Chapter

Principles of interventions

Anthony W. Bateman and Peter Fonagy

in Mentalization-based Treatment for Borderline Personality Disorder

Published on behalf of Oxford University Press

Published in print September 2006 | ISBN: 9780198570905
Published online February 2013 | e-ISBN: 9780191754456 | DOI: http://dx.doi.org/10.1093/med/9780198570905.003.008

Series: International Perspectives in Philosophy & Psychiatry

Principles of interventions

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In this chapter we discuss some general characteristics of mentalizing interventions and the principles to follow when deciding on the right intervention. As we shall see, being a good therapist is not simply a matter of giving the right intervention. Just as musicians may play most of the right notes but phrase them with inadequate sensitivity, thereby missing the meaning of the piece, so it is only too easy for therapists to make most of the right interventions in therapy but to use them at the wrong moments and without compassion and humanity, rendering therapy hollow. In an attempt to overcome this problem we provide some guiding principles, the first of which is ‘if in doubt go back to basics and return to the beginning of our pathway for interventions’. This will help you re-orientate yourself; it is easier to get back on track from a known position. Rather than flailing around in the dark or rushing headlong into danger, if in a hole, stop digging and return to the point at which you felt you knew where both your own and the patient’s mind was. In other words whenever you are in considerable doubt and your uncertainty is increasing, return to the basic principles and couple this with a stop, rewind (to a point at which the dialogue was understandable), and explore (see p 133) before moving forward again. There will be many times when the principles are, and should be, broken; being intuitive is an important part of therapy. Here, we can only offer advice that we hope experienced therapists will not find patronizing and condescending. Our training programme is aimed at generic mental health professionals who gallantly implement our treatment without having had extensive therapy training but having had good general experience of risk management, emergency assessment and crisis intervention. Ironically this initial therapeutic naivety of practitioners might be an important part of successful treatment, enabling them to follow basic principles without too much deviation. Experienced therapists have, often necessarily, come to believe in their therapy, their methods and their techniques, and may be in danger of becoming inflexible. Enthusiasts who are setting out on their therapeutic journey and have fewer pre-conceived ideas and hobby-horses to ride may stand a better chance of taking a mentalizing or ‘not-knowing’ stance (see p 93). But enough said before we are accused of forming straw-men, stereotypes and archetypes, all of which are examples of non-mentalizing phenomena!

Chapter.  6060 words. 

Subjects: Psychiatry

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