Mentalization-based therapy (MBT) focuses on developing the ability to understand how your mental state intersects with the mental states of those around you.

Your mood and emotions make up what’s known as your affective mental state. When you’re able to perceive how your affective state influences the affective states of others, it’s known as mentalizing.

Mentalizing is an important component of successful relationships. It’s also a feature typically missing in conditions such as personality disorders, where relationship instability is a distinguishing symptom.

Mentalization-based therapy (MBT) focuses on helping you understand the link between your mental state and your behaviors and the influence your mental state has on others.

MBT was originally developed specifically for the treatment of borderline personality disorder (BPD). It’s a form of psychodynamic therapy that aims to improve your affective awareness of self and your impact on others.

Dr. Maya Kaye, a psychotherapist and adjunct professor at Marist College, Poughkeepsie, New York, explains, “[MBT] helps clients attempt communicating, coping, and relating to self and others in ways that foster healthy attachment.”

Mentalization is a part of many therapy frameworks. In MBT, it becomes the primary focus based on the theory that certain conditions, such as BPD, stem from mentalization dysfunction.

Mentalization vs. theory of mind

Mentalization and theory of mind are two psychological concepts that deal with the mental states of others. They’re related to one another, but they aren’t interchangeable.

Mentalization is about how your mental state intersects the mental states of those around you.

Theory of mind is the understanding that others have their own mental states. It’s a concept within MBT but doesn’t fully encompass what it means to mentalize.

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Since its conceptualization, MBT has been used for a variety of conditions, especially when interpersonal relationship challenges are a core symptom.

“MBT is considered a ‘transdiagnostic’ therapy that can be used across a wide range of conditions,” says Dr. Carlene MacMillan, a psychiatrist and chief medical officer at Osmind, from Brooklyn, New York.

“It was originally studied for individuals with borderline personality disorder and antisocial personality disorder but has since been expanded to be used much more broadly across the human condition.”

Kaye adds that in addition to BPD, MBT is a potentially useful intervention for a variety of clinical conditions, such as:

She cautions that more research should be conducted to improve the qualitative and quantitative evidence of MBT across diagnoses. Currently, the bulk of research on this approach has been centered on BPD.

Eating disorders

If you’re preoccupied with food or your weight, feel guilt about food choices, or engage in restrictive diets, consider reaching out for support. These behaviors may indicate a disordered relationship with food or an eating disorder.

Disordered eating and eating disorders can affect anyone, regardless of gender identity, race, age, socioeconomic status, or other identities.

They can be caused by any combination of biological, social, cultural, and environmental factors — not just by exposure to diet culture. Consider speaking with a healthcare professional, or try chatting, calling, or texting anonymously with trained volunteers at the National Eating Disorders Association helpline for free.

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According to MacMillan, the typical MBT session involves more of a talk-based approach, rather than homework, journaling, and worksheets seen in other therapy settings.

The therapist focuses on the present moment and your dynamic within that setting.

“For example,” MacMillan says, “the patient may be recounting an upsetting or confusing experience that happened during the week and the therapist will ask them how it feels to be talking about that experience now during the session.”

In this way, your therapist takes on an inquisitive role, guiding you through your emotions and behaviors. They can then display their current thoughts and feelings in relation to yours, as a way of teaching you how to recognize the mental states of others.

You may also be asked to describe what you think your therapist is feeling or thinking about what you just said.

“This presents an opportunity to ‘understand misunderstandings’ and demonstrate the skill of mentalization right in the moment,” she says.

In MBT, a therapist serves as a window from which you can glimpse how your affective state is influencing someone else.

The overarching goal of MBT is to get your mentalization back on track when you’ve entered a nonmentalized state.

MacMillan explains there are three states of nonmentalization:

  • teleological mode (“prove it” thinking)
  • psychic equivalence (feelings equal facts)
  • pretend mode (thoughts and feelings aren’t evidence- or reality-based)

When you’re in one of these states, MBT techniques work to bring you back to an appropriate level of mentalization.

Kaye explains a session’s techniques are determined by your emotional arousal at the time, but the core process your therapist will use often looks like:

  • empathizing with your current subjective state
  • identifying affect and developing an affect-focus
  • exploring, clarifying, and challenging (if necessary) emotions and feelings
  • mentalizing within the therapeutic relationship

By following these steps, your therapist can help you regulate your initial emotional response, review that response and how it made you feel, and then assess how your reactions could influence your therapist’s thoughts and emotions.

Dialectical behavior therapy (DBT), similarly to MBT, was originally developed to treat BPD.

They’re both evidence-based therapies for BPD, which means research has found their approaches effective.

According to a 2022 review, no direct randomized comparison of DBT and MBT has yet been conducted. Indirect comparisons are largely inconclusive; DBT and MBT have the same goals but different approaches, making it difficult to measure differences in outcomes.

One hasn’t been proven to be better than the other.

They share more than just similar effectiveness. Both can be individual- or group-focused, and they each look to improve emotional regulation and end impulsive, harmful behaviors.

Kaye indicates, despite similarities, there are several main differences between MBT and DBT:

  • MBT uses the therapeutic relationship to enhance interpersonal processes, while DBT leverages the relationship to change behavior and develop coping skills.
  • DBT typically takes a year, while MBT can take up to 18 months.
  • MBT theory focuses on underlying attachment style, while DBT theory considers emotional dysregulation to be the heart of BPD.

“DBT focuses on mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills to modify behavior and enforce the ability to tolerate challenging or painful feelings,” she says.

“MBT attempts to help the client comprehend and recognize the feelings and thoughts that underpin overt behaviors in themselves and others, as well as to increase emotion regulation capacity and the ability to moderate impulsiveness.”

If you’re looking for a therapist who specializes in MBT, the first place to start is by reviewing their credentials. An MBT therapist will have formal MBT training and certifications. They’ll also have relevant experience in the mental health condition you’re seeking treatment for.

Experience isn’t everything. MacMillan points out that the strength of the therapeutic alliance is of utmost importance, so a lot will depend on what type of person you feel most connected to.

“A good MBT therapist sits on the edge of their metaphorical chair, not leaning back and taking a more passive role,” she says. “An MBT therapist is very interactive, curious and nonjudgmental, and not afraid to get things wrong.”

MacMillan emphasizes that embracing the fact we all “get it wrong” about each other and have misunderstandings is a core teaching of MBT.

MBT is a psychodynamic treatment originally developed for BPD. It’s now considered a beneficial transdiagnostic therapy for many conditions featuring interpersonal challenges.

Both MBT and DBT are effective therapies, but MBT focuses on helping you learn more about your affective state (i.e., your mood and emotions) and how it influences those around you.