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Peter Fonagy, PhD, FBA

Research Summary

Peter Fonagy is a clinical psychologist and a training and supervising analyst in the British Psycho-Analytical Society in child and adult analysis. His clinical interests centre around issues of borderline psychopathology, violence and early attachment relationships. His work attempts to integrate empirical research with psychoanalytic theory.

Extensive Research Description

A major focus of my research has been an innovative research-based dynamic therapeutic approach developed in collaboration with a number of clinical sites both in this country (the Anna Freud Centre, the Halliwick Psychotherapy Service, the Marlborough Family Service, the Brandon Centre, Islington CAMHS) and in the US (the Menninger Clinic and the Yale Child Study Center). This has come to be known as “mentalization based treatment” or MBT and has been the subject of a number of recent books by our team (Mentalization Based Treatment for Borderline Personality Disorder: A Practical Guide – Oxford; Mentalizing in Clinical Practice- American Psychiatric Press) and collections of papers (Handbook of Mentalization Based Treatment – Wiley; Mentalization in Mental Health Practice- American Psychiatric Press), as well as increasingly others who have adopted our approach (Busch (ed) Mentalization: Theoretical considerations, research findings, and clinical implications;. Slade & Jurist, (eds), Mind to Mind: Infant Research, Neuroscience and Psychoanalysis). It is based on developmental research relevant to a theory of personality disorder reported in a frequently cited 1991 paper (Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age) and a number of books from our group (particularly Affect Regulation, Mentalization and the Development of the Self – Other Press). The books have been translated into most major languages and some not so major ones (Korean, Danish, Norwegian, Czech, Japanese, Hungarian) and have high citation rates: Affect Regulation, Mentalization and the Development of the Self has been cited 1,650 times and Attachment Theory and Psychoanalysis 700 times (Google Scholar). I am engaged in a major collaborative programmes exploring developmental psychopathology from an attachment-mentalization perspective. A longstanding collaboration with the Child and Family Program of the Menninger Clinic (consistently rated in the top three of US psychiatric hospitals) has been successfully extended to include the Yale Child Study Center (top rated Department of Child Psychiatry in the US based in the 2nd highest ranked university by world league tables such as the THES). This international collaboration has yielded a number of cutting-edge research programs funded from the Menninger Child and Family Center endowment and other extra-mural sources. These include a study of infant-mother attachment classification and brain imaging (Strahearn), the hyper-scanning (fMRI) of an economic exchange (trust) task with individuals with borderline personality disorder (King-Casas, Montague) and the neural correlates of attachment and borderline personality disorder (Sharp). The first of these collaborative programmes has succeeded in identifying differences in brain responses to infant affect expressions in normal mothers (published in Pediatrics) and a moderation of this neural response by mother’s attachment classification. The hyperscanning study of BPD is the biggest imaging study of the disorder so far (we have imaged 55 BPD patients) and a report was published in Science. The Yale connection has led to an exciting new development at the Anna Freud Centre where we have received funds to build a £250,000 dense array EEG laboratory (EGI), modeled on Dr Mayes’ infant laboratory at Yale. With UK collaborators (with Fearon - Reading, McCrory - UCL), we are investigating the neural correlates of emotional development and maltreatment-associated attachment disorganization in very young children. Advancing this work, recently we have been successful in obtaining a significant (£5.4m) Strategic Award from the Wellcome Foundation for collaborative programme of work between Cambridge Psychiatry (Goodyer [CI], Bullmore, Jones) and UCL (Dolan and Fonagy). The broader aim of the work is to contribute to the embedding of neuroscience in psychiatry brining a neuroscience perspective to the emergence of psychiatric disorder in adolescence. A second thread of my research involves UK research collaborations concerned with the effectiveness of psychosocial treatments. With Anthony Roth, in 1996 we published What works for Whom? A critical review of psychotherapy research (Guilford Press) which represented 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 (2,000 studies 1st edition, and 2,500 2nd), accompanied by explication of the clinical implications of this literature (2,990 citations for first edition and 1,346 citations for second) as was the sequel concerning treatments for children. Beyond reviewing the studies of others, I am involved in several multi-site psychosocial treatment trials. The treatment phase of a randomized controlled trial of manualised out-patient therapy for borderline personality disorder, in collaboration with Anthony Bateman, which was funded by the Borderline Personality Disorder Research Foundation is now completed having randomized one of the largest group of patients with a diagnosis of BPD (n=134) so far reported and we are currently engaged in the follow-up of the patient group. This was also at the core of our contribution to the Europe-wide interdisciplinary Marie Curie Programme on Disorders & Coherence of the Embodied Self (DISCOS) involving nine sites across Europe where I was the Project leader for UK site (€3,100,000 total, distributed across 9 sites). Another completed trial is the Peaceful Schools Project (a cluster randomized study of a highly economical mentalization based violence prevention programme for schools) a major report is under final revision for the major child psychiatry journal (JCPP). We have completed an SDO funded Evaluation of pilot community services for adults with personality disorder (PI: Mike Crawford, £286,076) with a report recently accepted by the British Journal of Psychiatry. A randomized controlled trial of parent-infant psychotherapy, with support from the Community Fund (£206,000 for 2004-8) is also nearly complete. We also completed with a grant from the Ministry of Justice a unique prison-based cluster-randomized project working with mothers incarcerated with infants in mother and baby units to help them develop the skills necessary for establishing strong early relationships with their child. With two child psychiatrists (Bevington, Asen), Mary Target and I are working to develop an integrative multimodal treatment for severe acute psychiatric disturbance in adolescents and young adults, part-funded by the John Lyons Charity (£90,000). We were awarded from Department of Children, Schools and Families £1,014,000 for A National Randomized Controlled Trial of Multisystemic Therapy in England for severe conduct pobelems. I am CI with 9 other senior collaborators on this project which will be the largest trial of conudct disorder ever undertaken - 450 of 700 patients have already been recruited. The NHS Health Technology Assessment (HTA) programme has also awarded us £2.46m to conduct a Randomised Controlled Trial of Brief Psychodynamic Psychotherapy (BPP), Cognitive Behaviour Therapy (CBT) and Treatment as Usual (TAU) in adolescents with moderate to severe depression, led by Ian Goodyer from Cambridge, where I am principal co-applicant and in charge of the North London site (the project comes with an additional £2,960,000 NHS support costs). I have assisted Dr Wolpert in setting up the CAMHS Evidence Based Practice Unit based at the Anna Freud Centre and am co-PI (with Norah Frederickson) on her recently awarded grant from the Department of Children, Schools and Families An Evaluation of the Targeted Mental Health in Schools (TMHS) Programme (£1,495,493). We have obtained a research for Patient Benefit grant from NIHR to evaluate Dynamic Interpersonal Therapy, a short term psychodynamic psychotherapy for depression (£249,000), which we have developed for IAPT (Lemma, Target & Fonagy – manual recently published by OUP) and where I am leading a pilot RCT. I have been fortunate in receiving significant recognition for my research contributions. I was honoured to be elected to the British Academy at the age of 45, and have contributed actively to the psychology section. The following year I received the Gradiva Prize of the US National Association for the Advancement of Psychoanalysis. In 2005 I was fortunate to be presented with the Otto Weininger Memorial Award for Achievement by the Psychoanalytic Section of the Canadian Psychological Association and in 2007 I received the Sigmund Freud Prize of the City of Vienna. In 2009 I was awarded the 4th Annual Award for Distinguished Achievement in the Field of Severe Personality Disorders by the BPD Resource Center and 2011 I was honoured with the Mary J Sigourney Award and Senior NIHR Investigator Award.

Research Interests

Adaptation, Psychological; Anxiety Disorders; Feeding and Eating Disorders; Mental Disorders; Child Rearing; Emotions; Human Development; Disruptive, Impulse Control, and Conduct Disorders; Mental Health; Mental Processes; Neurotic Disorders; Personality Disorders; Psychiatric Status Rating Scales; Psychoanalytic Interpretation; Psychological Phenomena; Psychological Tests; Psychology, Applied; Psychology, Social; Psychotherapy; Mood Disorders; Substance-Related Disorders; Resilience, Psychological; Psychiatry and Psychology

Public Health Interests

Health Care Quality, Efficiency; Health Care Management; Maternal & Child Health; Mental Health; Obesity; Poverty and Economic Security; Child/Adolescent Health; Health Systems Reform

Selected Publications