Mentalization-Based Treatment for Children on the Autism Spectrum

Autism today is widely recognized as a common, lifelong neurodevelopmental difference. Although the neurodiversity movement has helpfully reframed autism as a difference to be respected, not a disorder to be cured, many psychotherapeutic approaches today still focus on behavioral normalization rather than emotional well-being and relational development. Therapies that address the emotional and relational needs of autistic children while respecting their neurological differences are still desperately needed.

This book is a clinical guide to applying mentalization-based treatment (MBT) to children on the autism spectrum. MBT offers a framework for enhancing emotional regulation and social connection by linking behavior to mental states, and thereby shifting the clinical focus from categorical diagnoses to a dynamic, strengths-focused perspective seeking to understand behavior. The approach, grounded in robust empirical evidence, extends mentalization-based treatment for children (MBT-C) to autistic children and their families, validating autistic perspectives and fostering mutual understanding between autistic and non-autistic individuals. 

The authors explore the background and theory of MBT-C, offer clinical case examples to show how clinicians can approach assessment, develop a focus formulation and mentalization profile, and adopt a mentalizing stance. They also discuss common challenges related to collaborating with parents, siblings, schools, and other systems. This developmental, relational, and neurodiversity-informed approach promotes epistemic justice by positioning autistic children as intentional agents whose perspectives, reasoning processes, and lived experiences are meaningful and worthy of collaborative exploration.

Foreword
Linda Mayes

Acknowledgments

Introduction

Part I: Theoretical Framework

• Chapter 1. A Developmental and Relational Approach to Autism
• Chapter 2. Causal Complexity and Diagnostic Heterogeneity: A Developmental Psychopathology Perspective on Autism
• Chapter 3. Sensory Processing, Joint Attention and Effortful Control as Precursors to Mentalizing in Typical and Atypical Development
• Chapter 4. Mentalization as a Relational and Developmental Achievement
• Chapter 5. Mentalization-Based Treatment for Children: An Overview of the Therapeutic Framework

Part II: Description of the Therapeutic Approach

• Chapter 6. Introducing Melanie and Robert: Composite Clinical Cases
• Chapter 7. Getting to Know Each Other: The Value of Dimensional Assessments
• Chapter 8. Reaching a Shared Understanding: Mentalizing Profile and Focus Formulation
• Chapter 9. The Mentalizing Stance in the Context of Autism: Working in the Self–Other Dimension
• Chapter 10. Serve-and-Return: A Developmental Framework for MBT-CA Technique
• Chapter 11. Direct Work with Children in the Three Blocks of Mentalization in MBT-CA
• Chapter 12. Ending Treatment and Generalization of New Learning

Part III: Clinical Applications to Individual and Systemic Work

• Chapter 13. Mentalizing the Systems Around the Autistic Child: An MBT-CA Perspective
• Chapter 14. Adapting Mentalization-Based Parent Work for Families of Autistic Children
• Chapter 15. MBT-CA: A Case Study

Appendix A: MBT-CA Assessment Template

Appendix B: MBT-CA Adherence Scale

References

Index

Author Biographies

Norka T. Malberg, PsyD, is a child and adolescent psychologist, psychotherapist, and psychoanalyst. She lives and practices in Barcelona, Spain, where she directs the IMAGINA Mentalization Applications Center and consults for community mental health organizations across Spain, Latin America, and Europe. Her clinical and research work focuses on mentalization-based interventions for trauma and autism, migration and parental reflective functioning, and group treatments for adolescents. She is a coeditor of the Psychodynamic Diagnostic Manual, Third Edition, and an APA Guest Master Clinician. She has published numerous articles and book chapters and is coauthor of Mentalization-Based Treatment with Children: A Time-Limited Approach, as well as lead author of Working With Parents in Therapy: A Mentalization-Based Approach. 

Stefanella Costa-Cordella, PhD,is a clinical child psychologist and holds a PhD in psychoanalytic studies from the Anna Freud Centre and University College London. She is currently a member of the academic staff at Diego Portales University in Chile and serves as research lead at CIC Solas–Oxford in the United Kingdom. Her primary research focuses on the intersection between mentalization-based treatment (MBT) and health psychology. She is also interested in research that facilitates the translation of psychosocial interventions into public policy in Chile. In this context, she is currently leading a Chilean government–funded research project on the cultural adaptation and pilot randomized controlled trial of the Lighthouse MBT parenting program.

Line Brotnow Decker, MSc, is a licensed clinical psychologist and clinical researcher focused on bridging developmental science and everyday clinical practice. She is a certified practitioner and supervisor in mentalization-based treatment for children (MBT-C) and adolescents (MBT-A) and has extensive experience in both community- and hospital-based services with children and adolescents facing complex, comorbid mental health difficulties in the context of significant life stress. Line Decker serves as head of research for the Intensive In-Home Child & Adolescent Psychiatric Service (IICAPS), and is also co-developer of SPOT-ME, a brief observational measure of parental mentalization. Line Decker currently lives in Oslo, Norway, where she chairs a government-appointed expert panel tasked with developing a national consensus on care for young people with substance use difficulties.