MBT Child (MBT-C)

Many practitioners have experienced situations in which parents and children have difficulties using
the kind of strategies that may be offered to manage their problems more effectively, often because
they do not have the affect regulation skills or the capacity to make use of the guidance that is a
prerequisite for benefitting from such therapeutic approaches (e.g., Scott & Dadds, 2009). Training
in time-limited Mentalisation Based Treatment for Children (MBT-C) hopes to fill an important gap
for practitioners by offering a short-term, focused intervention for school-age children that draws on
traditional psychodynamic principles but integrates them into attachment theory, the empirical
study of mentalization, and features of other evidence-based approaches, including CBT.

Time limited MBT–C focuses on enhancing children’s ability to use their mentalizing capacity to
manage emotions and relationships and to increase their capacity to make use of relationships for
emotional learning. Further, MBT-C supports parents to best meet the emotional needs of their
children. Enhancing mentalizing processes in the parents in turn helps the child to become aware of
and regulate emotions and/or develop explicit mentalizing skills that can help them manage key
difficulties. These key difficulties can be addressing trauma, parental mental illness or other family
and life difficulties, or developing better mentalizing about aspects of self, such as temperament or
specific emotional difficulties and concerns. Related to this is helping the child create a narrative and
develop a more coherent sense of self, which can lead to a more positive self-image. Working with
parents alongside the time-limited therapy with the child is seen as an essential element of MBT–C,
not only in the short-term but also to give the best possibility that the parents will continue to
support the child’s development after the therapy has ended. The overall aim of MBT–C is to
promote mentalizing and resilience in such a way that a developmental process is put back on track
and further psychopathology is prevented. In this way, the family and child feel they are better
equipped to tackle the problems that first brought them to therapy.

Which children might benefit from MBT-C?
It is suggested that MBT–C may be suitable primarily for children presenting with affective or anxiety
disorders, mild or moderate behaviour problems, as well as those with adjustment reactions or who
need help dealing with a particular life challenge, such as parental divorce or bereavement. Because
MBT has a relational focus and is rooted in attachment theory, MBT-C is likely to be especially
appropriate when attachment relations are at risk; when the duration of the problems is longer and
the problems are more complex because of trauma or severe family pathology; or when there is a
mix of internalizing and externalizing problems (which may be an indication of emerging personality
disorder in adolescence).

The basic MBT–C time-limited model is 12 individual sessions, with separate meetings for the
parent(s), however, In certain cases in which a longer-term intervention is appropriate (e.g., for
those children whose early relational trauma or attachment insecurity makes trusting an adult a real
challenge), it is possible to offer up to three blocks of 12 MBT–C sessions (i.e., up to a maximum of
36 sessions). These additional blocks of treatment are based on a review process that weighs the
pros and cons of additional treatment, and in these cases, the treatment is never open-ended but
continues to be time-limited, with a clear focus and aims.
Making treatment recommendations based purely on psychiatric diagnosis is of limited value. It is
suggested that MBT–C is suitable for children with a wide range of clinical difficulties and that
MBT–C is flexible so that therapists can adjust how they will work to ensure the process is
appropriate for particular children, considering their level of functioning and the limits of their
capacities.