Mentalization Based Therapy (MBT)

Mentalization Based Therapy is an approach, developed by Anthony Bateman and Peter Fonagy, to treat BPD patients in the U.K.

Before discussing their therapy technique, I'd like to look at what they posit as the central problem for a person living with BPD, and how they feel this condition is caused.

Much of what they have to say, if I have understood correctly, rings true for me.

BPD - Central Problem - Relationships

For Bateman and Fonagy, the central problem faced by a person with BPD, is the inability to form healthy balanced relationships. 

Relationships are either detached; or overly intense and enmeshed.  At core in this relationship impairment, is the inability to define the boundary between "self" and "other".  For the person with BPD, it is all or nothing.

The first of these two modes of how we with BPD relate to others, can perhaps be demonstrated by the following diagram:

Detached Mode

This modus operandi (way of functioning in the world) which, while lacking strong human bonds and connections, tends to be more stable. 

                                                Source: MBT Training Workshop, Bateman & Fonagy, 2009

Someone with this relationship structure has no strong human bonds or connections, so life is relatively calm.  It is also flat, empty and disconnected; contributing to a sense of emptiness--that "big hole inside" so many of us describe.

The isolation, alienation, lack of feeling understood or part of the world/reality, is intense and can lead to deep depression, self-harm and suicide.

However, compared to the other mode of BPD relationship functioning (that of being emotionally enmeshed) this mode of being in the world is relatively, a relief.

This detached form of relating is where I feel I am now.

Oliver Sacks & "Awakenings"

I've been reading a lot of Oliver Sacks recently.

In the '60s, he administered the drug L-dopa to patients suffering from Parkinsonian symptoms as a result of the "sleeping sickness" epidemic of the 1920s.

For more about his study, read his book Awakenings.  There was also a movie made, starring Robin Williams and Robert De Niro, directed by Penny Marshall, released in 1990 based, somewhat, on his book.

Something that spoke to me in the analysis of his patients, is the three stages they go through after receiving this drug: Awakening, Tribulations, Accommodation.

I can identify with these three stages in my experience of BPD.

Awakening:

For me, my awakening was being diagnosed two years ago, with this disorder.  It was such a relief to know what was wrong and that there is treatment. I was full of hope and optimism.  I was enthusiastic to embrace whatever I could find that would help.

Tribulations:

Then, over the two years of treatment and learning how to cope with this illness, I have had the return of symptoms as bad as anything I have ever experienced prior to diagnosis and treatment.  It feels terrible to have those feelings of depression, agitation, anxiety again; wanting to give up and die, even after all I have done to try to get well.

Accommodation:

This is where I am now.  And it seems to me the hard part.  Learning what I can and cannot do, or take on--without reactivating the symptoms of the disorder.  Understanding my limitations, the real life limitations of my disease.  Learning some sort of acceptance: this is how it is for me.

And finally, just staying steady.  Just doing my best to remain or regain, stability.  Not running away--neither physically, as I used to; nor through abusing substances.

Getting back up and back to therapy, even when I've missed a session or two due to depression or anxiety.  And being grateful for the incremental gains.

Accommodation is the long haul of living with BPD.  It is not giving up; while understanding there really is no cure.  That the bad times and feelings will come again, and yet again.  But to "hang in".  Keep trying to garner tools that will help cope with the symptoms.

Knowing somewhere inside myself, that it is better than it was before I was diagnosed; before I started on this journey of treatment.  Trying to stay calm and level, no matter how flat and joyless it feels some days.

As someone in my group said: "Some days it just feels as though I'm going through the motions."  And yes, that is exactly how it is.  Rinse and repeat.

Accommodation is somehow accepting the present, as well as the past; without giving up hope.  Moving forward with as much gratitude as I can muster.

For me, it is at least better to know what is "wrong" than not to know.  Which is where I used to live, for most of my life.