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MBT Ending Phase — MRCPsych Paper B MCQ

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ModeratePersonality DisordersMBT Ending PhaseMRCPsych Paper B

A 30-year-old woman with borderline personality disorder is approaching the agreed end of an 18-month mentalisation-based treatment programme. Her self-harm and interpersonal functioning have improved, but she has become anxious that ending therapy means the team is rejecting her. She is not currently in crisis. Which approach is most consistent with the final phase of MBT and UK guidance on managing treatment endings?

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Correct answer: C — Use a planned final phase to review gains, mentalise reactions to ending, and agree phased transition and crisis-access arrangements

The correct answer is C. MBT includes an explicit final phase that reviews progress and helps the patient mentalise thoughts and feelings arising from separation. Her interpretation of the ending as rejection is therefore clinically relevant material to explore, rather than a reason either to terminate abruptly or to continue indefinitely. NICE similarly advises that endings in borderline personality disorder should be anticipated, discussed in advance, structured and phased, with transition and crisis arrangements agreed. Starting another psychotherapy automatically is unnecessary and may undermine a coherent ending; further treatment should depend on assessed need. A final review alone is insufficient if it is followed by an unplanned discharge without contingency arrangements.

Reference: Desseilles M, et al. Mentalization based treatment and borderline personality disorder: therapy structure and final phase. L'Encéphale. 2017;43(4):340–345. https://pubmed.ncbi.nlm.nih.gov/27431343/