How understanding how we think about thinking can help us heal
One of the most powerful tools I use in my practice is a treatment called Mentalization-Based Therapy (MBT). It’s a therapy that helps people do something deceptively simple: make sense of what’s going on in their minds, and in the minds of others.
Mentalization might sound complicated, but the idea is straightforward. It's the ability to reflect on your own thoughts and feelings and consider how they influence your behavior—and then do the same for the people around you. In other words, it’s thinking about thinking.
And here’s the part that matters: when people experience trauma, invalidation, or intense stress, especially early in life, their mentalizing capacity can become disrupted. As a result, they may find themselves acting on feelings without fully understanding them, misinterpreting other people’s intentions, or getting caught in painful cycles in relationships.
MBT is a therapy designed to rebuild this capacity. It was originally developed for people with BPD, but it's useful for anyone who struggles with emotion dysregulation, relationship conflict, or an unstable sense of self. In my practice, I often integrate MBT with other modalities like EMDR, DBT, and psychodynamic therapy, depending on what best fits the person I’m working with.
Think of a time when you misread someone’s tone in a text message, or when you felt anxious or angry and couldn’t quite pinpoint why. Those moments represent gaps in mentalizing. Most of us have them, especially under stress. But if those gaps are frequent or intense, they can lead to a lot of suffering resulting in impulsive actions, volatile relationships, or feeling misunderstood or disconnected.
When it's done right, mentalization helps us slow down. It helps us pause and ask:
“What am I feeling right now?”
“Where might that feeling be coming from?”
“What might the other person be feeling?”
“Is there another way to interpret this situation?”
When we start asking those questions more often our relationships shift. Our sense of self becomes more grounded. We respond, rather than react. We begin to feel more in control.
MBT isn’t about analyzing childhood memories for hidden meanings or focusing purely on symptom management. It’s about cultivating a stance of not-knowing, and getting curious together. In session, I might gently slow the conversation down and say something like, “Let’s think about what might have been going through your mind in that moment,” or, “What do you imagine was happening for the other person?”
Sometimes this work is hard, but over time, it builds a powerful skill: the ability to hold multiple perspectives at once even when emotions are running high. That’s when real change happens.
Whether you’re dealing with trauma, BPD, or simply want to improve how you navigate relationships, MBT offers a path to deeper understanding and more meaningful connection. It’s not about becoming perfect or always getting it right. It’s about increasing awareness, building compassion, and learning to mentalize even when it’s hard.
In my practice, I’ve seen MBT change lives. I’ve worked with people who once felt overwhelmed by emotions or stuck in conflict begin to feel more stable and more hopeful about their future. As a psychiatrist, there’s nothing more rewarding than helping someone regain a sense of agency and wholeness.
If you’re curious about MBT and whether it might be a good fit for you, feel free to reach out. Therapy should always be a collaborative process, and I’d be happy to help you explore what path feels right.