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Simone Hoermann, Ph.D.Simone Hoermann, Ph.D.
A blog about the personality disorders (borderline, narcissistic, etc.) with a focus on research and therapy

Specialized Treatments for Borderline Personality Disorder: What is Mentalization Based Therapy?

Simone Hoermann, Ph.D. Updated: Apr 23rd 2009

illustration of a blue pause buttonMentalization Based Therapy (MBT) was developed by Anthony Bateman and Peter Fonagy and is one of the therapies for Borderline Personality Disorder (BPD) that has been tested in clinical research studies. The term “mentalization” refers to a mental process by which we try to understand our own and other people’s mental states and motivations. We mentalize when we try to make sense of behaviors of other people, or when we try to understand our own feelings. In their book “Psychotherapy for Borderline Personality Disorder- Mentalization Based Treatment” (Oxford University Press, Oxford: 2004), authors Anthony Bateman and Peter Fonagy state that mentalization is a new word for a concept that is in fact very old, and that mentalization is a process that we all use in order to interact with other people and to make sense of ourselves and others. Mentalization includes thinking about desires, needs, beliefs, feelings and reasons. It also includes understanding that internal states are different and separate from action, yet can cause action. 

 

In his paper “What Is Mentalizing and Why Do It?” Jon Allen refers to mentalizing as “keeping mind in mind”. So, why does Jon Allen think we should mentalize? For one, because mentalizing helps us to engage in fulfilling and emotionally close relationships. It allows us to influence and be influenced by others and thus helps us decrease conflict and antagonism. Jon Allen likens the act of mentalizing our own emotions to hitting a “pause button”, which can help us to tolerate and regulate our emotions instead of acting on them in harmful ways. Understanding ourselves better is also a first step towards change.

The theory behind MBT is that we develop the capacity to mentalize within the context of an attachment relationship and in an environment that fosters mentalizing. Bateman and Fonagy argue that people with BPD have difficulties in mentalizing, and that it is particularly hard for them to recognize internal states and motivations, especially in interpersonal and intimate situations. When I recently had the chance to speak with Peter Fonagy about MBT, he explained:  “It is hard to know what someone else is thinking. People with Borderline Personality have a certain vulnerability to get into intense relationships and then end up being so overwhelmed emotionally that they can’t think clearly. In intimate relationships, the attachment system gets activated, and for people with Borderline Personality who often have an attachment style that is disorganized, it then becomes harder to think clearly and to mentalize, because of the intense emotions involved. People get into a place of mind where this important capacity to mentalize becomes elusive.”  Fonagy compared MBT to physical therapy. “The same way that you train your muscles when you do physical therapy, you train the mentalization muscle in MBT. It is the muscle that allows you to control your feelings better and to use hints to avoid getting into trouble and to generally just become happier. Part of that has to be acknowledging that it is not easy. It is challenging and difficult and sometimes it is impossible. People won’t be able to do it all the time. “

In standard MBT, people work in once a week individual therapy and a once a week group. The individual therapy offers the opportunity to engage in an important relationship that allows for improving one’s understanding of themselves and improving relationships. The group offers an opportunity for people to learn from each other within a structured protocol. The goal is to improve relationships, be less impulsive, and understand oneself better.

Simone Hoermann, Ph.D.Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

    Reader Comments
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    Mentalizing when you can't mentalize - Mental Health Service Dog - Jun 29th 2010

    Dr. Allen has acknowledged that mentalizing can become almost impossible to do when you are in a highly emotional state, usually, as it happens, in the context of a close attachment relationship.  He calls it "Catch 22" - you most need to mentalize when you are least able to.  This includes mentalizing another person and mentalizing yourself.  I think that you can use DBT skills of emotional regulation, even if they feel somewhat mechanical, to attain a state in which it is possible to mentalize, and go on from there.

    "Keeping mind in mind" - - Feb 28th 2010

    “keeping mind in mind”

    I see a parallel between Mentalization Based Therapy and Dialectical Behaviour Therapy's CORE MINDFULNESS skills.

    Also, the DBT model of trying to stay in Wise Mind versus Emotional Mind or Reasonable Mind.

    Mentalization and mindfulness ? - Steve - Nov 18th 2009

    Id be interested in people's thoughts as to how mentalization as a process differs from the concept of mindfulness...from my reading it sounds like there is considerable overlap...

    Hrmm - Willow - Apr 23rd 2009

    Being someone diagnosed with BPD, I have to say that "mentalizing" sounds a lot like an attempt to clean up the mental guessing game. I would say I'm quite good at playing that guessing game and assuming many things about how others think or feel, often resulting in a negative view of myself, but not so good at getting the answers I find to be right, according to the feedback I do get. It's like a no-win situation, because being right hurts, and being wrong feels like being invalidated. I'm having a hard time understanding why keeping ourselves in a pattern like this would be helpful outside of ourselves. In examining our own motivations, I can see where this might help, but I can't help thinking this would negatively support the many assumptions those with BPD often make of other people without much evidence (and without weighing both the evidence for and against our thoughts/feelings) due to our hypersensitivity to outward actions of other people. I suppose this might be different for those with the diagnosis who feel numb more often than not, don't speak up, and/or dissociate more, maybe. I wouldn't describe my experience with BPD as a complete lack of "mentalization" I guess, but perhaps as a lack of ability to convince myself that my thoughts/feelings are just that, as more often than not, when I verbalize the thoughts or feelings - which often teeter on fear (of abandonment/rejection) - nothing good of it comes. I wonder if MBT puts much focus on differentiating between what should be vocalized and what shouldn't, or telling the difference between real and imagined outside of ourselves, because that is one of the hardest parts for me when my mind is so good at convincing myself that it should all come out. Thinking/feeling and ultimately making assumptions on the other hand, is quite easy!

    5.9 percent of the general population - Someguy - Apr 23rd 2009

    There have been studies showing that BPD is in 5.9 percent of the general population. This is a jump of about 2 percent from previous studies. I don't know if this means the criteria for BPD has broadened, the 'illness' is more prevasive then what was thought, or perhaps society is becoming more stressful/more abusive?   

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