Mentalization-Based Treatment for Children (MBT-C): Helping Kids—and Their Parents—“Get” What’s Going On Inside
Why mentalizing matters
Ask any parent of a worried, angry, or shut-down 8-year-old what they wish for most, and the answer is usually the same: I just want to understand what’s going on in their head.
That wish sits at the heart of Mentalization-Based Treatment for Children (MBT-C)—a play-rich, relationship-driven therapy that teaches kids and caregivers to tune into thoughts, feelings, and intentions (our own and each other’s) and to use that insight to navigate big emotions, tricky behaviors, and daily stresses.¹-³
MBT-C in a nutshell
| Core idea | When children—and the adults around them—can mentalize flexibly, they regulate emotions better, feel safer in relationships, and act out less. |
| Age range | 5 – 12 years (adaptations exist for preschoolers and teens) |
| Format | ‣ Individual play sessions (child)‣ Parent sessions (mentalizing coaching)‣ Joint sessions (practicing new skills together) |
| Typical dose | 8 – 12 weekly sessions, plus booster work as needed |
| Targets | Mixed emotional & behavioral problems, attachment difficulties, anxiety, mild depression, post-loss or post-trauma struggles; promising data for kids with ASD features.⁴ |
What does a session look like?
- For kids – The therapist enters the child’s imaginative world: dinosaurs debating feelings, Lego people negotiating fairness, drawings that reveal worry monsters. Each vignette becomes a chance to ask “What might T-rex be thinking right now?” and to link thoughts→feelings→actions.
- For parents – We slow conversations down, spotlight moments when a child’s behavior triggers parental “mind-blindness,” and practice curiosity over conclusions.
- Together – Therapist, child, and parent replay a recent blow-up (maybe that homework meltdown) with “pause buttons,” naming everyone’s inner experience in real time and brainstorming do-overs.
How is MBT-C different from standard play therapy?
- Explicit focus on mental states (not just expression of feelings)
- Parallel parent work—because caregiver mentalizing capacity predicts the child’s progress
- Time-limited & goal-oriented with structured assessment of mentalizing strengths/vulnerabilities³
What does the evidence tell us?
| Outcome | What we know | Citation |
| Emotion & behavior | Pilot RCTs demonstrate medium-to-large reductions in global symptom scores at 12-week follow-up compared to treatment-as-usual. | Thorén et al., 2025² |
| Reflective functioning | Significant gains in child and parent mentalizing skills were measured by the Reflective Functioning Scale. | Kasper et al., 2023⁵ |
| Feasibility in real-world clinics | > 80 % completion rates; high parent satisfaction in the foster-care population. | Midgley et al., 2019⁶ |
| School adaptations | Whole-class MBT curricula improve theory of mind and emotion regulation; disruptive behavior decreases. | Chelouche-Dwek & Fonagy, 2025⁷ |
| Long-term durability | The ongoing ERiC trial will report 9-month outcomes; early data suggest that gains are being maintained. | Midgley et al., 2023¹ |
Bottom line: MBT-C remains an “emerging evidence” treatment, but findings from multiple pilots and quasi-experimental studies consistently show promise, particularly for complex, mixed presentations where single-diagnosis protocols are insufficient.
Is MBT-C right for your family?
MBT-C may be a good fit when your child:
- Shows a blend of worry, sadness, and acting out that doesn’t map neatly onto one label
- Struggles to read social cues or to explain their own feelings
- Has experienced attachment disruptions (foster care, adoption, parental mental illness)
- Benefits when caregivers are actively involved in treatment
Situations that call for extra support first: acute suicidality, psychosis, or severe developmental delay—these require stabilization or alternative modalities before layering in MBT-C.
Five take-home tips for parents starting MBT-C
- Model “wondering aloud.” Replace “Why did you do that?!” with “I’m guessing you might have felt… did I get that right?”
- Narrate your own mental states. “I’m tired and worried about work, so I snapped—that’s on me.”
- Use play at home. Re-enact challenging moments with toys; let the figures voice hidden thoughts.
- Celebrate micro-shifts. A 30-second pause before a sibling smack is progress worth naming!
- Stay curious about setbacks. Regression signals stress, not failure—ask what changed in the internal or external world.
Looking ahead
Large-scale trials are now testing MBT-C in community CAMHS teams, schools, and culturally diverse families. Results will clarify optimal dosage and cost-effectiveness, but early signs suggest that teaching kids (and parents) to understand minds may be one of the most powerful levers we have for building lifelong resilience.
If you’d like to explore MBT-C with one of our child specialists at Mind Body Seven, reach out here. We work in-person in Brooklyn and via secure telehealth across New York State.
Remember: Mentalizing isn’t about always getting it right—it’s about staying open to the idea that there’s a mind behind every behavior, including your own.
References
- Midgley, N., Mortimer, R., Carter, M., et al. (2023). Emotion Regulation in Children (ERiC) trial protocol. PLOS ONE, 18(8), e0289503. https://doi.org/10.1371/journal.pone.0289503
- Thorén, A., Lindqvist, K., Nemirovski, J. P., & Mechler, J. (2025). Short-term MBT-C pilot RCT. Clinical Child Psychology & Psychiatry, 30(2), 436-451. https://doi.org/10.1177/13591045251316619
- Muller, N., & Midgley, N. (2015). Assessment in time-limited MBT-C. Frontiers in Psychology, 6, 1063. https://pubmed.ncbi.nlm.nih.gov/26283994
- Costa-Cordella, S., Soto-Icaza, P., et al. (2023). MBT-C for autism—integrating attachment & neuroscience. Frontiers in Psychiatry, 14, 1259432. https://doi.org/10.3389/fpsyt.2023.1259432
- Kasper, L. A., Hauschild, S., Schrauf, L. M., & Taubner, S. (2023). Enhancing mentalization via specific interventions in MBT-A. Frontiers in Psychology, 14, 1223040. https://doi.org/10.3389/fpsyg.2023.1223040
- Midgley, N., Besser, S. J., Fearon, P., et al. (2019). Herts and Minds foster-care MBT feasibility study. BMC Psychiatry, 19, 215. https://doi.org/10.1186/s12888-019-2196-2
- Chelouche-Dwek, G., & Fonagy, P. (2025). Mentalization-based interventions in schools: Systematic review. European Child & Adolescent Psychiatry, 34(4), 1295-1315. https://doi.org/10.1007/s00787-024-02578-5
© 2025 Mind Body Seven. Information provided here is educational and not a substitute for professional mental-health care.
A Message From Dr. Lewis If you’ve been struggling with depression or anxiety, I want you to know something important:
The Conversation That Surprised Me A few years ago, I had a patient named Greg who’d been on escitalopram (Lexapro)
The link between yoga and mental health has become sufficiently well established as to be practically mainstream. What was associated
You’re Not Meant to Go Through Life Alone In our increasingly connected yet often isolating world, you might sometimes feel