Mentalization Based Therapy (MBT)

Mentalization-based therapy (MBT) is a type of psychodynamic therapy originally designed to treat borderline personality. The process of mentalization, or the ability to understand how actions are influenced by mental states, is the focus of MBT.

The concept of mentalization has its roots in John Bowlby's attachment theory. Bowlby believed that secure attachment between an infant and her primary caregiver lays the foundation for emotional stability and healthy relationships. If a baby is raised by an attentive and loving caregiver, he is likely to grow up with a greater understanding of his own and other people's emotions, which facilitates healthy emotional regulation and mentalizing. However, if a baby is neglected or develops an insecure attachment to the caregiver, she may have difficulty with emotional regulation later in life. Furthermore, an insecure attachment is believed to affect an individual's ability to mentalize. If a caregiver is absent or inconsistent, the child may have difficulty understanding the intentions behind her actions, resulting in diminished mentalizing ability.

The main goal of MBT is to increase an individual's mentalizing capacity. To do this, a therapist focuses on the person's mental state, including their thoughts, feelings, and desires. One of the initial goals of treatment is to stabilize how emotion is expressed in therapy, which may mean helping the individual control his or her emotions so that they do not act impulsively. Regulation of emotional expression is often considered necessary before an individual explores how their own and others' minds work.

The specific techniques used in MBT vary greatly, as many interventions that improve a person's mentalizing ability are perceived as helpful. A therapist may ask questions that help the individual explore his or her own mental state or make interpretations to help the individual better understand his or her own thoughts or desires.

Although there are a variety of techniques used in MBT, practitioners maintain a specific therapeutic stance during the course of therapy. This stance typically involves curiosity and patience as the therapist and person in therapy explore different perspectives. In these cases, the therapist accepts that different perspectives exist and questions the individual about their personal experience while maintaining awareness of their own mentalizing process. The therapy session can provide a space to understand the mental processes that occur both inside and outside of therapy.

Infants and children who are securely attached to their primary caregiver often learn to understand others' emotions before they understand their own. A sensitive caregiver is likely to be attuned to and reflective of their child's emotions. For example, when a baby is distressed, the caregiver may show a worried or worried expression on her own face. When the child sees this expression of concern, she can begin to understand her own feelings and develop the ability to mentalize.

MBT can promote this mentalizing capacity in people who lacked secure attachment in childhood. The main mechanism of this change is the establishment of a therapeutic bond in which the mental states of the self and others are explored. The therapist can help the individual form rational and coherent representations of her thoughts and feelings. This greater capacity for mentalization can help the individual understand and regulate her thoughts and feelings more effectively.

Research has found that MBT is an effective treatment for people with borderline personality. However, there are many mental health problems that involve some degree of difficulty with mentalizing, including depression, antisocial personality, eating problems, and addiction, and MBT can be applied to treat these. MBT has also been used in family therapy and to improve parent-child relationships. Additionally, some people whose mental health conditions did not respond well to other types of treatment have found MBT to be effective.

Therapists are not required to be certified in Mentalization-Based Therapy to use the approach. In fact, some therapists use mentalization as part of their work, regardless of the specific theoretical orientation or approach to which they subscribe. However, training and certification are available for professionals who wish to become more expert in MBT. Training typically involves taking a basic MBT course, clinical supervision, and completing an advanced certificate course. The training program is offered at various locations in Europe internationally through the Anna Freud National Center for Children and Families.