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= Mentalization-based treatment =
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Introduction
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Mentalization-based treatment (MBT) is an integrative form of
psychotherapy, bringing together aspects of psychodynamic,
cognitive-behavioral, systemic and ecological approaches. MBT was
developed and manualised by Peter Fonagy and Anthony Bateman, designed
for individuals with borderline personality disorder (BPD). Some of
these individuals suffer from disorganized attachment and failed to
develop a robust mentalization capacity. Fonagy and Bateman define
mentalization as the process by which we implicitly and explicitly
interpret the actions of oneself and others as meaningful on the basis
of intentional mental states. The object of treatment is that patients
with BPD increase their mentalization capacity, which should improve
affect regulation, thereby reducing suicidality and self-harm, as well
as strengthening interpersonal relationships.
More recently, a range of mentalization-based treatments, using the
"mentalizing stance" defined in MBT but directed at children (MBT-C),
families (MBT-F) and adolescents (MBT-A), and for chaotic
multi-problem youth, AMBIT (adaptive mentalization-based integrative
treatment) has been under development by groups mainly gravitating
around the Anna Freud National Centre for Children and Families.
The treatment should be distinguished from and has no connection with
mindfulness-based stress reduction (MBSR) therapy developed by Jon
Kabat-Zinn.
Goals
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The major goals of MBT are: (1) better behavioral control, (2)
increased affect regulation, (3) more intimate and gratifying
relationships and (4) the ability to pursue life goals. This is
believed to be accomplished through increasing the patient's capacity
for mentalization in order to stabilize the client's sense of self and
to enhance stability in emotions and relationships.
Focus of treatment
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A distinctive feature of MBT is placing the enhancement of mentalizing
itself as focus of treatment. The aim of therapy is not developing
insight, but the recovery of mentalizing. Therapy examines mainly the
present moment, attending to events of the past only insofar as they
affect the individual in the present. Other core aspects of treatment
include a stance of curiosity, partnership with the patient rather
than an 'expert' type role, monitoring and regulating emotional
arousal, and identifying the affect focus. Transference in classical
understanding of this term is not included in the MBT model. MBT does
encourage consideration of the patient-therapist relationship, but
without necessarily generalizing to other relationships, past or
present.
Treatment procedure
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MBT should be offered to patients twice per week with sessions
alternating between group therapy and individual treatment. During
sessions the therapist works to stimulate or nurture mentalizing.
Particular techniques are employed to lower or raise emotional arousal
as needed, to interrupt non-mentalizing and to foster flexibility in
perspective-taking. Activation occurs through the elaboration of
current attachment relationships, the therapist�s encouragement and
regulation of the patient�s attachment bond with the therapist and the
therapist�s attempts to create attachment bonds between members of the
therapy group.
Mechanisms of change
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The safe attachment relationship with the therapist provides a
relational context in which it is safe for the patient to explore the
mind of the other. Fonagy and Bateman have recently proposed that MBT
(and other evidence-based therapies) works by providing ostensive cues
that stimulate epistemic trust. The increase in epistemic trust,
together with a persistent focus on mentalizing in therapy, appear to
facilitate change by leaving people more open to learning outside of
therapy, in the social interactions of their day-to-day lives.
Efficacy
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Fonagy, Bateman, and colleagues have done extensive outcome research
on MBT for borderline personality disorder. The first randomized,
controlled trial was published in 1999, concerning MBT delivered in a
partial hospital setting. The results showed real-world clinical
effectiveness that compared favorably with existing treatments for
BPD. A follow-up study published in 2003 demonstrated that MBT is
cost-effective. Encouraging results were also found in an 18-month
study, in which subjects were randomly assigned to an outpatient MBT
treatment condition versus a structured clinical management (SCM)
treatment. The lasting efficacy of MBT was demonstrated in an 8-year
follow-up of patients from the original trial, comparing MBT versus
treatment as usual. In that research, patients who had received MBT
had less medication use, fewer hospitalizations and longer periods of
employment compared to patients who received standard care.
Replication studies have been published by other European
investigators. Researchers have also demonstrated the effectiveness of
MBT for adolescents as well as that of a group-only format of MBT.
Further reading
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*Allen, J.G., Fonagy, P. (2006). 'Handbook of mentalization-based
treatment'. Chichester, UK: John Wiley. .
*Allen, J.G., Fonagy, P., Bateman, A.W. (2008) 'Mentalizing in
clinical practice'. Arlington, USA: American Psychiatric Publishing. .
*
License
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http://creativecommons.org/licenses/by-sa/3.0/
Original Article:
http://en.wikipedia.org/wiki/Mentalization-based_treatment
