Mentalization-Based Therapy

Mentalization-based therapy—or mentalisation-based therapy, as it’s written in the UK—operates on the premise that the ability to mentalize or understand one's own and others' mental states may be a challenge in individuals with certain mental health conditions like borderline personality disorder. The goal of the treatment of borderline personality disorder is to help strengthen this ability by creating a therapeutic environment based on evidence-based practices where patients in the treatment of BPD can explore thoughts, feelings, and behaviors without judgment. 

In this setting, the therapist based in this modality helps the patient identify gaps or inaccuracies in their mentalizing process, particularly during emotionally charged situations. The goal is to help turn the implicit into explicit, bringing unconscious thoughts and feelings into conscious awareness.

In individual sessions of treatment for borderline personality disorder, the therapist uses techniques to encourage the patient to reflect on their internal states and consider alternative perspectives. For example, if a patient describes a conflict with a friend, the therapist might ask questions like, "What do you think your friend was feeling during the argument?" or "How did your emotions influence your actions?" 

How mentalization-based therapy can impact thought patterns

These questions in mentalization-based treatment prompt the patient to engage in reflective thinking, a cornerstone of mentalization. The therapist may also use interventions to highlight moments when the patient may struggle with mentalizing, thereby providing feedback that can help the patient become more aware of their gaps in reflection.

Group therapy sessions in MBT can serve as a microcosm of the patient's external social world and offer a safe space to practice mentalizing skills with others enrolled in treatment for borderline personality disorder. Group members share experiences and reactions, allowing multiple perspectives to be considered. The therapist guides the group in exploring these different viewpoints and helps members recognize when their mentalizing ability may be compromised, such as when they’re emotionally activated or making assumptions about others. 

Over time, mentalizing in individual and group settings can help improve emotional regulation, reduce impulsivity, and enhance interpersonal relationships, contributing to overall psychological well-being.

Patients embarking on mentalization-based therapy can expect an initial assessment phase, which typically involves a series of diagnostic interviews and questionnaires to evaluate the individual's mental health condition and suitability for MBT and behavior therapy. 

This phase may also include an introduction to the basic principles of mentalization. In some cases, mentalization-based treatment of borderline personality disorder may be done alongside other modules designed to treat this personality disorder, such as dialectical behavior therapy (DBT).³ Dialectical behavior therapy also works on mindfulness⁴ and cognitive restructuring practices to support people with borderline personality disorder. The assessment helps establish a therapeutic alliance and set the stage for the work ahead. It allows the clinician to tailor the treatment plan to the patient's specific needs, considering the severity of symptoms, co-occurring disorders, and other relevant factors.

Once the assessment is complete, the patient engages in individual or group therapy sessions. Individual sessions are generally conducted weekly and last about 50 minutes. During these sessions, the therapist employs techniques to help improve the patient's mentalization skills. 

This may involve exploring the patient's emotional responses to specific situations, examining relational patterns, and identifying areas where they struggle. The therapist provides feedback and may use interventions to guide mentalizing lapses, thereby facilitating the development of more adaptive emotional and cognitive patterns.

Often conducted weekly, group sessions serve as an additional platform for practicing mentalization skills. These sessions are typically 75 to 90 minutes long and involve multiple participants under the guidance of one or more trained therapists. The group setting allows patients to interact with others working on improving their mentalizing abilities, providing a rich environment for learning and feedback. 

During these sessions, patients living with borderline personality disorder (BPD) and other conditions are encouraged to share their experiences, thoughts, and feelings while reflecting on the mental states of others in the group. The therapist moderates the discussion to remain focused on mentalization and provides corrective feedback as needed. Patients can expect a structured yet explorative therapeutic process to enhance their emotional regulation and interpersonal skills.

Mentalization-based therapy was initially developed to treat individuals with borderline personality disorder, characterized by emotional reactivity, impulsivity, and difficulties in interpersonal relationships. Clinical studies and randomized controlled trials have shown that MBT effectively reduces symptoms of BPD, including self-harm behaviors,⁵ emotional dysregulation, and relational conflicts. 

The therapy is focused on helping the individual better understand their mental states and those of others, thereby improving emotional regulation and social bonds. For patients with BPD, MBT offers a targeted approach to help manage the symptomatic behaviors associated with the disorder.

In addition to its application in treating BPD, randomized controlled trials show that MBT has been adapted for other psychiatric conditions. These include eating, substance use, and certain depression and anxiety disorders. 

The therapy has also been modified for adolescents, families, and couples. In these contexts, MBT focuses on the same core principles of teaching mentalizing skills but may incorporate specific techniques or interventions tailored to the unique challenges presented by each condition or demographic group.

It's worth noting that MBT may not be suitable for all individuals. Those with certain cognitive challenges, active psychosis, or an unwillingness to engage in the therapeutic process may not benefit from this form of treatment. 

However, MBT offers a structured yet flexible approach to improving mental health and interpersonal effectiveness for individuals interested in understanding the interplay between thoughts, feelings, and behaviors. The therapy may also benefit those who have found limited success with other forms of treatment and are seeking a more integrative and insight-oriented approach.

For those struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Research on mentalization-based therapy has shown promising results, particularly in treating borderline personality disorder. According to a systematic review published on PubMed, the evidence base for MBT includes a variety of study designs such as randomized controlled trials, uncontrolled pre- and post-effectiveness studies, and retrospective cohort studies. 

Additional information from a controlled trial at McLean Hospital corroborates the effectiveness of MBT in managing BPD. The hospital notes that MBT is a form of therapy that does not require extensive additional training for providers, making it relatively available for mental health professionals. This opportunity allows for a broader reach of this therapeutic approach, enabling more individuals to receive the care they need. 

The hospital emphasizes that MBT focuses on the patient's present experiences and aims to enhance the individual's ability to reflect on their thoughts, feelings, and behavior and those of others.

Moreover, while MBT is particularly effective for adults diagnosed with BPD and certain other client groups, the evidence for its effectiveness in treating conditions like depression and eating disorders is currently limited. Therefore, ongoing research is needed to further validate MBT's efficacy across a broad range of clinical presentations.

BetterHelp is one of the leading online platforms offering mental health services, including mentalization-based therapy (MBT) and other therapeutic approaches. The platform provides a convenient way to connect with licensed therapists trained in various modalities. 

To get started, individuals typically complete an initial questionnaire to assess their specific needs and preferences, which is then used to match them with a suitable therapist. The platform offers the flexibility of communicating with therapists via text, phone, or video sessions, accommodating different comfort levels and logistical constraints.

One advantage of using an online platform like BetterHelp is the ease of availability. Traditional in-person therapy may pose challenges, such as the limited pool of specialists in one's area, scheduling difficulties, or concerns about stigma. 

Online platforms can mitigate these difficulties by offering a wide range of therapists from the comfort of one's home. This can be particularly beneficial for individuals seeking specialized treatment approaches like MBT, developed by Anthony Bateman and Peter Fonagy, which may only be available in some localities.