and how easily they become disconnected in working with young people’s ambivalent or even hostile relationships to help.

Practical implications

First, developing a shared, mentalized formulation of a young person’s difficulties is an important aspect of working with highly troubled young people. Second, mentalizing is a relational process and is easily disrupted, for both workers and young people, by raised anxiety and affect, a common feature of working with this client group. AMBIT provides specific methods, for example, “thinking together” for supporting the mentalizing of individual workers in their team in an explicit way. Third, workers from different agencies may often find it difficult to make sense of each other’s behaviour and decision making. AMBIT proposes the use of a mentalizing approach to this difficulty using a technique called a disintegration grid. Finally, AMBIT proposes a new practitioner focused approach to manualising as a method by which a team can become more explicit about its methods of working in order to support systematic practice and evaluate outcomes.

Originality/value

The innovative AMBIT approach proposes that clinicians need to attend to team and network relationships at least as much as their relationship with the client, in addition to adopting a stance of learning as a team from their casework. A high level of clinical skill is needed to support a team to achieve this balanced approach to casework. This work is of interest to all multi-disciplinary teams working with hard to reach young people.

Details

Mental Health Review Journal, vol. 21 no. 1
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 10 April 2017

Gillie Ruscombe-King, Laura Mackenzie, Steve Pearce and Kate Saunders

The mentalisation based therapeutic community (MBTC) is a group experience which promotes the acquisition of the capacity to mentalise. Members of the community gain…

Abstract

Purpose

The mentalisation based therapeutic community (MBTC) is a group experience which promotes the acquisition of the capacity to mentalise. Members of the community gain greater emotional stability and psychological robustness. The paper aims to discuss these issues.

Design/methodology/approach

MBTC works with three theoretical principles: the intrapsychic, interpersonal and social. It is a slow open group where each member completes a ten-week course. The approach is deliberately non-interpretive with an emphasis on personal responsibility and accountability in order to promote clarity of mind.

Findings

The authors’ experience is that the model engages group members with few drop outs.

Originality/value

The combination of mentalising and the use of therapeutic community principles within in MBTC has enhanced outcomes for group members.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 38 no. 1
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 16 September 2019

John Chatwin and Phil McEvoy

Around 60 per cent of people with dementia in the UK live at home. The experience of caring for a family member with dementia can be rewarding and positive, but it can…

Abstract

Purpose

Around 60 per cent of people with dementia in the UK live at home. The experience of caring for a family member with dementia can be rewarding and positive, but it can also be significantly stressful. Current healthcare policy is encouraging greater provision to support family carers. Along with respite-care, day-care and support group-based initiatives, there has also been a focus on developing dementia-specific communication training. The paper discusses this issue.

Design/methodology/approach

The authors outline a new initiative “Empowered Carers” which is being piloted in the North of England. Empowered Carers is an online support and communication training service for family carers who are caring for someone with dementia at home. It utilises online video conference-calling technology to connect carers with support workers, and also allows for simultaneous interactions involving other family members. A central tenet of the approach is a theoretically grounded support model, based on the concept of mentalisation.

Findings

The authors describe the background to Empowered Carers, and how a conventional evaluation strategy for the initiative is being used alongside a socio-linguistic approach (Conversation Analysis – CA). This aims to provide empirical evidence about how the assimilation of mentalisation is reflected in the structuring of speech patterns in carers during support sessions.

Originality/value

The authors explain the CA method, how it has been applied to similar talk-based therapeutic settings, and why its ability to explore sequential linguistic patterns across extremely large data-sets is particularly suited to studying interaction in emerging online arenas.

Details

Journal of Enabling Technologies, vol. 13 no. 3
Type: Research Article
ISSN: 2398-6263

Keywords

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Article
Publication date: 19 December 2016

Josie Billington, Eleanor Longden and Jude Robinson

The purpose of this paper is to investigate whether Shared Reading (SR), a specific literature-based intervention, is transposable to a prison context and whether mental…

Abstract

Purpose

The purpose of this paper is to investigate whether Shared Reading (SR), a specific literature-based intervention, is transposable to a prison context and whether mental health benefits identified in other custodial and non-custodial settings were reported by women prisoners.

Design/methodology/approach

In all, 35 participants were recruited within an all-female maximum security prison and attended one of two weekly reading groups. Qualitative data were collected through researcher observation of the reading groups; interviews and focus group discussions with participants and prison staff; interviews with the project worker leading the reading groups; and a review of records kept by the latter during group sessions.

Findings

Attendance rates were good, with nearly half of the participants voluntarily present at =60 per cent of sessions. Two intrinsic psychological processes associated with the SR experience were provisionally identified, “memory and continuities” and “mentalisation”, both of which have therapeutic implications for the treatment of conditions like depression and personality disorder.

Research limitations/implications

Limitations included the small sample, lack of control for confounding variables, and constraints imposed on data collection by the custodial setting.

Originality/value

Although more controlled research is required, the findings indicate that women prisoners will voluntarily engage with SR if given appropriate support, and that the intervention has potential to augment psychological processes that are associated with increased well-being.

Details

International Journal of Prisoner Health, vol. 12 no. 4
Type: Research Article
ISSN: 1744-9200

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Article
Publication date: 14 March 2016

Emma Louise Johnson, Marie-France Mutti, Neil Springham and Ioanna Xenophontes

The purpose of this paper is to examine a gap in knowledge about the interaction between mentalizing skills and social inclusion activity immediate after completing an…

Abstract

Purpose

The purpose of this paper is to examine a gap in knowledge about the interaction between mentalizing skills and social inclusion activity immediate after completing an intensive mentalization-based treatment (MBT) program.

Design/methodology/approach

Lived experience was explored through the use of timelines, repeated cycles of audio-recorded focus groups and inductive thematic analysis.

Findings

Destructive cycles between self-hatred and social-exclusion were first disrupted by MBT because people felt understood. Being understood reduced self-hatred which was an essential precursor for attempting new forms of mentalizing in social interactions. This process was challenging but continued as a virtuous cycle after treatment finished.

Research limitations/implications

The sample was limited because at three, it was small. However, the study was co-produced between professional and service users at all stages. Lived experience was carefully explored in depth and triangulated between three people. The authors acknowledge too that they have reflected on experience within only one to three years after MBT finished. Future studies might usefully replicate the methodology to trace experience up to the eight year follow up point undertaken by Bateman and Fonagy (2008).

Practical implications

There is a great sense of loss for service users when therapy ends and that ending needs to be managed on both sides. Service users start to acquire powerful new skills and thought processes at the end of therapy. While this may not be overwhelming, they will not be used to them and so it helps when therapists help service users think about their plans and ideas for things they want to do or changes they might make in their lives.

Originality/value

While supporting quantitative data about the outcome of therapy, this study offers the type of qualitative detail about how the psychological and social interact post-therapy, which can inform the successful management of those processes by those involved.

Details

Mental Health and Social Inclusion, vol. 20 no. 1
Type: Research Article
ISSN: 2042-8308

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Article
Publication date: 8 February 2016

Helena Varnaseri, Tony Lavender and Lona Lockerbie

The purpose of this paper is to investigate whether early maladaptive schema (EMS) and autobiographical memory specificity mediate the relationship between abuse and…

Abstract

Purpose

The purpose of this paper is to investigate whether early maladaptive schema (EMS) and autobiographical memory specificity mediate the relationship between abuse and attachment in childhood with Borderline Personality Disorder (BPD) characteristics among forensic inpatients.

Design/methodology/approach

The study adopted a quantitative cross-sectional design. In total, 34 male adults residing in medium secure facilities completed self-report measures. Data were analysed using bootstrapped mediation procedures.

Findings

The study’s hypotheses received partial support. The EMS of “entitlement/grandiosity” and autobiographical memory specificity differentially mediated the relationship between emotional and physical abuse and neglect, and parental care and overprotection with BPD characteristics, including trait anger and the frequent expression of anger. In line with attachment theory and the functional avoidance mechanism (Williams et al., 2007), the proposed mediators are conceptualised as adaptive responses to early adversity with potential maladaptive consequences for later interpersonal functioning.

Research limitations/implications

These provisional findings will require further exploration with specific investigation of the relationship between EMS and autobiographical memory specificity. It is recommended that future research replicates the study’s design with a larger sample and investigate the role of other mediators and moderators in this complex relationship. Examples of these are mentalisation, social problem-solving capabilities, social support and adult attachment styles.

Practical implications

Clinical implications encourage the incorporation of these mediators into clinical formulation, intervention and ward practices.

Originality/value

For forensic inpatients with a history of adversity, interventions working directly with EMS and specificity of autobiographical memory, e.g. schema therapy (Young, 1999), mentalisation and mindfulness may be useful. Furthermore, the relationship between EMS and specificity of autobiographical memory with interpersonal experience and functioning can be incorporated into clinical formulation.

Details

Journal of Forensic Practice, vol. 18 no. 1
Type: Research Article
ISSN: 2050-8794

Keywords

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