A 30-year-old man with borderline personality disorder is receiving mentalisation-based therapy. During a session, the therapist briefly glances at

Question

A 30-year-old man with borderline personality disorder is receiving mentalisation-based therapy. During a session, the therapist briefly glances at the clock. He becomes visibly tense, raises his voice and says, "You cannot wait to get rid of me. You have never cared about me." He remains seated and makes no threats. Which is the most appropriate immediate therapeutic intervention?

Accepted Answer

Acknowledge the intensity, adopt uncertainty, and jointly reconstruct how the clock glance became evidence that the therapist did not care

Answer

Link the accusation to early attachment experiences and interpret it as transference before discussing the present interaction

Answer

Reassert the treatment frame, state that hostile accusations are unacceptable, and bring the session to an early close

Answer

Identify the accusation as a cognitive distortion, examine contrary evidence, and ask him to generate a more rational appraisal

Answer

Validate that the anger is understandable, use grounding, and defer examination of the therapist-patient interaction until a later session

MBT Technique — MRCPsych Paper B MCQ