Mentalization-Based Treatment (MBT) For Personality Disorders

Anthony Bateman and Peter Fonagy are the founders of Mentalization-Based Treatment (MBT). There is accumulating research evidence that MBT is an effective treatment for Borderline Personality Disorder (Paris, 2008). MBT originates from attachment theory. A brief review of this theory follows:

The basic premise of attachment theory is human infants have an inborn need to seek proximity to their caregiver. When an infant is distressed, attachment behaviors, such as clinging, smiling, and crying are activated in an effort to elicit a soothing response from the caregiver. The quality of the caregiver’s response to these attachment behaviors greatly influences the development and nature of the child’s basic sense of safety in the world.

Through repeated interactions with their caregivers, children develop an internal working model of relationships.  This relationship model is applied to other important relationships later in life.  To the extent caregivers respond effectively to sooth and comfort a child, a secure attachment is formed.  Through secure attachments, children learn to self-soothe and self-regulate their emotions because their caregiver has modeled these comforting responses.  To the extent the caregivers fail to respond effectively, an insecure attachment is formed.  This limits opportunities to learn self-soothing and self-regulating behaviors.

The term mentalization refers to the ability to reflect upon, and to understand one’s state of mind. Mentalization is the insightful understanding of what one is feeling, and why.  This skill of mentalization is thought to develop via  a caregiver’s empathic and insightful response to a child’s distress. This means mentalization is learned through a secure attachment to the caregiver.  Insecure attachments limit the development of this important skill.

Mentalization is assumed to be an important coping skill that is necessary for effective emotional regulation. Recall, difficulties with emotional regulation are one of the four hallmark features of personality disorders. Mentalizing has been likened to “hitting a pause button.” For instance, when we have a powerful negative feeling, it is often coupled with an intense urge or impulse to do something, or to take some immediate action. The ability to briefly tolerate the feeling, and to stop and reflect upon it, is a way of slowing down, and deterring us from acting upon destructive impulses and urges.

In addition to helping us to understand our own state of mind, mentalization also helps us to understand the state of mind of other people. Therefore, mentalizing is thought to be very important relational skill for several reasons. The benefits of mentalization are:

1) Mentalization enables us to understand our own contributions to problems and conflicts with others;
2) Mentalization helps us to change our behaviors and calm down when we are upset;
3) Mentalization allows us to relate to ourselves and other people with empathy and compassion; and
4) Mentalization promotes our ability to effectively cope with conflict.

Since the defining characteristic of all personality disorders is interpersonal difficulties it is quite logical to conclude this important mentalization skill may be missing. MBT proposes this highly necessary skill must be learned in order to correct these interpersonal difficulties. Therefore, MBT seeks to assist therapy participants to develop this necessary skill.