Mentalization-based Treatment Research Articles

Mentalization-based approach for schizophrenia spectrum disorders: a psychotherapeutic proposal for evolved schizophrenic trajectories and serious mental disorders

There is a growing interest in psychotherapeutic approaches to pre-psychotic high-risk states or first-episode psychosis, where mentalization-based treatment has shown its utility. This article presents a mentalization-based approach for the treatment of those individuals diagnosed with an evolved schizophrenia spectrum disorder, whose characteristics make them especially inaccessible to reflective psychotherapeutic treatment. A synthesis of the conceptual frameworks that justify the needs for technical modification of the mentalization-based treatment foundational techniques is carried out, followed by the proposal of adaptations, with a focus in self-agency and patient-therapist dyad. Therapeutic interventions are outlined, including illustrative examples. The mentalizing approach presented here holds promise for future research and treatment opportunities for patients with evolved schizophrenia and other serious mental disorders.

Mentalisation-based treatment for borderline personality disorder: a narrative review of recent process and outcome findings

This article presents a narrative review of recent process and outcome studies of mentalisation-based treatment (MBT) for borderline personality disorder (BPD). The author introduces the theoretical origins of mentalisation, its role in BPD, and the therapeutic approach of MBT. Quantitative and qualitative findings are then reviewed and critically appraised for their methodological strengths and limitations. The review finds that BPD patients benefit from the multicomponent structure and active ingredients of MBT. Finally, practical implications are discussed and directions for future research are proposed.

Mental flexibility and epistemic trust through implicit social learning – A meta-model of change processes in psychotherapy with personality disorders

This position paper follows the call for transtheoretical meta-models of general clinical change by concentrating on severe mental illness such as Personality Disorders (PDs). We have identified a core process of change related to mental flexibility through implicit learning and propose recommendations for stance and technique that are informed by research on Mentalization-Based-Treatment (MBT) and the learning components as represented in the Mediational Intervention for Sensitizing Caregivers (MISC). While the idea of corrective emotional experience as a general change mechanism involves discriminating between an old and new relationship to update relationship knowledge, the capacity to understand and process corrective emotional experiences may be limited and even iatrogenic in patients with PDs. By integrating MBT and MISC, a meta-model of change is created that allows training in and observation of the granular-level, behaviorally anchored, actions taken by the therapist to open up social learning. Here, social learning is conceptualized as epistemic trust, increasing the client’s reflective functioning during sessions to ultimately enhance cognitive flexibility outside the therapy room. This opens the possibility to implement and observe micro changes in what should be termed now implicit cognitive and emotional corrective experiences. Thus, we propose to shift towards implicit learning within professional relationships; that is, internalizing a new way of thinking about any life-event that requires adaption thereby creating adaptive capacities via mental flexibility as the general change mechanism of Personality Disorder (PD) treatment.

Primary school mentalisation-based art therapy (Primary-smART): a Person-Based Approach optimisation study

ABSTRACT Background The children’s mental health crisis in the UK continues to worsen and more and more schools are employing art therapists (ATs) to provide services for children experiencing social, emotional, and mental health (SEMH) difficulties. Although some studies have found indications of positive SEMH outcomes following art therapy, the evidence-base is still emerging. The initial development of a formalised art therapy intervention called Primary-smART included children, teachers, parents/carers, and art therapists. Indications from exploratory research showed this intervention could be helpful for children experiencing SEMH difficulties. Aims This study aimed to optimise a Primary-smART toolkit to ensure it is acceptable, engaging and persuasive for ATs in preparation for a future evaluation study in primary schools with children. Methods The Person-Based Approach (PBA) to intervention development was used to develop Primary-smART. In this study, feedback gained through online interviews with ATs was used to refine and optimise the toolkit. Results The 18 ATs who participated in this study perceived Primary-smART as acceptable overall. However, ATs during Rounds 1, 2, and 3 had important concerns which may have resulted in barriers to using Primary-smART. Seven out of eight main sections were modified and no new significant barriers were fed back by Round 4. Conclusions This study was successful in refining and optimising the Primary-smART toolkit. Results show that PBA methods enabled the research team to meet the study's aims. Implications for practice/policy/future research Future evaluation studies are now needed to test the clinical, carbon and cost effectiveness of Primary-smART. Plain-language summary The children’s mental health crisis in the UK has continued to worsen, especially since the COVID-19 pandemic. More and more schools are employing art therapists to provide services for children experiencing social, emotional, and mental health difficulties. Although some research studies suggest art therapy can be helpful for some children, it is still not clear exactly how it may help or if it can be helpful for many children experiencing social, emotional or mental health difficulties. To test art therapy in this way, we need to develop standardised approaches that lots of art therapists can use with many children in different schools and compare their results and experiences. This study focused on completing a step-by-step toolkit designed to enable primary-school-based art therapists to use a specific approach, which we are calling Primary-smART. This approach combines artmaking with other activities to help children understand and manage their thoughts and feelings. In this research, we asked art therapists to help us improve the toolkit. Now that the toolkit is complete, Primary-smART can be used in future studies to test if art therapy is helpful for many children in different schools and find out what is and is not helpful about the approach.

Mediation 2.0: a mentalizing-informed framework for renewed purpose and practice

In this paper, we outline a new way of thinking about the purpose and practice of mediation. We propose that mentalizing-inspired mediation can be an effective tool for understanding the interpersonal conflict behaviours that often perpetuate disputes, inhibit their resolution, and promote the likelihood of new disputes emerging in the future. By adapting the theory of mentalizing and the mentalization-based treatment (MBT) model, we introduce a scientifically grounded approach, which we call MBT-M, to inform and elevate mediation education and practice. MBT-M offers a neat and modern reframe on the purpose and practice of mediation as a process that can assist parties to identify, and recover from, impaired mentalizing in order to understand, or ‘mentalize’, the conflict behaviours that are preventing the meaningful resolution of their dispute. Future work will outline how the MBT-M model can offer a robust, evidence-based platform from which to guide mediation interventions, research and scholarship.

Psychotherapies at a Glance: Consensus Guideline-Recommended Psychotherapies for Adults With Psychiatric Disorders.

Clinical decision making by psychiatrists and informed consent by patients require knowledge of evidence-based psychotherapies (EBPs) and their indications. However, many mental health professionals are not versed in the empirical literature on EBPs or the consensus guideline recommendations derived from this literature. The authors compared rigorous national consensus guidelines for EBP treatment of DSM-defined adult psychiatric disorders-derived from well-conducted randomized controlled trials and meta-analyses and from expert opinions from the United States, United Kingdom, and Canada-to create the Psychotherapies-at-a-Glance tool. Recommended EBPs are cognitive-behavioral therapy, family therapy, contingency management, dialectical behavior therapy, eye movement desensitization reprocessing, interpersonal psychotherapy, mentalization-based treatment, motivational interviewing, peer support, problem-solving therapy, psychoeducation, short-term psychodynamic psychotherapy, and 12-step facilitation. The Psychotherapies-at-a-Glance tool summarizes the indications, rationales, and therapeutic tasks that characterize these differing psychotherapies and psychosocial treatments. The tool is intended for use in clinical teaching, treatment planning, and patient communications.

A INFLUÊNCIA DO AMBIENTE FAMILIAR NA MANIFESTAÇÃO DO TRANSTORNO DE PERSONALIDADE NARCISISTA

The manifestation of Narcissistic Personality Disorder (NPD) is often influenced by various factors, with the family environment being an important component. Family dynamics play a crucial role in the development of this disorder, impacting the formation of the individual's self-image and patterns of interpersonal relationships. In this context, understanding the influence of the family environment on the expression of NPD is fundamental to effectively address this complex psychological condition. Objectives: To investigate and understand the specific influence of the family environment on the manifestation of narcissistic personality disorder, exploring interaction patterns, parental styles, and family dynamics that may contribute to the development of this disorder. Methodology: Articles found were read, and inclusion and exclusion criteria were applied. Within the inclusion criteria, original articles addressing the investigated topic and allowing full access to the study's content were considered, published between 2016 and 2023, in Portuguese and English. The research was conducted through online access to the databases of the National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (SCIELO), Latin American and Caribbean Health Sciences Literature (LILACS) in February 2024. Results and Discussions: The complexity of treating narcissistic personality disorder (NPD) is highlighted. Psychopharmacological treatments have shown limited efficacy, being more useful in comorbidities with other conditions. Several psychotherapeutic approaches were explored, with Dialectical Behavioral Therapy and Schema-Focused Therapy standing out, as well as psychoanalytic approaches such as Transfer-Centered Psychotherapy and Mentalization-Based Therapy. However, regardless of the approach, narcissistic patients are challenging to treat due to difficulty in accepting the diagnosis and lack of empathy. Motivation for change often arises from external crises, making therapeutic commitment fragile. Therapists' countertransference is also a challenge, with difficult-to-manage negative feelings that, when understood, can provide valuable information about the patient's internal world. In summary, the results highlight the need for therapeutic strategies adapted to the complexity of NPD, considering the specific characteristics of narcissistic patients and the inherent challenges in the therapeutic process. Conclusion: In conclusion, addressing Narcissistic Personality Disorder (NPD) demands a deep understanding of therapeutic nuances. The results underscore the complexity in the effectiveness of psychopharmacological treatments and the importance of specific psychotherapeutic approaches. Difficulty in accepting the diagnosis, lack of empathy, and challenges in countertransference emphasize the need for adapted therapeutic strategies. Amidst these challenges, the pursuit of realistic treatment goals and the creation of therapeutic contracts are crucial. These findings underline the importance of continuing research and refining therapeutic approaches to effectively manage NPD.

Antisocial personality disorder and therapeutic pessimism - how can mentalization-based treatment contribute to an increased therapeutic optimism among health professionals?

Antisocial personality disorder (ASPD) is associated with therapeutic pessimism among health professionals. Several variables are associated with obstacles in therapist's willingness to treat ASPD. Variables that are relevant are (i) confusion associated with the term ASPD, (ii) characteristics of the disorder, (iii) attitudes, experiences, and knowledge clinicians possess, and (iv) insufficient management of countertransference. We assume that therapeutic pessimism is related to the lack of evidence-based, effective treatment for individuals with ASPD. This is problematic because ASPD is associated with large socio-economic costs and considerable suffering for the individual and the society. Mentalization-based treatment (MBT) was developed in treating borderline personality disorder (BPD) and is now considered an effective treatment for this group. Mentalization is defined as the process by which individuals make sense of themselves and others in terms of subjective states and mental processes. This ability affects an individual's psychological functioning, mental health, self-organization, and interpersonal relationships. The overall goal of MBT is to strengthen the individual's mentalizing abilities and facilitate more adaptive handling of problematic, internal states. Recently, a version of MBT tailored for individuals with ASPD (MBT-ASPD) has been developed. The purpose of this review is to investigate how MBT-ASPD relates to the major obstacles that contribute to the therapeutic pessimism toward this group. Despite a limited evidence base, preliminary studies indicate promising results for MBT-ASPD. More research is still required, this review suggests MBT-ASPD can contribute to increased therapeutic optimism and demonstrate specific characteristics of MBT-ASPD that contribute to management of therapeutic pessimism.

[On the Admission of Patients with Borderline Personality Disorder to Outpatient Psychotherapy].

Patients with borderline personality disorder (BPD) present difficulties in self-regulation and interaction, which is a challenge for psychotherapists that is also addressed in BPD-specific interventions. Against this background, outpatient psychotherapists were surveyed about the factors playing a decisive role in their treatment offer for patients with BPD. Psychotherapists for adults were contacted via their email address published on the website of the Kassenärztliche Vereinigung (Association of Statutory Health Insurance Physicians), 231 of whom answered an online questionnaire. The results were analysed descriptively and examined inferentially with regard to the psychotherapists' admission behaviour. Almost 90% reported that they would generally accept patients with BPD in therapy. However, of those, 85% did not have a therapy slot available. The psychotherapists' learned approach of treatment was not a decisive factor in determining whether they were willing to provide treatment. Most of the psychotherapists (85%) recommended a BPD disorder-specific therapy such as Dialectical Behavior Therapy (DBT), Mentalization-Based Treatment (MBT), Transference-Focused Psychotherapy (TFP) or Schema Therapy (ST). However, only just under 7% were certified in such a disorder-specific approach. Significant individual stress factors described by the psychotherapists were suicidal risk (70%) and potential other-directed aggression (59%). In addition, it was shown that it played a role whether the psychotherapists were trained in an additional therapy approach (with at least 16 teaching units) or not. The care situation for people with BPD seeking an outpatient psychotherapy place is clearly in need of improvement. This is mainly due to a general lack of available therapy places as well as various fears and anxieties, such as increased suicidality, which in turn can have a negative impact on the provision of outpatient therapy. Psychotherapists who have undergone disorder-specific further training feel less burdened by suicidal behaviour. However, since only a small number of them are able to offer BPD-specific therapies, it is essential to expand and (financially) support specific training programmes. In order to meet the demand for care, professional changes are urgently needed.

Psychometric properties of the Angolan version of the Reflective Functioning Questionnaire – 8 (RFQ-8): An exploratory study

Abstract: The Reflective Functioning Questionnaire (RFQ-8) is a brief self-report psychometric instrument designed to assess an individual’s reflective functioning abilities. This study aimed to examine the psychometric properties of the Angolan version of the RFQ-8, namely, to assess its factor structure and to examine its correlations with related constructs and clinical variables in a sample of the general population of Angola.A cross-sectional study was conducted with 132 participants (aged ≥18 years) with Angolan residency and nationality, recruited through non-probability, convenience and snowball sampling procedures. The online research protocol included a Portuguese translation of the RFQ-8 and a battery of self- report measures (Brief Symptom Inventory; Adult Attachment Scale – Revised; Beck Cognitive Insight Scale).Consistent with previous research, results supported a two-factor structure for the RFQ-8 (assessing certainty and uncertainty about mental states; RFQc and RFQu subscales) with satisfactory internal consistency. RFQ-8 scores also showed significant correlations to psychopathological symptoms, suggesting a close relation between uncertainty about mental states and clinical problems, consistent with the mentalization framework; statistically significant relationships with different attachment patterns that support mentalization’s developmental schema; significant correlations with cognitive insight, a construct closely related to reflective functioning. Even though the RFQ-8 was designed to assess two impairments in reflective functioning (hypermentalization and hypomentalization), it seems that only hypomentalization is adequately addressed by this instrument. Further research is thus needed to analyze the probable unidimensionality of the RFQ-8 and the viability of different scoring procedures.In conclusion, this study offers preliminary evidence on the reliability and validity of the Angolan version of this scale. Besides its usefulness in clinical assessment, it could also contribute to developing research on mentalization and the efficacy of psychotherapeutic interventions, including patients’ responses to mentalization-based treatments.

Impact of clinical severity on treatment response in a randomized controlled trial comparing day hospital and intensive outpatient mentalization-based treatment for borderline personality disorder.

This study examined the impact of clinical severity on treatment outcome in two programs that differ markedly in treatment intensity: day hospital mentalization-based treatment (MBT-DH) and intensive outpatient mentalization-based treatment (MBT-IOP) for borderline personality disorder (BPD). A multicenter randomized controlled trial was conducted. Participants include the full intention-to-treat sample of the original trial of N= 114 randomized BPD patients (MBT-DH n= 70, MBT-IOP n= 44), who were assessed at baseline and subsequently every 6 up to 36 months after start of treatment. Outcomes were general symptom severity, borderline features, and interpersonal functioning. Clinical severity was examined in terms of severity of BPD, general symptom severity, comorbid symptom disorders, comorbid personality disorders, and cluster C personality features. None of the severity measures was related to treatment outcome or differentially predicted treatment outcome in MBT-DH and MBT-IOP, with the exception of a single moderating effect of co morbid symptom disorders on outcome in terms of BPD features, indicating less improvement in MBT-DH for patients with more symptom disorders. Overall, patients with varying levels of clinical severity benefited equally from MBT-DH and MBT-IOP, indicating that clinical severity may not be a useful criterion to differentiate in treatment intensity.

Opacity, difference and not knowing: what can psychiatry learn from the work of Édouard Glissant?

Martinican poet, novelist and cultural theorist Édouard Glissant (1928–2011) rejected contemporary simplistic notions of creole hybridity popularised in the 1980s and 1990s in favour of a unique and explicitly antiessentialist...

Efficacy of mentalization-based therapy in treating self-harm: A systematic review and meta-analysis.

Mentalization-based therapy (MBT) and its adapted version for adolescents (MBT-A) are repeatedly highlighted as promising treatments for reducing self-harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self-harm, recent meta-analyses have yielded mixed results. To inform best-practice clinical decision-making, we conducted a systematic review and meta-analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(-A) in reducing self-harm (primary outcome) and symptoms of BPD and depression (secondary outcomes). Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre-post, three RCTs) and five MBT-A studies (two pre-post, three RCTs). Aggregated effect sizes were estimated using random-effects models. Meta-regressions were conducted to assess the effect of moderator variables (treatment duration, drop-out rates, and age) on effect sizes. Overall, both MBT and MBT-A demonstrated promising effects in reducing self-harm (g = -0.82, 95% CI -1.15 to -0.50), borderline personality disorder (g = -1.08, 95% CI -1.38 to -0.77), and depression (g = -1.1, 95% CI -1.52 to -0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(-A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults (g = -0.56, 95% CI -0.88 to -0.24). Although the pre-post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(-A) to control conditions, so that prioritizing the application of MBT (-A) for the treatment of self-harm is not supported. Possible explanations and further implications are discussed.

Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and currentcontroversies.

Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.

Enhancing mentalization by specific interventions within mentalization-based treatment of adolescents with conduct disorder.

Mentalization is discussed as a mechanism of change in psychotherapy due to its positive effects on psychological functioning. In order to specifically apply mentalization-based interventions, a better understanding of the relationship between interventions and in-session mentalization is needed. The study aimed to explore the association between interventions and effective mentalizing. Fifteen therapy sessions of three therapies with male adolescents with conduct disorder were transcribed and rated with the Reflective Functioning (RF) Scale and a newly developed Mentalization-based Treatment (MBT) intervention coding manual. The coded interventions were categorized into intervention levels according to the MBT manual. Fisher's exact tests were performed to test differences in frequencies of interventions in high-RF sequences (RF score ≥ 4) compared with remaining therapy sequences (RF score ≤ 3). Specific MBT interventions such as demand questions, affectelaboration, empathic validation, change of subject, challenge, patienttherapist relation and mentalizing for the patient were related to effective mentalizing. Moreover, intervention levels such as supportive & empathic, basic- mentalizing & affect mode and relational mentalizing were positively associated with effective mentalizing. MBT interventions seem to promote effective mentalizing at various intervention levels. Interventions that enhance effective mentalizing seem to be patient specific. In line with MBT theory, their effect on effective mentalizing might depend on various variables, such as the patients' arousal and pre-mentalizing mode.

The Investigation on the Public Awareness and Treatment of Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a mental disorder that is often accompanied by symptoms of dysfunction, which is common among young people. This study started with a survey to collect the public awareness of BPD. After survey, the authors found that the public awareness was not sufficient enough. Therefore, the study decided to carry out a review of treatment methods for BPD. The authors conducted a interview with a therapist who had a cas about BPD to dicuss the procedure and effective of psychotherapies. After reviewing previous studies and interview, the main finding of the review is that DBT (Dialectical Behvaioral Therapy) and MBT (Mentalisation-Based Therapy) were found to have the best efficacy as they both focus on control of emotions and behaviors, while medical treatment may have led to worse outcomes. Therefore, this study contributes to helping therapists select appropriate treatments and remind relevant institutions to pay attention to BPD. Moreover, it tends to give the therapist certain selection guidance and list some methods to increase the popularity of BPD in public.

Epistemic Justice and Neurodiversity: Mentalization–Based Treatment with Children in the Autistic Spectrum from a Dimensional Perspective

ABSTRACT Neurodiverse individuals often suffer the consequences of epistemic injustice, that lead to isolation and helplessness. By attempting to apply a mentalization lens to ASD, we seek to highlight the concept of neurodiversity as an invitation to “mentalize differences” that arise primarily as a response to the marginalization of people with autism spectrum disorders. We seek to move away from the non-mentalizing impact of the categoric deficit model, providing an integration of both existing theoretical and empirical clinical data into an intervention to address the heterogeneity of neurodiversity. An adaptation of mentalization-based treatment for children (MBT-C) to the needs of children and adolescents functioning in the Autistic Spectrum is discussed. A clinical model that integrates findings of developmental research, dyadic clinical psychodynamic intervention models and neuroscientific data with the aim to develop an integrative therapeutic intervention both relational and developmental in nature. A mentalization informed dimensional approach is applied to the scaffolding process necessary to accommodate the heterogeneity and overall unique needs of this population. The article explores the need for further empirical research which substantiates the need for both systemic and individual interventions which address the subjective experience of ASD children and adolescents and that of their families.

The Reflective Fostering Programme: A Dialogue Between Clinical Practice and Research

ABSTRACT This text is in the form of a discussion, based on a transcript of a talk that was given at the International Congress on Mentalization-Based Treatments with Children and Young People, in Barcelona, on 29th June 2023. As the topic of the conference was the dialogue between clinical practice and research, we took the decision to present our project in the form of a conversation. In doing so, we hoped to show the value of bringing different perspectives together, in the spirit of the mentalizing stance. As the clinical lead for the Reflective Fostering Programme, Sheila Redfern reflected on her perspective together with Nick Midgley, as the Principal Investigator on the Reflective Fostering Study. The two speakers have a mentalizing conversation about the main themes arising from integrating clinical practice with research. The talk began with an introduction from the chair, Nicole Muller.

Co-Constructing Mentalizing Contexts in Therapeutic Work with Adolescents-Exploring Resilience in Social Support Networks

ABSTRACT Adolescence, a transformative phase of human development, is marked by a growing need for social support. During this pivotal period, young individuals grapple with the challenges of identity formation, emotional regulation, and forging meaningful relationships. Research has underscored the significance of a robust social network in fostering resilience and promoting mental well-being. In this exploration, we consider the evolving landscape of adolescent support, drawing insights from the concept of Mentalization-Based Therapy (MBT), especially from the specialized treatment model explicitly designed for adolescents, known as Mentalization-Based Treatment for Adolescents (MBT-A). MBT-A is an approach that emphasizes establishing a therapeutic alliance, epistemic trust, and mentalizing within an adolescents’ therapy and social context. This approach includes forming a dynamic external support network to help the young person remain connected with their social context. Through two case examples, we illuminate how this approach aims to strengthen mentalizing within peer groups and the wider social contexts adolescents live within. This paper will consider the various ways in which therapists might step outside the activity of individual therapeutic sessions to address mentalizing barriers preventing the adolescent from accessing everyday social support. In this process, we encourage creativity and multiple participant involvement, challenging the boundaries of perceived therapeutic practice.

Mentalization-Based Treatment for Children, Adolescents and Families, Dialogues Between Research and Practice

Mentalization-Based Treatment for Children, Adolescents and Families, Dialogues Between Research and Practice