NHS conference: When Mentalisation Breaks Down - Suicide, Self-harm and Violence (SOAS, London, 9/11/2012)

On Friday 9 November Newham’s NHS MBT Team held a conference on ‘When Mentalisation Breaks Down: Suicide, Self-harm and Violence’ at SOAS. The programme was very diverse and approached personality disorders and difficulties with mentalising from a number of perspectives and different treatment models.

Dr. Dickon Bevington, who is one of the developers of the award-winning AMBIT (Adolescent Mentalization-based Integrative Treatment)  model, focused on taking mentalising to the streets, and finding new ways of engaging hard to reach troubled youths by approaching them in their environment and in a language (in the broadest sense) that they can communicate in more easily. This model is a team-based approach and emphasises the importance of communication and cooperation of all the involved agencies, as well as having one highly qualified key worker as a hub. This keyworker also takes on tasks that traditionally a social worker would take on, especially in the early stages. Distressed adolescents often perceive all the different agencies who approach them with the intention to help like an ‘annoying flock of starlings’ who all bother them. This can aggravate the adolescent’s difficulties and frequently they decide to protect themselves by withdrawing from what could potentially help them. The key worker can, however, take on the juggling and coordinating of the different agencies, which can lay the foundations to start the therapeutic work. Aspects of this model are already practiced in NHS MBT teams treating personality disorders – mutual support and assessment meetings within personality disorder service teams is an essential part of the work.

Dr Jessica Yakeley, consultant psychiatrist in Forensic Psychiatry at the Portman Clinic and Director of Medical Education and Associate Medical Director at the Tavistock and Portman NHS Foundation Trust and editor of Psychoanalytic Psychotherapy focuses on working with men diagnosed with antisocial personality disorder. In contrast to typical symptoms associated with borderline personality disorder, patients with antisocial PD tend to turn the aggression outwards. Working with these patients who bring a whole history of violence and crime is highly challenging for practitioners and institutions. A lot of her work deals with risk assessment, and the Portman clinic is one of the few institutions running an MBT group for men with antisocial personality disorder. In line with the common affiliation between MBT and attachment-based psychotherapy, Dr Yakely has published on antisocial personality disorder from an attachment perspective. She currently is conducting a trial of MBT for men with antisocial personality disorder.

This talk was followed by a panel case discussing various psychological therapies on offer for the treatment of personality disorders in Newham. Sam Coates-Stephens presented how he would approach a fictional case of a woman in her 20s with borderline personality disorder from a Cognitive Behavioural Therapy (CBT) perspective. The same fictional case was discussed by Dr Neelam Dosanjh who conducts individual psychodynamic therapy at Newham NHS, by Colm O’Keeffe, a systemic therapist, Tom Higgins, an MBT practitioner and attachment-based psychotherapist also from the Bowlby Centre, and by Tim Mold who focuses on DBT. This panel discussion clarified the overlaps and differences of the various models.

Peter Wilson’s talk was titled ‘Hatred and Helping: Workig with Our Own Fear and Narcissistic Rage’. He talked about his work in a school for very difficult children, and about the importance of therapists acknowledging and allowing feelings of fear, and especially rage, when working with patients with personality disorders. He described an example of a little boy at Peper Harow Therapeutic Community where he worked as a Consultant Child and Adolescent Psychotherapist shouted at him when he approached the front door. He described, in quite a humorous way, how the rage and fear resulting from this boy’s unexpected outburst intensely stayed with him for the rest of the day. His talk focused both on how difficult it is as a therapist to acknowledge and allow these feelings and on how important it is for the work and the well-being of the therapist to let them flow and to find constructive ways of venting them. Peter Wilson is Clinical Advisor to The Place2Be, co-founder and former director of Young Minds, former director of the Brandon Centre and Consultant Child Therapist and Consultant Child Therapist at Peper Harow Therapeutic Community.

Lennox Thomas is Consultant Psychotherapist at the Refugee Therapy Centre and used to be clinical director at Nafsiyat, as well as having run an MSc on Intercultural therapy at UCL. His talk ‘The Psychological Violence of Racism: Attending to the Scars’ focused on the impact of racism in and on psychotherapy, and on the importance of culture and race in both assessments and therapy session when working inter-culturally in a multi-ethnic society. He explained that it is common that a client tries to avoid acknowledging the impact of culture and race, and that the psychotherapist may also fall into a false notion of ‘neutrality’ and not needing to be aware of his or her own racism. This, according to Thomas, puts the client in a difficult situation because any ground for connecting with the client’s culture and background can be taken away. Assuming a neutral stance can also take away the client’s opportunity to speculate about the therapist’s background which can have an effect on the development of a therapeutic relationship and the fit. Thomas’ narrating speaker style was very engaging but unfortunately made him run out of time and he couldn’t finish his talk.

Professor Alessandra Lemma’s talk ‘Minding the body: A mentalising perspective on self-harm and violence’ focused on the many forms of self-harm and body modification. She is director of the Psychological Therapies Department Unit at the Tavistock and Portman NHS Foundation Trust and Consultant Psychotherapist at the Portman Clinic. There she works with transsexual patients. She has published widely on psychoanalytic views on body modification.