Mentalization-based psychotherapy

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Peter Fonagy (2008), one of the creators of the concept

The Mentalisierungsbasierte psychotherapy or Mentalisierungsgestütztes treatment concept (Engl. Mentalization-Based Treatment , in short: MBT ) is an integrative form of psychotherapy that combines psychodynamic, systemic, client-centered and dialectical behavior therapy approaches together and insights from developmental psychology, attachment theory and theory of mind involves. It was developed by the English psychiatrist and psychoanalyst Anthony W. Bateman and the English psychologist and psychoanalyst Peter Fonagy . It is based on the model of mentalization developed by Fonagy and the psychologist and psychoanalyst Mary Target .

Mentalization-based psychotherapy is intended to enable people to better understand their own wishes , thoughts and beliefs , as well as those of other people. It encompasses the ability to recognize mental, spiritual and emotional processes in other people as well as in oneself that underlie one's actions. It is also possible to mentalize yourself, i.e. to grasp reflexively which circumstances and experiences in the past and present have led to the current wishes, thoughts and convictions. This understanding is called mentalization in MBT, i.e. the ability to understand psychological processes as the cause of actions.

By dealing with the other person's ideas as well as your own ideas about their beliefs, feelings, attitudes and desires on which their behavior is based, one acquires the ability to "read what is going on in the minds of others" from their behavior. as well as understanding one's own affective and mental states and distinguishing them from behavior and at the same time recognizing it as the cause. This requires the exploration and self-reflection of one's own inner world, the sensitive exploration of the world of the other and the mutual relationship.

The so-called mentalization-based treatment concept, which was also manualized , was developed as a treatment program for borderline personality disorder and includes both individual and group psychotherapeutic procedures. It can be carried out as an inpatient or partial inpatient as well as outpatient.

The mentalization concept is also suitable for the treatment of other disorders that can be associated with a limited ability to mentalize. The main focus here is on dissocial personality disorder and other personality disorders , but also obsessive-compulsive disorder and other neurotic disorders that have an individually low level of structure .

In addition, interdisciplinary interventions that promote mentalization can also be used within other individual and group psychotherapeutic treatments.

For the German-speaking area there are psychoanalytic traditions that contain elements of MBT and have benefited from the concept of mentalization. These include traditionally the Göttingen model according to Heigl & Heigl-Ewers and, more recently, structure-related psychotherapy according to Gerd Rudolf .

Basics

The mentalization-based treatment concept developed in England is designed to improve the ability to mentalize in an inpatient, partial inpatient or outpatient psychiatric-psychotherapeutic setting. The ability to mentalize is seen in psychotherapy as a fundamental psychological and interpersonal structural function. The term mentalization describes the “ability to interpret one's own behavior or the behavior of other people by ascribing mental states.” With the help of the mentalization function, it is possible for people to intuitively gain an idea of ​​emotional-cognitive processes and thus his own how to explain the behavior of other people. This function can be developed to different degrees in the course of psychosocial development . Severe deficits in this function lead to restrictions in the perception of oneself and others and are considered one of the causes of severe mental disorders in psychoanalysis . The treatment concept includes group and individual therapy and is designed for a period of at least 18 months.

The ability to mentalize develops in a sensitive development process that begins after birth. On the basis of a secure bond with their caregivers, people develop an initial positive relationship with their environment. In a safe environment, infants and toddlers are able to concentrate on pre-linguistic communication with their caregivers. With children who are not yet able to speak, this communication is conducted through eye contact and with the help of sounds and gestures. The exchange of affects is in the foreground. Most of the time, the parents manage to enter into such an exchange intuitively, which can also lead to influencing the infant's strength of affect.

aims

The main goals of MBT are greater behavioral control and flexibility, improvement in emotional self-regulation , building and maintaining enriching personal and intimate relationships, jointly developing a perspective and goals for the patient's life, and improving the skills to cope with frustrations and achieve these goals.

This can be achieved in a structured and transparent therapy setting that provides specific interventions and relationship offers to improve the patient's ability to mentalize and thus stabilize his self-esteem and his emotions and relationships. The therapy does not aim to increase the patient's awareness of the disease, but rather to restore a valid and sustainable mentalization of himself and his environment in the patient, which is characterized by a precise perception of himself and others .

The focus of the treatment is a safe therapeutic relationship offering that the binding system strongly activated the patient and a safe therapeutic bonding experience and building epistemic trust allows for the patient. This provides a protected relational framework in which the patient feels safe to reflexively research and recognize his own mental processes and those of the other. The treatment focuses mainly on the here-and-now , the therapeutic relationship and the patient's current situation, and includes past events only to the extent that they influence the patient's present.

Another central feature of MBT is to create an attitude of exploratory curiosity in the patient, in that the therapist strives for an alliance with the patient instead of an asymmetrical "expert" role in the therapy relationship and himself adopts an attitude of "not knowing" to get involved in the inner world of the patient and seek to understand it together with the patient. This promotes the patient's epistemic trust in the relationship with the therapist, because the therapist accepts and validates his perception, point of view and affects as his valid experience (without judgment) (i.e. reports back to the patient that what he feels, thinks, believes and experiences is real and understandable for the therapist) and thus enables the patient to transfer to learn new from his experiences outside of therapy in the social relationships of daily life. In addition, this approach prevents the therapist from imposing his own point of view on the patient and thus disturbing the mentalization process and the therapeutic relationship. The promotion of mentalization in therapy is therefore not the actual therapy goal, but a way to better modulate affects and understand and regulate central relationship conflicts and thereby improve self-control and the feeling of self-coherence.

See also

literature

  • Holger Kirsch, Josef Brockmann, Svenja Taubner: Practice of mentalization. Klett-Cotta Verlag, 2016, ISBN 978-3-608-94940-7 .
  • Fonagy, Peter, Roth, Anthony: What Works For Whom ?: A Critical Review of Psychotherapy Research. 2nd Edition. Guilford Press, New York 2004, ISBN 1-59385-272-X .
  • Anthony W. Bateman, Peter Fonagy: Psychotherapy of Borderline Personality Disorder. A treatment concept based on mentalization. Psychosozialverlag, Giessen 2008, ISBN 978-3-89806-473-6 .
  • Anthony W. Bateman, Peter Fonagy: Handbook of Mentalizing in Mental Health Practice . American Psychiatric Association Publishing, Washington DC 2011, ISBN 978-1-58562-372-3 .
  • John F. Clarkin, Peter Fonagy, Glen O. Gabbard: Psychodynamic Psychotherapy of Personality Disorders. Schattauer Verlag, Stuttgart 2012, ISBN 978-3-7945-2835-6 .
  • N. Midgley, I. Vrouva: Minding the Child: mentalization-based interventions with children, young people and their families . Routledge Press, 2012, ISBN 978-1-136-33641-6 .
  • Ulrich Schultz-Venrath: Textbook Mentalizing: Designing Psychotherapies Effectively . Klett-Cotta Verlag, Stuttgart 2013, ISBN 978-3-608-94544-7 .
  • Annegret Boll-Klatt, Mathias Kohrs: Practice of psychodynamic psychotherapy: Basics - models - concepts. Schattauer Verlag, 2013, ISBN 978-3-7945-2899-8 .
  • Anthony W. Bateman, Peter Fonagy, Jon G. Allen, Eia Asen, Dawn Bales, Efrain Bleiberg, Cindy DeCoste, Catherine Freeman, Ulla Kahn, Mirjam Kalland, Sigmund Karterud, Morten Kjolbe, Alessandra Lemma, Benedicte Lowyck, Linda Mayes, Flynn O'Malley, Marjukka Pajulo, Björn Philipps, Trudie Rossouw, Finn Skarderud, Nancy Suchman, Mary Target, Bart Vandeneede, Annelies Verheugt-Pleiter, Rudi Vermote, Jolien Zevalkink: Handbuch Mentalisierung. (= Psychodynamic therapy ). Psychosozial-Verlag, 2015, ISBN 978-3-8379-2283-7 .
  • Thomas Bolm: Mentalization-Based Therapy. (= Ways of psychotherapy ). Ernst Reinhardt Verlag, 2015, ISBN 978-3-497-02540-4 .
  • Anthony Bateman, Peter Fonagy: Mentalization Based Treatment for Personality Disorders: A Practical Guide. Oxford University Press, 2016, ISBN 978-0-19-968037-5 .
  • Jon G Allen, Peter Fonagy: Mentalization Assisted Therapy: The MBT Handbook - Concepts and Practice. 3. Edition. Klett-Cotta Verlag, 2016, ISBN 978-3-608-94841-7 .
  • Ulrich Schultz-Venrath, Helga Felsberger: Mentalizing in groups: Mentalizing in clinics and practices. Klett-Cotta Verlag, 2016, ISBN 978-3-608-96156-0 .
  • Peter Fonagy, György Gergely, Elliot L. Jurist, Mary Target: Affect regulation, mentalization and the development of the self. 6th edition. Klett-Cotta Verlag, 2017, ISBN 978-3-608-96271-0 .
  • Sebastian Euler, Marc Walter: Mentalization-based Psychotherapy (MBT) . Kohlhammer-Verlag, Stuttgart 2018, ISBN 978-3-17-031651-5 .

Individual evidence

  1. ^ A b Sebastian Euler, Marc Walter: Mentalization-based Psychotherapy (MBT) . Kohlhammer-Verlag, Stuttgart 2018, ISBN 978-3-17-031651-5 .
  2. ^ A b c Anthony W. Bateman, Peter Fonagy: Psychotherapy of the borderline personality disorder. A treatment concept based on mentalization. Psychosozialverlag, Giessen 2008, ISBN 978-3-89806-473-6 .
  3. ↑ a b Holger Kirsch, Josef Brockmann, Svenja Taubner: Practice of Mentalizing. Klett-Cotta Verlag, 2016, ISBN 978-3-608-94940-7 .
  4. ↑ a b J. G. Allen, P. Fonagy, AW Bateman: Mentalizing in clinical practice. American Psychiatric Publishing, Arlington Press, 2008.
  5. ↑ a b c d Peter Fonagy, György Gergely, Elliot L. Jurist, Mary Target: Affect regulation, mentalization and the development of the self. 6th edition. Klett-Cotta Verlag, 2017, ISBN 978-3-608-96271-0 .
  6. ↑ a b c A. W. Bateman P. Fonagy: Mechanism of change in mentalization based treatment of borderline personality disorder. In: Journal of clinical Psychology. 62 (4), 2006, pp. 411-430. doi: 10.1002 / jclp.20241 PMID 16470710 .
  7. ^ AW Bateman, P. Fonagy: Randomized Controlled Trial of Outpatient Mentalization-Based Treatment Versus Structured Clinical Management for Borderline Personality Disorder. In: Am J Psychiatry. 166, 2009, pp. 1355-1364. doi: 10.1176 / appi.ajp.2009.09040539 PMID 19833787 .
  8. ^ A b A. W. Bateman, P. Fonagy: Mentalization-based treatment of BPD. In: Journal of Personality Disorders. 18 (1), 2004, pp. 36-51. doi: 10.1521 / pedi.18.1.36.32772
  9. ^ A. Bateman, P. Fonagy: 8 years follow up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. In: Am. J. Psychiatry. 165, 2008, p. 631-638.
  10. ^ AW Bateman P. Fonagy: Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. In: Am. J. Psychiatry. 156 (10), 2001, pp. 1563-1539. doi: 10.1176 / ajp.156.10.1563 PMID 10518167 .
  11. ↑ a b A. W. Bateman P. Fonagy: Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. In: Am. J. Psychiatry. 158 (11), 2001, pp. 1932-1933. doi: 10.1176 / appi.ajp.158.1.36 PMID 11136631 .
  12. ^ Peter Fonagy, Anthony Roth: What Works For Whom ?: A Critical Review of Psychotherapy Research. 2nd Edition. Guilford Press, New York 2004, ISBN 1-59385-272-X .
  13. ^ A b c John F. Clarkin, Peter Fonagy, Glen O. Gabbard: Psychodynamic Psychotherapy of Personality Disorders. Schattauer Verlag, Stuttgart 2012, ISBN 978-3-7945-2835-6 .
  14. ^ Anthony Bateman, Peter Fonagy: Mentalization Based Treatment for Personality Disorders: A Practical Guide. Oxford University Press, 2016, ISBN 978-0-19-968037-5 .
  15. ↑ AW Bateman, P. Fonagy: Comorbid antisocial and borderline personality disorders: mentalization-based treatment. In: Journal of Clinical Psychology. 64 (2), 2008, pp. 181-194. doi: 10.1002 / jclp.20451 PMID 18186112 .
  16. ^ Anthony W. Bateman, Peter Fonagy: Handbook of Mentalizing in Mental Health Practice . American Psychiatric Association Publishing, Washington DC, 2011, ISBN 978-1-58562-372-3 <.
  17. ^ Gerd Rudolf: Structure-related psychotherapy. Guide to the psychodynamic therapy of structural disorders. Schattauer, Stuttgart 2004.
  18. ↑ Ulrich Schultz-Venrath: Textbook Mentalize: Effective Design of Psychotherapies . Klett-Cotta Verlag, Stuttgart 2013, ISBN 978-3-608-94544-7 .
  19. ^ Ulrich Schultz-Venrath, Helga Felsberger: Mentalizing in groups: Mentalizing in clinics and practices. Klett-Cotta Verlag, 2016, ISBN 978-3-608-96156-0 .
  20. ↑ Peter Fonagy: Attachment Theory and Psychoanalysis . Klett-Cotta Verlag, Stuttgart 2006, ISBN 3-608-95991-2 .
  21. ↑ N. Midgley, I. Vrouva: Minding the Child: mentalization-based interventions with children, young people and their families . Routledge Press, 2012, ISBN 978-1-136-33641-6 .
  22. ↑ a b Thomas Bolm: Mentalization-based therapy. (= Ways of psychotherapy ). Ernst Reinhardt Verlag, 2015, ISBN 978-3-497-02540-4 .
  23. ↑ Anthony W. Bateman, Peter Fonagy, Jon G. Allen, Eia Asen, Dawn Bales, Efrain Bleiberg, Cindy DeCoste, Catherine Freeman, Ulla Kahn, Mirjam Kalland, Sigmund Karterud, Morten Kjolbe, Alessandra Lemma, Benedicte Lowyck, Linda Mayes, Flynn O'Malley, Marjukka Pajulo, Björn Philipps, Trudie Rossouw, Finn Skarderud, Nancy Suchman, Mary Target, Bart Vandeneede, Annelies Verheugt-Pleiter, Rudi Vermote, Jolien Zevalkink: Manual Mentalizing. (= Psychodynamic therapy ). Psychosozial-Verlag, 2015, ISBN 978-3-8379-2283-7 .
  24. ↑ Annegret Boll-Klatt, Mathias Kohrs: Practice of psychodynamic psychotherapy: Fundamentals - models - concepts. Schattauer Verlag, 2013, ISBN 978-3-7945-2899-8 .
  25. ^ A b c Jon G Allen, Peter Fonagy: Mentalization Supported Therapy: The MBT Handbook - Concepts and Practice. 3. Edition. Klett-Cotta Verlag, 2016, ISBN 978-3-608-94841-7 .