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.
At Cova Psychology in Melbourne, our team offers MBT as part of a supportive and evidence-based approach to therapy. We create a safe and collaborative space for clients to explore their own thoughts and feelings, as well as those of others, so they can build stronger emotional regulation and healthier relationships.
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 multi-dimensional, meaning it involves several different ways of understanding ourselves and others. Each dimension contributes to how effectively someone can mentalise.
Automatic mentalising happens quickly and intuitively — like reading someone’s facial expression or tone of voice without thinking about it.
Controlled mentalising is slower and more deliberate, used in complex or stressful situations where we need to pause, reflect, and think things through.
Cognitive mentalising is about understanding thoughts, intentions, and beliefs (sometimes called “theory of mind”).
Affective mentalising is about recognising and empathising with feelings — connecting with others emotionally, not just intellectually.
Self-mentalising involves tuning into your own thoughts and feelings and using that awareness to guide behaviour.
Other-mentalising is about perspective-taking — imagining what someone else might be thinking or feeling and responding with empathy.
Internal mentalising focuses on inner experiences such as emotions, intentions, and motivations.
External mentalising relies on what you can observe, like body language and behaviour, to infer mental states.
Effective mentalising means being able to shift between these modes as needed. For example, we may need to slow down automatic reactions and reflect more deeply when emotions run high. In MBT, much of the work focuses on building this flexible capacity — strengthening whichever dimension is underdeveloped or overused.
Sometimes our ability to mentalise goes offline, especially when we feel stressed or overwhelmed. MBT calls these non-mentalising modes. They can lead to misunderstandings, emotional outbursts, or feeling disconnected from ourselves and others.
In this mode, thoughts and feelings are experienced as absolute truth. The inner and outer world feel the same, which can be distressing.
Examples:
A child thinks “I must be bad” when a parent yells, rather than considering the parent might be stressed.
Someone feels anxious after a mild headache and becomes convinced something serious is wrong.
Here, only actions or physical evidence seem real. If there’s no proof, feelings or intentions are dismissed.
Examples:
Believing a partner doesn’t love you because they haven’t replied to a text quickly.
Feeling worthless unless a social media post gets enough likes.
This is when someone disconnects from their true feelings and stays in their head. Thoughts may become detached from reality, leading to inauthentic or “surface level” engagement.
Example:
Telling a therapist you feel “on fire” socially and everyone hangs on your every word, while actually feeling anxious or sad underneath.
In MBT, therapists gently help people notice when they’re in a non-mentalising mode and bring curiosity back to what’s really happening. This might include:
Psychoeducation – learning about these modes and how they affect behaviour.
Mindfulness and reflection – staying grounded and connected to real feelings.
Perspective-taking – considering other possible viewpoints.
Validation and empathy – feeling safe enough to explore experiences openly.
Over time, this helps clients regain balance and respond more thoughtfully in relationships and stressful moments.
Research consistently shows that MBT is one of the most effective therapies for Borderline Personality Disorder (BPD). People who take part in MBT often report:
Fewer episodes of self-harm or suicidal thoughts
Greater emotional stability
Less impulsivity
Improved relationships and social connection
A stronger and more stable sense of self
MBT was first tested in randomised controlled trials by Anthony Bateman and Peter Fonagy, who found that participants showed significant improvements compared to those receiving treatment as usual. These benefits were not just short-term — many participants maintained their gains years after therapy ended.
MBT is sometimes compared to Dialectical Behaviour Therapy (DBT), another evidence-based treatment for BPD. Both are highly effective, but MBT focuses specifically on strengthening the ability to understand and reflect on mental states, which can be particularly powerful in repairing relationships and reducing emotional reactivity.
Although MBT was first developed for Borderline Personality Disorder, its benefits reach well beyond BPD. Because it focuses on strengthening emotional understanding and improving relationships, MBT can also be helpful for:
Depression, especially when relationships feel strained
Anxiety and social anxiety
Eating disorders
Trauma-related difficulties
Emotional dysregulation and relationship challenges
Early research in these areas is promising, with many people reporting better mood regulation, stronger self-awareness, and healthier connections with others after MBT.
At our Melbourne clinic, we often use MBT principles alongside other evidence-based approaches to tailor therapy to each person’s needs. This integrative approach can help clients build resilience, feel more grounded, and lead more fulfilling lives.
MBT can be delivered in both individual and group therapy formats. Sessions usually involve exploring real-life situations, reflecting on what thoughts and feelings were present, and working with your therapist to consider different perspectives. Over time, this helps you build greater emotional awareness, improve communication, and respond more calmly in relationships.
If you or a loved one might benefit from Mentalisation-Based Therapy (MBT), our Melbourne psychologists are here to support you. You can learn more about MBT and other evidence-based approaches on our How We Help page, or get in touch with us to arrange an appointment. Our team provides MBT in Melbourne both face to face and via telehealth, so you can access support wherever you are.