1. The effectiveness of psychosocial treatments. In 1996 I co-published the first systematic and comprehensive review of quantitative studies of the efficacy of psychological therapy in relation to the major diagnostic categories of mental health disorder, accompanied by an explication of the clinical implications of this literature, as was the companion volume concerning treatments for children. Beyond reviewing the studies of others, I am involved in several multisite psychosocial treatment trials including a large RCT of manualized outpatient therapy for BPD funded by the Borderline Personality Disorder Research Foundation (N = 134) , and the largest UK trial of adolescent conduct disorder (N=687) examining the efficacy of MST (START) over 24 months. Further forensic trials include a trial of a group intervention for aggression based in probations (MOAM), The Peaceful Schools Project, a cluster randomized study of a mentalization-based violence prevention program, and, a unique prison-based cluster-randomized project working with mothers incarcerated with infants in mother and baby units.

2. Mentalization-Based Treatment. A developmental, mentalization-based approach to the understanding of BPD from an attachment–mentalization perspective included establishing mentalization as a cross-cutting feature in the development of psychopathology. In multiple papers, we have elaborated and extended a model of BPD development, based in insecure parent-child attachment associated with a low threshold for the activation of the attachment system and a deactivation of controlled mentalizing, a tendency to hypermentalize and poor integration of cognitive and affective aspects of mentalizing, including difficulties in differentiating between mental states of the self and others. With the development of MBT, a research-based dynamic therapeutic approach, I have collaborated with many clinical sites in the UK and USA to evaluate treatment outcomes and mechanisms of MBT. MBT is based on my transgenerational model of personality development based on the finding that a caregiver’s ability to mentalize was a significant predictor of infant’s attachment. Subsequent meta-analyses demonstrated MBT’s efficacy in treating BPD in adolescents and adults.

3. Neurobiology of Mental Disorder. In incorporating a neuroscience perspective to the emergence of psychiatric disorders in adolescence, another component of my work concerned the neurobiology of social cognition. Drawing from findings from social–cognitive neuroscience, we described how early attachment relationships moderate gene expression in youth as well as describing a multi-dimensional model of mentalizing based in neurobiology. Through multiple collaborative programmes, we have succeeded in identifying differences in brain responses to infant affect expressions in normal mothers and a moderation of this neural response by mother’s attachment classification. From a hyper-scanning study of BPD, the biggest imaging study of the disorder so far (55 BPD patients). With UK collaborators, we are investigating the neural correlates of emotional development and maltreatment-associated attachment disorganization in children. Advancing this work, we were successful in obtaining a significant (£5.4m) Strategic Award from the Wellcome Foundation for a collaborative programme of work between Cambridge University & UCL.