I have been in therapy for almost 9 months now. My particular therapy is known as ‘Mentalisation Based Therapy.’ I wrote this post over a year ago about my experience in the skills group which I was required to attend before embarking on the full course of therapy. I learnt a lot in the skills group but the psycho dynamic form of therapy has taught me much more and enabled me to put knowledge into practice. This will be the first in a series of blog posts exploring MBT and what it means for those diagnosed with BPD.
Where did MBT come from?
It appears to be a form of therapy which few people have heard of. All of my psychology graduate friends seem perplexed when I mention it. A common response has been ‘is that like mindfulness?’ No, not really. The term ‘mentalisation’ and ideas about it have been milling around for many years. However, it is only recently that the therapy itself has increased in popularity among therapists. Along with DBT, it is now seen as a very effective treatment in patients with a BPD diagnosis.
What does it mean?
Mentalising is “the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes. It is a profoundly social construct in the sense that we are attentive to the mental states of those we are with, physically or psychologically.” (www.ncbi.nlm.nih.gov/pmc/articles/PMC2816926/)
In more simple terms, it is all about how we understand ourselves and others. If, for example, somebody did something which upset you. Mentalising would involve thinking about what the other person might have going on and considering why the situation has upset you. This could involve consideration of your own mental state and that of others.
Example: a friend cancels on you last minute. You immediately think that they do not like you. You stop responding to their messages because you do not want to annoy them. The relationship is under strain. Mentalising about this would involve not assuming they hate you but wondering if maybe they have other things going on etc.
This is of huge importance in our relationships – being able to work at understanding others in relationships can be very beneficial for everyone. Most people have this ability, it has been found that those with BPD often lack this ability. The good news is that it can be broken down into skills which can be learned.
Why do some people struggle to mentalise?
There has been a lot of research into this and it tends to boil down to carer/child relationships. If, as a child, your carer does not respond appropriately to your emotions then you learn these behaviours. For example, a mother who gets angry when a child is crying. The child’s emotions are not being reflected in an accurate manner. Alternatively, it could be no reaction to an emotion being expressed. The child will internalise this and associate crying with anger and so forth.
This early development of mentalising is then compromised. Trauma is another common factor in troubles with mentalising – a child experiencing trauma is unable to consider what might be in the adult’s mind and clearly the adult is ignoring or misinterpreting what might be in the child’s mind.
All of this will have an impact on attachment issues in a person’s life and this is something very common with BPD – emotions not matching situations, for example.
Hopefully, this has provided a basic understanding of what mentalising is and why it is so important. Next up, I’ll be writing about what the therapy itself is like and how it works.