The Capacity to End: Termination of Mentalization-Based Therapy for Borderline Personality Disorder
- PDF / 625,587 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 52 Downloads / 172 Views
ORIGINAL PAPER
The Capacity to End: Termination of Mentalization‑Based Therapy for Borderline Personality Disorder Sophie Juul1,2 · Sebastian Simonsen1 · Anthony Bateman3
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Terminating a therapeutic relationship can be a challenging phase with patients suffering from borderline personality disorder. Despite the critical importance of the termination phase, the proportion of psychotherapy literature devoted to the demands and challenges of this phase is small. This paper describes a mentalization-based approach to detect and intervene against such challenges. It is proposed that termination challenges, while operating through overlapping and interactive mechanisms, can be attributed to (1) patient factors, (2) therapist factors, and (3) therapeutic relationship factors. The paper has clinical implications and suggests that the aim of enhancing mentalizing capacities should include mentalizing the often complicated and mixed feelings associated with separation and loss of the therapeutic relationship. To facilitate this process, we propose the use of a “termination formulation”, in which patients’ outcomes and future goals are recapitulated in the termination phase of mentalization-based therapy. Keywords Borderline personality disorder · Mentalization-based therapy · Treatment termination
Introduction Borderline personality disorder (BPD) is a prevalent psychiatric condition characterized by a pervasive pattern of symptoms such as intense and unstable relationships, chronic feelings of emptiness, intense anger, fear of abandonment, intolerance for aloneness, and a lack of a stable sense of self (American Psychiatric Association 2013). These fundamental aspects of BPD, particularly the relational aspects, can be understood as stemming from impairments in their underlying attachment organization (Levy et al. 2005). Attachment theory, developed by Bowlby (1972, 1973, 1998), proposed that internal representations of self and others provide prototypes for all later relationships. Such representations exist outside of awareness and are quite resistant * Sophie Juul [email protected] 1
Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Stolpegårdsvej 20, 2820 Gentofte, Denmark
2
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
3
Anna Freud Centre, Kantor Centre of Excellence, London, Great Britain
to change (Waters et al. 2000). Bowlby’s suggestion that early experience with the caregiver organizes later attachment relationships, has been used to explain the development of BPD psychopathology (Fonagy et al. 2000). Patients with BPD typically experience considerable distortions of attachment representations, resulting in a disrupted capacity to depict mental states in themselves and others (Levy et al. 2005). Further, feelings of abandonment anxiety can be easily triggered in attachment situations, which are likely to be transferred to the therapeutic relations
Data Loading...
