#mentalization based treatment

[the-doodle-chronicles]

The Not Knowing Stance A great example of why mentalizing is important. A balance of considering the self and the other in someone's actions or responses: try not to assume that someone's actions or reactions are because of you, but think about what might be going on for them.

[ptsdeer]

What is mbt & could it help me if I have bpd?

Hi! Erm… I don’t know when you sent this, probably a long time ago - I haven’t been ignoring you, just not had access to desktop and tumblr mobile wasn’t informing me of asks.

It’s hard to describe what MBT is exactly. It stands for mentalization-based treatment. It’s a type of therapy used to treat BPD but it's not like DBT, instead it’s mainly based on the psychodynamic approach and brings in elements from all sorts of psychological approaches. 

Mentalization is difficult to explain even for many psychologists, but simply put it’s how we interpret the actions of ourselves and others, and how we understand the mental state that underlies our actions. 

The theory is essentially that people with a diagnosis of BPD have reduced capacity to mentalize, and this is often due to prolonged childhood trauma that has disrupted the attachment. Not being able to mentalize leads to many of the symptoms we experience like emotional dysregulation, suicidality, self harm and interpersonal difficulties. The goals are usually better emotional regulation, increased control over our behaviours, and more stable relationships.

MBT itself usually consists of twice-weekly sessions, with one session being individual and another in a small group. Again it’s nothing like DBT or any sort of behavioural therapy - there’s no “homework”, it’s often unstructured and you just talk about what comes up. The therapist takes a questioning, curious stance about what comes up in conversation. 

Personally I’ve found it massively beneficial. I didn’t get any benefit at all from DBT because it didn’t work to address the attachment difficulties that were the root of many of my problems. MBT does that, and it’s been great.

[charmillaria]

Hey, Charlie. I have a friend who has BPD who is going through a hard time right now and I need some help. A couple of days ago, I had to modify my plans with her because my dad needed me to come to his house. She got very angry (probably due to feeling that she was abandoned) and defriended me, as well as several of our mutual friends, on just about every social media site. I am worried for her mental health, but don't know how to help her without her lashing out. Do you have any suggestions?

oh no! that's really tough, and I can't imagine how stressful this situation must be for you, your friend, and everyone else. but I'm gonna respond with how I think I would behave and want to be approached if I were in her place.

I'm gonna hazard a guess and say the issue isn't that she's feeling abandoned, but finally got the confirmation she needed to round off a list of "signs" that you aren't really her friend, or hate her, or whatever. this isn't anything that you've actually done - for me, I'm always unconsciously looking for evidence that someone doesn't like me. it can be something as innocuous as taking a while to answer a text, or looking at a watch when I'm speaking to you. there's an entire form of psychotherapy called mentalization-based treatment that's specifically meant to address these types of misconceptions. it's actually a huge problem for me, and any social interaction I have will always have the running mental commentary of talking myself out of this type of thinking.

I'm not trying to suggest that you necessarily have done anything wrong here, I'm saying it's possible that she may have interpreted some of your actions as being less than innocent, and that your sudden cancellation may have been the last straw of sorts in what is, for her, a sizable list of reasons why you don't like her anymore. especially if anything else has happened recently (did you have a conversation that maybe didn't go to well? did you have to cancel/change any other plans recently?)

can you still email her? my suggestion would be to write to her to remind her how much you care about her. tell her that you want to be friends no matter what, maybe write about a fond memory you have about the two of you, of course apologize profusely for changing the plans. tell her why you value your friendship. (but don't go over the top, if you're not super best friends don't pretend that you are, otherwise you'll sound fake, which will make things worse.) ask how you can make it up to her, for her forgiveness, maybe invite her out for coffee or whatever. tell her that you're committed to maintaining your friendship, no matter what happens. then give her some space to stew it over, like a week maybe, if she still doesn't answer then maybe send another email? if she does lash out in a reply email, that's okay. if she's mad, let her be mad. acknowledge her feelings and apologize again, validate her and however she's feeling, remind her how much you value your friendship and want to fix things. it may take a while. but hopefully, with enough patience and persistence, you both can recover from this. 

I hope this helps, please let me know if there's anything else I can do. (and borderline followers, anything you would add, or other suggestions you would make?)

[charmillaria]

You may have noticed that you are very sensitive to others' emotions, that when they are anxious, you get all jittery; when they are sad, you get sad; and so on. It might also bother you or seem confusing that others apparently don't pick up on your emotions. And other people might find it unsettling that you can detect what they are feeling even before they do. This can be unsettling to other people in your life who might not be fully aware of their own experiences. In fact, research shows that people with BPD consistently identify others' emotions sooner than do people without BPD (Fertuck et al, 2009). This capacity can lead to trouble when the brief hint of annoyance in the face of a friend triggers an intense fear of abandonment in you.

-Blaise Aguirre and Gillian Galen, "BPD and Symptoms Not in the DSM," Mindfulness for Borderline Personality Disorder

More specifically, it's that people with BPD are quicker to pick up on potential signs of an emotion, not necessarily the emotion itself. This can be especially tricky when the person with BPD also experiences paranoia and related symptoms. A yawn or a glance out the window could be interpreted as annoyance, boredom, wanting to leave, secret hatred, etc etc etc when really the other person is just tired, or something outside caught their eye.

...and this is why I really need to look into MBT (Mentalization Based Treatment, which focuses on this specific symptom).