Nottinghamshire Mentalization Based Treatment (MBT) Service

We provide a community service of individual assessments and group therapy for people with complex personality difficulties. We work with Service Users who are motivated towards change and who feel able to make use of group therapy. 

Our service users often have longstanding difficulties in relationships, early experiences of trauma, poor early attachments, and a pronounced difficulty in managing overwhelming emotions. Not everyone who uses our service has a diagnosis of personality disorder, but all will have significant issues with personality traits which are:

• Persistent - there all the time
• Pervasive - spread across most areas of their lives
• Problematic - causing difficulty for themselves and others

We do not routinely offer CPA care-coordination but work closely with those services that do. We do not prescribe or manage medication, nor do we diagnose personality disorder.

We provide Mentalization Based Treatment groups recommended by National Institute of Care and Excellent (NICE), initially with an introduction group of 10 weeks (MBTi) followed by an opportunity to engage in MBT therapy (up to 1 year in duration). We provide group therapy, as it has been proven to have the most effective treatment (positive outcome) with this patient group. Service Users benefit from developing appropriate relationships with others who have similar experiences to themselves.

Additionally, we also run an MBT group that is specifically for men who present with more prominent anti-social traits. This programme includes extended assessment and preparation work to support the individual in working towards helpfully accessing therapy and their desire to change.

We also offer Cognitive Analytic Therapy (CAT), both group based (InsPiRE group) and a limited offer of individual work. The InsPiRE group is specifically developed for 18-25 year olds, for those who will benefit from specialist earlier intervention. This intervention aims to help individuals develop an understanding of the current problems affecting their wellbeing and how these are caused by earlier life and relationships.

The service covers Nottingham City and Nottinghamshire County.

• MBT is offered in Nottingham City, Mansfield and Worksop.
• The InsPiRE group (CAT) and men’s MBT group is offered only in Nottingham City. 

InsPiRE: A 24 session weekly group programme, preceded by 5 individual weekly sessions prior to joining the group, for 18-25-year-olds, for those who will benefit from specialist earlier intervention. The service includes individual sessions and group work. It uses a psychological therapy called Cognitive Analytic Therapy (CAT). CAT helps understanding of the current problems affecting wellbeing and how these are caused by earlier life and relationships. In CAT, patterns of thinking, feeling, and acting, which are causing your current problems and how these represent the way you learnt to survive in earlier life are explored. Looking at how these patterns keep affecting life and think about other ways of doing things. Group attendance is supported by monthly individual 1:1 sessions with their named worker throughout.

Individual CAT therapy: CAT is a short-term focussed psychotherapy which brings together understandings from cognitive psychotherapies (such as Cognitive Behavioural Therapy) and from psychoanalytic approaches into one integrated, user-friendly, and effective therapy. CAT is a relational psychotherapy that focuses on how individuals relate to themselves and others and how others relate to them. By considering these patterns of relating individuals can reflect on the effects of these patterns on their relationships, their daily lives, and the way they are with themselves. Further, they can consider and test out new ways of relating which avoid repeating unhelpful patterns.

Mentalizing is about: Recognising and managing your own thoughts and feelings; Recognising and understanding what other people may be thinking and feeling; Interpreting feelings, actions and behaviours as being meaningful; Attending to mental states such as thoughts, beliefs, desires and feelings. 

A person who struggles to mentalize will have difficulties: in building and maintaining relationships; to manage some strong and overwhelming emotional experiences and feelings and get back to a more manageable state.

Sometimes when a person is distressed or experiencing strong emotions, the ir ability to recognise and manage their own thoughts and feelings, and to recognise and understand what other people may be thinking and feeling, is greatly reduced. This often means that a person may: Find it difficult to think clearly about their own and other people’s behaviour; To understand others behaviour towards them, which can lead to conflict; Have difficulties in building and sustaining relationships.

Mentalization Based Treatment (MBT) aims to help a person: understand their own thoughts and feelings; develop their ability to recognise and understand what other people might be thinking and feeling; reduce the chance of misinterpreting the intentions of other people; Manage overwhelming emotional experiences which may have led to unsafe behaviour in the past.

This weekly meeting is a forum for clinicians, teams and services such as LMHTs, MHSOP, CAMHS, inpatients etc., to discuss and think about complex cases (those who have been assessed or who are on team caseloads), to consider possible treatment plans / treatment pathways, and to access support and advice from a multi-disciplinary team. It's also an opportunity to understand the treatments available within the Personality Disorder Pathway, of which Notts MBT Service is one treatment option.

This process also enables specialists in Personality Disorder within Nottinghamshire Healthcare NHS Trust to have oversight of all the elements of the Personality Disorder pathway. This includes being aware of resource versus demand within the pathway and identifying issues to consider for the ongoing Personality Disorder strategy development.

We offer training within Nottinghamshire Healthcare NHS Foundation Trust. We also deliver bespoke training (please contact the Operational Team Leader to discuss this further) and one day training to a range of statutory/non-statutory/third sector services.