There can be many challenges in the work with people with severe personality disorders and approaching these without reflection can be problematic. Such challenges can include multiple comorbid diagnoses, significant levels of risk, challenging patterns of interacting with others, and frequent/extended hospital admissions. Commonly, the number of clinical services involved increases as the patient’s complexity and risk increases, as can the complexity of what the system around the patient attempts to process and manage. This can often result in different parts of the treating system holding very different perspectives from each other and, at times, the patient. Whilst such an occurrence is not uncommon, when it is left unreflected upon it can lead to processes that perpetuate the difficulties between patient and system, and within the parts of the system itself, inadvertently increasing the risk of iatrogenic harm. In such situations, a part of the system may seek secondary consultation from an outside source.
The process of approaching secondary consultation and supporting the system and, by proxy, the patient can be challenging, both in terms of formulating, and intervening. With this in mind, having an explicit method of conceptualising and working with these difficulties is required. Theoretical and clinical models that have been shown to help many people with BPD can be utilised to this end. This presentation will outline how providing secondary consultation can be informed by mentalization-based treatment (MBT). When consulting, it is critical to create a space in which the system can begin to reflect on and rebalance how its various parts understand themselves, and the patient they are working with. In doing so, the relationship between the system and the patient may begin to stabilize, allowing both parties to work more effectively together and increasing the likelihood of therapeutic engagement and change.