Dialectical Behavior Therapy versus Mentalization-Based Treatment for Borderline Personality Disorder

Two evidence-based treatment options for adolescents with borderline personality disorder are dialectical behavior therapy (DBT) and mentalization-based treatment (MBT).  

Dialectical behavior therapy emerged from a cognitive behavioral framework and added dialectics and validation to catalyze behavior change and acceptance.  The overall goal of DBT is a life worth living (Linehan, 1993; Manning & TIC, 2013). 

Mentalization emerged from investigating theory of mind and is defined as the “process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes” (Bateman & Fonagy, 2010, p. 11).  “Mentalization-based treatment is a model of psychodynamic therapy rooted in attachment theory that aims to enhance the individual’s capacity to represent thoughts, feelings, wishes, beliefs and desires in themselves and in others in the context of attachment relationships” (University College London Psychoanalysis Centre, 2013). 

The primary difference between the two approaches is that DBT is rooted in behaviorism, so there are specific targets and goal behaviors, and is more concrete than mentalization’s focus on thoughts and their frameworks, called schemata; essentially, the targets and goals are based on different perspectives and objectives.  Both have evidentiary support from randomized controlled trials, though DBT has a more substantial base of evidence with nine randomized controlled trials.

To learn more about mentalization-based treatment, visit the University College London's Psychoanalysis Centre at http://www.ucl.ac.uk/psychoanalysis/research/mbt.htm.