Mentalization: Understanding Misunderstanding Part II
by Amie Roe, LCSW
Over the course of the past year, I have become fascinated with mentalization and Mentalization Based Treatment (MBT), a psychotherapeutic modality that centralizes building and maintaining the capacity to mentalize in clients. Developed first to treat Borderline Personality Disorder (BPD), MBT has since been modified and applied to many other conditions, including Antisocial Personality Disorder (ASPD), eating disorders, and pathological narcissism. While it is not widely practiced in the United States, it is used in a variety of contexts in Europe. Research on the long-term benefits of MBT is promising, especially considering that it is a relatively straightforward form of psychotherapy that requires modest training compared to other modalities. For example, in one eight-year study of individuals diagnosed with BPD, Bateman and Fonagy (2008) found that individuals treated with MBT versus treatment as usual for three years had lower use of medication, lower use of emergency services, lower rate of suicide attempts, lower hospitalization, and greater participation in school as well as employment. Remarkably, these gains were sustained in the MBT group at a five year follow-up.
I’ve found MBT to support and uphold many of the values embedded in intersectional feminism and the model of psychotherapy that I learned through WTCI. It has been interesting to me that the same simple, straightforward techniques used in MBT to challenge and stimulate new learning in the face of the strongly held, emotionally infused beliefs and reactions commonly associated with personality disorder can also be helpful in dismantling the rigid, oftentimes unexamined beliefs and assumptions associated with racism and oppressive systems.
MBT encourages a clinician to assume a stance of humility, presumed “not knowing,” and active interest, all of which I can apply to navigating my own unconscious biases. As a white therapist, humility and a willingness to have my mind be changed and influenced by other minds is vitally important as I undoubtedly possess many yet unexamined ideas from my culture and my profession that are rooted in white supremacy. This can assist me in creating an anti-racist and anti-oppression holding space for BIPOC clients. Sustained curiosity and humility with regard to my own beliefs keep me more actively engaged in my own unlearning of many unexamined ideas from my culture and my profession that are rooted in white supremacy.
In MBT, we refrain from offering interpretations and suggestions for behavioral change. This upholds the autonomy of the individual in treatment, allowing them to arrive at insights and change that more authentically stem from their own experience – with all of the added and personally meaningful complexity, creativity, and color that their racial, gender, sexual orientation, and other identities afford them.
Inherent in MBT is a belief in the plurality of valid perspectives and an assumption that no one holds a monopoly on truth. While the MBT therapist refrains from offering interpretations or suggestions, they do frequently share their mind with the client. However, when they do share their thoughts, feelings, and reactions with the client, they clearly mark them as coming from their own mind, so as not to impose one’s perspective on another. When you walk into your therapist’s office complaining about your child, your therapist does in fact share their mind when they say, “I understand that you think your child was disrespecting you and that made you feel awful and sad. I’m having a hard time seeing how exactly your child was trying to disrespect you in that moment. Could you help me understand how you came to that conclusion? I want to know.” When the MBT therapist shares their own mind alongside a wish to understand the mind of the client, they model that it is possible to sustain interest, genuine curiosity, and empathy when there is not yet understanding for where the other is coming from. They demonstrate that it is possible for minds to be in two totally different places, and yet remain in respectful, meaningful contact with one another.
Amie Roe, LCSW is a psychotherapist in private practice, currently offering online psychotherapy to adults based in New York, Pennsylvania, and Florida. She holds a B.A. from Haverford College and an M.S.W. from the University of Pennsylvania, and completed WTCI's postgraduate training program in 2015. She currently studies and receives supervision in Mentalization Based Treatment (MBT) through McLean Hospital and The Anna Freud Centre.
References
Bateman, A. & Fonagy, P. (2008). 8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment. Versus Treatment As Usual. American Journal of Psychiatry, 165(5):631-8. https://doi.org/10.1176/appi.ajp.2007.07040636