26/10/22, 11:29 Mentalization Based Treatment · EFPT Psychotherapy Guidebook

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Mentalization Based Treatment

Brief Historic Overview

Mentalization Based Treatment (MBT) was developed in the early 90s, by Professor
Anthony Bateman and Professor Peter Fonagy, for the management of patients with
Borderline Personality Disorder (BPD). It is a psychodynamically informed therapy, rooted
in attachment theory and psychoanalytic concepts - mainly object relations theory. MBT
was developed at St Ann’s Hospital in London, United Kingdom, and its main training
centre is Anna Freud National Centre for Children and Families.

Indications

Initially developed for BPD, MBT is now being used for a wide range of disorders, such as
Eating Disorders, Depression, Addictions and Antisocial Personality Disorder (ASPD).

Description

The focus of MBT is to enhance patients mentalizing capacity. According to Bateman and
Fonagy (2010), “Mentalization is the process by which we make sense of each other and
ourselves, implicitly and explicitly, in terms of subjective states and mental processes.” In
other words, it is the capacity to think about one’s own and others’ mental states
(thoughts, emotions, needs) and their impact on interpersonal interaction. It is about
awareness of the self and the other as an independent human being. This capacity is
deeply dependent not only on individual genetic factors, but also on the quality of early
object relationships and attachment. Bateman and Fonagy (2010) argued that BPD
patients have a fragile mentalizing capacity – i.e. they have difficulty in thinking about their
thoughts, feelings, desires and actions, inadequate emotional regulation as well as

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inconsistent and inaccurate perceptions of self and others. These make them vulnerable
to experience very painfully the common difficulties in social and interpersonal
interactions, resulting in unstable and chaotic relationships.

The central feature of MBT is to establish a safe attachment environment within which
internal states can be represented, thought about and discussed and thereby the patient’s
mentalizing capacity can be developed and strengthened, resulting in patients being
better able to manage their intense emotional states and to respond to life’s challenges in
more adaptive ways.

Mentalization and overlapping terms

The concept of mentalizing is complex, has particular boundaries and refers to

phenomena that are fundamental to human interaction. It is therefore not surprising that it
shares similarity with some other terms. We will give some terms here to help
differentiating the concept of mentalizing:

Term Distinction

Mentali Attending to mental states in self and others, and interpreting behaviour
zing accordingly.

Theory Focusses on cognitive development and provides a conceptual framework for

of mind mentalizing.

Metaco
Focuses primarily on cognition in the self.
gnition

Mindful Focuses on the present and is not limited to mental states6Roberts Klotins, Foteini
ness Papouli, Bárbara Almeida.

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Empath Focuses on others and emphasizes emotional states.

y

Emotio
nal
Pertains to mentalizing of emotion in self and others.
intellige
nce

Psychol
ogical
Characterizes disposition to mentalize - very broadly defined.
minded
ness

Insight Mental content that is the product of mentalizing process.

Theory of mind term that applies to others and focuses on cognition, thus leaving
Mindrea
out self and emotions. The term also has connotations of telepathy delusions -
ding
‘knowing’ the other’s  thoughts directly.

Mindbli
Antithesis of mentalizing; the term originally was employed to characterise autism. 
ndness

Early mirror neurons research

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MBT draws on plenty of research in attachment, emotions and neurobiology, highlighting

the importance of the emotional component in thinking, emotion processing and
behaviour. It is a very persuasive and coherent treatment model, suggesting that
mentalization is the central process of all effective psychotherapies. Moreover MBT aims
to build on already acquired therapeutic skills rather than be just a treatment modality on
its own. Psychodynamic, cognitive, systemic and other therapists can all learn and
incorporate MBT in their practice. If one wants to implement MBT protocols - they are
readily available. It is a well researched treatment modality - particularly in Borderline
Personality Disorder, now showing also evidence of efficacy in treating other common
psychiatric conditions.

The treatment is organised in one-team model and is a combination of group and

individual therapy. The intensity varies between daily sessions to a two-session-a-week
basis, for up to 18 months. Adults, children and young people can have access to MBT.

Efficacy

The MBT is a relatively new psychological treatment and as such more research is
required to clarify its efficacy, although there is already evidence that it can be beneficial
for clinicians who have a framework when working with patients with BPD (Daubney and
Bateman, 2015). Randomised clinical trials have shown that MBT intervention can
decrease psychiatric symptoms in patients with personality disorders, such as suicidality
and hospitalisation (Bateman and Fonagy, 2009). Vogt and Norman (2018) published a
systematic review of evidence of the efficacy of MBT in the treatment of BPD. They
included 14 papers and the results showed superior or equal results in the management
of mental health symptoms however the authors high-lightened the need for better quality
papers as well as the limited knowledge in the MBT mechanisms.

“The failure to mentalize creates a kind of psychic version of an auto-immune deficiency

state that leaves these individuals extremely vulnerable to later sometimes quite brutal
social environments.” Psychotherapy for borderline personality disorder Mentalization-
based treatment.

Anthony Bateman and Peter Fonagy

“The most useful theory we have been taught so far.”

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“I will definitely use MBT principles in my practice. They make sense”.

Anonymous feedback from trainees in General Practice (GP) rotating in Psychiatry, who
received a pilot session of teaching on basic MBT principles.

Courses offered in Europe and Links to Societies

Online

Online MBT Training at Anna Freud Centre. The link will open a one-page PDF with
instructions.

Denmark

The Center for Mentalization - www.centerformentalization.com

Institut for Mentalisering - www.institutformentalisering.dk

Finland

MBT-F (Mentalizing Based Treatment for Families). In collaboration with the Anna Freud
National Centre for Children and Youth.

Pilke-klinikka: https://pilkeklinikka.com/trainings

Germany

Basic Training and Practitioner Level Training at University of Heidelberg

Greece

Basic Training in Thessaloniki

Ireland

International MBT centre in Dublin.

Italy

Gruppo Italiano MBT - www.gimbt.it

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Netherlands

MBT Netherlands - http://www.mbtnederland.nl

Norway

Norwegian Institute For Mentalizing - www.inst-mbt.no

Poland

Basic training in Poznan

Spain

Mentalización - www.mentalizacion.org

Switzerland, France and Belgium

Basic training in Paris, Brussels and Geneva:

Réseau Francophone des Thérapies Basées sur la Mentalisation - mentalisation.org

University of Geneva: International MBT centre - mentalization.unige.ch

United Kingdom

Anna Freud National Centre for Children and Families - www.annafreud.org

Other international centres can be found in Australia and the USA. Training is also offered
in Mexico.

Current Research

Research study into MBT as an intervention for children in foster care.

https://www.ucl.ac.uk/pals/were-starting-first-research-study-mbt-intervention-
children-foster-care

Mentalization for Offending Adult Males (MOAM). A randomised controlled trial,

across 13 sites. Men diagnosed with ASPD receive treatment in weekly basis in the
form of group MBT. This is a five-year project which started in 2016.

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https://tavistockandportman.nhs.uk/research-and-innovation/our-research/research-
projects/mentalization-based-treatment-antisocial-personality-disorder/

Ongoing research projects on MBT in Norway.

http://sigmundkarterud.no/index.php/hva-er-mbt/information-in-english and
https://www.annafreud.org/media/4468/mbt-research-2016-karterud.pdf.

References and Recommended Resources

‘MBT Resources’ https://www.annafreud.org/training/mentalization-based-treatment-

training/mbt-resources/

Espen Folmo. n.d. Mentalizing and MBT. Accessed 22 June 2019.

https://www.youtube.com/watch?v=kxUHILbZNaY.

Bateman, A. W. Mentalization Based Treatment: Clinical Training Slides.

http://www.ucl.ac.uk/psychoanalysis/people/bateman

Bateman, Anthony W., Dawn Bales, and Joost Hutsebaut. 2014. A Quality Manual
for MBT. https://www.annafreud.org/media/7863/quality-manual-2018.pdf.

Bateman, Anthony, and Peter Fonagy. 2010. ‘Mentalization Based Treatment for
Borderline Personality Disorder’. World Psychiatry 9 (1): 11.

Bateman, Anthony, and Peter Fonagy. 2016. Mentalization-Based Treatment for

Personality Disorders: A Practical Guide. Oxford University Press.

Daubney, Michael, and Anthony Bateman. 2015. ‘Mentalization-Based Therapy

(MBT): An Overview’. Australasian Psychiatry 23 (2): 132–135.
doi:10.1177/1039856214566830.

Vogt, Katharina Sophie, and Paul Norman. 2018. ‘Is Mentalization-Based Therapy
Effective in Treating the Symptoms of Borderline Personality Disorder? A
Systematic Review’. Psychology and Psychotherapy: Theory, Research and
Practice. doi:10.1111/papt.12194

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Allen, Jon G., Peter Fonagy, and Anthony W. Bateman. 2008. Mentalizing in Clinical
Practice. American Psychiatric Pub.

Bateman, Anthony, and Peter Fonagy. 2009. ‘Randomized Controlled Trial of

Outpatient Mentalization-Based Treatment versus Structured Clinical Management
for Borderline Personality Disorder’. American Journal of Psychiatry 166 (12): 1355–
1364.

Affiliations

Dr Foteini Papouli is a Senior Teaching Fellow in Psychiatry, currently working for

Northumberland Tyne and Wear NHS Foundation Trust (Newcastle-upon-Tyne, UK). Her
background is in working with offenders suffering from Personality Disorder(s).

Dr Bárbara Almeida is a psychiatric trainee, from Hospital Magalhães Lemos, Porto,

Portugal.

Dr Roberts Klotins was a psychiatric trainee in London during the writing of this chapter
and has just finished the sub-specialty training in Medical Psychotherapy. He has started
as a Consultant Psychiatrist in Psychotherapy at the Halliwick Unit, St Ann’s Hospital –
where MBT was developed.

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