Mentalization-Based Therapy

Mentalization-based therapy, or MBT, is an evidence-based psychodynamic approach that is rooted in the field of developmental research with conceptual origins in both psychoanalysis and attachment theory. It is also integrative in nature, as it incorporates elements of cognitive, psychodynamic, systemic and social-ecological under the theoretical umbrella of attachment theory.

Although MBT is known for its usefulness with patients diagnosed with borderline personality disorders (particularly clients with a history of relational trauma such as maltreatment or neglect), this model of psychotherapy has also proven to be useful with children, adolescents and families in the context of both clinical and outreach settings.

In this video Dr. Norka Malberg demonstrates the efficacy of the MBT approach with a young female client who is struggling with abandonment issues while trying to establish a healthy relationship with her mother.

The concept of "mentalization" is both a relatively new one and an extremely old one. It has been described as "a form of imaginative mental activity, namely, perceiving and interpreting human behavior in terms of intentional mental states (e.g. needs, desires, feelings, beliefs, goals, purposes, and reasons)" (Fonagy et al., 2002). Largely rooted in the field of developmental research and with conceptual origins in both psychoanalysis and attachment theory, mentalization — and the empirical research which has supported it — has provided a rich set of ideas about the development of the self and the ability to relate with others, the way in which attachment disruption and trauma impact on our capacity to think about our own minds and the minds of others, and the ways in which this capacity can be fostered in a therapeutic relationship with an explicit focus on mentalization.

From this perspective Fonagy and his collaborators (2002) propose that the capacity to reflect on the mental states of self and others is central to the process of therapeutic change across a range of treatments, and is therefore the legitimate focus of more targeted clinical interventions.

Mentalization-based therapy (MBT) is now an evidence-based approach for working with people diagnosed with borderline personality disorder (Bateman & Fonagy, 2004, 2006). However, this model of psychotherapy is becoming increasingly widespread in terms of its application with children, adolescent and families in the context of both clinical and outreach settings.

MBT is integrative in nature, as it incorporates elements of cognitive, psychodynamic, systemic and social-ecological under the theoretical umbrella of attachment theory. Furthermore, the construct of reflective functioning guides the assessment and treatment planning process in a way that the psychotherapist can "meet the patient" where he/she can feel "being with," giving place for a repairing developmental experience in the context of a new secure attachment relationship.

Norka T. Malberg, PsyD, is a certified child and adolescent psychoanalyst trained at the Anna Freud Centre in London. She obtained her doctorate from University College London under the supervision of Dr. Peter Fonagy for her work on clinical applications of attachment theory, namely mentalization-based therapy.

She is currently in private practice in New Haven, Connecticut, where she is also in the clinical faculty at the Yale Child Study Center serving as faculty member, where she teaches and supervises at the Yale Medical School psychiatry residency program.

Dr. Malberg is co-editor of the Lines of Development Book Series by Karnac Books for which she co-edited the first book: The Anna Freud Tradition. She has maintained her collaboration with the Anna Freud Centre through the development and delivery of short courses training other mental health professionals on applying mentalization-based interventions to clinical populations across the developmental continuum and in a diversity of clinical and community settings.

She is currently a lecturer and a member of the New England Western Psychoanalytic Society's Continuing Education Division and is a member and clinical instructor of the Contemporary Freudian Society in New York City. She is past president of Section 2 (Children and Adolescents) of APA Division 39 (Psychoanalytic Psychology). She is in the editorial board for the Psychoanalytic Study of the Child and the Journal of Infant, Child and Adolescent Psychotherapy.

She is the co-editor of the Child and Adolescent Sections of the upcoming PDM-2 (Psychodynamic Diagnostic Manual) edited by Guilford Press and co-author of the upcoming book by APA on mentalization-based therapy for children and parents. She has authored numerous articles on topics relating to clinical applications of mentalization-based therapy, trauma, early childhood intervention and the interface of infant and adult mental health.

• Allen, J., Fonagy, P., & Bateman, A. (2008). Mentalizing in clinical practice. Washington: American Psychiatric Press.
• Bateman, A., & Fonagy, P. (2004). Psychotherapy for borderline personality disorder: Mentalization-based treatment. Oxford: Oxford University Press.
• Fonagy, P., & Luyten, P. (2009). A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Development and Psychopathology, 21(4), 1355–1381.
• Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization and the development of the self. New York: Other Press.
• Fonagy, P., Redfern, S., & Charman, T. (1997). The relationship between belief-desire reasoning and a projective measure of attachment security (SAT). British Journal of Developmental Psychology, 15, 51–61.
• Luyten, P., Mayes, L., Fonagy, P., Target, M. & Blatt, S. (Eds) (2015) Handbook of psychodynamic approaches to psychopathology, Guilford Press, New York.
• Malberg, N. T. (2012) Creating security by exploring the personal meaning of chronic illness in adolescent patients. In: O'Reilly-Landry, Maureen (Ed) A psychodynamic understanding of modern medicine: Placing the person at the center of care. Radcliffe Medical Press.
• Malberg, N. T. (2013). Mentalization based group interventions with chronically ill adolescents: An example of assimilative psychodynamic integration? Journal of Psychotherapy Integration, 23(1), 5–13.

APA Videos

• Using Client Feedback in Therapy
  Barry L. Duncan

APA Books

• APA Handbook of Testing and Assessment in Psychology
  Edited by Kurt F. Geisinger