About the authors |
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xvii | |
Introduction |
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xix | |
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xix | |
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xx | |
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Core component of treatment |
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xxi | |
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xxii | |
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xxiii | |
Chapter 1: Epidemiological and etiological research on borderline personality disorder |
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1 | (38) |
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Definition of the problem |
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1 | (2) |
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2 | (1) |
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2 | (1) |
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3 | (1) |
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3 | (6) |
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3 | (1) |
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4 | (1) |
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5 | (2) |
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5 | (1) |
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5 | (1) |
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5 | (2) |
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7 | (1) |
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Dimensional models of BPD |
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8 | (1) |
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The natural history of BPD |
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9 | (3) |
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The stability of the diagnosis over time |
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9 | (1) |
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10 | (2) |
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Studies of mechanisms and aetiological factors |
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12 | (7) |
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Biological considerations |
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12 | (7) |
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12 | (1) |
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12 | (2) |
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Neurotransmitter abnormality |
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14 | (1) |
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14 | (1) |
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15 | (3) |
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Attention and self-control |
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18 | (1) |
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19 | (1) |
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19 | (15) |
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Theoretical considerations |
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19 | (2) |
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21 | (2) |
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Parental separation or loss |
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21 | (1) |
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21 | (1) |
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Abnormal parenting attitudes |
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22 | (1) |
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Childhood trauma and maltreatment |
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23 | (3) |
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Models of psychosocial aetiology based on neglect and trauma |
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26 | (8) |
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26 | (1) |
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The stress-diathesis model |
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27 | (1) |
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28 | (1) |
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Biological pathways of the impact of extreme stress |
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29 | (3) |
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Childhood trauma as a risk factor for adverse brain development |
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29 | (1) |
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30 | (1) |
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30 | (1) |
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30 | (1) |
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Anterior cingulate dysfunction |
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31 | (1) |
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Psychological pathways linking BPD to the impact of extreme stress: the role of affect dysregulation |
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32 | (2) |
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34 | (3) |
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Theoretical considerations |
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34 | (1) |
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Empirical studies using the AAI |
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35 | (1) |
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Empirical studies using self-report measures of attachment |
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35 | (1) |
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Summary of empirical data |
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36 | (1) |
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Problems with a simple attachment model |
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37 | (1) |
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37 | (2) |
Chapter 2: Therapy research and outcome |
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39 | (16) |
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40 | (10) |
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Psychoanalytic psychotherapy |
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40 | (6) |
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Empirical evidence for mentalization-based psychoanalytic treatment |
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43 | (1) |
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44 | (2) |
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Cognitive analytic therapy |
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46 | (1) |
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46 | (1) |
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Dialectical behaviour therapy (DBT) |
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47 | (2) |
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Therapeutic community treatments |
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49 | (1) |
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50 | (2) |
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51 | (1) |
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51 | (1) |
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51 | (1) |
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Problems of outcome research |
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52 | (3) |
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Randomization and personality disorder |
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52 | (3) |
Chapter 3: Mentalization-based understanding of borderline personality disorder |
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55 | (56) |
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The developmental roots of borderline personality disorder |
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55 | (1) |
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The relevance of the attachment theory perspective |
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56 | (1) |
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Optimal self-development in a secure attachment context |
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57 | (25) |
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Early stages of self-development |
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59 | (3) |
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The infant's sensitivity to social contingency |
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59 | (2) |
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61 | (1) |
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The self as an intentional and representational agent |
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62 | (6) |
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Parental mirroring and the development of mental state concepts |
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64 | (4) |
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Psychic equivalence and the pretend mode |
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68 | (2) |
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70 | (5) |
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Reflective function and attachment |
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75 | (4) |
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Neurological basis of mentalization |
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79 | (3) |
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The impact of an insecure base |
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82 | (9) |
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82 | (1) |
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83 | (2) |
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Enfeebled affect representation and attentional control |
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85 | (2) |
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Disorganization of attachment |
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87 | (1) |
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Establishment of the 'alien self' |
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88 | (2) |
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90 | (1) |
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The impact of attachment trauma |
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91 | (18) |
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92 | (2) |
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Changes to the arousal 'switch' |
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94 | (2) |
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Psychic equivalence, shame, and the teleological stance |
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96 | (1) |
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Failure of mentalization and the exposure of the 'alien self' |
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97 | (7) |
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Interpersonal relating and the transference |
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99 | (1) |
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100 | (1) |
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101 | (1) |
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Impulsive acts of violence |
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101 | (2) |
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103 | (1) |
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104 | (5) |
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109 | (2) |
Chapter 4: Current models of treatment for borderline personality disorder |
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111 | (34) |
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Transference-focused psychotherapy (TFP) |
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112 | (7) |
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117 | (2) |
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Dialectical behaviour therapy |
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119 | (7) |
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119 | (2) |
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121 | (1) |
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Mentalization and mindfulness |
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122 | (2) |
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124 | (2) |
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Cognitive behavioural therapy |
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126 | (3) |
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Cognitive analytic therapy (CAT) |
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129 | (3) |
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129 | (1) |
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Reformulation and interpretation |
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130 | (2) |
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Psychodynamic-interpersonal |
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132 | (2) |
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134 | (1) |
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Other North American approaches |
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135 | (4) |
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Other European approaches |
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139 | (2) |
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Mentalization: The common theme in psychotherapeutic approaches to borderline personality disorder |
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141 | (3) |
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144 | (1) |
Chapter 5: Treatment organization |
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145 | (38) |
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145 | (1) |
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145 | (3) |
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146 | (1) |
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147 | (1) |
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147 | (1) |
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148 | (2) |
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150 | (6) |
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150 | (2) |
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Characteristics of training |
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152 | (1) |
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152 | (1) |
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The key worker or primary clinician |
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153 | (1) |
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The responsible medical officer |
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154 | (2) |
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156 | (2) |
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158 | (17) |
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159 | (3) |
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159 | (2) |
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Clarification of key problems, as identified by the patient |
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160 | (1) |
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Explanation of the underlying treatment approach and its relevance to the problems |
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160 | (1) |
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Information about individual and group therapy and how it can lead to change |
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160 | (1) |
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An outline of confidentiality |
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161 | (1) |
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Clarification of some basic rules |
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161 | (4) |
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161 | (1) |
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161 | (1) |
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162 | (1) |
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Stabilizing social aspects of care |
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162 | (1) |
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Assuring the possibility of contact with the patient |
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162 | (1) |
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163 | (1) |
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Defining and agreeing roles of mental health professionals and others involved in the care of the patient |
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164 | (1) |
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165 | (2) |
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Interpersonal behaviour and intimate relationships |
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165 | (1) |
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Previous treatments and their outcome |
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166 | (1) |
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Formation of relational and working alliance |
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167 | (2) |
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167 | (2) |
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Reliability and readiness to listen |
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169 | (1) |
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169 | (3) |
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170 | (2) |
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172 | (2) |
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General strategic recommendations |
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173 | (1) |
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173 | (1) |
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173 | (1) |
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174 | (1) |
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174 | (1) |
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174 | (1) |
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175 | (4) |
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175 | (2) |
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177 | (2) |
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179 | (1) |
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180 | (1) |
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181 | (2) |
Chapter 6: Transferable features of the MBT model |
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183 | (20) |
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183 | (4) |
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183 | (1) |
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184 | (2) |
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184 | (2) |
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186 | (1) |
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Consistency, constancy, and coherence |
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187 | (2) |
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187 | (1) |
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187 | (1) |
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188 | (1) |
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189 | (2) |
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189 | (1) |
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189 | (1) |
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190 | (1) |
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191 | (1) |
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191 | (1) |
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191 | (1) |
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191 | (1) |
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192 | (2) |
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192 | (1) |
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193 | (1) |
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194 | (1) |
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Individual approach to care |
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194 | (1) |
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194 | (1) |
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194 | (1) |
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195 | (1) |
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195 | (5) |
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195 | (1) |
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196 | (1) |
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196 | (3) |
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Summary of guidelines for psychopharmacological treatment |
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199 | (1) |
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Integration of modalities of therapy |
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200 | (1) |
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201 | (2) |
Chapter 7: Strategies of treatment |
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203 | (18) |
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203 | (2) |
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205 | (2) |
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207 | (3) |
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Retaining mental closeness |
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210 | (2) |
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211 | (1) |
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Working with current mental states |
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212 | (2) |
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Bearing in mind the deficits |
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214 | (2) |
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216 | (4) |
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217 | (1) |
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Hyperactive mentalization and pretend mode |
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218 | (2) |
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220 | (1) |
Chapter 8: Techniques of treatment |
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221 | (48) |
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Identification and appropriate expression of affect |
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222 | (30) |
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222 | (2) |
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222 | (1) |
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General strategic recommendations for identification of affects |
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222 | (1) |
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222 | (1) |
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223 | (1) |
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224 | (9) |
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224 | (9) |
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224 | (1) |
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General strategic recommendations for dealing with problems of impulse control |
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225 | (1) |
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Suicide attempts and self-harm |
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225 | (1) |
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228 | (1) |
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230 | (1) |
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231 | (1) |
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232 | (1) |
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Other challenging affect states |
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233 | (19) |
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233 | (5) |
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233 | (1) |
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General strategic recommendations |
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234 | (1) |
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Aggression related to paranoid anxiety |
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234 | (2) |
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236 | (1) |
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237 | (1) |
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238 | (2) |
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238 | (1) |
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239 | (1) |
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240 | (2) |
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240 | (1) |
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241 | (1) |
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242 | (2) |
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242 | (1) |
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243 | (1) |
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244 | (3) |
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245 | (1) |
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246 | (1) |
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247 | (3) |
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248 | (1) |
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249 | (1) |
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250 | (2) |
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250 | (1) |
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251 | (1) |
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Establishment of stable representational systems |
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252 | (8) |
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252 | (8) |
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252 | (1) |
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General strategic recommendations |
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253 | (1) |
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Individual and group sessions |
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253 | (7) |
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Identifying primary beliefs and linking them to affects |
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254 | (2) |
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Identifying and understanding second-order belief states |
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256 | (1) |
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Exploring wishes, hopes, fears, and other motivational states |
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257 | (1) |
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258 | (1) |
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259 | (1) |
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Formation of a coherent sense of self |
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260 | (3) |
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260 | (3) |
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260 | (1) |
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General strategic recommendations |
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261 | (1) |
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261 | (1) |
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262 | (1) |
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Development of a capacity to form secure relationships |
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263 | (4) |
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263 | (7) |
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263 | (2) |
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General strategic recommendations |
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265 | (1) |
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265 | (1) |
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266 | (1) |
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267 | (2) |
Chapter 9: Implementation pathway |
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269 | (18) |
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Step 1: Consider the context in which you work, identify your skills and how you practice, and audit your resources |
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270 | (2) |
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270 | (1) |
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271 | (1) |
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272 | (1) |
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Step 2: Apply organizational principles |
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272 | (6) |
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273 | (1) |
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274 | (1) |
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274 | (1) |
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275 | (1) |
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276 | (1) |
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277 | (1) |
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Step 3: Modify the aims and techniques of your current practice |
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278 | (3) |
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Identify iatrogenic aspects of current practice |
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278 | (1) |
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Increase mentalization skill set incrementally to replace current iatrogenic techniques |
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279 | (2) |
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Step 4: Implement procedures for dealing with challenging behaviours |
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281 | (1) |
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Step 5: Constantly evaluate your practice |
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281 | (6) |
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281 | (1) |
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282 | (1) |
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Patient experience of treatment |
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282 | (5) |
Appendix 1: Suicide and self-harm inventory |
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287 | (14) |
Appendix 2: Training materials |
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301 | (12) |
Appendix 3: Crisis plan |
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313 | (2) |
Appendix 4: Rating of MBT adherence and competence |
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315 | (4) |
Appendix 5: Text of intensive out-patient programme (IOP) leaflet |
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319 | (2) |
Appendix 6: Admission feedback questionnaire |
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321 | (2) |
References |
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323 | (50) |
Index |
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373 | |