Mentalization-Based Therapy (MBT) is an evidence-based psychodynamic treatment designed to help individuals understand how their thoughts, feelings, and mental states influence their behaviors and relationships. Originally developed for borderline personality disorder, MBT has expanded to treat various mental health conditions by improving the capacity to "mentalize" — the ability to understand and interpret one's own and others' mental states.
This comprehensive therapy approach helps people develop better emotional regulation, stronger relationships, and improved self-understanding through structured therapeutic interventions. Several studies have observed that mentalization-based treatment (MBT) is an effective treatment for borderline personality disorder (BPD), but its effectiveness for other personality disorders (PDs) has hardly been examined.
Table of Contents
- What Is Mentalization?
- History and Development
- How MBT Works
- Core Techniques
- Conditions Treated
- Effectiveness and Research
- Training and Certification
- Frequently Asked Questions
- How Therapy Can Help
What Is Mentalization?
Mentalization refers to the imaginative mental activity that enables us to perceive and interpret human behavior in terms of intentional mental states such as needs, desires, feelings, beliefs, goals, and reasons. Mentalizing is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes. It is a profoundly social construct in the sense that we are attentive to the mental states of those we are with, physically or psychologically.
This fundamental capacity allows us to:
- Understand why people act the way they do
- Predict others' behaviors based on their mental states
- Regulate our own emotions by understanding their origins
- Navigate complex social situations effectively
- Build and maintain healthy relationships
When mentalization abilities are impaired, individuals may struggle with:
- Emotional dysregulation — difficulty managing intense feelings
- Interpersonal problems — challenges understanding others' perspectives
- Impulsive behaviors — acting without considering mental states behind actions
- Identity disturbances — unclear sense of self and others
History and Development
The concept of mentalization has deep roots in attachment theory, originally developed by John Bowlby. Bowlby believed that secure attachment between an infant and their primary caregiver establishes the foundation for emotional stability and healthy relationships throughout life.
From Attachment to Mentalization
Building on Bowlby's work, Peter Fonagy and Anthony Bateman developed the mentalization framework by observing that:
- Secure attachment relationships foster the development of mentalizing abilities
- When caregivers accurately reflect and respond to a child's mental states, the child learns to understand emotions
- Neglect or inconsistent caregiving can impair mentalization development
- These early experiences shape how we understand ourselves and others throughout life
Creation of MBT
Mentalization-based treatment (MBT) was developed with this in mind. It requires relatively little additional training on top of general mental health training, and has been implemented in research studies by community mental health professionals, primarily nurses, with limited training given modest levels of supervision.
Fonagy and Bateman specifically designed MBT to address the mentalization difficulties observed in people with borderline personality disorder, creating a structured treatment that could be delivered effectively in various clinical settings.
How MBT Works
The Therapeutic Process
MBT works by establishing a therapeutic attachment where mental states can be safely explored and understood. The main target of the treatment is to improve mentalizing—the ability to interpret the behavior of oneself and others in terms of underlying mental states (e.g., intentions, thoughts) (Fonagy et al., 2018).
The therapy progresses through several stages:
1. Stabilizing emotional expression — helping individuals regulate overwhelming emotions
2. Developing curiosity about mental states — exploring thoughts and feelings without judgment
3. Building mentalization capacity — practicing understanding of self and others
4. Applying skills to relationships and daily life
The Therapeutic Stance
MBT therapists maintain a specific therapeutic stance characterized by:
- Curiosity about the patient's mental states
- Not-knowing position — avoiding assumptions about what the patient thinks or feels
- Patience when exploring different perspectives
- Empathic validation of the patient's experiences
- Active questioning to promote reflection
Objective: Mentalization is discussed as a mechanism of change in psychotherapy due to its positive effects on psychological functioning. In order to specifically apply mentalization-based interventions, a better understanding of the relationship between interventions and in-session mentalization is needed. The study aimed to explore the association between interventions and effective mentalizing.
Core Techniques
1. Mentalizing the Transference
Rather than offering interpretations, the therapist helps the patient mentalize about the therapeutic relationship itself, exploring what each person might be thinking and feeling in the moment.
2. Stop and Rewind
When mentalization breaks down (often during emotional intensity), the therapist pauses the conversation to explore what happened just before the breakdown, helping rebuild mentalization capacity.
3. Contrary Moves
The therapist gently challenges fixed perspectives by offering alternative viewpoints, always maintaining empathy and validation while expanding the patient's understanding.
4. Mentalizing Functional Analysis
Together, therapist and patient examine specific incidents where mentalization failed, understanding the triggers and developing strategies for future situations.
Conditions Treated
Primary Applications
Borderline Personality Disorder (BPD)
Dialectical behavior therapy (DBT): This treatment was developed specifically for people with borderline personality disorder. DBT also teaches skills to help people control intense emotions, reduce self-destructive behaviors, and improve relationships. CBT can help reduce mood swings, anxiety symptoms, and self-harming or suicidal behaviors.
MBT has shown particular effectiveness for BPD, addressing core symptoms including:
- Self-harm and suicidal behaviors
- Emotional instability
- Interpersonal difficulties
- Identity disturbance
Other Personality Disorders
The present study examined whether (i) patients with a broad range of PDs enrolled in an MBT program would improve on several outcome measures; (ii) mentalizing capacity would improve over time; (iii) patients with BPD would improve more than those with non-borderline PDs. Personality disorders, psychiatric symptoms, social functioning, maladaptive personality functioning, and mentalizing capacity were measured in a group of individuals with various PDs (n = 46) that received MBT. Assessments were made at baseline and after 6, 12, and 18 months of treatment.
Recent research demonstrates MBT's effectiveness for:
- Antisocial personality disorder
- Narcissistic personality disorder
- Avoidant personality disorder
Emerging Applications
Mentalization-based treatment (MBT) is being adapted for narcissistic personality disorder (NPD), focusing on enhancing patients' mentalization abilities to address core emotional and interpersonal challenges. MBT targets the mentalizing deficits in NPD, such as empathic deficits, alexithymia, and overestimation of mentalizing abilities, which contribute to the disorder's functional challenges. Preliminary evidence supports MBT's effectiveness in improving outcomes for NPD patients, with significant improvements in self-harm, depression, social adjustment, and interpersonal functioning.
MBT has been adapted for:
- Depression — addressing underlying mentalization difficulties
- Eating disorders — improving emotional awareness and regulation
- Substance use disorders — understanding mental states driving addiction
- Adolescent mental health — including self-harm and conduct problems
- Family therapy — enhancing mentalization within family systems
Effectiveness and Research
Recent Meta-Analyses and Systematic Reviews
To inform best-practice clinical decision-making, we conducted a systematic review and meta-analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(-A) in reducing self-harm (primary outcome) and symptoms of BPD and depression (secondary outcomes).
A 2024 meta-analysis examining MBT's effectiveness for self-harm found:
- Significant reductions in self-harming behaviors
- Improvements in BPD symptoms
- Decreased depression scores
- Benefits maintained at follow-up
Mentalization-based therapy (MBT) is an evidence-based treatment for borderline personality disorder (BPD) and the second most studied psychotherapeutic intervention for this disorder. Despite its growing prominence, there is a lack of focused reviews summarizing the evidence base from randomized clinical trials (RCTs). This review aims to address this gap and highlight directions for future research. Building on the seven studies identified in the Cochrane review by Storebø et al. (2020), we conducted an updated search to incorporate RCTs published to 1st April 2025, expanding the evidence base to 14 trials.
Treatment Outcomes
Mentalizing capacity of the whole group improved over time (d = .68 on the Toronto Alexithymia Scale and 1.46 on the Social Cognition and Object Relations System). These results suggest that MBT coincides with symptomatic and functional improvement across a broad range of PDs and shows that MBT is associated with improvements in mentalizing capacity.
Research consistently shows MBT produces:
- 60-80% reduction in self-harm behaviors
- Significant improvements in interpersonal functioning
- Enhanced emotional regulation abilities
- Reduced psychiatric hospitalizations
- Sustained gains at long-term follow-up
MBT for Children and Adolescents
High comorbidity in childhood emotional and behavioral disorders calls for transdiagnostic interventions that can address both internalizing and externalizing problems. Mentalization-Based Treatment for Children (MBT-C) is a transdiagnostic, time-limited individual child psychotherapy with parallel parent sessions that aims to promote mentalization and emotion regulation. This pragmatic randomized controlled superiority trial investigated the efficacy of MBT-C compared with a group-based parenting and child social skills intervention (PSSG) at 12 weeks (primary end point) and 36-week follow-up (secondary end point). The trial included 222 children (mean age = 7.89; 34% girls) at clinical levels of internalizing, externalizing, or co-occurring internalizing and externalizing problems and their families equally randomized to MBT-C or PSSG.
Recent trials demonstrate MBT's effectiveness for young people:
- MBT-A (adolescents) reduces self-harm and depression
- MBT-C (children) improves both internalizing and externalizing problems
- Family-based MBT enhances family functioning
Training and Certification
Training Pathway
This is a knowledge- and skills-based course in Mentalization-Based Treatment (MBT) for adults. It provides participants with a solid conceptual understanding of mentalizing, its relevance to clinical problems associated with EUPD, BPD, ASPD, complex trauma, and other mental health difficulties, alongside the clinical skills required to deliver MBT to a defined standard of competency. MBT is an evidence-based therapy for BPD and offers a stepped training pathway, progressing from basic training to practitioner and supervisor levels.
The MBT training program follows a structured pathway:
1. Basic Training (3 days)
- Theoretical foundation of mentalization
- Core MBT techniques
- Clinical applications
1. Supervision Phase (6-12 months)
- Regular supervision with approved MBT supervisor
- Application of skills in practice
- Case discussion and skill refinement
1. Practitioner Certification
- Advanced training course
- Demonstrated competency
- Ongoing supervision requirements
Training Availability
The training programme for Mentalization-Based Treatment (MBT) aims to equip mental health and other professionals with the necessary skills and qualifications to implement MBT in the treatment of personality disorder. Individuals can be trained to a basic or practitioner level. There are currently three components to training in MBT. Attendance at an Anna Freud Basic Training course or Anna Freud accredited basic training course is required to progress onto other components of the MBT training programme.
Training is offered through:
- Anna Freud National Centre for Children and Families (UK)
- International MBT centers in various countries
- Online training options for theoretical components
- Specialized trainings for specific populations (children, families, antisocial PD)
Who Can Train?
MBT training is available to:
- Mental health professionals (psychologists, psychiatrists, social workers)
- Counselors and psychotherapists
- Psychiatric nurses
- Other healthcare professionals working therapeutically
Frequently Asked Questions
How long does MBT treatment typically last?
MBT is usually delivered as an 18-month treatment program, though shorter adaptations exist.
1. "Short-Term Versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder: A Randomized Clinical Trial (MBT-RCT)." Psychotherapy and Psychosomatics 92, no. 5: 329–339. Individual sessions are typically weekly, with some programs including group therapy components.
What's the difference between MBT and other therapies like DBT?
While both MBT and DBT are effective for borderline personality disorder, they differ in approach:
- MBT focuses on improving mentalization abilities to enhance emotional understanding
- DBT emphasizes skill-building for distress tolerance and emotion regulation
- MBT explores mental states behind behaviors, while DBT provides concrete coping strategies
- Both can be effective; choice depends on individual needs and preferences
Can MBT be combined with medication?
Yes, MBT is often used alongside psychiatric medication. The therapy can help individuals understand their relationship with medication and make informed decisions about their treatment. Regular medication reviews are typically part of comprehensive MBT programs.
Is MBT suitable for adolescents?
MBT-A combines individual weekly sessions for adolescents along with Mentalization-based family therapy sessions (MBT-F) and aims to enhance an adolescent's capacity to represent their own and others' feelings accurately and in emotionally challenging situations. MBT-A has been shown to be effective in reducing self-harm and depressive symptoms in adolescents (Rossouw & Fonagy, P. 2012). The approach has been specifically adapted for young people and their families.
How do I know if MBT is right for me?
MBT may be particularly helpful if you experience:
- Difficulty understanding your own or others' emotions
- Intense, unstable relationships
- Impulsive behaviors you later regret
- Struggles with identity or self-image
- History of trauma affecting relationships
What should I expect in an MBT session?
MBT sessions focus on exploring thoughts and feelings in the present moment. Your therapist will be curious about your mental states, ask questions to promote reflection, and help you understand connections between thoughts, feelings, and behaviors. The atmosphere is collaborative and non-judgmental.
How Therapy Can Help
If you or someone you know struggles with understanding emotions, maintaining relationships, or managing intense feelings, MBT might offer valuable support. Studies funded by the National Institute of Mental Health (NIMH) indicate that people with borderline personality disorder who do not receive adequate treatment are more likely to develop other chronic illnesses and are less likely to make healthy lifestyle choices. Psychotherapy, or talk therapy, is the primary treatment for borderline personality disorder. Most psychotherapy occurs with a licensed, trained mental health professional in one-on-one sessions or with other people in group settings. Group sessions may help people with borderline personality disorder learn to interact more constructively with others and express themselves more effectively.
Working with a trained MBT therapist can help you:
- Develop better understanding of your emotional experiences
- Improve your relationships through enhanced empathy
- Reduce self-destructive behaviors
- Build a stronger, more coherent sense of self
- Learn to navigate social situations more effectively
Find a Therapist
GoodTherapy can help you connect with therapists trained in Mentalization-Based Therapy. Our directory includes mental health professionals who specialize in evidence-based treatments for personality disorders, relationship difficulties, and emotional regulation challenges.
Take the first step toward better understanding yourself and others. Search our directory to find an MBT-trained therapist near you who can support your journey toward improved mental health and stronger relationships.
References:
- National Institute of Mental Health. (2024). Borderline personality disorder. https://www.nimh.nih.gov/health/publications/borderline-personality-disorder
- National Institute of Mental Health. (2024). FY 2024 narrative budget. https://www.nimh.nih.gov/sites/default/files/documents/about/budget/nimh_fy_2024_cj_0.pdf
- National Institute of Mental Health. (2025). Innovative mental health services research not involving clinical trials (PAR-25-283). https://grants.nih.gov/grants/guide/pa-files/PAR-25-283.html
- Hajek Gross, C., Oehlke, S. M., Prillinger, K., Goreis, A., Plener, P. L., & Kothgassner, O. D. (2024). Efficacy of mentalization-based therapy in treating self-harm: A systematic review and meta-analysis. Suicide and Life-Threatening Behavior, 54(2), 317-337. https://doi.org/10.1111/sltb.13044
- Jørgensen, M. S., & colleagues. (2025). Mentalization-based therapy for borderline personality disorder: State-of-the-science and future directions. Clinical Psychology & Psychotherapy. https://doi.org/10.1002/cpp.70120
- Rizzi, E., Weijers, J. G., Kate, C., et al. (2024). Mentalization based treatment for a broad range of personality disorders: A naturalistic study. BMC Psychiatry, 24, 429. https://doi.org/10.1186/s12888-024-05865-2
- Halfon, S., Beşiroğlu, B., Bulut, P., et al. (2024). The efficacy of mentalization-based treatment (MBT-C) for children with internalizing and externalizing problems: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry. https://doi.org/10.1016/j.jaac.2024.02.006
- Thorén, A., Lindqvist, K., Nemirovski, J. P., & Mechler, J. (2025). Short-term mentalization-based therapy for common childhood mental disorders – a pilot quasi-randomised controlled trial. Clinical Child Psychology and Psychiatry. https://doi.org/10.1177/13591045251316619
- Hauschild, S., Taubner, S., Vidalón Blachowiak, T., et al. (2025). Mentalization-based treatment versus bona fide treatment for patients with borderline personality disorder in Germany (MAGNET): Study protocol of a prospective, multi-centre randomized controlled trial. BMC Psychiatry, 25, 367. https://doi.org/10.1186/s12888-025-06809-0
- Kasper, L. A., Hauschild, S., Schrauf, L. M., & Taubner, S. (2024). Enhancing mentalization by specific interventions within mentalization-based treatment of adolescents with conduct disorder. Frontiers in Psychology, 14, 1223040. https://doi.org/10.3389/fpsyg.2023.1223040
- Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., et al. (2020). Psychological therapies for people with borderline personality disorder. Cochrane Database Systematic Reviews, 5(5), CD012955. https://doi.org/10.1002/14651858.CD012955.pub2
- Collins, R. M., et al. (2025). Clinical practice guidelines for the treatment of borderline personality disorder: A systematic review of best practice in anticipation of MAiD MD-SUMC. Borderline Personality Disorder and Emotion Dysregulation, 12, 13. https://doi.org/10.1186/s40479-025-00284-5
- Luyten, P., Campbell, C., Moser, M., & Fonagy, P. (2024). The role of mentalizing in psychological interventions in adults: Systematic review and recommendations for future research. Clinical Psychology Review. https://doi.org/10.1016/j.cpr.2024.102428
- Anna Freud National Centre for Children and Families. (2024). Mentalization-based treatment training programs. https://www.annafreud.org/training/health-and-social-care/mentalization-based-treatments-mbt/
