Mentalizing and borderline personality disorder

Abstract

Background: Mentalization-based treatment is a model of psychodynamic therapy rooted in attachment theory that aims to enhance the individual's capacity to represent thoughts, feelings, wishes, beliefs and desires in themselves and in others in the context of attachment relationships. \ud \ud Aims: To describe the normal development of mentalization as well as anomalies in mentalization that can arise and can ultimately lead to the development of personality disorder. \ud \ud Method: Description of the basic principles of mentalization-based treatment as well as the rationale for use of these techniques. \ud \ud Results: Summaries of randomized controlled trial and a description of an ongoing RCT for the outpatient treatment of BPD. \ud \ud Conclusion: MBT is a generic psychotherapeutic treatment which shares many features with other psychotherapeutic approaches but is unique in focusing on enhancing the patient's capacity to think about and regulate mental states. \ud \u

Mentalization-based treatment for patients with borderline personality disorder: an overview

“…In the teleological mode, an individual only acknowledges the existence of mental states when they are evidenced in concrete and physically explicit forms. These earlier mental structures manifest as concreteness of thought, impulsivity, affect dysregulation and a propensity for acting out 8,9,14 . An unstable or reduced mentalizing capacity is a core feature of BPD.…”

“…They must articulate what has happened in order to demonstrate that they are continually reflecting on what goes on in their mind and on what they do in relation to the patients. This models reflectiveness and allows patients to discover a way of perceiving themselves and others through the therapeutically generated experience of a mind considering a mind 14 . Regarding the interpretation of transference, MBT aims to focus the patient's attention on the mind of a therapist, and to assist patients in the task of contrasting their experience of interaction with how that may be perceived by another mind.…”

“…The overall aim of MBT is to develop a therapeutic process in which the patient's perception of one's own mind and the minds of others becomes the focus of treatment. The objective is that the patient should discover how one thinks and feels about oneself and others, how that dictates one's responses, and how errors in understanding oneself and others lead to actions that are attempts to retain stability and make sense of incomprehensible feelings 9,14,19 . Two variants of MBT have been empirically tested.…”

“…When therapists take a different perspective to the patient, this is verbalized and explored, highlighting alternative perspectives and avoiding assumptions about whose viewpoint has greater validity. The task is to identify the thought processes that have led to alternative viewpoints and to consider each perspective in relation to the other 14 . Therapists are required to observe their own non-mentalizing errors, which are treated as opportunities to learn more about feelings and experiences.…”

“…Many facets of borderline personality functioning can be understood as the consequence of a failure of mentalization and the associated capacities for affect representation, affect regulation and attentional control, together with the re-emergence of primitive forms of subjectivity, and, finally, the profound disorganization of the self-structure. To summarize, the phenomenology of BPD can be conceptualized as the consequence of: 1) the attachmentrelated inhibition of mentalization, 2) the re-emergence of modes of experiencing internal reality that antedate the developmental emergence of mentalization, and 3) the constant pressure for projective identification through the re-externalization of the selfdestructive alien self 8,14 .…”