Indications

Indication criteria

What must be present for treatment at the NPI:

Age

• The client is between 12 and 67 years old.
• Young people between the ages of 12 and 23 are assessed by the youth department.
• For clients aged 67 and over, the appropriateness of the treatment offered is assessed on a case-by-case basis.

Diagnostics

• The main diagnosis is a personality disorder within cluster B or C, with the exception of antisocial personality disorder (DPD).
• There is a plausible hypothesis that underlying personality problems play a role in the insufficient effect of any previous treatments aimed at syndrome disorders.

Motivation and treatability

• The client shows (partial) intrinsic motivation for treatment aimed at personality problems and has an interpersonal request for help.
• Curative treatment is considered feasible.
• The client has a meaningful daytime activity (guideline 4 half-days per week), such as (volunteer) work or study.

Cognitive functioning

• The IQ is higher than 80, with adequate cognitive functioning.
• Both verbal and performance intelligence scores are sufficient to understand and apply treatment interventions.

Psychological state

• There may be personality-related crises at registration, provided that they are not acute.
• Dissociative or reality testing problems that arise from stress with a weak personality structure can be assessed on a case-by-case basis.

Language skills

• The client has a sufficient command of the Dutch or English language for talk therapy.
• English-speaking clients can only participate in specific English-language programmes (not in the intensive programmes or the youth treatment offer).

Contraindications and exclusion criteria

What does treatment at the NPI exclude:

Diagnostics

• A syndrome disorder as a primary diagnosis.
• A personality disorder from cluster A as the main diagnosis.
• An antisocial personality disorder (DPD) as the main diagnosis.
• An autism spectrum disorder* (ASD) or similar problems as a main diagnosis.

At the case level, this can be deviated from provided that:

• • • Psycho-education and possibly. guidance, aimed at ASD.
    • There are suspicions of comorbid personality problems,
    • The client has a person-centred request for help that is in line with the NPI treatment model.
    • ASD is not in the foreground in the current functioning or in the request for help.

In such cases, it is assessed per case whether intake and treatment are appropriate.

*If an autism spectrum disorder has not yet been diagnosed, but there are suspicions or indications, the responsibility for screening and possibly diagnostic research lies primarily with the referrer.

Motivation & Treatability

• Lack of (partly) intrinsic motivation for treatment.
• Inability to reflect on a change-oriented request for help.
• Already had more than two intensive and curation-oriented treatments for personality problems in the past 5 years
• Psychosocial dysregulation that requires (first) different treatment or approach

Cognitive functioning

• An IQ lower than 80.
• Disharmonious intelligence profile that does not provide an adequate basis for treatment.
• Other cognitive disorders (such as ABI or dementia)

Psychological state

• Manifest psychotic complaints/state of mind.
• Structural severe dissociative syndrome disorders
• Acute psychiatric crisis or acute suicidality

Physical health

• BMI less than 17
• Morbid obesity can be a contraindication when the somatic complaints or need for care do not leave enough room for psychotherapy. In some cases, intake is done by a doctor/psychiatrist, who can also assess the somatic picture.

Substance use

• Substance dependence as a primary diagnosis.
• Substance abuse without motivation for change.

Specifically for internal Arkin references (in accordance with the rules of the Internal References and Collaboration Arkin) the following is additionally considered:

• What is the reason to refer now. Has a therapy break been observed?
• What is the reason that co-morbid personality problems are not treated in the referring specialty? What has already been tried to do?
• In case of unsuccessful treatment: is the reason the co-morbid personality disorder or is there another possible reason? Has the GGZ Care Standard been followed for the complaints in question?
• Has the referral been explicitly discussed with the client? Has the client received information about NPI and is it open to possibly. treatment at NPI?

Indication child and youth

Refer indications NPI

• Previous treatments for problems such as depression, anxiety, emotion regulation problems, problems in relationship and communication, school/work problems, have given insufficient results
• Motivated to understand the background of complaints
• Suspicion of identity problems and (precursors of) personality problems.
• Be open to involving your system that is structurally involved in our MBT treatment and is always part of the treatment under the age of 18.

Indication of pregnancy

• Previous treatments for problems such as depression, anxiety, emotion regulation problems, problems in relationship and communication, school/work problems, have given insufficient results
• Motivated to understand the background of complaints
• Suspicion of identity problems and (precursors of) personality problems.