Adaptive mentalization-based integrative treatment

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Adaptive mentalization-based integrative treatment (AMBIT) is a novel adaptation^[1] (by Dickon Bevington, Peter Fuggle, Liz Cracknell, Peter Fonagy, Eia Asen, Mary Target, Neil Dawson and Rabia Malik) of the theory of mentalization and practices of mentalization-based treatment to address the needs of chaotic, complex and multiply comorbid youth, via team-based (predominantly outreach) multimodal practices.^[2]

Previously called "adolescent mentalization-based integrative treatment", AMBIT changed its name to "adaptive..." in recognition of the fact that it is now being used by a wide range of teams across the UK and internationally, that extend beyond the adolescent age range (adults with severe and enduring relational difficulties, families with children where there are safeguarding concerns, young adults, etc.) Adaptation is also at the heart of AMBIT, which encourages local teams to adapt, build upon, and share these adaptations to its core components; AMBIT aspires to be an Open-source model of therapy innovation. This name change was recognised in the recent book published by Oxford University Press ^[3]

These practices, shaped by an eightfold principled therapeutic stance and using mentalization as the integrating framework, balance the development of a strong therapeutic attachment to a key worker with strong peer-to-peer relationships between workers that are designed counteract the potential for destabilizing effects from such intense work.^[4]

Mentalization is applied and fostered explicitly in four directions in AMBIT:

• Towards the young person and their family/carers.
• Towards colleagues and peers at the level of the team.
• Towards the wider multi-agency network.

In addition, a range of manualized 'barefoot' adaptations of existing evidence-based treatment modalities are available to workers, but the approach also encourages the development of a culture of team-based reflection upon practice and outcomes, of learning, and of sharing. This has much in common with the notion of a "learning organisation" stance (see the work of Peter Senge) within local teams, but AMBIT includes the promotion of constrained and disciplined approaches to the local adaptation of each team's own wiki-based practice manual. These wikis come to represent specific local implementations that offer a "fit" for local cultures and service ecologies. The collaborative disciplines around their adaptation is a practice referred to as "manualization"; manualization is seen as analogous to mentalization at the level of the team (making sense of "why we practice in this way in that kind of situation", and broadcasting this transparently, with a view to improving this current understanding through feedback.)