Reflection of people walking on sidewalk covered in rainMentalization-Based Therapy (MBT) is a type of psychodynamic therapy designed to treat borderline personality. The process of mentalizing, or the capacity to understand how actions are influenced by mental states, is the focus of MBT.

History and Development

The concept of mentalization draws roots from John Bowlby’s attachment theory. Bowlby believed secure attachment between an infant and their primary caregiver lays the foundation for emotional stability and healthy relationships. If a baby is raised by a nurturing and attentive caregiver, they are likely to grow up with an increased understanding of their own and other people’s emotions, facilitating healthy emotional regulation and mentalization. If, however, a baby is neglected or develops an insecure attachment to their parent, they may be vulnerable to difficulties with emotional regulation later in life. Additionally, it is thought an insecure attachment impairs an individual’s ability to mentalize. If a caregiver is absent or inconsistent, the child might have difficulty understanding the intentions behind their actions, resulting in impaired capacity for mentalization.

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Peter Fonagy and Anthony Bateman applied the concept of mentalization to treating people with borderline personality, creating Mentalization-Based Therapy. They believe people with borderline personality (BPD) have a limited ability to mentalize, due either to genetic predisposition or early exposure to neglect. The limited ability to mentalize could result in difficulty identifying personal thoughts and feelings, as well as those of others. 

Techniques Used in Mentalization-Based Therapy

The primary goal of MBT is to increase an individual’s ability to mentalize. To do so, a therapist focuses on the person’s mental state, including their thoughts, feelings, and desires. One of the initial goals of treatment is to stabilize how emotion is expressed in therapy, which can mean helping the individual get their emotions under control so they do not act impulsively. Regulating emotional expression is often considered necessary before an individual explores how their mind and the minds of others work. 

The specific techniques used in MBT vary greatly, as many interventions that enhance a person’s capacity for mentalization are perceived as useful. A therapist might ask questions that help the individual explore their own mental state or make interpretations to help the individual better understand their own thoughts or wishes.

Though there are a variety of techniques used in MBT, practitioners maintain a specific therapeutic stance throughout the course of therapy. This stance typically involves curiosity and patience as the therapist and person in therapy explore different perspectives. In these instances, the therapist accepts that different perspectives exist and questions the individual about their personal experience while maintaining awareness of their own mentalization process. The therapy session may then provide space for understanding mental processes that occur both within and beyond therapy.   

How Does Mentalization Work? 

Babies and children with secure attachment to their primary caregiver often learn to understand the emotions of others before their own emotions. A sensitive caregiver is likely to be attuned to their child’s emotions and mirror them. For example, when a baby is in distress, the caregiver may display an expression of concern or worry on their own face. When the child sees this expression of concern, they can then begin understanding their own feelings and develop the ability to mentalize.

MBT may promote this capacity for mentalization in people who lacked a secure attachment in childhood. The main mechanism for this change is the establishment of a therapeutic attachment in which the mental states of self and others are explored. The therapist can help the individual form rational, coherent representations of their thoughts and feelings. This increased capacity for mentalization may then help the individual more effectively understand and regulate their thoughts and feelings. 

Issues Treated with Mentalization-Based Therapy

Research has found MBT to be an effective treatment for individuals with borderline personality. However, there are many mental health issues that involve some degree of difficulty with mentalization, including depression, antisocial personality, eating issues, and addiction, and MBT may be applied to treat them. MBT has also been used in family therapy and to improve relationships between parents and children. Additionally, some people whose mental health conditions did not respond well to other types of treatment have found MBT effective. 

Training and Certification

Therapists are not required to be certified in Mentalization-Based Therapy to use the approach. In fact, some therapists use mentalization as part of their work, regardless of the specific theoretical orientation or approach they subscribe to. However, training and certification is available for practitioners who wish to become more adept at MBT. Training typically involves taking a basic course on MBT, clinical supervision, and completing an advanced certificate course. The training program is offered in various locations throughout the United States and internationally through the Anna Freud National Centre for Children and Families. 

Concerns and Limitations

Developers of MBT acknowledge that the treatment may not differ much from other interventions used to treat those with borderline personality. If so, other techniques may be just as effective as MBT. Additionally, although MBT has been shown to be an effective treatment for borderline personality, research supporting its effective application to other mental health issues is still emerging.

References:

  1. Allen, J.G., Bleiberg, E., & Haslam-Hopwood, T. (2003). Clinical resources: Understanding mentalizing. Retrieved from http://www.menningerclinic.com/education/clinical-resources/mentalizing
  2. Bateman, A. & Fonagy, P. (2010). Mentalization based treatment for borderline personality disorder. World Psychiatry, 9(1), 11-15. doi: PMC2816926 
  3. Fonagy, P. & Bateman, A.W. (2006). Mechanisms of change in mentalization-based treatment of BPD. Journal of Clinical Psychology, 62(4), p. 411-430. doi: 10.1002/jclp.20241 
  4. Mentalization-based treatment: Basic training. (n.d.). Anna Freud National Centre for Children and Families. Retrieved from http://www.annafreud.org/training-research/training-and-conferences-overview/training-at-the-anna-freud-national-centre-for-children-and-families/mentalization-based-treatment-basic-training/