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Mentalization-Based Therapy

Reviewed by Psychology Today Staff

Mentalization-Based Therapy (MBT) is an evidence-based treatment for people with borderline personality disorder and other mental health issues that draws from several different psychotherapeutic approaches. 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

MBT 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 MBT to help heal relationships between parents and their children.

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What to Expect

MBT borrows common elements and techniques from psychodynamic, cognitive-behavioral, systemic, and social-ecological therapies. MBT practitioners work to establish a secure therapeutic attachment with patients, and create a safe environment in which patients can begin to deeply explore their own feelings and those of others, ultimately developing their capacity for mentalization. One intervention commonly used in MBT treatment is transference, or directing a patient’s emotions toward the therapist to facilitate analysis of those emotions.

How It Works

MBT 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, but also better understand that another person’s thoughts, feelings, and behavior may be different than the way they are interpreted by the patient. The goal of MBT is for patients to not only mentalize themselves but also mentalize others and think about what may be driving other people’s thoughts and behaviors so as to not misinterpret the meaning and respond inappropriately.

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 issues.

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Bateman A and Fonagy P. Mentalization based treatment for borderline personality disorder. World Psychiatry. February 2010;9(1):11-15.
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;165:631-638