As a psychotherapist working with complexly disordered individuals, there has been a constant struggle to find a treatment modality that is superiorly effective in creating a remission in symptomology – at least not in my mind. Until, I started to work for a company called Brooklyn Minds in Williamsburg Brooklyn in New York.

To give a little background I’ve worked with complex disorders since I started my training as a mental health counsellor. I worked with children, adolescents, and families with a variety of different disorders, mostly utilising behavioural approaches. To be honest, this approach doesn’t always work and out of frustration over the system I quit, to set out to find something more effective.

Current modalities

Whether it was cognitive behavioural therapy, relaxation training, modelling, or dialectal behavioural therapy, something didn’t seem to stick with the patients and I’d be back to square one rethinking how best to help them.

I imagine many other practitioners in my shoes might feel the same. Thankfully, I boldly reached out to Brooklyn Minds in hopes to join their team.

Brooklyn Minds specialises in the more complex patients, you know the ones that most practitioners won’t touch, most likely because of their high risk acuity. The ones that probably need the most help because of the sheer increased risk of completing suicide.

They welcome those with open arms and a team of psychiatrists, psychologists, and psychotherapists construct the most effective; including a texting and calling application for your phone so patients have access to their practitioner more easily in times of crisis. So, lo and behold, Brooklyn Minds introduced me to new things.

New modalities

Mentalisation-based treatment (MBT) developed by Peter Fonagy and Anthony Bateman, originally for borderline personality disorder (BPD) and antisocial personality disorder (ASPD). Additionally, research studies and increased use in therapeutic settings, practitioners are realising the vast benefits that MBT has on other disorders.

MBT has been most successful through a combination of weekly individual and group therapy over the course of 18 months. What is even more interesting about this approach is that it doesn’t require intense training to utilise. In fact, Peter and Anthony attempt to make learning MBT easily accessible.

A little about the initial disorders

Borderline personality disorder is characterised by unstable relationships, moods, and behaviour. Symptoms include feelings of worthlessness, insecurity, impulsivity, emotional instability, impaired romantic/social relationships, issues regarding self-imagine, and experience ridged thinking.

These symptoms must be present for a sustained period of time. Additionally, it is not uncommon for those diagnosed with BPD to have been hospitalised, engaged in self-harm behaviours, or suicidal ideation. So, I’d hope you can imagine how serious and complex this disorder is.

Antisocial personality disorder is characterised by those whom have a pattern of breaking laws, act impulsively, lack regard for safety of self/others, and can be manipulative. Additionally, those diagnosed with ASPD can have problems with substance use, lack empathy, and often appear to be angry or irritable. Increased risk for developing this disorder consist of having antisocial or alcoholic parents.

Mentalisation-based treatment

Those who suffer from a personality disorder, or aspects of these disorders, frequently lose their ability to mentalise, which is the ability to understand our own and other people’s internal mental states. It is during these failures that we see heightened symptoms in those diagnosed with a personality disorder.

Therefore, the purpose of the treatment is to restore mentalisation, empower the individuals sense of self, and sustain the process of mentalisation outside of therapeutic settings.

There are three forms of mentalisation failures, which are: psychic-equivalence, teleological mode, and pretend mode. Psychic-equivalence and teleological mode are concrete thinking; whereas psychic-equivalence mode is experiencing feelings as facts and teleological mode requires action or proof. This attests to the ridge thinking of those with a personality disorder and though mentalisation we can start to see some flexibility. Pretend mode points to the patients lack of engagement in the discovery of their own mental processes and feelings.

These cognitive failures inhibit mentalisation and a mentalised stance cannot be restored until internal emotional states are stabilised. Once mentalisation is restored the therapist and patient may engage in a more controlled, curious, and exploratory interaction to help understand how the failure in mentalisation had occurred.

As the therapist, our stance, is to be relentlessly curious about the patient’s internal state, while engaging in a patient and actively style. At the same time, the therapist must also be aware of their own misunderstandings or failures in mentalisation. Through specific techniques outlined in the Mentalization Based Treatment for Personality Disorders: A Practical Guide, I’ve seen drastic changes in those suffering with personality disorders.

The treatment seems to be so successful that there has been continuous adaptations to include children (MBT-C), adolescents (MBT-A), and even families (MBT-F). In my most recent training, Mentalisation-Based Treatment for Adolescents, at University of California, Los Angeles by Trudie Rossouw we discussed the developmental process and how MBT can better be served for adolescents and families. Even in the trainings each practitioner takes an active stance, role playing different situations while getting live supervision to perfect techniques.

This approach has been such a profound addition to my arsenal of techniques to help those suffering from mental illness. I encourage other practitioners, teachers, and others that might interact with those grappling with attachment deficits to learn more about MBT.

I’ve worked with young adolescents suffering from chronic thoughts of suicide that are now engaging in a more fulling life and sustaining healthy relationships; young adults that have felt directionless and empty now express feelings purpose, and parent’s have expressed feeling they have better understand on how to interact with their children. These improvements have been mind-blowing, since I’ve adapted my psychotherapy sessions to include MBT and modality variations. As I continue down this path, we at Brooklyn Minds are now collaborating to be participants in more research studies being conducted around the world.

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• For UK readers: Here are free helplines to help when you’re feeling down or desperate.
• For US readers: If you’re feeling suicidal please call the National Suicide Prevention Lifeline 1-800-273-8255 or visit their website  to chat with someone 24/7 free and confidential.  *

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Image credit:  Freepik

Kyle McEvoy received his master’s degree in mental health counselling from Long Island University in Brooklyn.