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Mentalizing and Mentalization-Based Treatment: A clinical introduction

Prof. Anthony Bateman

Monday, 9 September 2024

Introduction

How does a person intuitively know that a certain look from their partner means they have had a tough day at work? How can best friends have entire dialogues with each other without completing a single sentence? In our everyday life, we are all philosophers of the mind – almost all of us devote substantial amounts of our “headspace” to wondering what is going on in other people’s heads and tracking our own thoughts or feelings. This is mentalizing, a term used to describe the ability to represent something beyond, behind, or simply different from physical objects, moving bodies, and expressive faces. Such “mind-wondering” is pretty central to social interaction, culture, and morality. In the world of mentalization-based treatment (MBT), the focus is on mentalizing as a way of making sense of mental health difficulties to shape psychotherapeutic treatment and help the individual identify and change their mental vulnerabilities as they negotiate a social world.


We all have vulnerabilities to poor mentalizing arising from our developmental experiences. Mentalizing develops in the context of attachment relationships. Secure attachment confers stable mentalizing which allows learning from others and effective social interaction; disorganised attachment leads to unstable mentalizing which leaves the person vulnerable to everyday stressors and with difficulties in understanding their own inner states as well as those of others. The result tends to be distrust in others, unstable relationships, problematic and intense emotions, and difficulties in deploying effective coping strategies to navigate complex social interaction. An inability of an individual to trust in others prevents them managing unmanageable mental pain through other’s minds and leaves the individual alone and isolated in the world and prone to self-harm and suicidality. Stabilising and improving their mentalizing stimulates social connection and positive change in personal interaction and more stable sense of self improving mental health over the long term.


The event will be equivalent to 2 hrs of CPD.

Content

MBT is an evidence-based treatment for borderline personality disorder but the intervention transcends categorical diagnoses due to the transdiagnostic nature of mentalizing. Some of the research evidence will be presented but the primary emphasis of this talk will be clinical practice targeting mentalizing. First mentalizing will be defined and placed in a developmental context. The long term effects of developmental trauma on mentalizing will be outlined. Second how it is recognised and assessed in clinical practice will be discussed. There are two main aspects to mentalizing – social mentalizing and mental dimensions of mentalizing. Social mentalizing is inherently relational and requires us to be aware of our own mental states and those of others along with how others are understanding our mental states. When this dynamic interactional process works well we are able to join together and form a ‘we-ness’ in which we have a sense of belonging and can ‘see to it’ together. Creating this process requires us to integrate and use flexibly our internal mentalizing processes of cognitive and affective mentalizing, automatic and controlled mentalizing, and external and internal focus of mentalizing. Third the translation of these aspects of mentalizing into a coherent intervention of mentalizing-based treatment will be presented. Clinical illustrations will be provided.

Learning Objectives

At the end of the workshop participants will be able to:
• define mentalizing in terms of psychological development and mental function
• understand how mentalizing assessment informs treatment in MBT
• consider using some mentalizing interventions in their clinical practice.

Training Modalities

Didactic, Q and A, live role play, video.

Key References

Bateman, A., & Fonagy, P. (2016). Mentalization based treatment for personality disorders: a practical guide. Oxford: Oxford University Press.

Bateman, A., Fonagy, P., Campbell, C., Luyten, P., and Debbane, M., (2023) Cambridge Guide to Mentalization-Based Treatment, Cambridge, Cambridge University Press

Fonagy, P., Luyten, P., Allison, E., & Campbell, C. (2017). What we have changed our minds about: Part 2. Borderline personality disorder, epistemic trust and the developmental significance of social communication. Borderline Personality Disorder and Emotion Dysregulation, 4, 9. https://doi.org/10.1186/s40479-017-0062-8

Luyten, P., Campbell, C., Allison, E., & Fonagy, P. (2020). The mentalizing approach to psychopathology: State of the art and future directions. Annual Review of Clinical Psychology, 16, null. doi: 10.1146/annurev-clinpsy-071919-015355

Luyten, P., Campbell, C., & Fonagy, P. (2020). Borderline personality disorder, complex trauma, and problems with self and identity: A social-communicative approach. Journal of Personality, 88(1), 88-105. https://doi.org/10.1111/jopy.12483

Anthony Bateman MA FRCPsych Consultant to the Anna Freud Centre, London; Visiting Professor University College, London; Honorary Professor in Psychotherapy University of Copenhagen.
Email: anthony.bateman@ucl.ac.uk

About the presenter

Anthony Bateman developed mentalization based treatment for borderline personality disorder with his colleague Peter Fonagy and studied its effectiveness in research trials. Adapted versions are now being used in multi-centre trials for antisocial personality disorder, eating disorders, and drug addiction and with mothers and babies and families. He was an expert member of National Institute for Clinical Excellence (NICE) development group for treatment guidelines for Borderline Personality Disorder in UK and was Chair of the National Guideline Development Group for Eating Disorders.

He received a senior scientist award from British and Irish group for the Study of Personality Disorder in 2012 and in 2015 the annual award for “Achievement in the Field of Severe Personality Disorders” from the BPDRC in the USA.

He has authored 17 books and over 150 peer reviewed research articles on personality disorder and the use of psychotherapy in psychiatric practice.

Who should attend

This introduction is suitable for all mental health professionals who work with people with complex emotional and interpersonal problems and trauma e.g. psychologists, nurses, high intensity practitioners, psychiatrists, counsellors, art therapists, and others.

Details coming soon

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