Mentalization-Based Treatment (MBT) is an evidence-based therapy, involving both group and individual sessions, for people whose struggle with emotions has led to difficulties such as breakdowns in relationships, impulsivity, self-harm, suicidal feelings, self-hatred, and social isolation. In MBT we focus on providing secure, boundaried and consistent therapeutic relationships where people can explore how their thoughts and feelings about themselves and others contribute to the difficulties they are experiencing. This process is what we call mentalizing and practicing it in MBT not only helps us to feel more in control of our emotions and behaviour, but it also improves our understanding of other people, enabling us to build better relationships.
Where and when?
The MBT group is held online via Zoom on Wednesdays from 6pm to 7:30pm. Individual sessions can either be online or in-person in London (Islington, Queen's Park or Battersea Park).
Why you might struggle with mentalizing
We learn to mentalize by having someone available to help us understand the thoughts and feelings we can’t manage on our own. However, when this hasn’t happened, especially in childhood, when feelings are often overwhelming, we develop non-mentalising ways of coping, such as withdrawing from difficult situations, blaming ourselves, or defending ourselves with anger. These help us to survive at the time, but later they cause difficulties. This is because when we get overwhelmed, we automatically turn back to these ways of coping rather than mentalising about what we think and feel. For example, you might respond to feeling rejected by perhaps cutting people off, self-harming, or becoming suicidal or angry, rather than feeling able to think about what has happened and how you want to respond.
Another way of describing this is using the language of attachment. A secure attachment style develops when someone has had a parent or caregiver to turn to for help when they were growing up. This not only enables them to feel safe to turn to others for help as adults, it also gives them the support they needed to develop a capacity to mentalise at stressful times. If you haven’t had someone consistently available for help when you were growing up, you are likely to develop an insecure attachment style. This means it can feel difficult to turn to others at times of need and gives you less chance to develop your capacity to mentalize in difficult moments.
How does MBT work?
Mentalization based treatment involves attending weekly group and individual therapy sessions for a minimum of 12 months to practice and develop your capacity to mentalize. When clinically indicated, some clients will be encouraged to continue treatment for up to 18 months. Each group is 90 minutes, and the individual sessions are 50 minutes. In both settings you are encouraged to bring emotional challenges and interpersonal difficulties so that you can think them through with the help of other people. We also focus on what it is like to form relationships with the therapists and the other group members, working on noticing patterns that might help us understand the difficulties you experience in relationships.
Yet whilst both the individual therapy and the group are important, the heart of MBT is the group. This is because it requires you to mentalize in a complex social situation, making it a great practice ground for managing the sorts of emotionally triggering situations you face in life more generally. For example, you might sometimes disagree with other group members, or find their reaction to you upsetting, but the aim is to try to keep mentalizing together.
In the group, two therapists support you in this process, working actively to help individual members to feel heard and allowing for an ongoing (re)connection at times when mentalizing breaks down. In this way, we prioritise a “mentalising culture” at all times, and we work actively to think about difficult topics that may previously have felt unthinkable. This helps you to feel that difficult emotions can be thought about and managed with help from other people and it helps you to feel more able to manage these feelings on your own.
However, even with the support of the therapists and other group members this can seem daunting when your past experiences of relationships have been challenging. For this reason, an important part of the individual therapy is helping you to mentalize the emotional challenges of being in the group.
What mentalizing promotes
- Curiosity (about your minds and other people’s minds)
- A “safe uncertainty” (knowing that we don’t know about what’s in others' minds)
- Allowing space to repair mistakes
- Awareness of your impact on others
- Playfulness
- Assuming responsibility and accepting accountability for your actions
- Flexible thinking.
To find out more about what mentalizing involves please watch this.
Who should join?
There is no specific diagnostic requirement for participation in the MBT programme. If any of the following challenges interfere with the quality of your life, either in personal or professional contexts, MBT can help.
- Rapidly changing moods that are difficult to understand
- Anger, intense emotional states and recurrent depression or anxiety
- Difficulties regulating intense emotions that lead you to behave in ways you don’t understand or later regret. This might include impulsive, risky or harmful behaviour towards yourself or others (e.g. self-harm, substance use, sex, suicidal feelings or acts)
- Not being able to put your interests first or take care of yourself
- Difficulty in managing long-term relationships e.g. intimate relationships, with work colleagues, with family or friends
- Difficulties with your sense of self: not knowing who you are, what you think and feel and what you want in life; or fluctuating and contradictory ways of being
- Chaotic relationships where you either frantically pursue people or impulsively push them away
- Feelings of intense loneliness or emptiness
- Fear of abandonment and trying to avoid it at all costs
- Experiences of dissociation or derealisation
- Difficulties realising your goals.
In the medical world, people with these difficulties may have been given the diagnosis of “borderline personality disorder”. However, while some people can find the diagnosis a helpful starting point, it is important to recognise that it only describes the problems rather than asking what is going on underneath.
How to begin?
All individuals interested in joining the MBT programme will be assessed by one of our experienced MBT therapists. We also welcome referral letters from professionals you may be having contact with such as your psychiatrist, community mental health team (CMHT), GP, or a previous therapist, however this is not required.
There are a number of steps before starting the full programme which help you to get ready to make the best use of the treatment. To begin, we start with an assessment process which can take up to three meetings and its aim is to enable us to get an understanding of the challenges you are wanting help with and explore how MBT can meet your needs and goals.
We then offer at least three pre-treatment sessions where we think about the key concepts of MBT so that you feel confident about how the treatment works and what you are trying to achieve. These include looking at the following topics:
- What is mentalizing and how do we recognise when we are not doing it
- What are the pre-mentalising modes and which apply to you
- Getting to know your attachment style and how this impacts your relationships
- Setting goals for treatment and thinking about potential challenges.
Please email us to arrange an assessment.
Fees
Fees for the full MBT programme start at £160 a week. This involves weekly individual and group therapy. We offer a small number of concessionary rates towards the MBT programme to people on low incomes. To find out more about our fees please visit the FEES section of this website.
The fee for the group component is £80 per session and it is payable eight weeks in advance. To reserve the place 50% of the fee must be paid at the time of receiving the invoice which is non-refundable. The remaining part of the fee is due a week before the next eight-week block begins. The fees are payable for each of the block sessions. This includes sessions that are not attended, missed or cancelled without any notice.