Mentalization-based therapy: what it is and how it works

The concept of mentalization has aroused a lot of interest in the field of mental health, neuroscience or philosophy, among other areas of research and knowledge about the human being from different perspectives, being a concept that is used fundamentally when it comes to refer to the process by which a person gives meaning to others and to himself.

Mentalization-based therapy (MBT) is a model of psychotherapy that is rooted within the framework of psychodynamic therapies and was initially developed as a treatment for adults with borderline personality disorder (BPD), although a new approach was later developed. new version of this treatment focused on adolescents (TBM-A).

In this article we are going to see what mentalization-based therapy consists of , but first we are going to talk in an introductory way about the concept of mentalization seen from the field of psychotherapy.

What is mentalization?

The word "mentalize" could be defined as the ability that people usually have to perceive and interpret different behaviors and associate them with different intentional mental states, based on the idea that people's mental states influence their own behavior. Therefore, we could say that mentalization is a capacity that the human being possesses to make a mental representation about himself; that is, of his own self, seen as an active agent, which allows him to have the idea that he is the owner of his thoughts and behaviors.

The concept of mentalization has been used in the field of psychology and psychotherapies fundamentally to refer to the ability of people to make an interpretation about their own actions , as well as those of other people based on a series of psychological states or subjective mental (feelings, thoughts, desires, etc.). In addition, mentalization serves to try to understand the close relationship between people's own behaviors with respect to those mental states.

On the other hand, mentalization is very important for each person's own self-regulation and also for them to be able to have close relationships with other people or intimate ones in a healthy and constructive way, being characteristic that these are deteriorated in those people who suffer from a of personality because in this type of case it is common for them to tend to lose their own ability to mentalize in difficult moments in which anxiety and stress, among others, could arise.

It should be noted that researchers in this field have managed to observe, through brain scans, a relationship between the deactivation of mentalization and the activation of the attachment system , since those areas of the brain that are associated with attachment inhibit activity in those areas. tasks in which there is a connection with cognitive control, among which could be included those that are associated with mentalization; furthermore, this capacity is not innate but should be developed through a context of secure attachment during childhood.

However, the theory that speaks about the relationship between borderline personality disorder and disorganized attachment has not been able to provide an explanation about the etiology or genesis of this disorder, despite the fact that there are several studies in which has been able to demonstrate a higher prevalence of insecure attachment in those patients with a borderline personality disorder compared to people who do not suffer from said disorder, with an association between loss or difficulty mentalizing and different interpersonal problems, emotional instability, violence and impulsiveness.

On the other hand, it should be noted that mentalization is a capacity that has different dimensions, among which we can find the following: cognitive-affective, implicit-explicit, oneself-the other, internal-external . When the balance is unbalanced towards one of these opposite poles, different problems could arise, as is usually characteristic in some psychopathologies.

What is mentalization-based therapy?

The psychoanalysts Anthony Bateman and Peter Fonagy have been the main precursors of mentalization-based therapy, who developed it in order to address through psychological treatment some difficulties associated with borderline personality disorder, arguing that people with a disorder of the borderline personality show a deterioration in their ability to mentalize or it may even be that in many cases this ability is non-existent.

Bateman and Fonagy have come to emphasize that the difficulty in mentalizing people with borderline personality disorder is a key factor in their mental illness, which is why in their therapeutic model they have placed special emphasis on work when it comes to try to develop, favor and optimize the use of this capacity that is so important for the human being, as we will see in the article later when we talk about the different phases that mentalization-based therapy is made up of and the techniques that most often used by therapists.

The phases of psychotherapy based on mentalization

Mentalization-based therapy (MBT) is generally composed of 3 main phases divided over several sessions and starting with an evaluation process in individual format, which is followed by a phase through several sessions of psychoeducation in group format , to then move on to individual sessions with each of the patients that make up the group.

Mentalization-based therapy has been extensively studied in recent years, having shown promising results; however, more studies are still needed, especially with clinical trials that are randomized and controlled. Even so, this therapy already has a high degree of recommendation for the psychological treatment of borderline personality disorder , and it is also necessary and interesting to carry out more research with other types of personality disorders.

Below we will briefly explain the 3 main phases into which mentalization-based therapy is mainly divided, explaining the main objectives and techniques used throughout each of them.

1. The initial phase

This initial phase is developed in an individual format and the main objectives pursued throughout the first sessions are the following:

• Carry out a formulation of each case with each patient in particular.
• Determine what would be the mentalization capacity of each patient.
• Try to get patients involved in psychotherapy.

On the other hand, the techniques that are most often used in this initial phase are: use by therapists of active listening, carrying out an analysis of relational and interpersonal patterns, as well as their dynamics, and a analysis of the patient's report about different situations, both emotional and social.

2. The middle phase

It should be noted that the middle phase of therapy based on mentalization is usually carried out through several sessions, both in group and individual format in a combined manner, being a phase in which it is essential to achieve the consolidation of the therapeutic alliance between the patient and the patient. the psychotherapist , as well as the promotion of the mentalization of the patient.

Throughout the middle phase of this therapy, various therapeutic techniques are usually used, such as the following: the “stop, listen and look technique”, the “stop, rewind and explore technique”, the “clarification and challenge” or reassurance and empathy on the part of the psychotherapist, among others.

3. The final phase

The final phase is developed fundamentally through individual sessions, being a phase in which the therapist will help the patient to maintain the gains achieved both throughout the therapy and in the period between sessions, in addition to preparing the end of the treatment by putting special attention to the possible feeling of loss on the part of the patient after the conclusion of the sessions.

In this final phase, it is important to highlight the following techniques, as they are the most used by the psychotherapist during this period: firstly, an analysis of the current interpersonal or relational patterns of the patient is usually carried out and, secondly, the technique of mentalizing transference and countertransference is used.