Mother-Infant Dialectical Behavioural Therapy (MI-DBT) Evaluation

20-week mother-infant dialectical behavioural therapy (MI-DBT) group, delivered to 8-12 women annually, with skills group, individual therapy, and phone coaching components. Women with a diagnosis of borderline personality disorder and an infant under two years of age are offered enrolment into an adaptation of an evidence-based therapy for perinatal BPD, Mother-infant dialectical behaviour therapy. Mothers attend groups whilst their infants receive care close by, and at the conclusion of the mother-only groups, infants join the group and mother-infant work concludes the group. In addition to a 20 session group program for the mothers, adapted from the South Australian model, 1. Introduction of weekly individual therapy sessions 2. Introduction of phone skills coaching during business hours Group skills content is organised in the four usual DBT categories of emotional regulation, mindfulness, distress tolerance, and interpersonal effectiveness. The Circle of Security (COS) parenting program (Powell 2016) is an evidence-based attachment focused parenting intervention, which helps parents to make sense of their own emotional reactions to the needs of their child, and improve reflective parenting function. COS content is interwoven with DBT content. Group skills sessions last for 2 to 2 ½ hours weekly for 20-24 weeks except in school holidays. They are administered by a team of psychologists, social workers, psychiatrists and mental health occupational therapists. Skills groups consist of mindfulness, homework review, teaching of new skills and in-vivo practice of skills, setting of homework, and a mother-infant component, for example mindfulness activities involving the infant, or coaching on reunion with the infant. Attendance is recorded on the electronic medical record. Weekly therapy sessions last for 1 to 1 ½ hours and are conducted either in person or by videoconference. There is a precommitment phase of between 3-5 weeks of weekly sessions, followed by 20-24 weeks of weekly therapy sessions except during school holidays. Individual sessions consist of mindfulness, diary card and homework review, and review of the use of DBT skills through the week where possible incorporating content involving the infant. Attendance is recorded on the electronic medical record. Phone coaching is available during working hours, clients can phone the MI-DBT team and one of the clinicians involved in the intervention, although not necessarily their allocated clinician, will coach them to use skills to manage distressing situations for 5-10 minutes. After hours clients can access the crisis mental health team who can provide some limited DBT informed phone support. Use of phone coaching is recorded on the electronic medical record.