1. Upper Garden Villa Royal Cornhill Hospital 01224 557398

2. Who Are We?

3. Who Is Referred To The Hub Day? Assessment Childhood Trauma Questionnaire (CTQ) Personality Questionnaire (PDQ4) BPD traits/diagnosis MBT formulation Understanding effects of past on the present. Not to re-live it. Set goals, plan for the future. Recover a sense of agency.

4. Pre-HUB Meeting Informal 20-30 mins. Meet staff Department Tour Discuss Anxieties Hub leaflet SCL90 Talk about formulation / goals

5. 24 weeks Business Meeting Morning Group 8 weeks Psycho-education 8 weeks SCID 11 8 weeks Mentalization Based Skills Lunch Time 12.15-13.30 Afternoon Group Mentalization Based Therapy (MBT) HUB DAY PROGRAMME

6. Business Meeting Not a Therapy Group Lasts up to 15 mins Brings 2 groups together All Hub staff attend Any Messages Already adopting an MBT stance Enforces a pro-social and relational approach.

7. Psycho-education (Morning Group Weeks 1-8) Week 1 Contracts and Boundaries Week 2 Mentalization Based Therapy Week 3 Attachment Week 4 Emotional Awareness Week 5 Crisis Planning Week 6 Personality Week 7 Looking after Yourself Week 8 Communication

8. S.C.I.D.D. II (Morning Group Weeks 9 -16) Structured Clinical Interview for DSM-IV AxisII Personality Disorders (SCIDD – II) Diagnostic questionnaire Mentaliszing Exercise in group Develops the idea of ‘Thinking about thinking’ Considers feeling states in self and others Related behaviours and thoughts.

9. MBT SKILLS (Morning Group Weeks 17 – 24) Mentalizing Based Skills Developed from MBT exercises. Thinking about future Managing endings Goals re-examined What next? Can be patient-led

10. Lunch Time Challenge patients views on social interactions ‘Have a go’ Can be material to use in the afternoon. Light hearted, fun, staff join in. Last days can be marked by a picnic/cakes.

11. Afternoon MBT Group Runs every afternoon for full 24 weeks. 1 1/2 hours long Aims To provide a training environment for mentalizing - In self In Others In Relationships

12. What is Mentalization? Understanding misunderstanding To see ourselves from the outside and others from the inside Shapes our understanding of others and ourselves Central to human communication and relationships Underpins clinical understanding, the therapeutic relationship and therapeutic change regardless of modality of therapy

13. Mentalization Based Therapy (MBT) Aims to strengthen patients capacity to understand their own and others mental states in attachment contexts in order to address difficulties with - –Affect regulation –Impulse regulation –Interpersonal functioning All of which contribute to suicide and self harm. Bateman and Fonagy 2009

14. Group MBT Non – mentalizing patients + (we hope) mentalizing therapist Based in the here and now Current issues Actively promote group interaction Intervene when there is an opportunity for mentalizing

15. Group MBT cont... Not waiting to see ‘how the group deals with it’ Open questions Curiosity Stop Rewind Explore Simple Affect focused but remember most reactions are about survival Focus on patients mind (not on behaviour)

16. What Group MBT is not... A support group Transference relationships Metaphor Interpretation

17. Inbetween the ‘HUB’ Not an out of hours service. Patients encouraged to use crisis plans Encourage to think about their original formulation goals and what they hope to achieve from the hub. On model to make contact in-between hubs if the patient hasn't made contact.

18. MBT Supervision MBT Adherence Scale Straight after HUB programme ends All therapists from the day attend

19. Post Hub Interview Thinking about the ending is part of the MBT work in the last weeks of therapy. 6-8 week allowed before follow-up Allows time to process work done Can feel rejected and abandoned Individual review appointment offered to discuss future.

20. Research Ongoing Pre and Post HUB - SCL90’s