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Crisis Management in MBT

Crisis Management in MBT
Mentalization-Based Treatment (MBT)
🛡️ Mastery

A specific protocol for working with crisis situations within MBT. The crisis is seen as the result of a complete collapse of mentalization under the impact of intense activation of the attachment system. The therapist does not act "for" the client (this is a teleological response), but helps to restore minimal mentalization under crisis conditions. The crisis plan is built jointly, in advance, while the client is still able to mentalize.

Step-by-step guide

  1. Before the crisis: jointly build a crisis plan — what to do, whom to call, what steps to take
  2. In the moment of crisis — empathic validation: "I hear that you are feeling very bad right now"
  3. Help to identify the current affect: "What do you feel right now?"
  4. Do NOT ask "why?" — only "what?" and "how?"
  5. Help to restore minimal mentalization: "Let us try to understand together what happened"
  6. Link the crisis with the loss of mentalization: "At some point it became so painful that you stopped being able to think"
  7. Restore the sense of agency: "What, according to your crisis plan, can you do right now?"

When to use

  • On suicidal thoughts or self-harm of the client
  • On emotional breakdowns between sessions (telephone contact)
  • On flare-ups of BPD symptoms (impulsivity, dissociation, destructive behavior)

Key phrases

I hear that it is very hard for you right now. I am here.

Follow-up questions

What do you feel right now? Not why — but what.
We have a plan. What from it can you do right now?

Alternative phrasings

Let us try to understand together what happened, step by step.
It seems to me that the pain has become so strong that thinking has become impossible. This is a normal reaction.

Warnings

  • ⚠️ Do not yourself fall into the teleological mode (do not "rescue" through actions without mentalization)
  • ⚠️ Do not minimize the crisis: "Everything will be fine" — that is NOT MBT
  • ⚠️ If there is a real threat to life — first the safety protocol; mentalization is secondary
  • ⚠️ Do not analyze the crisis in detail in the moment of the crisis — there is the next session for that

Source: Bateman A.W. Fonagy P. (2004, 2016). Mentalization-Based Treatment for Personality Disorders

crisis suicidality self-harm safety

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Materials are informational and educational and summarize publicly available scientific sources. They are not medical or psychological advice, are not intended for self-diagnosis or self-treatment, and do not replace consultation with a qualified professional.