This article seeks to further specify how the mentalization-based approach may inform clinical intervention before the onset of psychosis, that is, during the stage of clinical high-risk for psychosis (CHR-P). We first review the concept of CHR-P, as well as the research evidence of the impact of early intervention. Next, we present evidence for the centrality of mentalizing as a process that may mitigate the risk for psychosis. We then review some of the key contributions in the psychoanalytical and phenomenological traditions concerning the centrality of core self disturbances in psychosis, and relate this to the alien self concept put forward in the mentalization framework. This leads us to expand on the structure of MBT for CHR-P, and to present a clinical vignette illustrating the process of epistemic trust at beginning of an intervention with a young person suffering from CHR-P. We summarize the links between core self disturbances, epistemic trust, and therapeutic communication in the context of CHR-P.