What is Mentalization Based Treatment?

This article provides an overview of Mentalization Based Treatment (MBT), including theoretical foundations, applications, and evidence supporting its efficacy.

Related articles: What is Metacognitive Therapy?, What is Dialectical Behaviour Therapy?, What is Person Centred Therapy?, What is Acceptance and Commitment Therapy?

Introduction

Mentalization Based Treatment (MBT) is a psychotherapeutic approach designed to improve the mentalization capacity in individuals, particularly those with Borderline Personality Disorder (BPD). This article aims to provide mental health professionals with an understanding of MBT, its theoretical underpinnings, and its practical applications. We briefly mention its evidence base. As we explore this treatment modality, we will delve into its core components, the populations it benefits, and how it can be integrated into therapeutic practice.

What is mentalization?

Mentalization is the ability to understand the mental states – thoughts, feelings, desires, and beliefs – that underlie one’s own and others’ overt behaviours. Effective mentalization allows individuals to interpret human behaviour in terms of mental states, facilitating empathy, attachment, and healthy relationships. Deficits in mentalization, particularly evident in people with Borderline Personality Disorder (BPD), manifest as difficulties in understanding what others are feeling or thinking, often leading to interpersonal conflicts and intense emotional experiences.

Fundamentals of Mentalization Based Treatment (MBT)

Theoretical foundations of MBT

Developed by Peter Fonagy and Anthony Bateman, MBT is rooted in attachment theory and psychoanalytic concepts. It posits that borderline personality disorder and similar disorders stem from disruptions in early attachment relationships, leading to poor mentalization abilities. These early experiences can hinder the development of an individual’s capacity to understand the mental states of themselves and others, contributing to the symptoms and behaviours associated with BPD.

Core principles of MBT

Mentalization Based Treatment involves several key principles:

• Focus on mentalization: Therapy continually aims to bring attention to mental states and their impact on behaviour.
• Emphasis on relationships: Therapeutic encounters emphasise understanding and interpreting interpersonal interactions.
• Attachment security: The therapeutic relationship provides a secure base from which to explore mental states safely.

Mentalization Based Treatment (MBT) in practice

Mentalization Based Treatment can be applied in individual and group therapy settings, and it typically involves two phases:

• The initial phase: Focusing on stabilising the individual, building a therapeutic alliance, and fostering the capacity to mentalize.
• The consolidation phase: Aiming to apply mentalization skills to broader social and interpersonal contexts, reinforcing gains, and promoting further independence.

Some of the techniques used in MBT include:

• Controlled regression: Allowing the client to explore difficult thoughts and emotions in a safe environment.
• Clarification: Asking questions to clarify the client’s thoughts and feelings.
• Challenge: Gently challenging the client’s perceptions to foster deeper understanding.

Evidence base and efficacy for MBT

MBT has been extensively researched and is supported by empirical evidence, particularly in treating Borderline Personality Disorder (BPD). Studies have shown that MBT can significantly reduce symptoms of BPD, including emotional dysregulation, impulsivity, and self-harm. Additionally, improvements in social and interpersonal functioning have been noted, contributing to an overall enhancement in quality of life for clients.

Key studies supporting MBT include:

• Bateman and Fonagy’s seminal studies in the early 2000s demonstrating the effectiveness of MBT in reducing hospitalisations and improving BPD symptoms.
• Follow-up studies, which have shown sustained improvements in clients treated with MBT over several years.

Another therapeutic approach commonly used to treat clients with Borderline Personality Disorder (BPD) is Dialectical Behaviour Therapy (DBT). DBT was developed in 1991 by U.S. psychologist Marsha Linehan for use specifically with clients diagnosed BPD, who cope with distressing emotions and situations by using self-destructive behaviours such as suicide and self-harm, eating disorders, and substance abuse.

Conclusion

Mentalization Based Treatment represents a significant advancement in the treatment of borderline personality disorder and other conditions characterised by impaired mentalization. Its emphasis on understanding and interpreting mental states makes it a uniquely effective intervention in the realm of psychotherapy. When mental health professionals integrate MBT into therapeutic practices, it can significantly enhance outcomes for individuals struggling with complex emotional and interpersonal issues.

Key takeaways

• Mentalization, the ability to understand the mental states that drive behaviours, is a core focus of Mentalization Based Treatment (MBT), especially relevant for treating conditions like Borderline Personality Disorder (BPD).
• MBT is based on attachment theory and psychoanalytic principles, suggesting that disruptions in early attachment relationships can lead to deficits in mentalization.
• The therapeutic relationship in MBT provides a secure base for exploring and understanding mental states safely, through both the initial and consolidation phases of treatment.
• MBT is empirically supported, particularly for treating BPD, with studies indicating significant reductions in symptom severity and improvements in interpersonal functioning through better emotional regulation and reduced impulsivity.

References

• Bateman, A., & Fonagy, P. (1999). Effectiveness of partial hospitalization in the treatment of borderline personality disorder: A randomized controlled trial. American Journal of Psychiatry.
• Fonagy, P., & Bateman, A. (2006). Mechanisms of change in mentalization-based treatment of BPD. Journal of Clinical Psychology.
• Allen, J.G., & Fonagy, P. (Eds.). (2006). The Handbook of Mentalization-Based Treatment. John Wiley & Sons.