When Clients Don’t Change, It’s Often Because We’ve Stopped Mentalizing

Why Stuckness Isn’t a Client Problem, but a Relationship Signal
Let’s say the quiet part out loud: Sometimes the client isn’t stuck. The system is stuck, the relationship is stuck, and the team is stuck. The moment we stop mentalizing, the work becomes mechanical; and the MBT principle can change that.

MBT teaches a core clinical rule: When certainty rises, curiosity falls; and when curiosity falls, change stops, for mentalization thrives when we feel safe enough to explore. However, when a threat is perceived, internally or relationally, the brain shifts toward survival states, and reflective functioning drops (Luyten et al., 2020; Siegel, 2012).

That’s why “difficult clients” often become more difficult when we become more certain.

What Stuckness Often Really Is
Stuckness can be:

• fear disguised as resistance
• shame disguised as defiance
• disconnection disguised as apathy
• attachment panic disguised as anger

MBT helps clinicians stop asking: “What’s wrong with them?”…and start asking: “What’s happening in their mind right now?” And equally important: “What’s happening in mine?”

MBT restores movement. In MBT, the clinician becomes a stabilizing mind. They are not a fixer, a judge, or a detective. They are a mind. This is why MBT has strong evidence for borderline personality disorder and complex relational dysregulation. It directly targets the collapse of mentalizing under stress (Bateman & Fonagy, 2009; Cristea et al., 2017). When someone feels misunderstood, they become more symptomatic. When someone feels seen, they become more reachable. MBT is how we stop doing therapy to people…and start doing therapy with them.

Call to Action
MBT Virtual Conference at SWEET — Friday, February 13th 4 Hours | Live, Virtual | CEUs available

Register. Bring your supervisees. Invite your team. Send this to someone who’s tired of “stuck cases.”

Because the work doesn’t change when we become more forceful. It changes when we become more curious.

Scientific References

• Bateman, Anthony W., and Peter Fonagy. “Randomized Controlled Trial of Outpatient Mentalization-Based Treatment versus Structured Clinical Management for Borderline Personality Disorder.” American Journal of Psychiatry, vol. 166, no. 12, 2009, pp. 1355–1364.
• Cristea, Ioana A., et al. “Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-Analysis.” JAMA Psychiatry, vol. 74, no. 4, 2017, pp. 319–328.
• Luyten, Patrick, et al. “Borderline Personality Disorder, Mentalization, and the Developmental Origins of Self-Disturbance.” Development and Psychopathology, vol. 32, no. 5, 2020, pp. 1–19.
• Siegel, Daniel J. The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. 2nd ed., Guilford Press, 2012.