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Mentalization-Based Therapy

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Mentalization-based therapy is an evidence-based treatment for people with borderline personality disorder and other mental health conditions that draws from several different psychotherapeutic approaches. Mentalization-based treatment was developed in the 1990s by Anthony Bateman and Peter Fonagy specifically for people with borderline personalities. Mentalizing, or the ability to focus on and differentiate between your own emotional state of mind and that of others, and understand how one’s mental state influences behavior, is a normal cognitive function that is limited in those with borderline personality disorder. Enhancement of mentalization and improved emotional regulation are at the core of MBT treatment.

When It’s Used

Mentalization-based therapy can be an effective treatment for increasing the capacity to mentalize in people with borderline personality disorder, antisocial personality, addiction, eating disorders, and depression, even when other treatments have been unsuccessful. Although there may also be a genetic basis, an inability to mentalize often stems from an insecure attachment to a parent, or abandonment issues early in life. If you lack an understanding of your own and other people's feelings, you may have difficulty both regulating your own problematic emotions and behavior and correctly identifying the thoughts and feelings of others. You may not understand the intent behind other people’s behavior and respond impulsively and inappropriately in ways that can disrupt your relationships. Family therapy may incorporate aspects of mentalization to help heal relationships between parents and their children.

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What to Expect

Mentalization-based therapy shares common elements and techniques with psychodynamic, cognitive-behavioral, systemic, dialectical behavior, and social-ecological therapies. MBT practitioners work to create a safe environment in which patients can begin a deep exploration of their own feelings and those of others, ultimately developing their capacity for mentalization. The health professional is very much focused on the client's present and not so much on the past

What is the difference between mentalization-based and dialectical behavior therapies?

Dialectical behavior therapy (DBT) is based in behaviorism, mindfulness, and the investigation of self, and mentalization-based therapy is based in psychoanalysis, attachment theory, and acceptance, among others. Both can be useful modalities.

How It Works

Mentalization-based therapy helps patients think before they react to their own feelings or to the perceived feelings of others. With an improved ability to mentalize, patients not only process their own thoughts, feelings, and related behaviors differently, they also better understand that another person’s thoughts, feelings, and behavior may differ from their own interpretation.

The goal of mentalizing is for patients to not only better understand themselves but also to improve theory of mind regarding others and to think about what may be driving other people’s thoughts and behaviors. Such an ability will help the patient avoid misinterpreting another person’s meaning and respond appropriately to them.

There have been studies conducted on mentalization for borderline personality disorder, with participants showing improvement in depressive symptoms, a decrease in suicidality and self-mutilation, and better social and interpersonal functioning, among other outcomes. Session frequency can differ but some therapists recommend two sessions a week both one-on-one with a mental health professional as well as group treatment; these sessions can last for 12 to 18 months or more.

What to Look for in a Mentalization-Based Therapist

Look for a licensed, experienced mental health professional with an understanding of borderline personality disorder, and some training and experience in mentalization-based interventions. In addition to finding someone with the appropriate educational background and relevant experience, look for a therapist with whom you feel comfortable working on personal, family, and relationship matters.

This therapist can be found in health clinics, private practice, and other settings and institutions.

Screen your potential therapist either in person or over video or phone. During this initial introduction, ask the therapist:

  • How they may help with your particular concerns
  • If they have dealt with this type of problem before
  • The process and timeline for treatment
Mentalization-based treatment for borderline personality disorder. World Psychiatry.
Bateman A and Fonagy P. Mentalization-based treatment. Journal for Mental Health Professionals. November 2013
Bateman A and Fonagy P. Mentalization-based treatment for borderline personality disorder. World Psychiatry. February 2010
Bateman A and Fonagy P. 8-year follow-up of patients treated for borderline personality disorder: Mentalization-based treatment versus treatment as usual. American Journal of Psychiatry. May 2008