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Specialized Treatments for Borderline Personality Disorder: What is Mentalization Based Therapy?

Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression ...Read More

Mentalization Based Therapy (MBT) was developed by Anthony Bateman and Peter Fonagy and is one of the therapies for Borderline Personality Disorder (BPD) that has been tested in clinical research studies. The term “mentalization” refers to a mental process by which we try to understand our own and other people’s mental states and motivations. We mentalize when we try to make sense of behaviors of other people, or when we try to understand our own feelings. In their book “Psychotherapy for Borderline Personality Disorder- Mentalization Based Treatment” (Oxford University Press, Oxford: 2004), authors Anthony Bateman and Peter Fonagy state that mentalization is a new word for a concept that is in fact very old, and that mentalization is a process that we all use in order to interact with other people and to make sense of ourselves and others. Mentalization includes thinking about desires, needs, beliefs, feelings and reasons. It also includes understanding that internal states are different and separate from action, yet can cause action. 

In his paper “What Is Mentalizing and Why Do It?” Jon Allen refers to mentalizing as “keeping mind in mind”. So, why does Jon Allen think we should mentalize? For one, because mentalizing helps us to engage in fulfilling and emotionally close relationships. It allows us to influence and be influenced by others and thus helps us decrease conflict and antagonism. Jon Allen likens the act of mentalizing our own emotions to hitting a “pause button”, which can help us to tolerate and regulate our emotions instead of acting on them in harmful ways. Understanding ourselves better is also a first step towards change.

The theory behind MBT is that we develop the capacity to mentalize within the context of an attachment relationship and in an environment that fosters mentalizing. Bateman and Fonagy argue that people with BPD have difficulties in mentalizing, and that it is particularly hard for them to recognize internal states and motivations, especially in interpersonal and intimate situations. When I recently had the chance to speak with Peter Fonagy about MBT, he explained:  “It is hard to know what someone else is thinking. People with Borderline Personality have a certain vulnerability to get into intense relationships and then end up being so overwhelmed emotionally that they can’t think clearly. In intimate relationships, the attachment system gets activated, and for people with Borderline Personality who often have an attachment style that is disorganized, it then becomes harder to think clearly and to mentalize, because of the intense emotions involved. People get into a place of mind where this important capacity to mentalize becomes elusive.”  Fonagy compared MBT to physical therapy. “The same way that you train your muscles when you do physical therapy, you train the mentalization muscle in MBT. It is the muscle that allows you to control your feelings better and to use hints to avoid getting into trouble and to generally just become happier. Part of that has to be acknowledging that it is not easy. It is challenging and difficult and sometimes it is impossible. People won’t be able to do it all the time. “

In standard MBT, people work in once a week individual therapy and a once a week group. The individual therapy offers the opportunity to engage in an important relationship that allows for improving one’s understanding of themselves and improving relationships. The group offers an opportunity for people to learn from each other within a structured protocol. The goal is to improve relationships, be less impulsive, and understand oneself better.

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