Mentalisation based treatment (MBT) – information for service users

1. “Mentalising” is simply something we do imaginatively with our minds to work out what we or others are feeling, thinking, believing, imagining etc. and how this affects what we do.

2. We can mentalise about:
• Ourselves
• Other people
• Our relationships

3. Mentalising can be done:
• Quickly and automatically – “gut” reactions
• Slowly and deliberately – through careful

4. Mentalising can focus
• Internal things (e.g. thoughts, feelings, desires)
• External things (e.g. facial expression, tone of voice, behaviour)

5. Mentalising is important to practice because:
• It helps us make sense of ourselves and other people
• It helps us cope with painful feelings and thoughts in healthy ways
• It reduces the risk of doing things impulsively which might be harmful
• It helps us have more fulfilling relationships
• We can feel more ‘put together’

Mentalisation Based Treatment (MBT) is a psychological talking therapy which aims to improve a person’s ability to mentalise (think about and understand) themselves, other people and their relationships. This is particularly important when we are under stress and this ability is not likely to work so well.
Mentalising is sometimes described as understanding ourselves from the outside and others from the inside”.

People may benefit from MBT if they:
• Want to better understand their own mind and what causes them to act and feel as they do
• Want to better understand the minds and causes of actions and feelings in other people.
• Want to be able to develop and maintain more satisfying and mutually fulfilling relationships.
• Want to find new ways of understanding and coping with their emotions so they feel more resilient in themselves.

In addition you may:
• Have difficulties which have been diagnosed as Emotionally Unstable Personality Disorder and possibly other mental health difficulties. This is not essential to be able to access the therapy, as this will be based on an assessment of your needs.
• MBT can be of specific benefit to people who have self-harmed and/or have suicidal thoughts or behaviour. The aim here is to develop greater mental ability to reflect on feelings before acting on them. It is not a ‘behavioural’ therapy aimed at teaching you skills, although it does help if you practice the mentalising (thinking) both in therapy sessions and outside in your daily life.
• Participating in any therapy may, understandably, also cause some discomfort or anxiety, especially at the beginning, as it involves talking and thinking about things you may find difficult. You and your therapist can discuss the best ways to support and ‘mentalise’ with you about this.

1. Mentalisation Based Treatment: Introduction (MBTi) – An 8–10-week group focused on developing participants understanding of mentalising, relationship difficulties and mentalisation based therapies. The MBTi group can also help assess whether the full MBT programme is suitable for you.

2. Individual Review – Each person who attends MBT-i is offered an individual appointment to consider if MBT is the most appropriate therapy. If both service user and therapist are in agreement, MBT will be offered.

3. Mentalisation Based Treatment (MBT) – This involves attending weekly group and individual therapy for up to 12 months. Within MBT, there is an assumption that mentalising is a learned mental skill and ability, which can be developed through therapy and secure relationships with others. Individuals are required to bring their own mentalising difficulties and experiences to group and individual sessions and also to mentalise about others experiences as described in the group.

4. Follow up to support ongoing mentalising and promote resilience and greater recovery.

Your therapist(s) will initially spend time with you getting to know the kind of situations and relationships which have tended to provoke strong emotional reactions and less helpful mentalising in you or shifts in your mood states.

They will work with you to develop a shared understanding (formulation) of your key difficulties in these areas. This will include looking at how these difficulties affect you emotionally and what happens as a result in your relationships. There will be some sense or story about what the patterns look like, and what might be keeping things stuck or not progressing so well. This formulation is designed to help you focus your therapy on difficulties in mentalising but is meant to be flexible and can be reworked and updated as you and your therapist understand things differently during therapy.

You will be asked to share some of the mentalising difficulties identified in your formulation with your individual therapist within the group. This helps group members mentalise each other so as to understand each other better and support the mentalising skills and abilities of everyone in the group. Mentalising is best done in the group and by the group with each other, with a bit of help from the group therapists.

MBT therapists provide little direct advice and do not try to provide solutions; instead, they encourage you to take a ‘mentalising stance’ with yourself and other members in the group, including the therapists. This means helping you to work out bit by bit your own understandings of mental states and compare these to other suggestions. This will take time and lots of practice.
MBT therapists provide little direct advice and do not try to provide solutions; instead, they encourage you to take a ‘mentalising stance’ with yourself and other members in the group, including the therapists. This means helping you to work out bit by bit your own understandings of mental states and compare these to other suggestions. This will take time and lots of practice.

As part of MBT you are encouraged to discuss how you experience your therapist(s) and/or other people you are in therapy with and yourself in relation to them, as this can also help you in developing your mentalising skills.

It may be helpful for you to consider the following:
• Will you be able to get to the venue and attend regularly? We ask people to aim for at least 75% attendance of appointments.
• If you are already in therapy, it’s likely you will be advised to finish that therapy before embarking on the MBT programme.
• If you use drugs or alcohol, it is likely to make therapy less effective and limit your mentalising ability. If you significantly use substances or are addicted in a harmful way, you would likely need to address this first with Addictions services so that you can get the most from MBT or other interventions offered to you.

If you are interested in accessing MBT please discuss this with your care coordinator, key worker and/or psychological therapist within your Community Mental Health or Treatment Team.

Staff can arrange an interpreter if you need one.

Personality Disorder Hub team
Benfield House
Walkergate Park
Benfield Road
Newcastle upon Tyne
NE6 4 PF
Tel: 0191 287 6100

If you want to make a comment, suggestion, compliment or complaint you can:
• talk to the people directly involved in your care
• ask a member of staff for a feedback form, or complete a form on the Trust website www.cntw.nhs.uk (click on the ‘Contact Us’ tab)
• telephone the Complaints Department 0191 245 6672
• email [email protected] Please note that information sent to the Trust via email is sent at your own risk
• We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention.
You can provide feedback in the following ways:
– the quickest way for you to do this is to complete our short online survey at
www.cntw.nhs.uk/poy
– complete a Points of You survey, available from staff.

• Asen, E. & Fonagy, P. (2021) Mentalization-Based Treatment with Families. New York & London: Guilford Press.
• Bateman, A. & Fonagy, P. (Eds.) (2019) Mentalizing in Mental Health Practice: Second Edition. Washington, DC: American Psychiatric Association Publishing.
• Bateman, A. & Fonagy, P. (2016) Mentalization-Based Treatment for Personality Disorders: A Practical Guide. Oxford: Oxford University Press.
• Hagelquist, J. O. (2015) The Mentalization Guidebook. London: Karnac.
• Karterud, S. (2015) Mentalization-Based Group Therapy (MBT-G): A theoretical, clinical and research manual. Oxford: Oxford University Press.
• For information about the current evidence for MBT see: National Institute for Clinical Excellence (NICE) Guidelines for Borderline Personality Disorder: www.nice.org.uk/Guidance/CG78

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Tel: 0191 246 7288

Published by the Patient Information Centre
2022 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
Ref, PIC/769/0422 April 2022 V3
www.cntw.nhs.uk Tel: 0191 246 7288
Review date 2025