What is Mentalisation Based Therapy?

At one time or another, most of us may take things the wrong way. Whether at work, with our friends or loved ones, we could find ourselves misinterpreting where others are coming from, especially when the stakes feel high.  

The notion of understanding other people’s intentions is at the heart of “mentalisation”. Mentalisation relates to how people make sense of their social world by imagining how other peoples’ states of mind that could influence their behaviour. For example, after receiving no response from his girlfriend, a man could assume that she is not interested in him, that she sees him as a nuisance or that she has gone off with someone else. He might conclude that she won’t be there for him. He could feel annoyed or anxious, and end up isolating himself or checking for phone messages repeatedly. His beliefs about his partner’s intentions could therefore have a bearing on his feelings and behaviour.

The term mentalisation was introduced by Professor Peter Fonagy and his colleagues in their research of borderline personality disorder. They observed that this group of patients display a pattern of thinking that seems to emerge from insecure attachments in childhood. In relatively secure attachments, parents attempt to understand the infant’s emotions, desires and intentions. A mother might ask a baby, “Are you hungry? Do you need changing?” This could indicate curiosity of the child’s internal states. However, if a parent overreacts to the child’s distress, then the child’s state of mind may not be reflected upon. The child may internalise the parent’s fear in lieu of their own mental states. Furthermore, when child is exposed to trauma, the intentions of the adult cannot be thought about (or mentalised) by the child. Gradually, problems with mentalising capacity become linked to periods of distress in the social world of the adult.

In Mentalisation Based Therapy (MBT), the therapist focuses on the client’s understanding of their own intentions and those of others. He or she tries to help manage the client’s levels of emotional arousal to enable mentalising capacity. MBT places less emphasis on past relationships and the meaning of events; rather the therapist and client explore the client’s processes when mentalising capacity is compromised in present relationships. The therapist adopts a so-called “inquisitive” or not-knowing approach, setting assumptions aside to allow for uncertainty. He or she strives to remain open to how the client interprets the actions of themselves and others. This in turn aims to help the client develop and maintain an attitude of curiosity.

MBT is recommended by the NICE guidelines as a treatment for borderline personality disorder. The therapeutic approach has been extended to treating problems in adolescence, families, couple relationships and eating disorders.

In recent years, MBT has become increasingly popular amongst therapists. This may be unsurprising. A few years ago, I had the good fortune of interviewing practitioners of MBT through the training institution, the Anna Freud Centre. The participants came from around the world to study. What seemed to emerge in my research was that MBT was becoming somewhat of a philosophy of life. Perhaps, this could only be a good thing to impart to clients to alleviate their distress by contemplating the unknown.