Mentalization-based art therapy

Domain VIII · Creative & expressive arts therapies · Dominik Havsteen-Franklin · 2013 · United Kingdom

What it is

What it is: an art psychotherapy that uses the principles of Mentalization-Based Treatment (MBT; Bateman & Fonagy) inside the art therapy triangle of client, therapist and artwork. It was developed mainly for adults with borderline personality disorder (BPD) or "complex emotional needs" and for…

Format

• Phase 1: Image-making mentalization psychoeducation group (12 weekly sessions, 90 minutes). Closed group of people with BPD, two art psychotherapists facilitating, in a secondary-care adult mental health service. It works both as a standalone intervention and as preparation for longer treatment.
• Session sequence: attendance and refresher of the previous session → presentation and development of the week's theme → discussion → image-making → feedback → preparation for the next session.

Who practises it, and how they are trained or regulated

• Professional frame. In the UK "art therapist" and "art psychotherapist" are legally protected titles; practitioners train to master's level and must be registered with the Health and Care Professions Council (HCPC); the professional body is the British Association of Art Therapists (BAAT). Havsteen-Franklin is an accredited MBT practitioner; the MBT accreditation route itself is. Training specific to the approach:…
• Phase 0: Assessment and formulation (up to 4 sessions). Covers attachment trauma, self-harm, identity disturbance, affect dysregulation, motivation, family, finances, social factors and risk. A formulation report is co-written with the patient, shared, and reviewed during the programme. Move on when: diagnosis confirmed (in the published programme all members had a confirmed BPD diagnosis), risk manageable in a…
• Weekly themes (adapted from Karterud & Bateman's MBT-I psychoeducation manual): (1) mentalizing and the mentalizing stance; (2) what it means to have problems with mentalizing; (3) why we have emotions and the core emotions; (4) registering and regulating emotions; (5) the significance of attachment relationships; (6) attachment and mentalizing; (7) what BPD is; (8–9) mentalization-based arts therapies, parts 1 and…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• 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 intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• 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

• perfectionism; reassure that accuracy is not the point.
• shame at being "caught"; keep the tone warm and curious.
• the client hearing blame; make your own part explicit first.
• pauses used to avoid all feeling; return to the image when calmer.
• members who need there to be one correct answer; normalise uncertainty.

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.