MBT (Mentalization Based Therapy) focuses on how the person feels now, rather than on the past. Imagine yourself talking to a client. Try to think about how you would think about the situation the person is describing. When the other person isn’t making sense, it is because he is not bearing in mind the person he is talking to – you. That means he isn’t “mentalizing”.
The therapist makes “simple sound-bite” interventions that are affect-oriented (related to love, desire, hurt, catastrophe, excitement), and focus on the patient’s mind, not on his behavior, nor on his past. MBT relates to a current event or activity, and identifies non-mentalizing as getting in the way of the patient’s stated goals.
Technically, the therapist in MBT notes breaks in the patient’s mentalizing – when the patient starts to talk as if the world is against him and he is the helpless victim, for example – and rewinds the conversation to the moment before the patient stops mentalizing. Suppose the patient is explaining a disagreement with her boss and then says that her boss treats her the way all men treat her, in fact the way you, the therapist, is treating her right now – by not ‘hearing’ her! In fact, she should leave right now since she is just wasting her time in this therapy!” You might then go back to what the boss said to her that morning and explore how it feels the same as what is going on now between you. How is she feeling ‘not heard’ by you? You accept responsibility for contributing in some way you do not yet understand, for generating this terrible feeling in the patient.
In MBT the mind of the patient becomes the focus of the treatment. Your job as therapist is to help the patient learn about the complexities of his thoughts and feelings about himself and others, how that relates to his responses, plus how “errors” in his understanding of himself can lead to actions that cause problems for him. It is not your job to tell the patient how he feels, what he thinks, how he should behave, or what the underlying reasons are. Instead, you are helping him build new competencies for maintaining a self-reflective mind even under the stress of intense affect. Peter recommends adopting a “not knowing” stance, conveying to the patient a sense that mental states are opaque.
In the therapy, the therapist first of all helps the patient become better regulated. That sounds familiar, doesn’t it? You want to lower arousal as much as possible. Then you validate the patient’s perceptions. Finally, you begin the painstaking work of trying to get the patient to see the situation from another person’s point of view – that is “mentalizing”. Suppose the patient says, “I am just a bad mother.” That is not mentalizing. You stay with what she is saying right here, recognize the self critical feelings are flooding back, and do not turn your attention to the past. If she is not mentalizing when she tells you about herself as a mother, go to another subject and help her regain her more mature perspective, then return to her distress as a mother.