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Peter Fonagy and Anthony Bateman have published the results of a prospective randomized controlled trial comparing mentalization-based treatment (MBT) to structured clinical management (SCM) for borderline personality disorder (BPD). Patients treated with MBT had fewer suicide attempts, episodes of severe self-injury, and psychiatric hospitalizations during the eighteen months of treatment compared with patients treated with SCM. Before a discussion of this finding, some background on mentalization may be useful. Mentalization is the capacity to meaningfully reflect on one's own and other people's mental states (Fonagy 2000). Mentalization is a hybrid concept derived from Wilfred Bion's discussion of containment in the infant-mother dyad, attachment theory, and cognitive theory. Fonagy and Bateman have have used mentalization as a conceptual framework to develop a manualized treatment for BPD in a variety of clinical settings. MBT focuses on mental states and fosters attachment contexts that in turn enhance patients' capacity to mentalize.
In the current trial, 134 outpatients referred for treatment to a specialist personality disorder service were randomly assigned to either MBT or SCM. Inclusion criteria were diagnosis of BPD (DSM-IV criteria), recent suicide attempt or episode of self-harm, and age 18-65. Exclusion criteria were active engagement in long-term psychotherapy, psychotic or bipolar I disorders, opiate dependence requiring specialist treatment, or organic brain disorder. The authors describe MBT as “manualized, consisting of 18 months of weekly combined individual and group psychotherapy provided by two different therapists” and SCM as “regular individual and group sessions … based on a counseling model closest to a supportive approach.” Patients were allowed to continue or begin psychotropic medications, and treatment was provided by a study psychiatrist blind to the psychotherapy assignment. The primary outcome measure was the rate of patients who du