Mentalization-based therapy (MBT) is a type of psychodynamic therapy developed for people with borderline personality disorder (BPD). It assumes that people with BPD often have difficulty mentalizing, which contributes to unstable relationships. This type of therapy helps them improve their understanding of themselves and others, resulting in healthier behaviors in relationships.
What Is Mentalization?
Mentalization refers to someone’s ability to infer and understand other people’s mental state (e.g., thoughts and feelings).1 This ability develops when a child has a secure attachment with a caregiver.2
Mentalizing is unique to humans since it requires a higher level of cognitive and emotional skills. It’s also imaginative since you can never really know what’s in another person’s mind. However, when you see someone frowning, you might infer that they’re sad and reflect on why they could feel this way.
How Does Mentalization-Based Therapy Work?
MBT therapy is an evidence-based treatment with roots in psychodynamic therapy.3 It’s based on the theory that people with borderline personality disorder often have difficulty mentalizing. This contributes to emotional instability, impulsivity, and relationship conflict. MBT helps them improve their mentalization and subsequently improve emotional regulation and interpersonal relationships.
Naturally, mentalizing is the key focus of MBT therapy.3 The therapist works to establish a healthy attachment with the client while encouraging their ability to mentalize. The client’s mind becomes the focus and over the course of treatment, they learn about their thoughts and feelings, how their thoughts and feelings impact their behavior, and how distortions lead to negative behaviors in relationships.
The goal of MBT is for the client to better mentalize themselves and others, to consider others’ thoughts and feelings, and to avoid misinterpreting others and responding in negative ways that hurt their relationships.
9 MBT Therapy Techniques
Mentalization-based therapy is structured and active.2 Treatment takes place over an 18-month period, during which a client participates in weekly individual and group therapy. Before addressing their mentalization skills, the therapist works to develop a secure attachment with their client. In some cases, crisis intervention and medication management may be a part of the treatment plan.
Here are nine techniques used in mentalization-based therapy:3
- Exploration of the client’s mental state
- Identifying and labelling emotions
- Validation and empathy
- Clarification of the connection between a client’s feelings and behaviors
- Challenging the client’s point of view while exploring their emotions
- Processing the client’s thoughts and feelings about the therapeutic relationship
- Encouraging the client to consider the therapist’s and other group member’s thoughts and feelings
- Reflecting on how the client’s perceptions of themselves differ from how others perceive them
- Addressing ruptures and impasses between client and therapist or the group as they arise
What Can Mentalization Based Therapy Help With?
MBT therapy can help teens, adults and families struggling with borderline personality disorder improve their capacity to mentalize. This helps them better regulate their emotions and maintain stable relationships.2,3
Studies have shown that because BPD often co-occurs with other mental health conditions, such as eating disorders and substance use disorders, MBT can help with those as well.4,5,6
Mentalization-based techniques have been used to help the following:4,5,6,7
- Eating disorders
- Substance use disorder
- Antisocial personality disorder (ASPD)
- Depression
3 MBT Therapy Examples
The techniques and goals of MBT therapy are similar across diagnoses; however, people with different diagnoses may require crisis support, medication management, or coordination with other healthcare providers to fully address their mental health concerns.
Here are three examples of mentalization-based therapy for different diagnoses:
1. MBT for Borderline Personality Disorder (BPD)
MBT for BPD is a structured treatment involving weekly group and individual sessions with a trained therapist who takes an empathic approach to develop a secure attachment. When the relationship is established, the client and therapist explore the client’s mentalizing abilities together. They may talk about events that occur in the therapeutic relationship and in outside relationships.
For example, if a client expresses anger toward a group member during their individual session, the therapist may explore their feelings and their perception of the group member’s intentions. The therapist could introduce alternative explanations for the group member’s behavior to help improve the client’s mentalization skills.
Individual and group therapists collaborate to improve the client’s mentalizing and emotional-regulation skills. Treatment typically takes place over 18 months.
2. MBT for Eating Disorders
MBT for eating disorders involves similar techniques and goals as traditional MBT for BPD. However, when adapted, the MBT therapist will collaborate with other treatment professionals, like psychiatrists, physicians, and nutritionists, to aid in the client’s care.
Addressing any medical issues related to the client’s eating disorder is important. Medications may be prescribed to treat psychiatric and eating-disorder symptoms, and weekly weigh-ins may be recommended to monitor the client’s progress.
3. MBT for Substance Use Disorder
When MBT is used to treat substance use disorders, clients participate in substance use disorder treatment in addition to individual and group MBT sessions. This may include additional therapy and self-help groups. The impact of substance use on a person’s mentalization abilities and relationships will also be explored.
For example, substance use may impair a person’s ability to consider other people’s thoughts and feelings. Using drugs and alcohol could also be a way of dealing with social anxiety or self-doubt. Clients will learn how to relate to others without using drugs and alcohol.
How to Find a MBT Therapist
To find a therapist who practices mentalization-based therapy for BPD, start by conducting a search using an online therapist directory. If a therapist practices MBT, they will often indicate it in their profile. You can also contact them directly to see if they offer MBT.
Many therapists who offer MBT have received post-graduate training in this area. However, additional training is not required and many therapists use elements of MBT without considering themselves mentalization-based therapists.
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How Much Does MBT Cost?
The cost of MBT depends on your location and an MBT therapist’s training and experience. Cost typically ranges between $100 – $200 per 50-minute session. Masters-level therapists, including social workers, counselors, and therapists, may charge around $100-$150 per session. Doctorate-level providers, like psychologists, may charge $150-$200 per session. MBT often costs more in urban areas, where the demand for services is higher.
You may be able to find MBT at a lower cost if you attend a community mental health clinic or meet with a pre-licensed provider. This includes graduate students or post-graduate students who are in the process of getting licensed. Though they have less experience, they are supervised by licensed clinicians.
Health insurance may cover all or a portion of your costs for therapy. Your deductible, co-pay, and coinsurance will depend on your specific plan. Contact your health-insurance company directly to find out whether therapy is covered and your total out-of-pocket costs.
What to Expect at Your First Appointment
The first session of mentalization-based therapy involves a diagnostic assessment; a therapist will ask you several questions to gain an understanding of what led you to seek treatment.3 For example, they may ask about your early childhood attachments, current and past relationships, and any symptoms you’re experiencing.
The therapist will also talk to you about MBT and explain how it works, what to expect, the duration and frequency of treatment, and goals. They will also encourage you to ask any questions and talk to you about your diagnosis. After the first session, you should leave with a better understanding of how MBT can help you.
Is Mentalization Based Therapy Effective?
Mentalization-based therapy is considered an evidence-based treatment.3 It’s effectiveness as a treatment for BPD is well-established and more recent research has looked at using it with other populations.
Studies on MBT have found:
- MBT was effective in improving functioning in a group of people with BPD who participated in individual and group therapy twice weekly for two years8
- A preliminary study compared MBT with short-term psychodynamic therapy for people diagnosed with eating disorders and found that both therapy approaches were effective4
- A group diagnosed with both BPD and antisocial personality disorder who participated in MBT showed decreased anger, paranoia, hostility, self-harm, suicidality, relationship problems, and psychiatric symptoms5
- A group of people diagnosed with BPD and substance use disorder who participated in MBT combined with substance use disorder treatment showed improvements, including fewer suicide attempts6
- A study looked at short-term psychodynamic psychotherapy with mentalization-based techniques among people with major depressive disorder and found that the combination of these two approaches were effective in improving depression7
- Mothering from the Inside Out (MIO) is a 12-week, mentalization-based course for substance using mothers; one study carried out in a community mental health center found that MIO helped improve mother-child interaction and reduced parenting stress9
Alternatives to Mentalization-Based Therapy
Therapy is an important part of BPD treatment. Although BPD treatments vary in their specific approaches, they share common goals, including improving a person’s emotion regulation skills, interpersonal relationships, and self-image.
Alternatives to mentalization-based therapy are:10
- Dialectical behavioral therapy (DBT): DBT is an evidence-based treatment for BPD that teaches skills in four main areas (mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness). DBT involves weekly phone check-ins and group and individual therapy sessions.
- Cognitive behavioral therapy (CBT): CBT focuses on changing unhealthy thoughts and belief systems and replacing them with healthier alternatives. CBT also teaches coping and relaxation skills to manage negative emotions.
- Schema therapy: this type of therapy assumes that in early childhood, people develop schemas, which are deeply held beliefs about the self and others. When these schemas persist into adulthood, they can lead to unhealthy behaviors and patterns. Schema therapy helps people identify and change these negative schemas and develop healthier perceptions of themselves, others, and the world.
- Transference-focused psychotherapy (TFP): in TFP, clients are able to work through their reactions to the therapist in the here-and-now, which can help them develop healthier behaviors in relationships.
Final Thoughts on MBT Therapy
If you are dealing with BPD, mentalization-based therapy may be right for you. It can help you better understand yourself and others, which can improve your relationships and emotion regulation skills.
