Mentalization Based Therapy

If you or a loved one have been diagnosed with borderline personality disorder (BPD), you may be looking for professional support and treatment. Many treatment options are available, but mentalization-based therapy (MBT) may be one of the most beneficial therapies for people with BPD. Mentalization-based therapy can help those with borderline personality disorder better understand themselves and others, and it can be delivered in person or online. Borderline personality disorder (BPD) is often characterized by a pattern of mood instability, challenges with interpersonal relationships, and an unstable or insecure self-image. However, people with BPD don’t need to feel defined or limited by their diagnosis. With the support and understanding of professionals, it is possible to manage the symptoms of BPD and enjoy healthy, fulfilling relationships.  

An introduction to mentalization based therapy

Curious about mentalization-based therapy?

Learn more in therapy

The first step in mentalization-based therapy may be to establish a trusting relationship between the client and therapist. In any form of therapy, this foundation may be necessary to ensure that the patient feels safe while discussing personal topics. Because borderline personality disorder (BPD) can be one of the most frequently misdiagnosed and misunderstood personality disorders, therapists may approach each MBT session with care and strive to help patients feel understood.

Dr. Carla Sharp, a BPD researcher, says that we can only help people with BPD feel understood when we slow down. Children and adults with BPD may have especially sensitive temperaments, which can make it important to slow down when discussing emotional content in sessions. With patience, effort, and the support of a therapist and loved ones, those with BPD may develop their capacity for mentalization, which can improve their ability to navigate social situations and enhance their overall mental health.

How does MBT work?

MBT therapists may set two main goals for their clients: 

1. Stabilize their emotional expression.
2. Reduce their impulsive behaviors.

By evaluating a person with BPD, a mental health professional practicing mentalization-based treatment may gain a general understanding of the person’s challenges with emotional expression, mentalization, impulsivity, and other concerns associated with BPD. Throughout treatment, which typically spans 12 to 18 months, therapists may work to maintain a mentalizing stance, meaning that they may figuratively “sit” with the person in an effort to unravel their mental processes.

For mentalization based therapy, this can mean therapists asking themselves the same questions they ask patients such as:

• Why am I feeling like I do now?
• Why is the patient behaving like this?
• What might I have done to affect the client’s emotional state? 

In contrast to other therapies, which may offer skills, insights, and explanations, mentalization-based treatment or MBT typically emphasizes teamwork between a therapist and client. With the therapeutic support of their mentalization-based therapy “teammate”, a person with BPD may be challenged to get curious about their internal experiences and reflect on the internal states of other people with BPD through group sessions.

Therapist-patient relationship in MBT

As with any therapy, the therapist-patient bond can be essential in mentalization-based therapy. As an emotional attachment develops, a patient may be able to internalize and learn from healthy interactions with their therapist. Ideally, as the therapist-patient duo works together to process the patient’s experiences (which include present interactions with the therapist), the patient may improve their ability to mentalize and apply a more flexible, nuanced mindset to their non-therapeutic relationships.

How does MBT improve mentalization? 

One of the greatest challenges of BPD can be learning to understand other people, which is why therapists practicing mentalization-based treatment are usually equally involved in the mentalization process. People with BPD may commonly face challenges with mentalization under the following circumstances:

Hyperactivation

When a person with BPD attaches to another person too quickly, they might idealize that person and risk becoming overly trusting. People with hyperactive tendencies may have a history of volatile relationships.

Deactivation

In the event of emotional distress, a person with BPD may take the alternate route by distancing themselves emotionally. People who deactivate tend to avoid intimate relationships and may isolate themselves from others.

Mixed hyperactivation and deactivation

People with BPD might not fall neatly into one of the above categories. MBT therapists may see a combination of hyperactivation and deactivation when their patients relate to and describe others. As they transition from hyperactivated to deactivated emotional states, people with BPD may move through relationships quickly or engage in self-destructive behaviors. By identifying where and how a person experiences difficulty with mentalization, a mental health professional can identify the best therapeutic starting point for that individual. 

Other treatments for borderline personality disorder

For some patients, mentalization-based therapy alone may not be enough to manage the symptoms of BPD. Many people benefit from working with a therapist, psychiatrist, and doctor. Together, these professionals can address other aspects of BPD and recommend medication when appropriate. Depending on the person’s symptoms and goals, they may also pursue other BPD therapies such as the following: 

CBT

CBT may be another effective option for people with BPD. The goal of CBT is often to help patients recognize negative thought patterns and respond with healthy coping strategies. Cognitive behavioral therapy is often effective in treating a wide range of mental health disorders, such as depression, anxiety, and eating disorders, as well as BPD.

Schema treatment

Schema Therapy (ST) typically combines elements from CBT, attachment theory, gestalt therapy, and other psychodynamic perspectives. It can help patients unpack their schemas, which are cognitive structures representing our knowledge about various concepts. Using ST, therapists can help their clients identify and remedy dysfunctional schemas and develop coping skills in a safe environment.

Dialectical behavioral therapy

DBT is an empirically supported therapy option for people with BPD. During DBT treatments, individuals may work on four main goals: distress tolerance, emotional control, interpersonal effectiveness, and mindfulness.

Transference-focused psychotherapy (TFP)

TFP generally focuses on the symptoms and self-destructive behaviors associated with BPD. It may emphasize the present experience of the therapist and patient, rather than the patient’s past. TFP treatments typically last from one to three years and may require a treatment contract as well as clearly defined goals.