Mentalizing refers to the capacity to understand one’s own and others’ behaviour in terms of underlying mental states (e.g., emotions, intentions, beliefs, and desires) either implicitly or explicitly. Behaviours are not just habits or conditioned responses; they are the outcomes of mental states. Mentalizing capacity enables self-reflection and empathy and supports emotion regulation and interpersonal effectiveness. Many forms of psychopathology are characterized by difficulties in mentalizing, including personality disorders, eating disorders, mood disorders, and psychosis. Mentalization-based interventions include a therapist taking a not-knowing stance (curiosity and interest in the patient’s mind), maintaining a clear focus in a session, exploring the patient’s subjective experience rather than confronting it with alternatives, identifying and exploring emotions, and exploring relational dynamics as they unfold in the therapeutic relationship. Mentalization-based treatment (MBT ) is a specific form of therapy focused on helping patients to recover and sustain a reflective (mentalizing) stance in the face of emotional and relational challenges. In this study, Colli and colleagues were interested in whether other types of therapy also used mentalization-based interventions as transtheoretical treatment processes. The authors randomly selected 75 transcripts from audio-recorded individual adult psychotherapy sessions involving patients with a personality disorder. MBT, CBT and psychodynamic therapy (PDT) were represented by 25 cases each. Therapy sessions were independently rated by trained judges for mentalization-based interventions and for the level of reflective functioning (mentalization displayed by the patient). As expected, mentalization-based interventions were observed in PDT and CBT sessions, though at lower levels than in MBT sessions. MBT therapists scored particularly higher in maintaining a not-knowing stance (curiosity in the patient’s mind). Across all orientations, those sessions with higher overall levels of mentalization-based interventions by therapists were associated with greater within-session increases in reflective functioning (i.e., mentalization) in their patients.
Practice Implications
Even when mentalization is not an explicit focus of therapy (such as in CBT or PDT), therapists from different theoretical orientations may use similar mentalization-based strategies to help patients better understand their behaviours as consequences of mental states (thoughts, feelings, intentions, desires). Patients’ reflective capacity (i.e., mentalization) will improve if therapists are curious and interested in their patients’ minds, explore patients’ subjective experience rather than confronting it, identify and explore patients’ emotions, and explore patients’ problematic relational dynamics as they unfold in the therapeutic relationship.
Colli, A., Gullo, S., Gagliardini, G., Pandolfi, G., Bateman, A., & Fonagy, P. (2026). Mentalization-based treatment techniques across psychodynamic, cognitive and MBT therapies, Psychotherapy Research. https://doi.org/10.1080/10503307.2026.2654792.