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Mentalization Based Therapy for Borderline Personality Disorder

Is Mentalization Based Therapy Right For You?


Updated July 22, 2008

Mentalization based therapy for borderline personality disorder (BPD) is a type of psychotherapy that focuses on the your ability to “mentalize,” or recognize thoughts, feelings, wishes, and desires, and see how these internal states are linked to behavior.

What is Mentalization?

Mentalization refers to your ability to recognize your own and others’ mental states, and to see these mental states as separate from behavior. Mentalization includes being able to think about thoughts, emotions, wishes, desires, and needs in yourself and other people, and to see that these internal events may have an impact on the actions that you and others take, but are separate from those actions.

For example, imagine that you are having a conversation with a friend, and you mention that you do not like her haircut. Your conversation continues, and then several minutes later she ends the conversation abruptly, saying she needs to go, and leaves after giving a curt goodbye. Mentalization about this situation would lead you to think about your friend’s internal state and how it relates to her behavior. Perhaps she was hurt by your comment about her hair, and this led her to be short with you.

How is Mentalization Related to BPD?

Anthony Bateman and Peter Fonagy, the developers of mentalization based therapy for BPD, believe that people with BPD are not able to mentalize adequately due problems that occurred in childhood relationships. They propose that the capacity to mentalize is learned in early childhood through interactions between the child and caregiver, and if the child-caregiver relationship is disrupted in some way, development of mentalization is interrupted. This theory is supported by evidence that childhood maltreatment and/or early loss of caregivers is associated with increased risk of BPD.

What to Expect in Mentalization Based Therapy for BPD

Mentalization based therapy for BPD is a psychodynamic psychotherapy, which means that the focus of the therapy is on the interaction between the patient and the therapist. In this therapy, the therapist will focus on the present (rather than the past), and will work with you to enhance your mentalization ability. To do this, the therapist may ask you questions about how your thoughts or emotions are connected to your behavior in the session. In mentalization based therapy, the therapist will usually not give advice or an opinion. Instead, your therapist will help you explore your internal states and help you form new ways of mentalizing.

Research Support for Mentalization Based Therapy for BPD

Some research has supported the effectiveness of mentalization based therapy for BPD. Researchers conducted one randomized controlled study (the most stringent type of therapy study) in which patients with BPD were assigned to either an intensive treatment program that used mentalization based treatment strategies or a “treatment as usual” condition (patients received the standard care they would normally receive if they were not in a research study). That study showed that patients in the mentalization based therapy program had larger reductions in deliberate self-harm, suicide attempts, anxiety, and depression, and better social functioning, than the patients who received standard treatment.

While this study supports the possibility that mentalization based therapy for BPD is useful, the study methods have some major limitations. For example, the patients in the mentalization based therapy program received far more treatment than those in the "treatment as usual" program. So their improvements could just mean that more therapy is better for BPD, not that mentalization based therapy specifically is better for BPD. Future research is needed to examine whether this treatment is indeed effective in reducing the symptoms of BPD.


Bateman AW, Fonagy P. “Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial.” American Journal of Psychiatry. 156:1563-1569, 1999.

Bateman AW, Fonagy P. “Mentalization-Based Treatment of BPD.” Journal of Personality Disorders, 18:36-51, 2004.

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