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In this article we describe the structure and technique of mentalization-based therapy for adolescents (MBT-A), an evidence-based intervention that has shown effectiveness in helping young people with self-harm, borderline personality, and depression. We describe also the differences between MBT with adults and MBT-A, which primarily focuses on the developmental aspects of adolescence. The developmental trajectory of adolescence culminates in a coherent and consolidated sense of self. Mentalizing provides the main supporting socio-cognitive-emotional process for achieving a coherent sense of self and, consequently, authentic and rewarding intimacy, making its evolutionary relevance clear and underscoring the importance of scaffolding this critical process during adolescence, regardless of diagnosis or therapeutic modality. We further argue that mentalization is a central mechanism by which personality functioning is achieved. In our view, mentalizing can be seen as a cross-diagnostic feature common to all personality pathology and, arguably, all psychopathology. This broadens the relevance of MBT-A beyond its original remit of self-harm and borderline personality disorder and identifies the enhancement of mentalizing and epistemic trust as a common factor in all psychotherapies that support adolescents through a challenging but critical developmental period. As such, mentalizing can be viewed as the property of all good psychotherapy.