"And whatever you say, you say nothing" Establishing epistemic trust in The Lighthouse MBT-parenting programme: a case study

Abstract

Mentalization-based treatment (MBT), developed by Anthony Bateman and Peter Fonagy for treatment of borderline personality disorder (BPD), is explicit in seeking to establish epistemic trust in the therapeutic relationship and has as a goal its generalisation to other relationships and social connections/opportunities (Fonagy et al., 2017a, 2017b). MBT adaptations have shown some promising results with parents with histories of disrupted/disorganised attachments and abuse in childhood, and who themselves have maltreated their children (Byrne et al., 2018). These parents rarely seek referral for treatment but are coerced into the therapeutic space by a court order or child protection plan, effectively; by the threat of removal of their children from their care if they do not attend. This article outlines the research context including a summary of what we know about the childhood experiences and attachment histories of those parents with BPD who have been identified as at risk of maltreating their children and the recent research on MBT informed parenting interventions. It describes the climate of epistemic mistrust within which a specialist treatment service attempts to engage these parents and the challenges to the establishment of epistemic trust. Clinical examples are used to illustrate the journey from epistemic mistrust and hypervigilance to trust in the facilitators and the group.