Mentalizing is the process of making sense of self and others in terms of underlying mental states. It is what we do when we are imagining what might be going on in the mind of someone, underneath the behaviour that we see on the outside. Mentalizing is a uniquely human process, and it is something that we do automatically, often without conscious thought in our every-day social interactions.
Increasingly mentalizing is thought to be one of the core processes that effective therapies have in common. Effective mentalizing supports wellbeing in several ways; it enables us to predict and make sense of the behaviour of self and others, to understand the social world, to regulate attention and emotion and helps to form a strong sense of self and develop good interpersonal relationships.
Mentalization based treatments place mentalizing at the centre of the therapeutic process. They aim is to promote mentalizing and resilience in children and young people, along with their families and carers, so they can feel better equipped to tackle the problems that brought them to therapy and to learn how to make better use of supportive relationships.
A core part of all mentalizing approaches is the therapist’s mentalizing stance. The mentalizing stance is both an attitude and a skill. It is a ‘way-of-being-with’ that creates safety, trust and curiosity and facilitates mentalizing in the therapist and those seeking help.
Please watch the video and read the sections below for more information about mentalizing and training in a mentalization based treatment for children, young people, families, and carers at the Anna Freud Centre.
Read more about MBT-CYP below:
- Our trainings
Our trainings aim to equip you with the knowledge and skills to implement a mentalizing approach to your current clinical work. The trainings also provide you with the opportunity to continue developing your skills and work towards becoming a MBT CYP Practitioner and Supervisor.
Click on the training you are interested in to find out more and to book your place.
This self-guided online training will introduce participants to Mentalizing and Mentalization Based Treatments for Children, Young People, Families, Parents, Carers and Teams. It will cover the theory of mentalization and its relevance to work with children, young people and families and will provide learners with a foundation for developing further skills in using a Mentalizing approach.
Mentalization Based Treatment with Children (MBT-C) is a time-limited approach to working with children in middle childhood (ages 5-12) and their parents. MBT-C is an integrative approach, which brings together psychodynamic principals with findings from attachment and affect-regulation theory, systemic family therapy and empirical studies of mentalization. It is a flexible approach for use in clinical settings to address a range of childhood difficulties including emotional and behavioural problems, anxiety, depression, and relational difficulties.
Mentalization Based Treatment for Families (MBT-F) focuses on the application of mentalizing ideas in work with families to enhance communication and minimise misunderstandings leading to stressful interactions and controlling behaviours. MBT-F is an integrative approach bringing together psychodynamic principles, systemic theory, CBT practices and a social ecological framework to understanding and working with families. It is a flexible approach and time limited approach for use in clinical settings to address a range of difficulties experienced in families including emotional and behavioural problems, anxiety, depression, relational difficulties, and family conflict.
Mentalization Based Treatment for Adolescents (MBT-A) is treatment approach for working with adolescents presenting with a wide range of mental health needs including interpersonal difficulties, emotional dysregulation, impulsivity, and self-harm. MBT-A combines individual weekly sessions for adolescents along with Mentalization Based Family Therapy sessions (MBT-F) and aims to enhance an adolescent’s capacity to represent their own and others’ feelings accurately and in emotionally challenging situations. MBT-A has been shown to be effective in reducing self-harm and depressive symptoms in adolescents (Rossouw & Fonagy, P. 2012).
Reflective Fostering is a new approach to working with children and young people in foster care and aims to support their emotional wellbeing through working with foster carers, adopters, and the wider professional network.
Reflective Fostering focuses on supporting foster carers to understand and manage their own emotional responses to having children and young people in their care. This is a psychoeducation approach, aimed at improving the core components of secure attachment, including increasing carer sensitivity and reflective capacity, developing reflective practice within the professional network, promoting collaboration around the child or young person and with the eventual aim of helping to stabilize placements where there has been a history of placement breakdown or instability.
Reflective Parenting is a model of parenting which focuses on the application of theoretical ideas from mentalization, attachment theory and reflective functioning in promoting positive outcomes for children’s emotional and behavioural wellbeing, where there are difficulties in the parent-child relationship. It was originally developed for children with behavioural difficulties (or conduct disorder) where children showed difficulties in emotion regulation leading to behavioural problems.
Reflective Parenting makes distinct and explicit the need for self (parental) mentalizing and other (parent to infant, child, or adolescent) mentalizing. It is offered only to parents, not children or young people. Research has shown that it is parental self-mentalizing that has the greater impact on the quality of parent-child interactions, over and above the parents’ capacity to mentalize the child. Reflective Parenting is a psychoeducation intervention and not a therapy. It aims to support professionals in primary and secondary care settings to work collaboratively with groups of parents, to identify difficulties in the parent-child relationship and intervene directly to improve the connection between parent and child via the 8-week manualised programme.
The course will focus on working with children age 5-12 who have experienced long term relational trauma, physical, sexual and emotional abuse and neglect and the impact of parental conflict and domestic violence. Work with children with both internalizing and externalizing responses to trauma will be discussed.
This course will provide further opportunities to learn about, and practice the implementation and integration of the MBT-C approach.
Intensive Clinical Training Program for Professionals Working with Infants and Parents.
The Parental Embodied Mentalizing Assessment (PEMA) is a 12-point tool used to assess non-verbal risk and protective factors in parent-infant (0-2) dyads.
PEMA is based on over a decade of empirical research in which PEM has been found to be associated with parental mental health and predict infant’s security of attachment, behaviour problems, and cognitive functioning in infancy and childhood.
- Getting supervision
Once you’ve completed your MBT CYP training we hope you will be able to bring this knowledge to your current practice, whatever setting you are working in.
For those who want to be registered as an MBT CYP practitioner, ongoing support and supervision in the model you trained in will be important. This will help you to continue to develop your skills in implementing the MBT techniques acquired in your training and develop your ability to hold a mentalizing stance in working with children, young people and families. If you’d like to be recognised as an MBT CYP Practitioner supervision with an approved supervisor on two cases is essential. Click here to download a list of registered MBT CYP supervisors. You can also email the training team on firstname.lastname@example.org to register your interest in a supervision or online practitioner development group run from the Anna Freud Centre.
Mentalization theory is a developmental theory and is supported by an extensive body of empirical research (Fonagy, 2002; Fonagy & Bateman, 2016). There is also evidence for the relevance of mentalizing as having a key role in help seeking processes and the establishment of “epistemic trust”, an individual's willingness to consider new knowledge as trustworthy and relevant, and therefore worth integrating into their lives (Egyed et al, 2014, Fonagy, Luyten, & Allison, 2015). Increasingly mentalizing is thought to be one of the core processes that effective therapies have in common (Goodman, Midgley & Schneider 2016; Goodman, G., Reed, P., & Athey-Lloyd, L. 2015).
MBT models have been shown to be particularly effective interventions for the treatment of adults with a diagnosis of BPD, adolescents who self-harm and mothers enrolled in substance abuse treatments. There is some further evidence for their effectiveness for depression and eating disorders and in the benefits of professionals supporting mothers of children at risk receiving training in the principles of MBT, although more systematic study is needed. This research is now taking place with several feasibility and randomised control trials taking place internationally.
Many of the components of Mentalization Based Treatments for children, young people and families are underpinned by the above research. Our treatments are rooted in empirical findings from; attachment theory, systemic-theory, developmental research, and social-cognitive neuroscience.
The following papers provide further information on the growing evidence base for mentalizing interventions with children, young people, families, and carers:
Mentalization-based treatment and its evidence-base status: A systematic literature review Javier Malda-Castillo 1 , Claire Browne 2 , Guillermo Perez-Algorta 1 Affiliations PMID: 30091506 DOI: 10.1111/papt.12195
Byrne G, Murphy S, Connon G. Mentalization-based treatments with children and families: A systematic review of the literature. Clin Child Psychol Psychiatry. 2020 Oct;25(4):1022-1048. doi: 10.1177/1359104520920689. Epub 2020 Jun 3. PMID: 32493055.
Nick Midgley, Eva A. Sprecher & Michelle Sleed (2021) Mentalization-Based Interventions for Children Aged 6-12 and Their Carers: A Narrative Systematic Review, Journal of Infant, Child, and Adolescent Psychotherapy, 20:2, 169-189, DOI: 10.1080/15289168.2021.1915654
Barlow J, Sleed M, Midgley N. Enhancing parental reflective functioning through early dyadic interventions: A systematic review and meta-analysis. Infant Ment Health J. 2021 Jan;42(1):21-34. doi: 10.1002/imhj.21896. Epub 2020 Nov 18. PMID: 33210359.
Nicola-Hans Schwarzer, Tobias Nolte, Peter Fonagy & Stephan Gingelmaier (2021) Mentalizing and emotion regulation: Evidence from a nonclinical sample, International Forum of Psychoanalysis, 30:1, 34-45, DOI: 10.1080/0803706X.2021.1873418
Rossouw TI, Fonagy P. Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2012 Dec;51(12):1304-1313.e3. doi: 10.1016/j.jaac.2012.09.018. PMID: 23200287.
Midgley, N. et al. (2017) The Herts and minds study: evaluating the effectiveness of mentalization-based treatment (MBT) as an intervention for children in foster care with emotional and/or behavioural problems: a phase II, feasibility, randomised controlled trial. Pilot and Feasibility Studies. 3(12)
- Training resources
Anna Freud Manuals
Further information and resources on MBT CYP models can be found on the Anna Freud Centre’s manuals page https://manuals.annafreud.org/. Here you can read more about some of the MBT CYP models on offer, watch videos, see how others are developing mentalizing approaches in their services and download resources which can be used in sessions.
Guidelines and Forms
The following documents may be downloaded to support you in participating in your training and becoming registered as an MBT CYP practitioner in your chosen MBT CYP model.
- Application form for MBT CYP Practitioner Status
- MBT-C Fidelity/Adherence Scale
- MBT-C Submission guidelines for case formulation letter and reflective commentary for Practitioner Status
- MBT-F Fidelity/Adherence Scale
- MBT-F Submission guidelines for family mentalizing profile and reflective commentary for Practitioner Status
- MBT-A Submission guidelines for case formulation letter and reflective commentary for Practitioner Status
The following books are useful companion texts for our trainings and will support your learning and implementing of a Mentalization Based Treatment in you practice.