mentalisation-based therapy (MBT)
Mentalisation-based therapy or MBT is an effective and evidence-based treatment for people struggling with anxiety and depression, trauma, overwhelming emotions, addictions, self-defeating patterns and harmful behaviours, eating disorders, and problems maintaining secure and healthy relationships.
In MBT, the focus is on providing a secure, boundaried, and consistent therapeutic relationship in which to explore thoughts and feelings about yourself and others, and how these relate to your actions and interactions. This process is called 'mentalising' and, through practicing it in MBT, we learn to understand ourselves, to feel more in control of our emotions and behaviours, and to improve our relationships with others.
what is mentalisation?
Mentalisation is the capacity to think about and make sense of what goes on in our minds and the minds' of others. It is thinking about thinking.
Mentalising is what we do when we are imagining what might be going on in the mind of someone else, underneath the words and actions we see and hear on the outside. We can think of it as the inside story.
We use mentalising when we piece together information to make sense of our experiences and interactions. In our day-to-day lives, for example, we can attend to how we feel, what we are thinking, our context and surroundings, who is around us, what we know about them and their states of mind, and so on. Mentalising is the process by which we join all of this together to make a coherent picture of ourselves and others, to understand what makes us/them behave and say the things we/they do.
Mentalising is keeping mind in mind. It takes mental effort to be mindful of what others are thinking and feeling as well as being mindful of your own thoughts and feelings.
Mentalising is seeing ourselves from the outside and others from the inside. It is taking the perspective of the person we are relating to - rather than assuming others feel the same way and/or that our perspective is the only way.
Mentalisation also has a lot to do with misunderstanding! Misunderstandings are inevitable because our minds naturally make assumptions, and because we all have different life experiences and perspectives, and we naturally use different strategies and hide aspects of ourselves. In understanding misunderstandings, we make an effort to be interested in how and why we may be at cross purposes with someone, and try to sort out the assumptions we are both making.
what is helpful about mentalising?
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Helps us to understand why others behave as they do, and what is taking place between people
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Helps us to understand ourselves and why we feel and behave as we do, who we are, our preferences, our own values
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Understanding helps us to cope with others and with our own emotions (ie to regulate our own and other people’s feelings)
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It helps us to get on with others and communicate well with our family and close friends
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It helps us to press the 'pause' button
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Helps us to work through misunderstandings
non-mentalising & why we struggle to mentalise
We learn to mentalise in childhood through our interactions and relationship with our main caregiver. Exposure to childhood stress and trauma (such as loss, serious illness, addiction, mental illness, divorce, poverty, etc.) interrupts and inhibits this process. If a caregiver is scared, depressed, unpredictable, unavailable, etc. they cannot help us to make sense of and understand the thoughts and feelings we cannot manage on our own. When this happens - particularly in childhood when feelings are often felt to be overwhelming - we develop non-mentalising ways of coping, such as withdrawing, blaming, threatening, or demanding. These strategies help us to survive when we are younger. They help us to manage ourselves and to get our needs met. But, as we get older, they tend to become less effective and even problematic.
Later on, we may find ourselves still struggling to understand and respond effectively to our thoughts, feelings, and interactions with others. This is because when we are overwhelmed we tend to revert to old coping strategies. Responding to rejection, for example, by cutting people off, becoming angry, threatening, or even suicidal - rather than pausing to think about and process what has happened and consider how best to respond. Non-mentalising strategies make it difficult to trust and build safe and meaningful relationships. As a result, we may find ourselves feeling isolated and lonely, and missing out on opportunities to feel cared-for, supported, and understood.
what happens in MBT?
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MBT is an individual and group therapy.
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The focus of MBT is on the relationship and interactions between you and the therapist.
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Initially, our goal is simply to build a secure and trusting relationship and to create a space where we can be curious and interested in you and others.
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We will pause, slow things down, and connect with your emotional experiences - rather than 'talking about' or 'around' your feelings.
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I will be very interested in and ask lots of questions about your internal experiences, thoughts, and feelings.
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We will pause, rewind, reflect, and rethink interactions and situations, particularly where there has been strong emotional activation or problematic reaction.
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We will explore together and come to understand your own and others’ mental states.
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You will learn and practice new ways of responding and relating to yourself and others.
frequently asked questions
when would I be offered MBT?
MBT is usually recommended if you are struggling to manage overwhelming feelings (including anxiety and depression), you are finding it difficult to manage at work/school, and you are struggling with relationships (including feeling isolated/lonely, unstable/volatile relationships, fear of rejection/abandonment, etc.)
how many sessions will I need?
MBT is a long-term treatment typically lasting 12 - 24 months. Most people see significant benefits after 9 – 18 months.
Why might I be offered MBT vs DBT?
Both Dialectical Behavioural Therapy (DBT) and Mentalisation-Based Therapy (MBT) are effective, evidence-based, and NICE recommended treatments. DBT is a behavioural approach and typically the frontline treatment for managing very risky and suicidal patients. MBT is a psychodynamic approach, focused on attachment relationships and interpersonal processes.
MBT is usually recommended if there is a strong relational component to your difficulties. As an attachment-based approach, MBT is also the treatment of choice if the history indicates attachment disruption in childhood (e.g. where there has been significant family stress or trauma).