Mentalization based treatment
Encyclopedia
Mentalization-based treatment (MBT) is an innovative form of psychodynamic psychotherapy
, developed and manualised by Peter Fonagy
and Anthony Bateman. MBT has been designed for individuals with borderline personality disorder
(BPD), who suffer from disorganised attachment and allegedly failed to develop a mentalization
capacity within the context of an attachment relationship. Fonagy and Bateman claim mentalization is the process by which we implicitly and explicitly interpret the actions of oneself and others as meaningful on the basis of intentional mental states. The object of treatment is that BPD patients increase mentalization capacity which should improve affect
regulation and interpersonal relationships.
The treatment should be distinguished from and has no connection with the more common Mindfulness-Based Stress Reduction
(MBSR) therapy developed by Jon Kabat-Zinn
.
, retaining mental closeness, and working with current mental states.
and individual treatment. During sessions the therapist activates the attachment system through a range of largely unconscious techniques. Activation occurs through the elaboration of current and past attachment
relationships, the therapist’s encouragement and regulation of the patient’s attachment bond with the therapist and the therapist’s attempts to create attachment bonds between members of the therapy group.
, placebo-controlled, crossover design.
8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment Versus Treatment as Usual. Am J Psychiatry 2008; 165:631-638.
Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry. 2001 Nov;158(11):1932-3.
Effectiveness of partial hospitalization
in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry. 2001 Nov;158(11):1932-3.
Psychodynamic psychotherapy
Psychodynamic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. In this way, it is similar to psychoanalysis. It also relies on the interpersonal relationship between client...
, developed and manualised by Peter Fonagy
Peter Fonagy
Peter Fonagy, born in 1952, at Budapest, Hungary, currently residing in London with his family; he has two children, Carolina and Francisco. Fonagy is a prominent contemporary psychoanalyst and clinical psychologist. He studied clinical psychology at University College London...
and Anthony Bateman. MBT has been designed for individuals with borderline personality disorder
Borderline personality disorder
Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the...
(BPD), who suffer from disorganised attachment and allegedly failed to develop a mentalization
Mentalization
Mentalization is a psychological concept that describes the ability to understand the mental state of oneself and others which underlies overt behaviour. Mentalization can be seen as a form of imaginative mental activity, which allow us to perceive and interpret human behaviour in terms of...
capacity within the context of an attachment relationship. Fonagy and Bateman claim mentalization is the process by which we implicitly and explicitly interpret the actions of oneself and others as meaningful on the basis of intentional mental states. The object of treatment is that BPD patients increase mentalization capacity which should improve affect
Affect (psychology)
Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" .The affective domain...
regulation and interpersonal relationships.
The treatment should be distinguished from and has no connection with the more common Mindfulness-Based Stress Reduction
Mindfulness-based stress reduction
Mindfulness-Based Stress Reduction is a structured complementary medicine program that uses mindfulness in an approach that focuses on alleviating pain and on improving physical and emotional well-being for individuals suffering from a variety of diseases and disorders. The program was established...
(MBSR) therapy developed by Jon Kabat-Zinn
Jon Kabat-Zinn
Jon Kabat-Zinn is Professor of Medicine Emeritus and founding director of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. Kabat-Zinn was a student of Zen Master Seung Sahn and a founding member of...
.
Goals
The major goals of MBT are: (1) better behavioral control, (2) increased affect regulation, (3) more intimate and gratifying relationships and (4) the ability to pursue life goals. This is believed to be accomplished through increasing the patient’s capacity for mentalization in order to stabilize the client’s sense of self and to enhance stability in emotions and relationships.Focus of treatment
A distinctive feature of MBT is placing the enhancement of mentalizing itself as focus of treatment. The aim of therapy is not developing insight, but the recovery of mentalization. The focus should be on the present state and how it remains influenced by events of the past. Other core aspects of treatment include bearing in mind patient’s deficits, using transferenceTransference
Transference is a phenomenon in psychoanalysis characterized by unconscious redirection of feelings from one person to another. One definition of transference is "the inappropriate repetition in the present of a relationship that was important in a person's childhood." Another definition is "the...
, retaining mental closeness, and working with current mental states.
Treatment procedure
MBT is offered to patients every 2 weeks with sessions alternating between group therapyGroup therapy
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group...
and individual treatment. During sessions the therapist activates the attachment system through a range of largely unconscious techniques. Activation occurs through the elaboration of current and past attachment
Attachment theory
Attachment theory describes the dynamics of long-term relationships between humans. Its most important tenet is that an infant needs to develop a relationship with at least one primary caregiver for social and emotional development to occur normally. Attachment theory is an interdisciplinary study...
relationships, the therapist’s encouragement and regulation of the patient’s attachment bond with the therapist and the therapist’s attempts to create attachment bonds between members of the therapy group.
Mechanisms of change
The safe attachment relationship with the therapist provides a relational context in which it is safe for the patient to explore the mind of the other. At the same time the individual is encouraged to mentalize, to experience and confront negative affect and to elaborate and review issues of morality. The simultaneous activation of the attachment system and development of psychological processes move the pattern of arousal within these systems closer to that characteristic of secure attachment and increase the mentalizing capacity.Efficacy
Fonagy et al. have done extensive outcome research on MBT for borderline personality disorder and the results have compared favorably with existing treatments. The most recent study on this was an 8-year follow-up of MBT versus treatment as usual. Not all of these, however, were of a randomized, double-blindDouble-blind
A blind or blinded experiment is a scientific experiment where some of the people involved are prevented from knowing certain information that might lead to conscious or subconscious bias on their part, invalidating the results....
, placebo-controlled, crossover design.
8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment Versus Treatment as Usual. Am J Psychiatry 2008; 165:631-638.
Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry. 2001 Nov;158(11):1932-3.
Effectiveness of partial hospitalization
Partial hospitalization
Partial hospitalization, also known as PHP , is a type of program used to treat mental illness and substance abuse. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment center up to seven days a week...
in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry. 2001 Nov;158(11):1932-3.
Further reading
- Allen, J.G., Fonagy, P. (2006). Handbook of mentalization-based treatment. Chichester, UK: John Wiley.
- Allen, J.G., Fonagy, P., Bateman, A.W. (2008) Mentalizing in clinical practice. Arlington, USA: American Psychiatric Publishing
- Mentalization Based Therapy (John M. Grohol, PsychCentral, March 17, 2008)