How Mentalization-Based Treatment Works
The first step in MBT is to help patients stabilize their emotional expression and limit their impulsive behaviors. Developing some initial control in these areas helps patients better sense states of mind within themselves and others.
The highly level of emotional attachment common in the therapeutic relationship allows the patient to internalize and learn from interactions with their therapist. Because it is harder for BPD patients to mentalize within intense relationships, the therapist will gradually increase this aspect of the therapeutic bond only as treatment progresses.
As the therapist and patient work together to process the patient’s experiences, including interactions with the therapist, the patient’s mentalizing capacity usually stabilizes. The patient gradually begins to apply a more nuanced and flexible mindset to understanding self and others within the therapeutic relationship and relationships outside of therapy.
Then, every week, the patient participates in individual and group therapy sessions for the determined length of treatment. Treatment is accompanied by crisis planning and integrated care with a psychiatrist or similar provider. A standard MBT treatment period lasts 12-18 months.
During the treatment process, the therapist and patient each express their understanding of the patient’s experiences and reasons for seeking treatment. The therapist does not take an authoritative or “correct” stance in such exchanges.
Instead, the therapist takes a position of curiosity towards patients and sits figuratively “side by side” with the patient in a shared effort to work out what is going on.
MBT is a proven, effective treatment
MBT therapists ask questions of themselves, such as, “Why is the patient behaving like this?” “What might I have done that explains the patient’s state?” “Why am I feeling as I do now?”
Such questions help the therapist maintain a “mentalizing stance.” The therapist may even share these questions with the patient to demonstrate ways to understand how another person may think and reach more accurate conclusions about another person’s behavior.
Instead of offering skills, insights, or explanations, MBT therapists encourage patients to think through hyperactivated or deactivated emotional states themselves.
The point of these therapeutic interactions is for each person to reflect on the point of view of others alongside their own point of view. This increases the patient’s capacity to mentalize multiple perspectives that may differ.
In MBT, the therapist emphasizes a stance of humility. As part of this process, they carefully monitor and acknowledge any misunderstandings they may have about the patient. They own up to and explore such misunderstandings when they do occur.
When the therapist changes their mind based on the experience and feedback of the patient, they demonstrate the openness and flexibility of mentalization. The patient witnesses and internalizes this process in therapy.
As therapy progresses, the patient continues to build on their ability to mentalize. The individual becomes more curious about their own and others’ internal experiences. They become better at understanding and assessing their own and others’ states of mind.
The therapists applies the same treatment techniques in weekly group therapy sessions. The group therapy component of MBT allows patients to work on mentalizing in the context of several different relationships and many different perspectives.
The therapist encourages patients to reflect on the other group members’ motives and experiences by asking questions such as, “Why do you think they might feel that way?” and, “Why might they have said what they did?”
By thinking about emotional and interpersonal situations in different ways, patients learn to view their lives through a lens that is grounded in reality, flexible, and kind to themselves and others.
In addition to leading individual and group therapy sessions, therapists attend a weekly reflection team meeting, in which they receive support from other therapists on their own mentalization regarding the treatment process.
MBT Is Incredibly Effective
MBT is one of several treatments proven effective in treating patients with BPD.
In a 1999 randomized controlled trial, patients in an outpatient hospital, who received MBT as opposed to standard treatment, experienced greater improvements. The MBT group showed decreased suicidality, reduced hospitalization, and improved social skills 18 months, 36 months, and 8 years after treatment.
A 2009 randomized controlled trial of outpatient MBT recruited and trained therapists in either MBT or structured clinical management (SCM). Then 134 BPD patients were assigned to work with therapists from one of the two groups. When assessed at six months, 12 months, and 18 months, the percentage of patients who attempted suicide, engaged in self-harm, or required hospitalization was significantly lower in the MBT group.
A follow-up study published in 2020 demonstrated that the gains made in treatment persisted for six subsequent years after treatment ended, and that patients treated with MBT had better functional outcomes.
Who Benefits From MBT?
While MBT was originally developed for the treatment of borderline personality disorder, its use has been extended to treat antisocial personality disorder, substance use disorders, eating disorders, and anxiety disorders.
Adaptations of MBT have been proposed for treating narcissistic personality disorder, avoidant personality disorder, depression, psychosis, and other conditions.
Finding Treatment Using MBT
Interest in MBT is growing internationally. McLean Hospital’s MBT Clinic offers insurance-based group and individual MBT sessions.
If you or a loved one needs help managing borderline personality disorder, McLean is here to help. Contact us today at 877.372.3068 to learn more about treatment options.
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1. Bateman AW, Fonagy P. Mentalization-based treatment of BPD. Journal of Personality Disorders. 2004;18(10),36-51.
2. Bateman AW, Fonagy P. Mentalization-based treatment. Psychoanalytic Inquiry. 2013;33(6), 595-613.
3. NEA BPD (2012, December 10). Mentalization-based therapy: Dr. Bateman.