Thanks to decades of clinical expertise and the support of McLean’s philanthropic community, McLean Hospital has become a preeminent training center for one of the most promising therapies for borderline personality disorder (BPD): mentalization-based treatment (MBT). One of five empirically validated treatments for BPD, MBT helps patients develop the ability to understand the mental state of themselves and others—a skill that is critical for regulating emotional responses and having positive interpersonal relationships.
“We are creating a system of basic training and supervision in MBT, which will translate into better care for many more individuals throughout North America,” said Lois W. Choi-Kain, MEd, MD, who oversees the trainings with colleague John G. Gunderson, MD, a pioneering BPD researcher and clinician. Dr. Choi-Kain is also the program director of McLean’s Gunderson Residence, a residential program established thanks to donor support that treats women with BPD.
BPD is characterized by an unstable self-image and a pervasive pattern of impulsive behavior, volatile emotions, and tumultuous relationships. It occurs in about 1% of the population and accounts for approximately 20% of all psychiatric hospitalizations in this country. People with BPD make use of emergency room services at 10 times the rate of people with major depression, which can create financial burden for families and communities. The illness also has profound public health repercussions, in terms of mortality, given that 10% of people with BPD die by suicide.
Despite its prevalence and severity, the disease is frequently misdiagnosed and many clinicians are reluctant to care for patients with BPD. With evidence-based treatments like MBT, however, patients can have an excellent prognosis.
“Too few clinicians are trained in MBT, making access to treatment a big issue,” said Dr. Gunderson. “But MBT is a very effective BPD treatment, and thanks to our generous donors, we’re able to offer training from the two giants in the field: its creators, Peter Fonagy, PhD, and Anthony Bateman, MA, FRC Psych.”
Starting in 2010, Dr. Fonagy, a psychologist, and Dr. Bateman, a psychiatrist, have traveled from England to McLean several times to present three-day introductory MBT trainings for clinicians, including physicians, psychologists, nurses, and social workers. More than 200 clinicians from the United States, England, and Mexico have attended the trainings, creating a wider network of treaters who can now practice MBT. Philanthropy from a number of supporters has made this work possible.
The fact that MBT training is only modestly resource-intensive makes it an accessible treatment to patients of all socioeconomic backgrounds, according to Dr. Choi-Kain. “MBT is easy to implement in a public health setting,” she said. “Our trainings are addressing the access issue and making the therapy available to people in all types of communities.”
Through video conferencing, Dr. Bateman has been providing weekly supervision to a group of McLean clinicians who completed the basic training in order to advance their mastery of MBT. In turn, this cadre of practitioners has supervised several dozen individuals and care teams throughout the United States in MBT. In June, for the first time, Drs. Bateman and Fonagy will offer advanced training at McLean for clinicians who have completed the basic course.
Paying it Forward
Priscilla and Kurt Dasse’s philanthropic support of McLean is deeply rooted in the care a relative received at the hospital several years ago. “McLean offered multidisciplinary, comprehensive care with a laser focus on BPD. I don’t know anywhere else where the clinicians would be as attentive and helpful,” said Priscilla. “We wanted to pay it forward and, through supporting the MBT trainings, help other people access this kind of care.” Today, the couple’s loved one is thriving.
Borderline personality disorder can have a deep impact on family dynamics and, therefore, family members may also need to invest time in therapy. “It was a difficult period for our entire family. We were in crisis, and McLean supported us in countless ways,” said donor Jim Bennett, whose relative received care for BPD at the hospital. “We were so lucky to have had access to one of the premier treatment centers for BPD and we want to ensure other families receive the treatment they need.”
For their part, Drs. Gunderson and Choi-Kain remain dedicated to extending McLean’s expertise in BPD as far and wide as possible. “This treatment works and we owe it to patients and families to make it as widely available as possible,” said Dr. Gunderson. Through the combination of McLean’s clinical leadership, a strong partnership with MBT founders Drs. Fonagy and Bateman, and generous support from donors, more patients and their families will benefit today and into the future.
McLean and Gunderson: Pioneers in BPD
McLean has the largest concentration of BPD services of any hospital in the country, including inpatient care, a residential program named Gunderson Residence, and outpatient programs for both women and men. The hospital also has extensive services for children and adolescents, including residential, partial hospital, outpatient, and community-based programs—and even offers a residence on campus where adolescents who are unable to live at home can be in treatment while attending a therapeutic high school based at McLean.
McLean’s expertise in BPD is largely due to John Gunderson, MD, whose seminal work helped define borderline personality disorder as a distinct illness with very specific symptoms. Dr. Gunderson built some of the first treatment programs in the country for BPD, and his research helped define criteria for making the diagnosis. Over the years, clinicians have come to McLean from all over the world to train, study, and deliver clinical care based on his work.
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