Understanding the space between what we feel, what we believe, and how we respond.
Have you ever looked back on an argument and wondered why you reacted so strongly? Perhaps a small comment felt deeply personal, or someone's silence seemed to confirm your worst assumption.
When emotions become intense, our ability to reflect can change. We may become more certain of what someone else intended, less aware of what we're experiencing internally, and quicker to respond before considering another perspective.
Mentalization-Based Treatment (MBT) offers a different way of approaching these moments. Rather than focusing immediately on changing a reaction, it invites us to become curious about what happened in our minds, and in the minds of others.
What Does It Mean to Mentalize?
Mentalizing is our capacity to understand behavior in terms of underlying mental states: thoughts, feelings, beliefs, desires, and intentions.
It allows us to ask questions like:
What was I feeling when that happened? Why might that person have responded that way? Could there be something I'm not seeing?
Mentalizing isn't simply empathy or the ability to understand another person's perspective. It also involves reflecting on ourselves and recognizing that our interpretation of an experience may not tell the whole story.
This capacity develops through relationships, beginning early in life.
Understanding Begins in Relationships
In a recent interview with The Carlat Psychiatry Podcast, clinical psychologist and MBT researcher Carla Sharp, PhD, discusses the importance of early interactions in developing our ability to mentalize.
She describes a process called serve and return.
When a child expresses distress and a caregiver responds with interest, recognition, and reassurance, the child gradually develops a clearer understanding of their own emotional experience.
Through repeated interactions, we begin connecting what happens around us with what happens within us.
These experiences help shape our ability to recognize emotions, regulate distress, and make sense of relationships.
Importantly, mentalizing continues to develop throughout life. It is not something we either possess or lack permanently.
Why Strong Emotions Can Make Understanding Harder
One of the central ideas of MBT is that mentalizing becomes more difficult during periods of heightened emotional arousal.
This is particularly true in relationships that matter deeply to us.
Consider a situation in which someone doesn't respond to a message.
One person may assume the other is busy. Someone else may begin to feel rejected, become convinced they've done something wrong, and respond with anger or withdrawal.
The emotional experience is real. But the explanation we attach to it may be only one of several possibilities.
When feelings become overwhelming, our thoughts can begin to feel like facts.
MBT helps us recognize these moments and regain the flexibility to consider what else might be happening.
What Actually Happens in an MBT Session?
Dr. Sharp describes an approach grounded in careful attention to specific experiences.
Instead of beginning with broad explanations about someone's personality or patterns, MBT often explores a particular interaction in detail.
What happened? What was said? What did you feel at that moment? How did you understand the other person's response?
The therapist helps clarify the experience and recognize the emotions involved before exploring alternative perspectives.
This process is sometimes described as the mentalizing loop.
The goal is not to determine who was right or wrong. It is to understand how the interaction unfolded, what meaning each person may have assigned to it, and how those interpretations influenced what happened next.
Emotional validation is an important part of this work. Before someone can consider another perspective, they may first need to feel understood in their own.
Curiosity Rather Than Certainty
One of the most distinctive aspects of MBT is the therapist's not-knowing stance.
This does not mean the therapist lacks expertise. Rather, it means recognizing that another person's internal experience cannot be known with complete certainty.
Instead of imposing an explanation, the therapist and patient work collaboratively to develop understanding.
This curiosity can become particularly important when relationships feel confusing, painful, or emotionally charged.
Sometimes meaningful change begins not with a new answer, but with a willingness to ask a different question.
Beyond the Therapy Room
MBT was originally developed as a treatment for borderline personality disorder (BPD), and Dr. Sharp's interview focuses specifically on its clinical application in this area.
BPD can involve significant emotional distress, difficulties with self-understanding, and challenges in relationships. MBT aims to help individuals maintain or recover their capacity to mentalize, especially during these difficult moments.
But the underlying experience of losing perspective during intense emotion is not unique to any diagnosis.
The broader value of mentalizing lies in learning to recognize when our understanding becomes less flexible.
Over time, the aim is for the reflection practiced in therapy to become more available in everyday life: during conversations, disagreements, moments of uncertainty, and our relationships with ourselves.
A Different Way of Understanding
At The Mentalizing Collaborative, curiosity is central to the way we think about psychotherapy and psychiatric care.
Understanding ourselves does not require having a perfect explanation for every feeling. Understanding others does not mean we can know exactly what they are thinking.
Sometimes the most meaningful shift is simply recognizing that there may be more to the story.
When we make room for uncertainty, we make room for understanding.
Explore Further
Learn more about Mentalization-Based Treatment and Erica's approach to psychotherapy.
Source and inspiration: This article was informed by The Carlat Psychiatry Podcast, “Treating BPD Series, Episode 4: Mentalization-Based Treatment—From Reacting to Reflecting with Carla Sharp, PhD,” published October 5, 2026, featuring an interview by Abigail Rasol with Carla Sharp, PhD.
