Guideline SupportedPsychodynamicAttachment-based

Mentalisation-Based Therapy(MBT)

Last evidence review: January 20265 printable resources

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Overview

Mentalisation-Based Therapy is a structured psychological therapy that focuses on improving the ability to understand one’s own and others’ mental states — thoughts, feelings, intentions, and motivations. Developed by Peter Fonagy and Anthony Bateman, it was originally designed for borderline personality disorder but is now used more broadly.

What this therapy focuses on

MBT strengthens mentalising capacity, especially under emotional stress, to improve relationships, emotional regulation, and sense of self. Mentalising breaks down most readily under high arousal, leading to impulsive, rigid, or poorly attuned responses.

What sessions are usually like

Individual and/or group formats

Weekly sessions (typically 50 minutes individual, 75–90 minutes group)

Medium- to long-term (typically 12–18 months)

The therapist adopts a curious, not-knowing stance

Session profile

Duration: 50 minutes (individual), 75–90 minutes (group)

Frequency: Weekly

Typical course: 12–18 months

Between sessions: Reflective journaling, mentalising practice in relationships

Common uses and suitability

What problems it is commonly used for

Borderline personality disorderAttachment difficultiesEmotional dysregulationSelf-harmAntisocial personality disorder (MBT-adapted)Families and adolescents (MBT-F, MBT-A)

Who this therapy may suit best

People whose difficulties are relational and attachment-based
Those who struggle to understand their own or others’ emotional states
Individuals with impulsive or reactive patterns linked to mentalising breakdown

When it may need adapting or may not be suitable

Active psychosis without stabilisation
Severe substance dependence without parallel support
Where structured behavioural intervention is the priority

Where this therapy may not be enough

MBT requires structured programme delivery. It is not designed for acute symptom-focused work. Availability is limited outside specialist services.

What happens in therapy

Mental State Exploration

Your therapist helps you explore what you and others might be thinking and feeling in difficult situations.

Affect Focus

Paying attention to emotions as they come up in sessions, and understanding what triggers them.

Therapist Stance of Curiosity

Your therapist approaches your experience with genuine curiosity rather than expert interpretation.

Evidence Base

Guideline support

Present for BPD. NICE CG78 includes MBT among structured psychological therapies for BPD. International guidelines also recognise MBT.

Strength of evidence

Moderate to strong for BPD. The Bateman & Fonagy RCTs are landmark studies demonstrating sustained improvement in BPD symptoms, self-harm, and functioning.

Limitations

Evidence is strongest for BPD; evidence for other presentations is developing. Resource-intensive programme delivery.