Mentalizing in the margins: a pilot study of group-based MBT-TF for underserved neurodiverse late adolescents

Introduction Complex trauma can severely impair mentalizing capacities and epistemic trust, leading to pervasive difficulties in self-concept, emotion regulation, and relationships. Late adolescents with co-occurring complex posttraumatic stress disorder, personality dysfunction, and features of autism spectrum disorder represent a particularly underserved and clinically complex group. This pilot study explored the feasibility and perceived impact of a group-based adaptation of Mentalization-Based Treatment for Trauma (MBT-TF) tailored to the developmental and neurodiverse needs of this population. Methods Four late adolescents aged 18–23 participated in a six-month adapted MBT-TF module delivered within a specialized mental health program. The intervention incorporated structural modifications to enhance predictability, visual support, and emotional safety. A mixed-methods design combined pre- and post-treatment self-report questionnaires with qualitative interviews assessing treatment engagement, acceptability, and perceived change. Results Attendance and engagement were high across all participants. Thematic analysis identified improvements in self-image, emotion regulation, reflective functioning, and relational trust, supported by the structured and predictable group format. Participants reported increased self-compassion, reduced shame, and a sense of belonging within the neurodiverse peer group. Quantitative data showed favorable trends in reflective functioning, interpersonal problems, dissociation, and posttraumatic stress symptoms, with several participants demonstrating clinically meaningful change. Discussion and conclusion Findings suggest that group-based MBT-TF is feasible, acceptable, and potentially beneficial for neurodiverse late adolescents with complex trauma and personality difficulties. Structural adaptations emphasizing predictability, collaboration, and visual scaffolding appear to enhance epistemic trust and engagement. Future research should evaluate these preliminary findings in larger samples to further refine trauma-focused mentalization-based approaches for neurodiverse populations.