Borderline Personality Disorder,  DBT-FST,  Mentalizing,  Parenting,  Treatment

DBT, MBT and the Behavioral Chain

One of the things I have noticed about Dialectical Behavior Therapy Family Skills versus Mentalization Based Skills is that they operate at a different link on the behavioral chain. In “When Hope is Not Enough” I have a section called “the BPD Dynamic.” What this dynamic outlines is a behavioral chain. That chain goes like this:

Event -> Interpretation -> Emotional/Physical Feelings -> Action Impulses -> Expression and Behavior

DBT-FST seems to me to operate at the Action Impulses to Expression and Behavior link, while validating the Emotional/Physical Feelings link. Don’t get me wrong, the DBT-FST skills are extremely powerful in communicating with someone with BPD. Yet, the change that is requested is at the end of the chain. I have heard that Marsha Linehan is quoted as saying something like, “Just because you feel like a crazy person, doesn’t mean you have to behave like one.” The point here is that DBT is a behavioral therapy and by modifying behavior, that works backwards toward regulating emotion and tolerating distress. In other words, DBT trains you to behave differently based on your feelings. When you gradually learn that your new behavior is more effective than the previous behavior, you break the conditioned chain between Action Impulses and Expression and Behavior. That is the essence of the DBT skill “Opposite Action.” An interesting side note is that by practicing Opposite Action (that is, doing the exact opposite of what your feelings implore you to do – such as engaging when you feel sad, rather than hiding under the covers all day), you actually feel better, because the action does work backward. Dr. Paul Ekman found that configuring one’s face to mimic a certain feeling actually causes that feeling to be experienced. That is the theory behind DBT’s “Half Smile” skill. Ultimately though, by working at that link in the chain, the person still feels the emotion, yet he or she just behaves differently than the emotion originally informed him/her to behave.

MBT on the other hand takes on the on the problem at the Interpretation link. By asking questions and being open to alternative interpretations, the person with BPD is more likely to have a broader view of other people’s behavior and the events in life. DBT never asks about the intent or motivation of the other person and just takes the interpretation as a given in a person with BPD. If a person with BPD says something happens and that something means X, then in DBT it means X. There is very little questioning of the validity of the interpretation X. In MBT, however, the interpretation X can be questioned and alternative interpretations (such as Y or Z) can be examined. The nice thing about this is that when the person with BPD is faced with a similar situation, he/she is less likely to jump to conclusion X and might consider Y or Z.

An example of the differences in the two approaches is as follows:

My daughter comes home from school after being teased by a boy on the playground. My daughter ends up throwing a thermos at the boy’s head.

With DBT, I would validate her anger and ask her how she could behave more effectively the next time this teasing occurs. So next time she will behave more effectively and not throw the thermos.

With MBT, I would validate her feelings and begin to probe with curious and straight-forward questions as to the intent of the boy. Perhaps he actually likes my daughter and that is why he is teasing. Perhaps he is showing off to his friends. If this approach is taken, my daughter is more likely to consider the boy’s motivation for the teasing. If she understands the motivation, she can actually never get angry and risk throwing the thermos.

All of that being said, I believe these skills have to be learned as a “ladder” to effectiveness. You can’t start at point E without going through points A-D. DBT-FST provide the foundation for more advanced skills, like those in MBT.


  • John Lucas

    I like that you are working on incorporating MBT into your skill set for effective interactions with BPs, Bon. In the example with your daughter, I notice that you are still intervening after she has felt the emotion, experienced the action impulse, and engaged in the behavior. You validate the emotion so I presume your daughter is no longer in the throes of an EDM when you begin a mentalization approach. If I understand this correctly, then this clarifies something for me:

    Previously, I thought you meant that for mentalization to be effective, you would have had to catch your daughter at the moment of interpretation, interrupt the behavioral chain, and suggest alternative interpretations before she experiences the emotions/feelings stemming from her initial (negative) interpretation.

    Now, however, my understanding is that you CAN do this in certain circumstances, but you do not HAVE to intervene at that precise moment in time: instead, you can intervene at the same moment in time that you had suggested in “When hope is…” (ie after the behavior has appeared and after validating the emotions that preceded the behavior).

    Then, after the validation step, instead of taking the DBT-based approach (pointing out negative consequences for her of her behavior and facilitating consideration of alternative behaviors), you can take the MBT-based approach (clarifying her interpretation and suggesting alternative interpretations–which actually sound much like a common CBT technique, of identifying negative automatic thoughts and consciously examining them).

    Incidentally, I suppose you can do both, right?

    If the EDM is directed at me from my wife, then I worry a bit that the MBT approach might come across as defending myself–but I think that, if the validation is done well, then this would likely not be a problem.

    Thanks for all of your work on converting this into tools for interaction!

  • Bon Dobbs


    As always your points are well-taken. Yes, in both cases I am using skills after the fact. And yes, I do use both techniques in my daily interaction with people. One other thing I noticed about DBT vs. MBT is that DBT is solely focused on the person with BPD, whereas MBT is focused on the interaction of BOTH people. The purpose is to mentalize (and for both to mentalize) and in doing so the intentions, thoughts, feelings and implicit goings-on in each mind are interacting. The example I give with my daughter is a real life one.

    I can see how MBT techniques can come across as defending and/or challenging to the person with BPD. However, if done with compassion, curiosity and authenticity (the mentalizing “stance”), mentalization will more often be seen as an honest interesting in understanding the thinking of another person.


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