A New Approach May Benefit People With Borderline Personality

"There's something new they are doing with BPD other than DBT," a psychologist said while sipping his coffee in the breakroom of my then-internship site. Early in my career, dialectical behavior therapy (DBT) had everything I was looking for in a therapy—evidence-based, clear protocol, and familiarity. Still, I was curious about what my colleague had to share. He told me about mentalization-based treatment.

What is mentalization?

The word "mentalization" gave me pictures of hypnosis and kid jokes. This couldn't be a real word, could it? Well, it is.

Mentalization describes how we relate to ourselves and others. It is an intricate dance of connection and awareness of what we and others think and feel. How well we mentalize can vary drastically based on the situation.

Yet, people with personality disorders like borderline personality often encounter specific challenges in mentalization. A person with borderline personality might become so blended with another person, for example, that they lose touch with themselves. Similarly, strong emotions can produce a sense that what one feels is reality, a pre-mentalizing stance called psychic equivalence. Psychic equivalence is a common problem in borderline personality and can make for difficulties in relationships.

Mentalization-based treatment

Mentalization-based interventions utilize a combination of group and individual therapy to assist individuals in understanding their unique profile of relating to self and others. An MBT therapist will practice listening with intensity, not just to provide support but to understand what the world looks like through others' eyes. Building awareness of mentalizing patterns can help individuals to find the strengths and challenges they are dealing with.

From here, magic can happen as relationships are mentalized both in and outside of the therapy room. A group component also lends a particular avenue for individuals to engage in mentalization in real time.

Mentalization-based treatment is complex. Yet, the goals of mentalization-based therapy are equally so. Often, a prime objective is to improve long-standing challenges with social connection, in addition to the emotion regulation and presence that are hallmarks of borderline personality disorder.

What's the evidence?

While dialectical behavioral therapy remains the most well-known psychotherapy for borderline personality disorder, mentalization-based therapy also has the status of an evidence-based treatment for borderline personality disorder.

A study in which participants received intensive mentalization-based therapy in a day treatment setting for over 18 months found that even 8 years later, 74 percent of recipients met the criteria for recovery from their borderline personality diagnosis (Bateman et al., 2021). Mentalization-based therapy has also shown efficacy in treating borderline personality in individuals who have experienced childhood trauma in addition to borderline personality (Smits et al., 2022).

With this in mind, 18 months of intensive therapy is not accessible to everyone. Adaptations have been made to mentalization-based therapy to make for a more compact version. A study comparing 84 clients in short-term and 87 in long-term mentalization-based therapy found no difference in outcomes between the groups (Juul et al., 2023).

Closing

A borderline personality disorder is a complex condition with a variety of treatment options. It involves a rainbow of experiences that manifest differently between people. What is most effective for one person might vary from what works for the next. Evidence-based psychotherapy, including dialectical behavioral therapy and mentalization-based therapy, is available. Still, options such as mentalization-based therapy grant new hope to individuals looking for a fresh approach.

To find a therapist, visit the Psychology Today Therapy Directory.