The implementation of mentalization-based treatment for adolescents: a case study from an organizational, team and therapist perspective

International Journal of Mental Health Systems

Roel Verheul⁴  Jan JV Busschbach²  Dawn L Bales¹  Joost Hutsebaut³ 

[1] Viersprong Institute for Studies on Personality Disorders (VISPD), Halsteren, The Netherlands;Department of Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands;PO Box 7, 4660, AA, Halsteren, The Netherlands;Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands

关键词: Mentalization-Based Treatment;    Adolescents;    Personality disorders;    Treatment integrity;    Implementation;   

Others  :  801891
DOI  :  10.1186/1752-4458-6-10

 received in 2012-03-28, accepted in 2012-07-08,  发布年份 2012

【 摘 要 】

Background

Reports on problems encountered in the implementation of complex interventions are scarce in psychotherapy literature. This is remarkable given the inherent difficulties of such enterprises and the associated safety risks for patients involved.

Case description

A case study of the problematic implementation process of Mentalization- Based Treatment for Adolescents (MBT-A), a new therapy for 14 to 18 year old youngsters with severe personality disorders, is presented. The implementation process is described and analyzed at an organizational, team and therapist level.

Discussion and evaluation

Our analysis shows that problems at all three levels contributed and interacted to make the implementation cumbersome and hazardous.

Conclusion

The implementation of complex psychotherapeutic programs for difficult patients could benefit from a structured attention to processes at multiple levels. We therefore propose a new comprehensive heuristic model of treatment integrity. This new model includes organisational, team and therapist adherence to the treatment model as necessary components of treatment integrity in the implementation of complex interventions. The application of this new model of treatment integrity potentially increases the chance of successful implementations and reduces safety risks for first patients enrolling in a new program.

【 授权许可】

   
2012 Hutsebaut et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Bateman A, Fonagy P: Eight-year follow-up of patients treated for borderline personality disorder. Am J Psychiatry 2008, 165:631-638.
• [2]Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard H, Korslund KE, Tutek DA, Reynolds SK, Lindenboim N: Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006, 63:757-766.
• [3]Giesen-Bloo J, van Dyck R, Spinhoven P, van Tilburg W, Dirksen C, van Asselt T, Kremers I, Nadort M, Arntz A: Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry 2006, 63:649-658.
• [4]Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF: Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry 2007, 164:922-928.
• [5]Blum N, Pfohl B, St.John D, Stuart S, McCormick B, Allen J, Arndt S, Black DW: Systems training for emotional predictability and problem solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up. Am J Psychiatry 2008, 165:468-478.
• [6]Davidson K, Norrie J, Tyrer P, Gumley A, Tata P, Murray H, Palmer S: The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. J Personal Disord 2006, 20:450-465.
• [7]Mahajan RP: Critical incident reporting and learning. Br J Anaesth 2010, 105(1):69-75.
• [8]Hatcher S: Risk management in mental health: applying lessons from commercial aviation. Australasian Psychiatry 2012, 18(1):4-6.
• [9]Wilf-Miron R, Lewenhoff I, Benyamini Z, Aviram A: From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care. Quality Safety Health Care 2003, 12:35-39.
• [10]Laurenssen EMP, Hutsebaut J, Feenstra DJ, Bales DL, Luyten P, Busschbach JJV, Verheul R: Feasibility of Mentalization-based Treatment for adolescents with borderline symptoms: a pilot study. Psychiatry ResearchSubmitted
• [11]Bateman A, Fonagy P: Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999, 156:1563-1569.
• [12]Bateman AW, Fonagy P: Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment. Oxford University Press, Oxford; 2004.
• [13]Bales D, Bateman AW: Partial Hospitalization Settings. In Handbook of Mentalizing in Mental Health Practice. Edited by Bateman AW, Fonagy P. American Psychiatric Publishing Inc, Washington DC; 2012:197-225.
• [14]Bleiberg E: Treating Personality Disorders in children and Adolescents: A Relational Approach. Guilford Press, New York; 2001.
• [15]Bales D, van Beek N, Smits M, Willemsen S, Busschbach JJV, Verheul R, Andrea H: Treatment outcome of 18-month, day hospital Mentalization-Based Treatment (MBT) in patients with severe borderline personality disorder in the Netherlands. J Personal Disordin press
• [16]Chiesa M, Healy K: The struggle to establish a research culture in the psychotherapy hospital: reflections from the Cassel Hospital experience. Bull Menn Clin 2009, 73:157-175.
• [17]Shaver PR, Mikulincer M: Attachment-related psychodynamics. Attachment and Human Development 2002, 4:243-257.
• [18]Bateman A, Fonagy P: Randomized controlled trial of outpatient Mentalization-Based Treatment versus structured clinical management for Borderline personality disorder. Am J Psychiatry 2009, 2009(166):1355-1364.
• [19]Vermilyea BB, Barlow DH, O’Bren GT: The importance of assessing treatment integrity: An example in the anxiety disorders. J Psychopathol Behav Assess 1984, 6:1-11.
• [20]Perepletchikova F, Kazdin AE: Treatment integrity and therapeutic change: issues and research recommendations. Clinical Psychology 2005, 12:365-383.
• [21]Henggeler SW, Schoenwald SK, Borduin CM, Rowland MD, Cunningham PB: Multisystemic Therapy for Antisocial Children and Adolescents. Guilford Press, New York; 2009.