Prof Peter Fonagy
Head of the Division of Psychology and Language Sciences
Clinical, Edu & Hlth Psychology
Div of Psychology & Lang Sciences
- Joined UCL
- 1st Sep 1977
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.
I have a leadership role in the development and ongoing growth of clinical psychology within UCL and the teaching of psychoanalysis. There was no clinical psychology at UCL when I joined the staff in 1977. It took 10 years (1977 to 1986) for us to be able to establish a programme. In 2017 we celebrated the 30th anniversary of the Clinical Psychology Professional training programme which I established at UCL and which I was proud to co-Direct for 25 years, now the most popular and respected doctoral programme in the UK. Despite cuts on almost all other UK-based courses in 2007 and 2011, UCL retained all its 42 new commissions (126 in total), which indicates the esteem in which this course is held by the Strategic Health Authority. It remains the most popular program in the country in terms of the number of applications (1,300 this year). I have overseen a successful major expansion of the programme (across 3 years from 15 to 150) associated with staff expansion (from 4 to 24), change of degree status (MSc to a Doctoral degree), pay scale and workload reallocation negotiations, introduction of new examination procedures and successfully negotiated several 10 major quality and accreditation reviews, the last of which identified UCL as housing a ‘beacon programme’.
I have worked to maintain UCL at the forefront of psychological therapy training: established an MSc in Cognitive Behaviour Therapy, successfully bid, in collaboration with the Institute of Psychiatry, to be providers of training for around 120 ‘Wellbeing Practitioners’ and in 2008-2009 established the Increasing Access to Psychological Therapies (IAPT) Postgraduate Diploma, which is continuing full strength despite cuts in 2010-2011. A further fully funded IAPT Postgraduate Diploma programme for child and adolescent professionals involving also training of supervisors and managers was established in 2012 following a tendering process to provide professional training in CBT, Parenting training, Intrapersonal Psychotherapy and Systemic Family Psychotherapy as well as management and supervision training to 100s of CAMHS professionals in London and the South East.
I have worked hard to fulfil the mission of my endowed Chair: the promotion of the teaching of psychoanalysis at a world-class university. The cumulative achievements over 25 years provide evidence for the continued success of these efforts. In 1993 I established the MSc in Psychoanalytic Developmental Psychology in collaboration with the Anna Freud Centre and in 1996 the MSc in Theoretical Psychoanalytic Studies with major contributions from the Institute of Psychoanalysis, which I now co-direct. In 2000 we set up a Doctorate in Child Psychotherapy. In 2006, I initiated and contributed to the successful establishment of a joint Masters programme with Yale University covering a psychodynamic approach to developmental psychopathology from a neuroscience perspective (MSc in Psychodynamic Developmental Neuroscience). A further initiative in 2009-2010 was the establishment of a psychoanalytic research school to provide doctoral-level research supervision for those interested in pursuing a PhD in Psychoanalysis, with 35 PhD students now in the school.
- University College London
- Doctorate, Doctor of Philosophy | 1980
- British Psychological Society
- Other Postgraduate qualification (including professional), Diploma | 1980
- University College London
- First Degree, Bachelor of Science (Honours) | 1974
Professor Peter Fonagy OBE FMedSci FBA PhD
Peter Fonagy is Head of the Division of Psychology and Language Sciences at UCL; Chief Executive of the Anna Freud National Centre for Children and Families, London; Consultant to the Child and Family Programme at the Menninger Department of Psychiatry and Behavioural Sciences at Baylor College of Medicine; and holds visiting professorships at Yale and Harvard Medical Schools.
He is Programme Director of the UCLPartners Integrated Mental Health Programme, Senior National Clinical Advisor of the NHS England Children and Young People’s Mental Health programme, the Leader of the Mental Health theme in the North Thames CLAHRC and a Senior Investigator for the National Institute of Health Research. He has occupied a number of key national leadership positions including Chair of the Outcomes Measurement Reference Group at the Department of Health, Chair of two NICE Guideline Development Groups, Chair of the Strategy Group for National Occupational Standards for Psychological Therapies and co-chaired the Department of Health's Expert Reference Group on Vulnerable Children.
His clinical interests centre on issues of early attachment relationships, social cognition, borderline personality disorder and violence. A major focus of Professor Fonagy’s contribution has been an innovative research-based dynamic therapeutic approach, called Mentalization-Based Treatment, which was developed in collaboration with a number of clinical sites both in this country and in the US. He is currently PI or Co-PI on research grants worth in excess of £15 million. He has published over 450 scientific papers and 250 chapters and has authored or co-authored 17 books. He is a Fellow of the British Academy, the Academy of Medical Sciences, and the American Association for Psychological Science, and was elected to Honorary Fellowship by the American College of Psychiatrists. He has received Lifetime Achievement Awards from several national and international professional associations including the British Academy, the British Psychological Society and the World Association for Infant Mental Health.