What's Mentalization-Based Treatment About?

15 April, 2021
Mentalization-based treatment helps interpret human behaviors in relation to every person's own mental states. This is a useful clinical approach to regulate behaviors and strengthen social bonds.

Mentalization-based treatment is a fairly new therapeutic approach. Its goal is the same as many other types of clinical strategies: to help you better understand thoughts and emotions for the purpose of linking them to your own behavior. In essence, it’s to focus attention on mental processes, use them to your advantage, and, thus, achieve a greater sense of control over everything you do.

These integrative currents are always as interesting as they’re useful in clinical psychology. This particular therapy, which emerged at the beginning of the second millennium, is one such example. It integrates everything from the cognitive-behavioral school to the psychodynamic one, including the systemic and ecological schools. All this comprises a resource that’s as valid as it’s interesting, designed by psychologists Peter Fonagy and Anthony Bateman.

They initially created this therapy to provide a more effective response to patients with borderline personality disorder. Nowadays, however, it’s an equally valid tool for treating various disorders such as depression, anxiety, eating disorders, and trauma. Patients with addictions usually undergo it as well.

A woman undergoing mentalization-based treatment.

The characteristics of mentalization-based treatment

You must understand what mentalization is before delving into this type of therapy. What does it mean in the context of this particular dimension? Basically, it refers to one’s ability to understand oneself in-depth, unraveling the internal processes that sometimes lead people to act impulsively.

Anthony Bateman, the creator of this therapy, defined mentalization as that process by which one can understand others, but, above all, oneself, by becoming fully aware of what’s going on in one’s mind. Here’s a simple example to understand it better.

Today, when I got home from work, I responded badly to my partner and it led to an argument. Mentalization-based treatment would help me understand why this happened: my mood, my worries and stress make me choose the wrong words to communicate. In addition, I projected my work anger onto my partner.

As you can see, this type of resource can be good for regulating emotions and help you improve your relationships. Continue reading to find out more about mentalization-based treatment.

Mentalization and Bowlby’s attachment theory

Mentalization-based treatment is largely based on the psychodynamic approach that stems from John Bowlby’s attachment theory. According to this approach, people can develop good mentalization. That is, good control and understanding of their thoughts, emotions, and mental representations thanks to a secure attachment.

Thus, growing up in an environment in which your parents provide an affectionate environment. One in which they validate your emotions. One in which they cover your needs and make it easier for you to build your identity, label your feelings, desires, and thoughts, everything will progress healthily. This is because you’ll little by little develop that coherence and self-control between your actions and thoughts. Also, between your behavior and emotions.

Thus, the creators of mentalization-based treatment point out that there’s a disintegrated sense of self in borderline personality disorder.

Impulsive behavior is the main characteristic of these people and they have clear difficulty regulating their emotions. Also, it’s hard for them to manage their interpersonal relationships. This is because mentalization fails in them. Thus, they don’t understand what’s going on in their mind. This is most likely due to the fact that they grew up in an environment based on a disorganized and insecure attachment (Bateman and Fonagy, 2006).

A seemingly sad woman.

The goals of a mentalization-based treatment

This kind of therapy is based on the following idea: the failure to adequately develop the mentalization process leads to a series of rather concrete realities:

  • Interpersonal and social problems.
  • Emotional instability.
  • Impulsivity.
  • Stress disorders such as anxiety, and depression, among others.
  • Self-destructive and violent behaviors.

Thus, the goals of mentalization-based treatment require, first and foremost, a well-trained professional in the following dimensions:

  • Ensuring that the patient has a better understanding of their mental states.
  • Favoring emotional and behavioral regulation.
  • Impulse control.
  • Improving social skills so that relationships are more rewarding.
  • Clarifying and establishing vital purposes.
  • Promoting a rich, safe, and motivated internal reality where the person feels in control and also has an illusion to build a balanced and happy life.
  • Building continuity in their autobiography. Often, going through certain traumas, problems, or addictive behaviors creates a block in a person. The purpose of this therapy is to unblock and create new perspectives for the future.
A man undergoing mentalization-based treatment.

Is mentalization-based therapy effective?

As you can see, this approach is certainly interesting. What does the evidence say about its effectiveness?

Studies such as the one conducted at the Department of Psychology and Behavioral Sciences at Aarhus University in Denmark reveal that therapy based on mentalization has a high success rate in patients with borderline personality disorder. Hence, it’s the most recommended in mental health services.

In conclusion, there’s one more resource worth taking into account for a certain type of clinical need.

  • Bateman, A.W., Fonagy, P. (2006). “Mechanism of change in mentalization based treatment of borderline personality disorder”. Journal of Clinical Psychology. 62 (4): 411–430. doi:10.1002/jclp.20241
  • Bateman A. (2016) Tratamiento basado en la mentalización. Biblioteca de psicología
  • Bateman A, Fonagy P. Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry. 2009 Dec;166(12):1355-64. Epub 2009 Oct 15.
  • Bateman A, Fonagy P. 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. Am J Psychiatry. 2008 May;165(5):631-8. Epub 2008 Mar 17.