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Mentalisation-Based Therapy (MBT) is a type of psychotherapy designed to help individuals understand and interpret the mental states of themselves and others. MBT originated from the work of Peter Fonagy, Anthony Bateman and his colleagues as they were researching the role of attachment and mentalisation in the development of personality disorders in the 1990s. Findings from this initial research indicated that individuals with Borderline Personality Disorder (BPD) often had difficulties with mentalisation, particularly in emotionally charged situations. These difficulties were linked to early attachment disruptions, which could impair the development of a stable sense of self and the ability to regulate emotions.
Fonagy and Bateman developed MBT as a structured approach to help individuals improve their mentalising capacity. This therapy integrates principles from attachment theory, cognitive-behavioural therapy (CBT), psychodynamic therapy, and systemic therapy to create a multifaceted treatment approach. MBT practitioners play a crucial role in establishing a secure therapeutic relationship and creating a safe environment where clients can explore their personal emotions and those of others, ultimately improving mentalisation and emotional regulation.
Mentalisation-Based Treatment (MBT) emphasizes the importance of understanding mental states to maintain healthy relationships and improve psychological resilience. The therapy aims to help patients develop a better understanding of their own and others’ mental states, which can lead to more effective emotional regulation and interpersonal functioning.
Mentalising, or mentalisation, refers to the ability to make sense of actions by inferring the mental states that underlie them. It involves understanding that behaviour is driven by thoughts, feelings, and intentions.
The capacity to mentalise develops over time, influenced by early attachment relationships and social experiences. Secure attachment in childhood provides a foundation for healthy mentalising, as caregivers model and support the understanding of mental states. Conversely, disruptions in attachment can impair the development of mentalising capacities. Therapists often monitor emotional arousal levels to ensure clients can maintain mentalising without becoming overwhelmed.
When individuals can mentalise effectively, they are better able to manage their emotions, understand the perspectives of others, and respond adaptively to social situations. However, disruptions in the capacity to mentalise can lead to significant interpersonal difficulties and emotional dysregulation, which are common features of a number of disorders. Recognising and regulating emotional distress is crucial for fostering better mentalising capabilities and interpersonal relations.
Mentalising is considered to be multi-dimensional, and each dimensions encompasses an aspect that contributes to how effectively an individual can mentalise. Here are the key dimensions of mentalising:
1. Automatic vs. Controlled Mentalising
2. Cognitive vs. Affective Mentalising
3. Self vs. Other Mentalising
4. Internal vs. External Mentalising
These dimensions of mentalising often interact and influence one another. For example, effective mentalisation typically requires a balance between cognitive and affective components, as well as the ability to shift between automatic and controlled processes depending on the context. Similarly, understanding oneself can enhance the ability to understand others, and vice versa.
The key to effective mentalising is balancing these dimensions and much of the work in MBT is on understanding and developing flexible capacity to mentalise by working on these various dimensions.
Non-mentalising modes (or mentalising failures) are cognitive and emotional states where an individual fails to adequately understand and interpret their own and others’ mental states. These modes can lead to misunderstandings, emotional dysregulation, and interpersonal conflicts. Identifying and addressing non-mentalising modes is also crucial component of MBT. Here are 3 non-mentalising modes:
1. Psychic Equivalence Mode
Individuals experience thoughts and feelings as absolute realities, leading to a lack of differentiation between their internal and external worlds. Feelings tend to be experienced as overwhelming and indisputable facts.
Examples:
2. Teleological Mode
Individuals focus on physical actions and tangible outcomes as the only way to verify internal states. There is a reliance on concrete evidence or external validation to prove thoughts, feelings, or intentions.
Examples:
3. Pretend Mode
Individuals disconnect from reality and engage in superficial or fantasy-based thinking. This mode involves a dissociation from true emotional experiences, leading to an inauthentic or detached engagement with oneself and others.
Example:
1. Psychoeducation: Understanding the different modes of non-mentalising and how they impact thoughts, emotions, and behaviours.
2. Reflective Practice: Encouraging people to reflect on their experiences and recognise when they are in a non-mentalising mode.
3. Mindfulness: Using mindfulness techniques to help people stay present and connected to their authentic emotional experiences.
4. Perspective-Taking: Practicing perspective-taking exercises to help people consider multiple viewpoints and develop a more nuanced understanding of mental states.
5. Validation and Empathy: Providing validation and empathy to help people feel understood and supported, fostering a safe environment for exploring mental states.
Understanding non-mentalising modes is crucial for improving mentalisation skills and fostering healthier relationships. By identifying and addressing these modes, therapeutic approaches like MBT can help individuals develop a more balanced and accurate understanding of their own and others’ mental states.
Research has shown that MBT can be highly effective in treating BPD and other conditions characterized by difficulties with mentalisation. MBT has also been shown to reduce depressive symptoms and self harm incidents among patients treated for BPD. Studies have found that MBT can lead to significant improvements in symptoms of BPD, including emotional instability, impulsivity, and interpersonal difficulties. Patients who undergo MBT often report better relationships, greater emotional stability, and a stronger sense of self.
Evidence-Based Support
Numerous clinical trials and studies support the effectiveness of MBT. For example, a randomised controlled trial conducted by Bateman and Fonagy found that patients who received MBT showed significant improvements in BPD symptoms compared to those who received treatment as usual. These improvements were maintained at follow-up, indicating the long-term benefits of the therapy. Comparative studies have shown that while both MBT and dialectical behaviour therapy (DBT) are effective in treating BPD, they differ in their approaches and techniques. The therapeutic relationship in MBT is crucial, as empathetic statements and support strengthen the rapport between therapist and client, enhancing the client’s capacity to mentalise and effectively address the complexities of BPD.
Application to Other Conditions
While MBT was initially developed for BPD, its principles can be applied to other conditions characterised by difficulties with mentalisation, such as depression, anxiety, and eating disorders. Research is ongoing to explore the effectiveness of MBT in these contexts, and preliminary findings are promising. Patients treated with MBT often show significant improvements in symptoms and overall mental health compared to those receiving standard care.
Mentalising is a complex and multi-dimensional capacity that plays a crucial role in social cognition and emotional regulation. By understanding and enhancing the various dimensions of mentalising, therapeutic approaches like MBT can help individuals improve their relationships, manage emotions, and lead more fulfilling lives.
If you or a loved one might benefit from MBT, our Melbourne based psychologists and therapists are here to help. Get in touch with our friendly reception team to book an appointment. Contact us by:
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Cova Psychology acknowledges the Traditional Owners of the land where our Melbourne CBD practice is located—the Wurundjeri Woi-wurrung and Bunurong/Boon Wurrung peoples of the Kulin Nation. We pay respect to their Elders, past and present, as well as the Elders of other Aboriginal communities in Melbourne and beyond.
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We would like to acknowledge the Traditional Owners of the land on which the practice is located. We pay our respects to their Elders, past and present, and the Aboriginal Elders of other communities who may be here today.
