Lecture 9 Flashcards
What is MBT ?
MBT (Mentalization-Based Treatment) is an evidence-based therapy for adults with severe Borderline Personality Disorder (BPD), developed by Anthony Bateman and Peter Fonagy in 2004
What are the theoretical roots of MBT ?
MBT is rooted in Attachment Theory and Psychodynamic concepts
What research supports MBT ?
MBT is supported by four RCTs (Randomized Controlled Trials) by Bateman & Fonagy (1999, 2009), Jorgensen et al. (2013), and Rossouw & Fonagy (2012)
Is MBT included in clinical guidelines ?
Yes, MBT is included in Cochrane, APA, NICE & Dutch MD Guidelines
What adaptations of MBT exist ?
- Families (MBT-F)
- Adolescents (MBT-A)
- Parents (MBT-P)
Eating disorders, antisocial personality disorder & more
What is Mentalizing ?
The ability to interpret the actions of oneself and others as meaningful based on thoughts, feelings, desires, & intentions
Why is mentalizing important ?
- Understand ourselves & others
- Create a feeling of being understood
- Recognize misunderstandings
- See ourselves from the outside & others from the inside
What are the four polarities of mentalizing ?
- Automatic vs. Controlled
- Internally focused vs. Externally focused
- Self-oriented vs. Other-oriented
- Cognitive vs. Affective
How is mentalizing related to BPD ?
BPD is linked to too little controlled mentalizing, externally focused thinking & pre-mentalizing modes
What does good mentalizing look like ?
- Acknowledging uncertainty in others’ thoughts
- No paranoia
- Reflection & contemplation
- Perspective-taking
- Openness to discovery
- Forgiveness & understanding
- Predictability in others’ behaviors
What does non-mentalizing look like ?
- Anti-reflective (hostile, blaming)
- Gross assumptions (black-and-white thinking)
- Failure to elaborate (one-sided explanations)
- External explanations (blaming environment)
- Over-reliance on labels
- Rigid rule-based thinking
- Absolute certainty
How does mentalizing develop in childhood ?
- Parents mirror their child’s emotions
- “Good” parents make mind-minded comments
- Mirroring helps create an inner representational world
What are the two key conditions for effective mirroring ?
- Congruence: The mirroring matches the child’s actual emotions
- Markedness: The parent signals that the feeling belongs to the child, not the parent
What leads to impaired mentalizing development ?
- Insecure attachment
- Early trauma or neglect
- Distorted mirroring (unmarked or incongruent)
- Lack of mentalizing opportunities
How is BPD understood through mentalizing theory ?
BPD is a disorder of mentalizing, meaning patients can mentalize but lose this ability under stress
What happens when BPD patients lose mentalizing ability ?
They rely on pre-mentalizing modes:
- Psychic equivalence: Rigid, black-and-white thinking, paranoia
- Pretend mode: Dissociation, emptiness
- Teleological mode: Need for concrete actions from others
What is the aim of MBT ?
- Promote mentalizing about oneself, others, and relationships
- Develop stable relationships through therapy
What are key characteristics of MBT ?
- Highly structured
- Adapted to patient tolerance
- Active & outreaching
- Focus on mentalizing process and relationships
What is the therapist’s attitude in MBT ?
- “Not-knowing” stance
- Empathic, validating
- Curious & inquisitive
- Transparent about own mind
- Active questioning (no silence)
What are key therapist interventions ?
- Simple, short interventions
- Focus on affect (feelings)
- Focus on mental states (not behavior)
- Relate to the here-and-now
What are the three phases of MBT treatment ?
- Initial phase: Assessment, psychoeducation, crisis planning
- Main phase: Intensive therapy focusing on mentalizing relationships
- Termination phase: Separation and reintegration
What are common MBT treatment formats ?
- Partial Hospitalization (PH): 3-5 days a week, suited for severe BPD
- Intensive Outpatient Program (IOP): 2 group sessions + 1 individual session per week
What are the treatment goals of MBT ?
- Commitment to treatment
- Reducing psychiatric symptoms
- Improving interpersonal relationships
- Reducing self-destructive behavior
- Enhancing social and occupational functioning
Is MBT effective ?
Research shows MBT improves:
- Self-injury, suicide risk, depressive symptoms
- Interpersonal functioning
- Crisis intervention needs
How cost-effective is MBT?
MBT costs are earned back within two years due to reduced hospitalizations and crises
Is reduced mentalizing unique to BPD ?
No, all personality disorders involve mentalizing issues, but they are most severe in BPD
Is MBT psychoanalytic therapy ?
Not exactly, MBT is more active and transparent, with less focus on unconscious motives
Is MBT a cognitive therapy ?
No, MBT focuses more on affect, motivation, and deep processing rather than cognition
Is MBT a supportive therapy ?
Yes, but it is also challenging and confrontational when needed
