What is it and how does it work

The concept of mentalization has aroused much interest in the field of mental health, neuroscience or philosophy, among other fields of research and knowledge about the human being from different angles, being a concept used fundamentally when it it is 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 in the framework of psychodynamic therapies and was originally developed as a treatment for adults with borderline personality disorder (BPD), although more later a new version of this treatment focused on adolescents. (TBM-A).

In this article let’s see what mentalization-based therapy is all aboutbut before that we will speak in an introductory way of the concept of mentalization seen from the field of psychotherapy.

What is mentalization?

The word “mentalizing” could be defined as the ability that people generally 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 behaviour. We could therefore say that mentalization is a capacity that human beings have to make a mental representation of themselves; that is to say of himself, considered 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 psychotherapy mainly to designate this people’s ability to interpret their own actions, as well as other people based on a series of subjective psychological or mental states (feelings, thoughts, desires, etc.). In addition, mentalizing serves to try to understand the close relationship that exists between people’s own behaviors in relation to these mental states.

On the other hand, mentalization is very important for everyone’s self-regulation and also for being able to have close or intimate relationships with other people in a healthy and constructive way, being characteristic that these are impaired in people who suffer of one of the personality due to the fact that in this type of case it is common that they tend to lose their own capacity for mentalization in the difficult moments in which anxiety and stress, among others, could appear.

It should be noted that researchers in this field have succeeded in observing, thanks to brain scans, a relationship between mentalizing deactivation and attachment system activation, since areas of the brain that are associated with attachment inhibit activity in tasks in which there is a link with cognitive control, among which one could include those associated with mentalizing; moreover, this capacity is not innate but must be developed in a context of secure attachment during childhood.

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

On the other hand, it should be noted that mentalization is a capacity with different dimensions, among which we can find the following: cognitive-affective, implicit-explicit, self-other, internal-external. When the balance is unbalanced in the direction of one of these opposite poles, different problems can arise, which is generally characteristic of certain psychopathologies.

What is Mentalization-Based Therapy?

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

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

The phases of psychotherapy based on mentalization

Mentalization-based therapy (TBM) is usually made up of 3 main phases spread over several sessions and starting with an assessment process in individual format, which is followed by a phase through several psychoeducation sessions in group format, to then move on to sessions in individual format with each of the patients who make up the group.

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

Next, we will briefly explain the 3 large phases between which the therapy based on mentalization is mainly divided, explaining what are the main objectives and the 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:

  • Realize a formulation of each case with each particular patient.
  • Determine what the mentalizing capacity of each patient would be.
  • Try to involve patients in psychotherapy.

On the other hand, the techniques most often used in this initial phase these are: the therapists’ use of active listening, carrying out an analysis of relational and interpersonal patterns, as well as their dynamics, and an analysis of the relationship of patients to different situations, both emotional and social.

2. The intermediate phase

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

Throughout the middle phase of this therapy, various therapeutic techniques are generally used, such as the following: the “stop, listen and watch” technique, the “stop, rewind and explore” technique, the “clarify and challenge” technique. or reassurance and empathy from the psychotherapist, among others.

3. The final phase

The final phase is developed mainly through individual sessions, being a phase in which the therapist will help the patient to maintain the gains obtained both throughout the therapy and in the period between sessions, in addition to preparing for the end of the treatment, paying particular attention to the possible feeling of loss on the part of the patient after the end of the sessions.

In this final phase, it is important to emphasize the following techniques, since they are the most used by the psychotherapist during this period: on the one hand, an analysis is generally carried out on the current interpersonal or relational patterns of the patient and, on the on the other hand, transference and counter-transference mentalization techniques are used.

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