The Unbroken Circle: From Child Analysis to Mentalization-Based Treatment (MBT) with Children, Adolescents, and Families

It is now more than 30 years since Peter Fonagy published his classic 1991 paper introducing the concept of "mentalization" into the psychoanalytic literature, and in the period since then mentalization-based treatment (MBT) has emerged as an important therapeutic approach. In reviewing the history of this treatment, it is often assumed that MBT emerged at the interface between three domains: first, the developmental research on theory of mind; second, the clinical challenges of treating borderline personality disorder; and third, the empirical research on intergenerational patterns of attachment. This article suggests that there was one more domain, which was equally important to the development of MBT and which is perhaps less widely recognized. This fourth domain was developments in child analysis, especially those taking place during the late 1980s and early 1990s at the Anna Freud Centre in London. Although the origins of MBT theory and technique in child work is perhaps not widely acknowledged, recognizing these roots helps us to better understand mentalizing therapy. It also enables us to see how the development of MBT for children, young people, and families can be understood as a closing of the circle in the development of mentalization-based interventions.