Mentalization-based treatment

Domain I · Psychodynamic & depth psychology · Bateman, Fonagy · 2009

What it is

Mentalization-based treatment (MBT) is a manualised, time-limited psychodynamically rooted therapy, developed for borderline personality disorder (BPD) and since adapted for other presentations. Mentalizing means making sense of one's own and others' behaviour in terms of mental states (feelings,…

Format

• Delivery formats
• Intensive outpatient MBT (standard): one individual session (about 50 min) plus one group session (about 75–90 min) per week, with different clinicians for individual and group, plus crisis cover and psychiatric/medication review. Original duration 18 months (roughly 140 sessions in the outpatient…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• shame, compliance or rejection; explore the reaction rather than defend the diagnosis.
• rewinding into blame. Working: the patient can locate the shift and what triggered it.
• treating the agreement as a rule set to enforce (teleological on the clinician's side).
• sliding into CBT-style correction. Working: members generate alternative perspectives themselves.
• self-disclosure that serves you, not the patient. Working: ruptures are named and repaired without escalation.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.