Mentalization Based Therapy for BPD

Teenage girl (16-17) talking to therapist

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Mentalization-based is a type of psychotherapy for borderline personality disorder (BPD) that focuses on your ability to recognize thoughts, feelings, wishes, and desires to see how they are linked to behavior. 

What Is Mentalization?

Mentalization is a term for your ability to recognize your own mental state as well as others' emotions, separate from actions. It includes being able to think about feelings and understand that these thoughts may have an impact on the actions that you and others take.

For example, imagine that you are meeting up with a friend after her salon appointment. When she arrives, you mention that you don't think her new haircut is flattering. Your conversation continues and then minutes later she ends the conversation abruptly, saying she needs to go and leaves after a curt goodbye. Mentalization about this situation would lead you to think about your friend’s internal state and how it relates to her behavior. While she never said she was hurt, by recognizing others' emotions and feelings, you may recognize that your words affected her negatively. 

How Is Mentalization Related to BPD?

Anthony Bateman and Peter Fonagy, the developers of mentalization-based therapy for BPD, believe that people with BPD are not able to mentalize adequately due to problems that occurred within their childhood relationships. They propose that the capacity to mentalize is learned in early childhood through interactions between the child and caregiver and if the child and caregiver relationship are disrupted in some way, appropriate development of mentalization is interrupted. This theory is supported by evidence that childhood maltreatment or the early loss of caregivers is associated with an increased risk of developing BPD.

What to Expect 

Mentalization-based therapy for BPD is psychodynamic psychotherapy, which means that the focus of the therapy is on the interaction between the patient and the therapist. In this therapy, the therapist will focus on the present rather than the past and will work with you to enhance your emotional recognition and connection. To do this, the therapist may ask you questions about how your thoughts relate to your behavior during the session. In mentalization-based therapy, the therapist will not usually give you advice or opinion.

In mentalization-based therapy your therapist will coach you to explore your internal states and help you form new ways of mentalizing.

Research Support 

Some research has supported the effectiveness of mentalization-based therapy for BPD. Researchers conducted one randomized controlled study, one of the most rigorous forms of studies, in which people with BPD were assigned to either an intensive program that used mentalization-based treatment strategies or the typical treatment plan for BPD. That study showed that patients in the mentalization-based therapy program had larger reductions in deliberate self-harm, suicide attempts, anxiety, depression and learned to better handle social functioning than the patients who received the standard treatment

While this study supports the potential of mentalization-based therapy for BPD, there is still limited research showing the success of mentalization-based therapy. Before switching therapists or treatment methods, you should consult with your current therapist and medical help to discuss your options and unique needs. 

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  • Bateman AW, Fonagy P. “Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial.” American Journal of Psychiatry. 156:1563-1569, 1999.
  • Bateman AW, Fonagy P. “Mentalization-Based Treatment of BPD.” Journal of Personality Disorders, 18:36-51, 2004.

By Kristalyn Salters-Pedneault, PhD
 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.