What is mentalization-based therapy?

Last week I had the opportunity to observe a mentalization-based group therapy. Mentalization was developed by Peter Fonagy and Anthony Bateman and is the only other treatment (besides DBT) that has strong empirical (scientific) support for treating borderline personality disorder.

What exactly is mentalization? This is my own attempt to describe what I know about it so far: We are constantly making interpretations about the intentions of other people, and we tend to be pre-occupied with their intentions towards us.  When we assume the intentions of others we think we “know” what other people are wanting, thinking, or feeling. While sometimes this is perceptive and accurate, poor (or inaccurate) mentalizing can often exacerbate conflict or add stress to relationships.

Consider the following scenario: You are late to work. Consider what your reaction might be if your employer insisted that the following scenarios are true:

“You must really hate me. You do hate me, don’t you? Why don’t you tell me why you hate me so much and we can get everything off our chests. Come on. You can be honest. Tell me what your problem is with me.”

“You think you are too good for other people. What makes you think you are better than everyone else? If you think you are better than everyone here, then maybe we should give you extra work so you can keep proving to the rest of us how important you are.”

When other people do not “mentalize” accurately, it can increase defensiveness and emotional arousal. And talk about being misunderstood! When other people insist that their interpretation of your behavior is accurate (when it is not), it makes it more difficult to keep emotions on an even keel and steer clear of more conflict. Can you think of a time in which this has happened to you?

In a mentalization-based group, group members are encouraged to generate many “interpretations” of reported or observed behaviors. Some of these “interpretations” may be accurate and some may not. Some may be entirely out of this world! Attempts at accurate mentalization (“You must have been really taken aback when your boss said those things!”), may increase understanding, lower emotional arousal, and enable a person to use the group for perspective-taking and problem solving. Additional benefits include seeing things from a wide variety of viewpoints (What might have been going on with your boss that day?), considering things that have not been previously considered, increasing compassion when others misinterpret intentions, and staying level-headed when there are strong urges to engage in extreme ways of responding.