Commentary on 'Minding the difficult patient': Mentalizing and the use of formulation in patients with borderline personality disorder comorbid with antisocial personality disorder

Sebastian Simonsen and colleagues raise some interesting points about the use of formulation in a mentalization-based treatment. In the initial manuals (Bateman & Fonagy, 2004, 2006), we described the formulation as a process by which the therapist organizes his or her understanding of the patient, eventually sharing it with the patient in written form. The aim of the formulation is not only to organize the mind of the therapist but also to model the mentalizing process. The written form has a number of characteristics which, importantly, include brevity, simplicity and clarity without use of jargon. The content of the formulation is less important than the process of developing it. The intention is to engage in a collaborative process in which the patient considers the mind of the therapist just as the therapist considers the mind of the patient. It is a fundamental principle of mentalization-based therapy (MBT) that we ask patients to juxtapose their own mind alongside their representation of the therapists' mind, and that it is equally essential for the therapist to consider his/her own mental state in relation to his/her representation of the patient's mind. It is the continual focus on, and the reworking of, the subjective reality of the patient that forms the core of mentalizing approaches (Fonagy & Bateman, 2007). Adapted from the source document.