Although I was given the task of reviewing this book in isolation, the first paragraph of the preface makes it clear that the authors intend it to be a companion to their more comprehensive account published in 2004 as Psychotherapy for Borderline Personality Disorder (Bateman & Fonagy, Reference Bateman and Fonagy2004). This laid out in detail the theoretical basis for their theory that central to the problems people with borderline personality disorder face is a fundamental deficit in their ability to mentalize. This is the ability to understand the people around them, and to some extent themselves, as people who behave in the way that they do in a way related in a complex fashion to that person's mental state and that this is particularly true when they are aroused in ways related to their attachment system. The purpose of this book was, in their words ‘to provide an understandable, accessible and comprehensive account of what we actually do and say in everyday clinical practice’. I had previously grappled with the larger, earlier volume and I had enjoyed it. I did not read it again in order to review the companion.
I was impressed when I first read the original book of this dyad that there was a real attempt to take a fresh look at the whole problem of borderline personality disorder and a break with the analytical and cognitive traditions which offer understanding but little in the way of amelioration.
Chapters 1 and 2 deal with the relevant theory. Firstly we are told in a concise way what mentalization is and how it might be part of our normal emotional life and how we may acquire these skills through the stages of childhood. In chapter 2 this understanding is narrowed down to the specifics of how borderline personality disorder can be understood utilizing this framework. It is not a narrow framework and their formulation of the problem uses this as a way of understanding the whole gamut of problems these patients experience. Chapter 2 includes sections looking at hyperarousal, attachment issues and finishing up with the issues of self-harm and suicide that preoccupy services that these individuals are treated within. So wide and integrative are these chapters that you do come to an understanding of the potential power of this model. In their hands it has wide explanatory power and they back this up with quotes from relevant sources.
Chapter 3 begins the switch to the practical but opens with a review of the evidence of the potential of borderline personality disorder to be altered by both the passage of time and with treatment and does not involve special pleading for their therapeutic model. It also looks at how iatrogenic harm is a real issue in the management of these patients. The subsequent chapters then move on to a discussion of the mechanics of the delivery of this type of therapy and include many case vignettes and examples of actual dialogue that is taken from therapeutic sessions to illustrate their arguments.
Compared to the original book this volume skips through the relevant theory at pace. However chapters 5–8 deal with the practicalities of the mentalization-based approach to assessment and therapy in a way that actually makes the theory clear by example. In this way I found that my understanding of the ideas behind the therapy driven forwards in this section of the book in concert with an understanding of the practical issues of therapy. Real world issues are tackled head on. It is always refreshing to read books written by people who obviously do a job the rest of us would recognize.
Overall I found this a concise, readable book and it was never a struggle to read it. It is written with clarity and although the focus is practical it never assumes large chunks of theory but gets theory across through practice points. My view that the theory is adequately covered may be due to the fact that I had already read the main book. I cannot know for sure whether someone who had never read the main book would have felt that they lacked understanding of the main concepts.
This book presents an easily readable account of a coherent system for understanding the core problems of borderline personality disorder and a clear account of how to take this theory and use it with patients and outlines the service structure the authors have used in their work. I would recommend this book to anyone interested in borderline personality disorder and considering the competing claims of rival therapies to be at the centre of services for this client group that are very slowly being established in England. As a readable account of their thinking on the subject, style of therapy and model of service delivery it achieves its goal.
