MBT for children and families

1. Introduction

Version followed: two named versions, kept distinct throughout. MBT-C = time-limited Mentalization-Based Treatment for Children, Midgley, Ensink, Lindqvist, Malberg & Muller (2017, APA), with assessment detail from Muller & Midgley (2015). MBT-F = Mentalization-Based Treatment with Families / Mentalization-Informed Systemic Therapy (MIST), Asen & Fonagy (2021, Guilford), with techniques taken from Asen & Fonagy's 2017 papers, which the 2021 book builds on. A second edition of MBT-C (Midgley et al., May 2026) exists. Its table of contents was seen but its text was not consulted [uncertain].

MBT-C is a play-based, time-limited treatment for children aged about 5–12 with emotional, behavioural or relational problems, together with their parents. It is indicated by impaired mentalizing rather than by diagnosis. The 2017 book presents it as a clinical guide, not a fully evaluated manual [source: Midgley et al. 2017, introduction, Spanish-edition sample]. MBT-F is a systemic way of working with whole families. It adds a deliberate, consistent focus on mentalizing to family-therapy methods and relies on playful games and exercises [source: Asen & Fonagy 2012 abstract; Guilford summary 2021].

Core idea of change. Problems are maintained when mentalizing breaks down under arousal. Both versions try to restart a stalled developmental process rather than produce insight into origins. MBT-C rebuilds the child's three "building blocks": attention regulation, affect regulation and explicit mentalizing. It also strengthens parents' capacity to see their child as a separate mind. MBT-F slows family interactions down so that members can recover curiosity about each other's minds. In both, the experience of being accurately mentalized reopens epistemic trust: the person becomes willing to learn from others again, and that learning generalises outside therapy [source: Midgley et al. 2017 intro; Muller & Midgley 2015; Asen & Fonagy 2017 Part 1; Asen & Fonagy 2021 ch. 1 sample].

2. Framework

MBT-C (Midgley et al. 2017; Muller & Midgley 2015)

Supervision is built in at assessment, at formulation and focus, for monitoring the therapist's position, at the mid-treatment review, at outcome evaluation, and as external supervision [source: Midgley et al. 2017 intro; Muller & Midgley 2015; Thorén et al. 2025]. Session length during treatment blocks is [uncertain].

MBT-F (Asen & Fonagy 2017, 2021)

MBT-F has no fixed session count or formal phase model [uncertain]. The 2021 chapter order implies a working sequence [source: Guilford contents; Desclée Spanish sample]:

1. Setting up. Convene the family and the relevant professional network so several minds work towards one purpose. Adopt the mentalizing stance (ch. 3).
2. Assessing mentalizing. Observe effective and ineffective mentalizing, the pre-mentalizing modes and the dimensions or polarities (ch. 2). Do not explain mentalization at the first meeting. Teach it through experience, and offer psychoeducation later [source: Asen & Fonagy 2017 Part 2].
3. Loop work. Use the mentalizing loop and pause-and-review on live family interactions (ch. 4).
4. Active techniques. Games, "instruments", scans and role-play that build mentalizing without lecturing (ch. 5–6).
5. Generalising. Link in-session change to home. Multifamily groups and schools are possible extensions (ch. 9).

Within each session the described sequence is: allow natural interaction, then notice and name a problematic pattern, then pause and reflect, then speculate and experiment [source: Asen & Fonagy 2017 Part 2]. A fuller in-session order is: orienting questions, building a shared language for feelings, exploring the context through mental states, pause and review, mentalizing the moment, then generalising and considering change [source: Asen & Fonagy, "Mentalization in systemic therapy"].

Combining the two [synthesis]: offer MBT-F-style family sessions at assessment and as needed, and individual MBT-C for the child. The vignette in Midgley et al.'s introductory paper moves from family sessions to individual time-limited MBT with parallel parent work [source: Midgley et al., "Mentalization-based approaches for parents, children, youth and families"].

3. Guiding principles

• Process over content. Strengthen how the child and family think about minds, not insight into why problems began. In practice: track whether mentalizing is "on" or "off" before deciding what to say [source: Midgley et al. 2017 intro].
• Treat mentalizing capacity, not diagnosis. In practice: the formulation names the building blocks that fail, and when they fail [source: Midgley et al. 2017; Muller & Midgley 2015].
• Mentalizing is not fixed; it comes and goes with context and arousal. In practice: note when the child or parent loses it, not only whether they can do it [source: Muller & Midgley 2015].
• Time-limitation is a therapeutic tool. In practice: show the remaining sessions visibly and refer to them; use Winnicott's question, "what is the least that needs to be done?" [source: Muller & Midgley 2015; Thorén et al. 2025].
• Curious, not-knowing stance. In practice: ask rather than assert, admit you don't know what someone feels, and check your guesses [source: Midgley et al. CYP intro; Asen & Fonagy, Systemic].
• Respect the opacity of minds. In practice: avoid firm conclusions about another person's inner state, and model tentative language [source: Asen & Fonagy 2017 Part 2].
• Validate first when arousal is high; explore when it falls. In practice: start with empathic validation. Move to exploration, challenge, affect elaboration and relational mentalizing only as arousal settles [source: Midgley et al. CYP intro].
• Monitor arousal, including your own. In practice: if you feel a rush to solve, treat it as a sign of teleological pressure and slow down [source: Asen & Fonagy 2017 Part 2; Muller & Midgley 2015].
• The therapist is active and a "developmental object", not a neutral screen. In practice: join the play, respond contingently and show your own mind [source: Midgley et al. 2017 intro].
• Do not intrude on the child's mental space. In practice: offer meanings lightly and through play characters, and let the child correct you [source: Midgley et al. 2017 intro].
• Attunement plus mismatch and repair, not perfect understanding. In practice: when you get it wrong, name the miss and repair it openly [source: Muller & Midgley 2015].
• Strengthen the child's agency. In practice: let the child lead the play and choices within the frame [source: Muller & Midgley 2015].
• Hold limits clearly. In practice: stop unsafe behaviour firmly, then mentalize what happened [source: Muller & Midgley 2015].
• Parents are collaborators, not culprits. In practice: avoid blame, treat the relationship as two-way, and support the parent's own reflective capacity [source: Midgley et al. 2017 intro].
• Build on strengths. In practice: find the child's "vital spark", and phrase the focus as resources and possibilities [source: Muller & Midgley 2015].
• Use your own reactions as data. In practice: notice countertransference and enactments, and check whether the focus reflects pressure to "fix" behaviour [source: Muller & Midgley 2015].
• Balance the polarities. In practice: strengthen the neglected pole (self/other, cognitive/affective, internal/external, automatic/controlled) with "contrary moves" [source: Asen & Fonagy 2017 Parts 1–2; Midgley et al. CYP intro].
• Avoid mechanical emotion questions. In practice: repeating "how do you feel?" can be as non-mentalizing as never asking [source: Asen & Fonagy 2017 Part 2].
• Work in the here-and-now. In practice: use the interaction happening in the room rather than abstract talk [source: Asen & Fonagy 2017 Part 1; Systemic].
• Check repeatedly. In practice: ask whether your description fits after every observation [source: Asen & Fonagy, Systemic].
• Teach mentalizing without explicitly teaching it. In practice: use games and experiences rather than explanations [source: Asen & Fonagy 2021 ch. 5 title; 2017 Part 2].
• A firm frame makes play safe. In practice: set the rules of a game before starting. Play must never belittle or humiliate anyone or become a place to settle scores [source: Asen & Fonagy 2017 Part 2].
• Keep moving (dialectics). In practice: when stuck on one idea, shift to its opposite [source: Asen & Fonagy 2017 Part 2].
• Pace like peeling an onion. In practice: "bookmark" a hot interaction and return to it later rather than confronting it early [source: Asen & Fonagy 2017 Part 2].
• Safety first. In practice: if a child lacks a safe haven, protection takes priority over therapy [source: Muller & Midgley 2015]. Use role-plays and enactments only when the family can regulate itself [source: Asen & Fonagy 2017 Part 2].
• Supervision is part of the model. In practice: take your own breaks in mentalizing to supervision [source: Muller & Midgley 2015; Midgley et al. 2017 intro].

4. Intervention inventory

Notes on what follows:

• Items 1–16 are MBT-C and items 17–36 are MBT-F.
• All example wording is my own and labelled (illustrative), except short quotes that are marked and cited.
• The specific child-session techniques in chapters 6–7 of the 2017 MBT-C book ("Working with children on the building blocks" and on "explicit mentalizing and breakdowns") are not drawn on here. Items 7–12 therefore use the principles the sources do state, and their step-by-step detail is marked [synthesis] [uncertain].
• The MBT-C Adherence Scale (2nd ed., Appendix B) was not seen.

MBT-C

1. Opening family assessment session

• Purpose: See how the family mentalizes together and hear each member's reason for coming. Used in the first meeting, with both therapists present [source: Muller & Midgley 2015].
• Steps: (1) Members introduce one another. (2) Each chooses an animal for every other member, and the family talks about the choices. (3) Each person gives their own account of why the family has come. (4) Do a family activity: a structured game, or a free task (clay or drawing, e.g. a "dream family house" or "family zoo") if the family can cooperate. (5) Watch the process as much as the product: who leads, who is left out, how disagreement is handled.
• Example language (illustrative): "If your mum were an animal, which would she be? … Mum, what do you make of that choice?"
• Watch for: rehearsed adult accounts that drown out the child; quick negative attributions; whether anyone shows curiosity about why another person chose an animal. It is working when members ask about each other's reasons rather than defending themselves.

2. Individual child assessment sessions

• Purpose: Assess the child's attention regulation, affect regulation and explicit mentalizing, and find the "vital spark" [source: Muller & Midgley 2015].
• Steps: Three sessions of about 45 min. Allow about 30 min of free play, then about 15 min of structured tasks, chosen from:
  • Shell or animal genogram: the child picks an object for each family member and places them to show relationships. This often runs over time.
  • Picture-card storytelling modelled on the TAT.
  • Drawings to complete and emotion-recognition tasks, such as a feelings book followed by drawing a fish.
  • Three words about yourself, each with an example, adapted from the Child Attachment Interview.
  • Optionally, WISC or ASSQ when cognitive or autism questions arise.
  For a chaotic child, use a small room with few materials.
• What to rate:
  • Attention: impulse control, joint attention, sensory reactivity, hyperarousal.
  • Affect: emotion vocabulary, triggers, tolerating feelings without acting them out, accepting limits, capacity for play and fantasy.
  • Explicit mentalizing: how the child represents self and others, and curiosity about minds.
  • Context: when mentalizing collapses.
• Example language (illustrative): "Can you tell me three words about you? … 'Brave' — when were you brave?"
• Watch for: your own countertransference and enactments, which are also data.

3. Parent assessment sessions

• Purpose: Assess parental mentalizing: seeing the child as a separate mind, curiosity about the child's intentions, recognising that the child's mind is not fully knowable ("opacity"), and whether this holds under stress [source: Muller & Midgley 2015].
• Steps: Three sessions held in a mentalizing stance (empathy, curiosity, interest in other perspectives). Use questions adapted from the Parent Development Interview: three words for the relationship with the child, and a recent time the parent was angry with the child. Add an Adult Attachment Interview-style question about how the parent's own upbringing affects their parenting. The PDI reflective-functioning coding is used as a guide to attention, not scored formally.
• Example language (illustrative): "Think of a recent time you got really cross with her. What do you think was going on for her just then? And for you?"
• Watch for: fixed, global explanations ("he's just manipulative") versus tentative, specific ones; whether the parent can hold their own history and the child's needs at the same time.

4. Shared formulation as a metaphorical story

• Purpose: Give back the understanding without jargon, so the family feels "held in mind". Done in the final joint assessment session [source: Muller & Midgley 2015].
• Steps: (1) Integrate the family, child, parent and school data into the strengths and vulnerabilities of each building block, for child and parents, linked to the presenting problems. (2) Write a short metaphorical story; in the published vignette, a chimpanzee moves between families. (3) Read or tell it, and invite corrections.
• Example language (illustrative): "We made a little story about what we've understood. Tell us what we got wrong."
• Watch for: recognition and emotional resonance rather than polite agreement.

5. Focus formulation (motto)

• Purpose: Give a shared, resource-oriented anchor for the 12 sessions [source: Muller & Midgley 2015; Thorén et al. 2025].
• Steps: (1) Build a short motto or metaphor, ideally from the child's own words or drawings. (2) Phrase it as possibilities, not a problem. (3) Agree it with the child and the parents. Common themes are control, autonomy, dependency and self-esteem. (4) Check in supervision whether it reflects pressure to fix behaviour. (5) Keep a concrete reminder in the room; in the vignette, a clay figure stayed in the same spot every session. Parent sessions follow the same focus.
• Example language (illustrative): "So our motto could be something like: 'Getting to know my angry lion and my scared mouse.' Does that sound right?"
• Watch for: a focus that only describes behaviour control. That suggests teleological pressure and needs reworking.

6. Session calendar and time-limitation

• Purpose: Make the time limit visible and usable [source: Thorén et al. 2025].
• Steps: The child draws a calendar with each numbered session. Mark each session off together, and refer to the number remaining, especially near the review and the ending.
• Example language (illustrative): "That's session 7 crossed off. Five left. What do you notice when you see that?"
• Watch for: reactions to the shrinking number (anxiety, denial, anger). These are material for mentalizing separation.

7. Following, joining and narrating play

• Purpose: Play is the main channel through which children show what they cannot yet put into words. Use it in every session [source: Thorén et al. 2025; Muller & Midgley 2015].
• Steps [synthesis]: (1) Let the child choose the play, which supports agency. (2) Join actively when invited. (3) Describe the action and the characters' likely states, briefly and tentatively. (4) Keep the focus in mind, and link play themes to it lightly, without interpreting the child directly.
• Example language (illustrative): "The dinosaur is stamping really hard… I wonder if he's cross, or maybe a bit worried?"
• Watch for: whether the child takes up, corrects or extends your description. Correcting you is mentalizing. Collapse of the play into repetition or action signals arousal.

8. Supporting attention regulation

• Purpose: Build the first building block (shared, sustained, flexible attention) so that affect and mentalizing work becomes possible [source: Midgley et al. 2017 building blocks; Anna Freud Centre course description].
• Steps [synthesis] [uncertain: the specific games in the book were not seen]: (1) Reduce stimulation; Muller & Midgley recommend a small room with few materials for chaotic children. (2) Use short, structured joint-attention or turn-taking activities. (3) Mark shared moments of attention. (4) Gradually lengthen periods of focus.
• Example language (illustrative): "We both looked at the same thing just then. You held it for ages!"
• Watch for: longer joint attention, fewer impulsive switches, and the child tolerating waiting.

9. Supporting affect regulation

• Purpose: Help the child recognise, name and tolerate feelings without acting them out [source: Muller & Midgley 2015; Thorén et al. 2025].
• Steps [synthesis built on the sources' stance]: (1) Attune to the child's affect through face, voice and body, in a "marked" (clearly reflective) way. Therapist body-movement coordination is linked with children's regulation in MBT-C research [source: Sözüer 2024 thesis abstract]. (2) Validate empathically. (3) Name the feeling tentatively and widen the vocabulary. (4) Explore triggers once the child is calmer.
• Example language (illustrative): "That was SO unfair, wasn't it. Your whole body went stiff."
• Watch for: quicker recovery after upsets, feelings named in play rather than enacted, and new feeling words.

10. Explicit mentalizing in play and talk

• Purpose: Build the capacity to think about one's own and others' minds as minds [source: Midgley et al. 2017; Midgley et al. CYP intro].
• Steps: Wonder aloud about characters' and people's intentions. Mark mixed feelings: the CYP-intro vignette therapist verbally marks when a child holds two feelings at once. Ask "how did you know?" when the child reads another person's state, as in the same vignette. Link states to behaviour [synthesis on sequencing].
• Example language (illustrative): "You looked happy and a bit sad at the same time when Dad left. Can both be true?"
• Watch for: pseudo-mentalizing (fluent but empty talk about feelings) versus genuine curiosity and surprise.

11. Mismatch, repair and showing your own mind

• Purpose: Show that misunderstanding can be survived and repaired. This builds epistemic trust [source: Muller & Midgley 2015; Midgley et al. CYP intro].
• Steps: (1) Notice the miss: the child disengages or protests. (2) Own it. (3) Share your own state briefly. (4) Ask the child to help you understand.
• Example language (illustrative): "Oops, I think I got that wrong. I thought you were bored, but maybe you were angry with me?"
• Watch for: the child re-engaging after repair, and the child starting to repair with you.

12. Breakdowns: stop, rewind, explore

• Purpose: Recover mentalizing after it is lost in session. The topic of the book's chapter on breakdowns [source: Midgley et al. 2017/2026 TOC]. The "stop, replay, explore, reflect" sequence comes from Asen & Fonagy's family work.
• Steps [synthesis for the child version]: (1) Regulate first: validation and limits. (2) When calmer, go back to the moment just before things went wrong. (3) Explore what each person, child or therapist, felt then. (4) Consider what might help next time.
• Example language (illustrative): "Let's press rewind to just before the tower fell. What was happening inside you?"
• Watch for: do not rewind while the child is still flooded, because that escalates.

13. Holding limits

• Purpose: Keep safety and the frame [source: Muller & Midgley 2015].
• Steps: (1) State the limit clearly and briefly. (2) Protect people and the room. (3) Afterwards, mentalize the event with the child.
• Example language (illustrative): "I won't let you throw that at me. You're really furious. Let's work out what made it so big."
• Watch for: limits used as punishment or delivered in your own anger.

14. Parallel parent work (MBT-parents)

• Purpose: Strengthen parents' reflection on the child's inner experience and on themselves as parents, during and after therapy [source: Midgley et al. 2017 intro; Thorén et al. 2025; Muller & Midgley 2015].
• Steps: (1) Hold sessions alongside the child's, usually with a separate therapist, on the same focus. (2) Work on recent concrete incidents: slow them down and explore the child's likely states and the parent's own. (3) Add psychoeducation about mentalizing where useful. (4) Address the parent's own mentalizing inhibitions, including "ghosts" from their own history, without blaming. (5) Coordinate with the child's therapist, respecting the child's confidentiality [synthesis].
• Example language (illustrative): "When he slammed the door, what do you imagine he hoped would happen? And what did it stir up in you?"
• Watch for: more specific, tentative descriptions of the child, and the parent noticing their own part without collapsing into guilt.

15. Mid-treatment review

• Purpose: Joint evaluation and a decision about continuing [source: Muller & Midgley 2015].
• Steps: Around session 8, review the focus with the child and parents. Hear everyone's view, decide together whether to end at 12 or extend by another block, and treat the negotiation as mentalizing work.
• Example language (illustrative): "We've had eight of our twelve. What's different, what isn't, and what do each of you think we need?"
• Watch for: extension driven by therapist anxiety rather than by goals.

16. Ending work and school liaison

• Purpose: Mentalize the goodbye, and connect with the child's wider network [source: Midgley et al. 2017 ch. 8; Muller & Midgley 2015].
• Steps [synthesis on detail]: (1) Count down using the calendar. (2) Invite feelings about ending, in play and in words. (3) Review the focus with the child and parents. (4) Plan how parents will keep the work going. (5) Contact the school for observations and, where agreed, to share understanding.
• Example language (illustrative): "Two sessions left. Some children feel sad, some cross, some relieved. What's it like for you?"
• Watch for: regression near the end. It is expected; mentalize it rather than extending automatically.

MBT-F

17. Developmental unfolding

• Purpose: Get past rehearsed adult accounts and see the family's mentalizing strengths and gaps. Used at the opening of sessions [source: Asen & Fonagy 2017 Part 2].
• Steps: (1) Ask each member in turn, starting with the youngest, why they think the family has come. (2) Then ask older siblings, then the parents. (3) Ask each member what they make of the others' answers.
• Example language (illustrative): "Sami, you're the youngest, so you go first. Why do you think everyone's here today? … Mum, what do you make of what Sami said?"
• Watch for: adults correcting the child rather than wondering about the child's view. That is useful data, not a problem to fix yet.

18. The mentalizing loop

• Purpose: The core tool for turning a live interaction into reflection and then into change [source: Asen & Fonagy 2017 Part 2; Systemic paper; 2021 ch. 4].
• Steps:
  1. Notice and name a specific interaction sequence, such as arousal shifting between a parent and child. This puts the interaction briefly on pause.
  2. Check your description, e.g. "have I got that right? Do you see it that way?" [quoted, Asen & Fonagy 2017 Part 2].
  3. Mentalize the moment. Ask a member what another, often the child, was thinking or feeling just then. Ask parents about the child before their own states.
  4. Mindstorm. Members brainstorm and check each other's guesses, the therapist included.
  5. Generalize and consider change. Ask whether this happens at home and what could be done differently. Then notice, name and check the new proposals, so the loop starts again.
• Example language (illustrative): "I noticed that when Dad raised his voice, Ella went very quiet and looked at Mum. Did anyone else see that? … Mum, what do you think was going through Ella's mind?"
• Watch for: reaching step 3 is often enough in one session. The published vignette did not reach step 5 [source: Midgley et al. CYP intro]. It is working when members start noticing patterns before you do.

19. Pause and review / the reflective pause button / rewind

• Purpose: Interrupt escalation so explicit mentalizing can come back, balancing self-other and emotion-cognition [source: Asen & Fonagy 2017 Part 2; 2021 ch. 4].
• Steps: (1) When conflict heats up, "press pause". (2) Name the rising heat. (3) Ask what usually happens next. (4) Rewind to the moment before mentalizing was lost (stop, replay, explore, reflect) and explore each person's state there [source: Systemic paper].
• Example language (illustrative): "Let me press pause. It's getting hot in here. If we let it run, what normally happens next at home?"
• Watch for: pausing too late, after shouting has begun, means you must regulate first. Asen & Fonagy name six markers of rebalancing: curiosity, respect for opacity, awareness of impact, perspective taking, narrative continuity, and agency/trust [source: Part 2].

20. Contrary moves and polarity rebalancing

• Purpose: Correct a lopsided way of mentalizing [source: Asen & Fonagy 2017 Part 2; Midgley et al. CYP intro].
• Steps: Identify the neglected pole and push towards it:
  • If someone is stuck on self, turn to others' perspectives.
  • If the talk is all thinking, bring in feeling, and vice versa.
  • If someone makes a quick automatic assumption, slow it down and question it.
  • If the focus is on outward behaviour only, ask about inner states.
• Example language (illustrative): "We've heard a lot about how unfair it felt for you. What do you imagine it was like for your brother?"
• Watch for: contrary moves made mechanically. Shift again if the person rigidifies.

21. Mentalization-eliciting questions (triadic and hypothetical)

• Purpose: Bring several minds into view [source: Systemic paper].
• Steps: Ask one member to comment on the relationship between two others (triadic). Ask "what if" questions that require taking another's perspective. Reframe blame towards alternative explanations. The aim differs from Milan circular questioning: these questions are meant to strengthen attachment, not to build the therapist's hypotheses.
• Example language (illustrative): "Jo, when Mum and Grandma argue, what do you think each of them is worried about?"
• Watch for: children pulled into loyalty conflicts. Keep these questions light and drop them if the child freezes [synthesis].

22. Enactment ("make it happen now") and structured tasks

• Purpose: Bring the problem interaction into the room to mentalize it live. Adapted from Minuchin and from Gammer's "representation by demonstration" [source: Asen & Fonagy 2017 Part 2].
• Steps: (1) Ask the family to show how a typical difficulty unfolds. Alternatively, set a structured task (a game, a board game, homework) with the instruction to show how they all play, and sit back. (2) Interrupt when conflict builds, and run the loop. (3) Variant: ask what a parent would need to do to trigger the child's problem behaviour. Use this only after safety has been considered. (4) Couples can enact a conflict without the children present.
• Example language (illustrative): "Could you show me how homework goes on a bad night? Just do it here, and I'll stop us at some point."
• Watch for: an enactment that becomes the real fight. Pause earlier.

23. Inverted role-play with a reflecting team

• Purpose: Take an outside perspective on oneself, adapted from psychodrama [source: Asen & Fonagy 2017 Part 2].
• Steps: (1) First validate the parent's own view. (2) The parent plays the feared other person, e.g. the social worker, and the therapist plays the parent, while the family watches. Some exaggeration is allowed. (3) Afterwards, members describe what they observed, in reflecting-team style after Andersen, and build a shared view.
• Example language: "imagine you are the social worker, just for a minute, and I am you" [quoted, Asen & Fonagy 2017 Part 2].
• Watch for: role-play can trigger trauma. Use it only when the system can regulate itself, and never in a way that humiliates anyone.

24. Role-swap replay and future dramatizations

• Purpose: Build perspective taking and continuity between past, present and future [source: Asen & Fonagy 2017 Part 2].
• Steps: (1) Partners swap roles and speak each other's lines. (2) Together they write constructive lines. (3) They restage the scene with the new lines. (4) Optionally, stage a hopeful future (e.g. three months on) and, separately, what happens if nothing changes.
• Example language (illustrative): "Now swap chairs. You're her and she's you. Same argument, go."
• Watch for: mocking the other person's role. Restate the frame if it happens.

25. Masks and the Masked Ball

• Purpose: Lower fear of disapproval so people can express or observe feelings [source: Asen & Fonagy 2017 Part 2; Systemic paper].
• Steps: Choose a variant:
  • A parent wears a neutral mask to observe the child's responses and their own impact.
  • A parent wears a series of masks showing intense feelings, predicts how the child will respond, then removes the mask to check against reality.
  • A frozen member uses a protective mask to try out expressions, removing it when "safe enough".
  • Masked Ball: members wear masks and role-play a family dinner far in the future (2070), then "rewind the clock" towards the present to identify turning points and concrete steps.
• Example language (illustrative): "With this mask on, nobody can see your real face. Show us what 'furious' looks like. … Ali, what did you feel watching Dad?"
• Watch for: fear in young children. Introduce masks gradually and let the child handle them first [synthesis].

26. Video feedback

• Purpose: Let members view interactions "off-line" from a shared meta-perspective once arousal has dropped [source: Asen & Fonagy 2017 Part 2].
• Steps: (1) With consent, record the session. (2) Replay it the same day or at the next session. (3) Pause and ask about perspective, opacity and impact. (4) Variants: subtitling, where members caption actions with mental states; sound-off, where members watch without sound and imagine the words, taking a film-director or deaf-observer perspective.
• Example language: "what do you think she might be feeling at this very moment?" [quoted, Asen & Fonagy 2017 Part 2].
• Watch for: shame at seeing oneself on screen. Start with neutral clips [synthesis]. Agree consent and data storage in line with local policy [synthesis].

27. Reading the Mind behind the Face (affect snapshots)

• Purpose: Practise reading and showing feelings, and challenge fixed readings such as "he's always angry" [source: Asen & Fonagy 2017 Part 2; Systemic paper].
• Steps: (1) Members name feelings (typically 15–20), and the therapist writes each on a card. (2) Each member draws a card and shows the feeling without words while the others guess. (3) Photograph each display. (4) Print the photos and "exhibit" them. (5) Discuss when each person really felt that way and whether others noticed. (6) Look for exception photos that contradict the dominant story. The photos can go home.
• Example language (illustrative): "Look at this one of Ty looking friendly. When did the family last see that face?"
• Watch for: adults becoming more alert to children's subtle feelings. The published foster-care case reported this.

28. Talking (therapeutic) selfies and thought bubbles

• Purpose: Practise perspective taking with teenagers, and let parents test their readings against the teenager's view [source: Asen & Fonagy 2017 Part 2; Systemic paper].
• Steps: Choose one or more variants:
  • The teenager brings about ten selfies, and the family speculates about the states shown.
  • Or the therapist photographs the teenager during a one-to-one talk. The parents narrate each photo in the first person, in the teenager's voice, and the teenager says how accurate they were without having to reveal everything.
  • Parents complete thought bubbles at home.
  • Each member brings three photos with bubbles for self and others.
  • Use photos to talk about warning signs of escalation.
• Example language: "how do you know Dad is not going to explode any moment now?" [quoted, Asen & Fonagy 2017 Part 2].
• Watch for: the teenager's right to privacy. They decide how much to confirm.

29. Mind mirroring (parent–infant)

• Purpose: Help a parent separate their own states from the baby's and see themselves through the baby's eyes. Used with parents whose older children were removed [source: Asen & Fonagy 2017 Part 2]. This is outside the 5–12 age range but used within family work.
• Steps: (1) Place a mirror behind the infant and record a five-minute play task. (2) Pause the recording and ask what the baby feels and why. (3) Ask what kind of mother the baby sees. (4) Link past, present and future children.
• Example language (illustrative): "Here, where he turns away, what might he be feeling? What do you think he sees in your face?"
• Watch for: guilt flooding the parent. Validate before you explore.

30. Body-feeling scan (body maps)

• Purpose: Locate feelings in the body, especially feelings linked to violence (fear, rage, panic, powerlessness) [source: Asen & Fonagy 2017 Part 2].
• Steps: (1) Each member lies on paper and is outlined. (2) Each draws or paints feelings in the body using colours, shapes and labels. (3) Members compare maps and interview each other about where and how feelings sit. (4) Discuss how feelings are managed, displaced or shared.
• Example language (illustrative): "Where does the scared go when Dad shouts? What colour is it?"
• Watch for: discomfort with being touched or lying down. Offer a pre-drawn outline instead [synthesis].

31. Mind–brain scan

• Purpose: Make guessing about another person's mind concrete and open to checking [source: Asen & Fonagy 2017 Part 2; Systemic paper; 2021 ch. 5, "body and mind scanners"].
• Steps: (1) Give each member an outline of a brain cross-section with about ten spaces. (2) Each fills the spaces with what they imagine another member feels, wishes, believes or thinks. (3) The person being "scanned" compares the scan with their own view.
• Example language (illustrative): "Fill in Mum's brain: what's taking up the most room in there this week?"
• Watch for: scans used as accusations. Reinforce the playful frame.

32. Mind-reading stethoscope games

• Purpose: Slow mentalizing down playfully. Popular with younger children, and usable with teenagers and parents with humour [source: AMBIT manual page; 2021 ch. 5, "mind-reading stethoscopes and similar instruments"].
• Steps: (1) Use a real or imaginary stethoscope that "hears" thoughts (placed on the head) or feelings (placed on the heart). (2) Ask what it would have picked up at a specific moment. (3) Check the guess with the person.
• Example language (illustrative): "If we'd put the magic stethoscope on Mum's head when you said you were quitting football, what would we have heard? And on her heart?"
• Watch for: the instrument being used to "prove" someone wrong. Reaffirm that only the person can confirm.

33. The secret life of volcanoes

• Purpose: Make escalation and safety concrete for families with children under about ten [source: Asen & Fonagy 2017 Part 2].
• Steps: (1) The family researches volcanoes together. (2) Draw the dormant volcano. (3) Chart early warning signs, safety, shelter and "stemming the lava flow". (4) Recall the last eruption at home and reflect on each person's states at each stage. (5) The therapist links the past eruption, the interaction in the room and the volcano picture.
• Example language (illustrative): "What's the first rumble before our volcano blows? Who notices it first?"
• Watch for: the safety plan must be real. Link it to formal safety planning where there is violence [synthesis].

34. Family sculptures

• Purpose: Show positions, closeness and power, and explore the minds of the figures [source: Asen & Fonagy 2017 Part 2; Systemic paper].
• Steps: (1) Make a joint or individual sculpture in clay or similar materials. (2) Others interpret the sculpture and the sculptor's mind before the sculptor gives a "guided tour". (3) Explore the states of the figures. (4) Re-sculpt to show how the family was before the problem, or how it might be in three months.
• Example language (illustrative): "Before Nia explains it, what do you think she wanted to show by putting Dad over here?"
• Watch for: children's sculptures that reveal danger. Follow safeguarding procedures (see section 5).

35. "Emotional plastic surgery" [uncertain]

• Purpose: Named as a game in 2021 ch. 5 [source: Desclée Spanish sample TOC]. Its procedure is not drawn on here. Do not improvise it as if it were the authors' method. Consult the book.

36. Multifamily groups and school work [uncertain]

• Purpose: Mentalizing activities and games across several families, peer support, and mentalizing in schools [source: 2021 ch. 9 TOC]. Specific procedures are not drawn on here. The building-block games above can be adapted for group use [synthesis].

5. Handling problems

• Safeguarding concerns or a disclosure (both versions). The sources say protection comes first: if a child has no "safe haven", removing the child from danger may be needed before therapy can help [source: Muller & Midgley 2015]. Family work involving violence is framed as building a reflective space that is incompatible with violence [source: Asen & Fonagy 2017 Part 1]. Concrete steps [synthesis]:
  • Explain the limits of confidentiality to child and parents at assessment, in age-appropriate words.
  • If a child discloses abuse or shows harm (in drawings, sculptures or play), listen without leading questions and record the child's own words.
  • Follow your local child-protection procedure and consult your designated safeguarding lead the same day.
  • Do not run joint family sessions or enactments that put the child in front of an alleged abuser until risk is assessed.
  • Never use games to elicit disclosures.
  • Where there is family violence, do individual safety planning alongside the volcano work.
• Child or parent suicidality or self-harm. Not addressed in the sources. Use standard structured risk assessment and local crisis pathways. Bring in the parents' protective role and keep mentalizing the distress rather than stopping the work [synthesis].
• Arousal escalates in a family session. Press pause, name the heat and validate before exploring. If shouting continues, regulate first: slow your voice, separate seating, or take a short break. Return to it with rewind once calm [source: Asen & Fonagy 2017 Part 2; Midgley et al. CYP intro; break procedure = synthesis].
• Teleological demand ("just tell us what to do"). Resist a quick solution while the family is too aroused to use it. Validate the urgency, then mentalize the demand itself [source: Midgley et al. CYP intro]. Offer one small concrete step only once arousal falls, framed as an experiment to review together [synthesis].
• Rehearsed narratives and stuck families going in circles. Use developmental unfolding and turn to the youngest member. Move to here-and-now interaction or an enactment instead of retelling. Use "continuous motion": shift to the opposite pole when stuck [source: Asen & Fonagy 2017 Part 2; 2021 ch. 4 "mentalizing a well-rehearsed narrative"].
• Pseudo-mentalizing or hypermentalizing (fluent feeling-talk with no anchor). Ask for a specific moment and for evidence ("how did you know?"), and introduce opacity: we can't be sure [source: Asen & Fonagy 2017 Part 1 on pretend mode; Midgley et al. CYP intro]. With children in "pretend mode", Muller & Midgley (2020) wrote a dedicated paper [uncertain]. Gently link play to felt reality, and notice your own boredom or disconnection [synthesis].
• Psychic equivalence ("I just KNOW he hates me"). Do not argue the content. Validate the feeling, then introduce a second perspective through play, a role swap or a stethoscope game [synthesis drawn from the sources' definitions].
• Chaotic, overwhelmed child. Reduce materials and space and use short structured activities. Prioritise attention and affect work over explicit mentalizing [source: Muller & Midgley 2015; prioritisation = synthesis].
• Child won't play or talk. Narrate your own mind and do parallel play without demands. Use the animal or shell genogram or drawing as an indirect channel. Respect agency [synthesis].
• Rupture with the child or parent. Name the mismatch, own your part and repair. Treat repair as the intervention [source: Muller & Midgley 2015]. Take repeated ruptures to supervision.
• Parents miss sessions or disengage. Mentalize the absence (what makes coming hard?) rather than interpreting it. Revisit the shared focus and check whether parents feel blamed. Offer a joint review earlier than session 8 if needed [synthesis].
• A parent's own history floods the work. Acknowledge the "ghosts". Keep the parent work anchored on the child and the focus, and consider referring the parent for their own therapy [source: Muller & Midgley 2015 on ghosts; referral = synthesis].
• Games become weapons (mockery, score-settling). Stop the game, restate the frame, and mentalize what happened [source: Asen & Fonagy 2017 Part 2].
• Role-play or masks trigger trauma. Stop and ground the person. Use role-play only when the system can self-regulate [source: Asen & Fonagy 2017 Part 2]. Use less evocative methods, such as drawing or sculpting with distance [synthesis].
• Pressure to extend. Use the review at session 8. Ask "what is the least that needs to be done?" and decide with the family, not alone [source: Muller & Midgley 2015].
• Regression or acting out near the ending. Expect it. Count down visibly and mentalize the feelings about separation. Avoid extending in reaction to it [synthesis].
• Therapist loses mentalizing (rescuing, irritation, rushing). Treat your own pressure as data. Disclose your state where helpful, and use supervision, which is built into the model [source: Muller & Midgley 2015; Systemic paper].
• Cultural differences in how families talk about minds. The 2021 book has a chapter on this (ch. 10) [uncertain]. Ask about family and cultural norms for showing feelings. Do not treat less verbal emotional expression as poor mentalizing [synthesis].
• Online or remote delivery. The Anna Freud Centre's MBT-C training covers online adaptations, and 2021 ch. 8 covers distance therapy, but the details are [uncertain]. Agree privacy at home, use shared-screen drawing and shorter activities, and plan how to manage escalation remotely [synthesis].
• Co-morbid neurodevelopmental difficulties. Assessment may include the WISC or ASSQ [source: Muller & Midgley 2015]. Adapt the pace and use more concrete, visual tools [synthesis].

Sources

Sources

• Midgley et al. – Tratamiento basado en la mentalización para niños, sample (front matter, introduction)
• Muller & Midgley (2015) Approaches to assessment in time-limited MBT-C, Frontiers in Psychology
• Patrinum record of Muller & Midgley 2015 abstract
• Anna Freud – MBT-C: A Time-Limited Approach (training page)
• UCL Discovery – MBT for Children: A Time-Limited Approach (record)
• APA – MBT for Children, Second Edition (description and contents)
• Thorén, Lindqvist, Pertoft Nemirovski & Mechler (2025) Short-term MBT for common childhood mental disorders, pilot trial
• Mentalization-based approaches for parents, children, youth and families: an introduction (UCL accepted manuscript; authors and year not shown in the text) [uncertain]
• Sözüer (2024) Therapist body movement coordination in MBT-C, thesis abstract
• Asen & Fonagy (2017) Mentalizing family violence part 2: techniques and interventions (accepted manuscript)
• Asen & Fonagy (2017) Mentalizing family violence part 1 (accepted manuscript)
• Asen & Fonagy – Mentalization in systemic therapy and its empirical evidence (manuscript; year not stated) [uncertain]
• UCL Discovery – Asen & Fonagy (2012) Mentalization-based therapeutic interventions for families (abstract only)
• Guilford – MBT with Families, summary
• Guilford – MBT with Families, contents
• Asen & Fonagy – Tratamiento basado en la mentalización con familias, sample (full TOC, preface, ch. 1 opening)
• AMBIT manual – Stethoscope games

Books and papers cited

• Midgley, N., Ensink, K., Lindqvist, K., Malberg, N., & Muller, N. (2017). Mentalization-Based Treatment for Children: A Time-Limited Approach. APA. (Only the introduction was read directly.)
• Midgley, N., Ensink, K., Lindqvist, K., Malberg, N., & Muller, N. (2026). Mentalization-Based Treatment for Children (2nd ed.). APA. (Contents only.)
• Asen, E., & Fonagy, P. (2021). Mentalization-Based Treatment with Families. Guilford.
• Asen, E., & Fonagy, P. (2012). Mentalization-based therapeutic interventions for families. Journal of Family Therapy, 34(4), 347–370. (Abstract only.)
• Asen, E., & Fonagy, P. (2017). Mentalizing family violence, Parts 1 and 2. Family Process.
• Muller, N., & Midgley, N. (2020). Paper on MBT-C with children in pretend mode, Journal of Infant, Child, and Adolescent Psychotherapy. [uncertain].