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MBT-A refers to Mentalization based treatment for adolescents.


MBT-A was adapted for adolescents who self-harm, have BPD, and manifest suicidality (Fonagy et al. 2014; Hutsebaut, Bales, Busschbach and Verheul 2012; Laurenssen et al. 2014; Rossouw and Fonagy 2012). MBT-A is usually delivered in combination with mentalization-based family therapy (MBT-F). The aim of MBT-A is to help adolescents develop the capacity to represent their own feeling and that of others more accurately, particularly when they are emotionally aroused or dealing with interpersonal stressors, with a strong focus on impulsivity and affect regulation.

From a MBT perspective, suicidality and self-harm are understood as attempts to maintain self-organization and to counteract destabilization associated with experiencing the alien self, abandonment or attachment loss and accompanying primitive fears. Consistent with the attachment and mentalization model delineated here, the impact of MBT in reducing self-harm appears to be mediated by a reduction in avoidant attachment and an improvement in the capacity to mentalize (Rossouw and Fonagy 2012).

There is empirical support for the effectiveness of MBT-A. In a randomized control trial of MBT-A (Rossouw & Fonagy, 2012), 80 adolescents presenting to mental health services with self-harm during the preceding month were randomized to MBT or TAU; 97% received a diagnosis of depression and 73% met the criteria for borderline personality disorder. At the end of 12 months of treatment, MBT-A was found to be superior to TAU in reducing self-harm and depression. The recovery rate was 44% for MBT-A versus 17% for TAU based on self-report, and 57 versus 32% based on interviews. A laregr reduction in depressive symptoms and BPD diagnoses and traits was also found in the MBT-A group. After 12 months self-harm remained significantly lower in the MBT-A group (Rossouw and Fonagy 2012).