ABSTRACT
Mentalization-based treatment (MBT) is a psychodynamically oriented form of psychotherapy originally developed for the treatment of borderline personality disorder. The focus of MBT is on enhancing mentalizing, the imaginative capacity to reflect on the internal states (i.e. thoughts, feelings) underpinning one’s own and others’ behaviours. Disruptions in the capacity to use mental state information to understand oneself and others have been identified across the continuum of psychosis expression, from the premorbid and prodromal stages to its clinical forms. Recently, clinical adaptations of MBT for people diagnosed with psychosis have been reported in the literature. In this chapter we provide the conceptual framework to support the application of MBT to the recovery of the self in emerging psychosis during adolescence. We focus on adolescence as a critical period, during which robust mentalizing can help young people confronted with genetic and other risks for psychosis embark on interpersonal trajectories that contribute to sustaining the development of the self. We propose that among genetically predisposed individuals and in the context of early attachment difficulties, failures of the mentalizing processes to regulate increasing affective and bodily arousal in adolescence may lead to the perturbations in the sense of self seen as characteristic of psychosis. Against this background, we review clinical issues, as well as the core technical principles through which MBT can support the recovery of a coherent sense of self in young people faced with emerging psychosis.
