If you have trouble understanding other people’s behavior, reading what they might be thinking, or realizing your own motivations, you might be having difficulty mentalizing. Mentalization is basically the ability to understand thoughts, feelings, and actions in ourselves and others, and the theory of mentalization has its roots in attachment theory.

Mentalization is a skill we all possess to a certain degree, but for some people, mentalization comes more naturally than others. Mentalization based therapy (also referred to as MBT, MBT therapy, or mentalization based treatment) aims to help people learn to mentalize to gain better emotional regulation, impulse control, and relationship quality.

If this sounds like something you might be interested in, you might be wondering: who does MBT help? And what does MBT involve? To answer all of your questions about mentalization-based therapy, in this article we’ll talk about the principles and goals of mentalization-based therapy, the applications of MBT, what MBT involves, who trains in MBT, and how MBT compares to other therapeutic approaches.

DISCOVER YOUR ATTACHMENT STYLE

What Is Mentalization Based Therapy?

Mentalization-based therapy (MBT) is a form of time-limited, structured psychotherapy. It can last anywhere from around 20 weeks to 18 months, but its duration will be decided from the outset. It typically involves a combination of group skills-based sessions and individual sessions with your MBT therapist.

Anthony Bateman and Peter Fonagy developed MBT in the 1990s, originally for people with borderline personality disorder (BPD)¹. However, since then, adaptations of MBT have successfully been used to help manage a range of mental health difficulties, including depression, eating disorders, and post-traumatic stress disorder.

MBT uses mentalization skills to help you to develop a more stable understanding of who you are and why you might behave in certain ways, as well as to control difficult emotions in relationships and understand other people better.

What Is Mentalization?

Mentalization is our ability to think about thinking. In essence, it involves understanding:

• our own thoughts and feelings, and
• other people’s thoughts and feelings.

For example, say you want to buy some flowers for your friend. Before you decide which flowers to buy, you take a moment and think about what they would like. You personally can’t stand roses, but you know that your friend loves them. You buy the roses because you know that they’ll make your friend happy even though you wouldn’t like to receive them yourself – this is an example of mentalizing, because you were able to understand that your friend has different preferences to you and that their preferences will make them happy.

According to Bateman & Fonagy, mentalizing is learned in infancy through the same processes that form our attachment styles:

“Our understanding of others critically depends on whether as infants our own mental states were adequately understood by caring, attentive, non-threatening adults.”¹

They also suggest that psychological trauma in childhood, whether early or late in childhood, makes it difficult for us to understand mental states and our relationships with others. Therefore, attachment dynamics play a key role in MBT.

MBT Therapy Principles and Goals

Mentalization-based therapy is guided by these principles of attachment and stabilizing your sense of self. Bateman & Fonagy outlined three core techniques that make up MBT¹:

Flexible Approaches to Reinstating Ability to Mentalize

Any therapeutic approach with the goal of restoring someone’s ability to mentalize can be considered MBT. This means that different techniques can be used to achieve this goal, which is part of why MBT is popular and adaptable. A psychologist with a particular approach can adapt their existing techniques to focus on mentalizing, as long as they keep in mind all 3 core elements of mentalization based therapy.

Therapeutic Stance

The “therapeutic stance” describes the attitude that the therapist takes toward their client and the session. In MBT, the therapeutic stance should involve:

• Not knowing – the assumption that the therapist does not know their client’s internal states better than the client themselves. They should actively ask questions and seek to understand their client’s perspective by working together, instead of offering explanations.
• Patience – time is taken to carefully understand differences in perspectives.
• Acceptance – the therapist should validate and accept differences in perspectives.
• Active questioning – the therapist should ask their client to explain their experiences and perspectives in detail, looking for descriptions instead of probing the client to consider explanations.
• Avoiding stating the need to understand everything – attempting to understand an unclear difference in perspective can demonstrate a failed ability to mentalize, so should be avoided as we focus instead on acceptance.

This therapeutic stance is designed to give both the therapist and the client a collaborative relationship, where both hold the responsibility to mentalize.

Mentalizing Transference

In short, transference is what happens when you transfer your feelings about one person or group of people onto another. For example, studies have found that we tend to project our feelings about past romantic partners onto potential future ones, whether or not they actually resemble our previous partners². The same can happen in therapy – the feelings you have toward your parents, siblings, friends, partners, or any particular group of people can be projected onto your therapist.

In MBT, the therapist is supposed to take a 6 step approach to this phenomenon:

1. Validating the client’s experiences – not necessarily agreeing, but understanding the client’s feelings.
2. Exploring what thoughts and feelings trigger the transference.
3. Accepting the therapist’s role in transference; the therapist likely played a role in this transference by enacting their client’s expectations of them, even if unintentionally. It’s important to acknowledge that the transference experience isn’t entirely the fault of the client.
4. The client and the therapist should collaborate to arrive at an interpretation of the transference.
5. The therapist should present an alternative perspective.
6. The therapist should continue to keep an eye on the client’s reaction, as well as their own.

While other therapies might focus on interpreting transference to gain insight into the client’s experiences, MBT mentalizes transference to help the client to see their experience from someone else’s perspective. This gives them the opportunity to focus on their current client-therapist relationship, rather than past relationships, and practice understanding how two people can see the same scenario differently.

Who Does MBT Therapy Training?

Since any therapy that centers these core concepts can be considered MBT, you might be wondering who you can see for mentalization based therapy. Any mental health professional with experience in psychological therapy can train as an MBT practitioner, including³:

• Psychiatrists.
• Psychologists.
• Mental Health Counsellors.
• Mental Health Nurses.

This means that you don’t need to look specifically for a “mentalization based therapist” – you can broaden your search to anyone with accredited training in mentalization based therapy.

What is the Goal of Mentalization Based Therapy?

We know that the goal of MBT is to help somebody to improve their mentalizing skills, but what does this mean for them in day to day life?

Considering that MBT was initially developed to help people with BPD, its ultimate aim is to manage intense emotions and build a greater understanding of the self and others. This can help with impulsive actions, interpreting feelings and experiences, and maintaining relationships.

People with insecure attachment styles may find MBT helpful in building trust and security with others.

Mentalization Based Therapy Applications

Mentalization based treatment has proven highly effective for people with BPD. A 2019 systematic review, which examines all of the existing evidence to find a pattern, found that MBT significantly reduced symptoms of BPD⁴.

Since its development, MBT treatment has been adapted to help people of different ages and those struggling with other mental health conditions. In theory, any mental health challenge involving difficulty mentalizing could be helped by MBT.

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MBT Treatment Process

Mentalization-based therapy starts with one or multiple assessment meetings. These involve meeting a therapist for the first time and identifying whether they’re the right fit for you. Assessment sessions give your potential therapist the chance to understand your main struggles, identify how your difficulties are affecting your life, and assess whether MBT is the right therapy approach for you. These assessment sessions are also there to give you the opportunity to learn more about how your potential therapist works, learn more about the MBT treatment process, and decide whether it’s what you’re looking for.

Before you begin treatment, the duration and number of MBT sessions will already be decided and clarified. This will usually be a combination of group and individual therapy. Keeping sessions time-limited makes sure you have time to make plans for what you’ll do when the sessions are over and keeps the treatment focused on the here and now.

Comparison of MBT With Other Therapeutic Approaches

MBT treatment is similar to Dialectical Behavior Therapy (DBT), another form of talking therapy. While MBT came from psychodynamic principles like attachment theory, DBT arose as a form of cognitive behavioral therapy⁵.

Both were developed to treat people with borderline personality disorder – however, there are some key differences between the two. While both help you to hold other people’s perspectives in consideration, DBT is more focused on immediate emotional regulation skills and managing impulsivity.

MBT is also similar to Mindfulness-Based Cognitive Therapy (MBCT), another form of talking therapy. The main difference between the two therapeutic approaches is that MBCT focuses on cognitive-behavioral approaches mixed with mindfulness practices, while MBT is firmly rooted in mentalization and attachment theory.

These are just a few examples of therapeutic approaches; the therapy approach that’s right for you will depend on your unique situation and struggles. It’s important to seek guidance from a mental health professional to identify which avenue is best for you, and it’s normal to try a few different therapists before finding the right fit.

Final Word on Mentalization Based Therapy

We all mentalize to some degree, but some of us can find it more difficult due to mental health challenges and difficult experiences. Mentalization based therapy is a structured therapeutic approach, focusing on improving our ability to understand our thoughts and feelings and how these guide our behaviors, as well as to recognize this process in others and accept different perspectives.

Although originally developed for people with borderline personality disorder, MBT treatment has since been adapted and applied to other conditions. People with insecure attachment styles could benefit from MBT, as it could help you to accept other perspectives and build trust and security in relationships.

Do you know your attachment style? Take our free attachment quiz to find out.

References

1. Bateman A, Fonagy P. Mentalization based treatment for borderline personality disorder. World psychiatry. 2010 Feb;9(1):11.
2. Levy KN, Scala J. Transference, transference interpretations, and transference-focused psychotherapies. Psychotherapy. 2012 Sep;49(3):391.
3. Anna Freud Centre, MBT Practitioner Status Pack. Accessed August 14, 2025. https://brandplatform.annafreud.org/share/KtTaMTCK2gwb8GzGtEh2/assets/4077
4. Vogt KS, Norman P. Is mentalization‐based therapy effective in treating the symptoms of borderline personality disorder? A systematic review. Psychology and Psychotherapy: Theory, Research and Practice. 2019 Dec;92(4):441-64.
5. Barnicot K, Crawford M. Dialectical behaviour therapy v. mentalisation-based therapy for borderline personality disorder. Psychological medicine. 2019 Sep;49(12):2060-8.