Objectives This article demonstrates the clinical utility of attachment-informed and mentalization-based approaches in modern psychiatry, focusing on relationships as a primary source for healing and resilience. Background Rooted in the psychoanalytic tradition of Donald Winnicott, the framework emphasizes that the mind cannot be understood in isolation from its social environment. In the current youth mental health crisis, social and economic stressors fragmented the scaffolding necessary for healthy emotional development. These forces often result in impaired mentalization and the breakdown of epistemic trust, particularly among marginalized populations. Methods Through a theoretical review and a clinical case illustration of a young man navigating cumulative trauma and systemic inequity, the article explores the transition from nonmentalizing modes (psychic equivalence, teleological, and pretend modes) to reflective awareness. Results The authors advocate for a “mentalizing stance” characterized by clinician humility, transparency, and genuine curiosity. This approach moves beyond classical neutrality and purely skills-focused models, positioning the therapeutic alliance as a transdiagnostic vehicle for change. By modeling self-reflection, clinicians can foster the regaining of mentalization capacities and healthy emotional and social functioning. Conclusions Enhancing mentalization offers a robust pathway for addressing emotional dysregulation and trauma across various clinical settings and diagnostic groups, offering a promising avenue to mitigate the ongoing youth mental health crisis.

This introduction to the special issue on mentalization-based treatment (MBT) with children, adolescents, and families highlights a range of conceptual and clinical contributions that illustrate the richness and usefulness of applying developmental and family systems perspectives to an MBT framework to alleviate the plight of young people and their parents.

This article reviews an approach to working with families that grounds in systemic thinking the framework of mentalization-based treatment. Employing a mentalizing stance, this approach aims to interrupt coercive, nonmentalizing cycles of interaction within the family system and replace them with mentalizing conversations in which epistemic trust and the shared social-emotional learning of the we-mode can be generated. The process thus promoted is a spiral of shared attention and co-mentalizing, constantly lost and then recovered, in which therapist and family members learn to hear, recognize, understand, and trust one another and repair the inevitable disruptions in mentalizing and trust that allow family members to experience a way of shared knowing— the we-mode—that they can apply to communicate and solve problems both within the family system and in the broader social systems in which the family is embedded.

Mentalizing-based therapy (MBT) was developed as a treatment for borderline personality disorder (Bateman and Fonagy, 2006); it also shows increasing empirical support as a useful approach for patients who are harder to reach (Bevington, Fuggle, and Fonagy, 2015). In this Workshop, participants will learn about: 1) mentalizing, epistemic trust, and how those capacities develop; 2) the impact of adolescents' emerging mentalizing capacities on emotion regulation by means of feeling understood; and 3) the relations between mentalizing, epistemic trust, and the spread of lies/disinformation across media platforms. The Workshop will offer hands-on experience with the MBT approach to mood dysregulation and epistemic mistrust. Participants will learn the mentalizing stance, how to assess mentalizing and nonmentalizing, and the core techniques of MBT. After video and clinical examples, participants will be given prompts for role plays, working in small groups. Participants will receive links to MBT training materials as well as copies of the presentation. Participants will understand the basic premise of mentalizing theory and epistemic trust. Participants will gain skill and confidence in utilizing the mentalizing stance and techniques. The aim of MBT is to provide clinicians with a theoretically sound, practical, empirically validated approach to emotion dysregulation among adolescents, families, and anyone who has a high degree of mistrust/disbelief.

Mentalizing-based therapy (MBT) was developed as a treatment for borderline personality disorder, and it also shows increasing empirical support as a transdiagnostic approach. In this Workshop, participants will learn about: 1) how mentalizing capacities develop in the context of attachment relationships; and 2) the impact of adolescents’ emerging mentalizing capacities on their emotion regulation in relationships. The Workshop will offer hands-on experience with the MBT approach for adolescents with mood dysregulation and their families. Participants will learn the mentalizing stance, how to assess mentalizing and nonmentalizing, and the core techniques of MBT. After viewing video examples, participants will be given prompts for role plays, working in small groups. Participants will receive links to MBT training materials as well as copies of the presentation. Participants will understand basic mentalizing theory and technique. Participants will have gained experience in MBT for adolescents with mood dysregulation. MBT provides an empirically supported, coherent way to address mood dysregulation. Participants will practice the techniques that aim to increase adolescents’ and families’ mentalizing capacity. Mentalizing capacity in turn facilitates emotion regulation, allowing repair of relationship ruptures and strengthening feelings of belonging.

Mentalizing-based treatment (MBT) has been developed over the last 2 decades as a coherent conceptual framework and is an increasingly empirically supported approach to borderline personality disorder, family treatment of children and adolescents, eating disorders, and self-harming adolescents. In this Workshop, participants will learn about the following: 1) how mentalizing capacities develop in the context of attachment relationships; and 2) the impact of neurodevelopmental changes in adolescent’s mentalizing capacities.

It is important to synthesize and apply advances in developmental infant research to the psychotherapy of older children and adolescents.

In this article, the process of mentalizing, its components, and role in self-regulation and attachment are reviewed. An examination is presented of the neurodevelopmental changes affecting the adolescent's capacity to mentalize and the role of such compromised mentalizing in the adolescent's vulnerability to adaptive breakdown and psychopathology, in general, and to emerging personality disorders, in particular. The principles, objectives, and core features of mentalizing-based treatment and its application to adolescents and families are discussed.

This article is based on a patient education program the authors are conducting in the Professionals in Crisis program at The Menninger Clinic. This program is designed to foster a therapeutic alliance by helping patients understand a central aim of treatment, namely, fostering mentalizing, the awareness of mental states in self and others. The educational material is based on research in the Menninger Child and Family Program. The educational sessions are conducted like seminars in which the leaders and patients collaborate in understanding these concepts and their application to treatment. Patients in the program are provided with this article as background material for the seminar.