Dr. Carla Sharp is a leading expert in Mentalization-Based Treatment (MBT), developmental psychopathology, and the treatment of personality disorders. She is the John and Rebecca Moores Professor of Clinical Psychology at the University of Houston, where she serves as Associate Dean for Faculty and Research and directs the Developmental Psychopathology Lab and the Adolescent Diagnosis, Assessment, Prevention, and Treatment Center. A prolific scholar with more than 380 peer-reviewed publications and eight books, she has made substantial contributions to the development and dissemination of mentalization-based approaches and is a certified supervisor and licensed trainer in MBT for both adults and adolescents. In this episode, Dr. Sharp offers a comprehensive introduction to MBT as a treatment for BPD — from what mentalizing is and how it develops through early “serve-and-return” interactions, to how disruptions in this capacity contribute to the difficulties characteristic of BPD. She takes clinicians inside an MBT session, explaining experience-near exploration, empathic validation, affect elaboration, and the mentalizing loop. She also unpacks the three pre-mentalizing modes — psychic equivalence, teleological mode, and pretend mode — and discusses the therapist’s use of self, the importance of maintaining a curious “not-knowing” stance, and how clinicians can recognize when a patient’s capacity to mentalize is strengthening. 

Learning Objectives 
After completing this educational activity, participants should be able to: 

1. Define mentalizing and explain how disruptions in its development and functioning contribute to borderline personality disorder.

2. Describe how MBT uses experience-near exploration, empathic validation, and the mentalizing loop to strengthen a patient’s capacity to reflect on the mental states of self and others. 

3. Identify the three pre-mentalizing modes — psychic equivalence, teleological mode, and pretend mode — and recognize when mentalizing has broken down in a clinical interaction. 

4. Apply the MBT mentalizing stance, including curiosity, uncertainty, and therapist use of self, to support reflective functioning in patients with borderline personality disorder. 

Topics Covered in This Interview 

• What mentalizing is and its role in psychological functioning 

• How mentalizing develops through early “serve-and-return” interactions 

• Mentalizing difficulties in borderline personality disorder 

• Strengthening mentalizing as the core treatment target of MBT 

• What an MBT session looks like in practice 

• Experience-near exploration and the mentalizing loop 

• Empathic validation and managing emotional arousal 

• Affect elaboration and working with underlying emotional experience 

• Mentalizing relationships with others and with oneself 

• How patients and therapists determine the focus of an MBT session 

• The three pre-mentalizing modes: psychic equivalence, teleological mode, and pretend mode 

• Recognizing when mentalizing has gone offline 

• The therapist’s use of self in MBT 

• The mentalizing stance: curiosity, uncertainty, and “not knowing” 

• Recognizing progress and the generalization of mentalizing outside therapy 

Abbreviated Interview Transcript 

Abigail Rasol: Welcome back to the Carlat Psychotherapy Podcast, where we review different psychotherapeutic approaches to better expose you to the wide range of modalities available. We’re continuing our Treating Borderline Personality Disorder series today by diving into Mentalization-Based Treatment, MBT, with Dr. Carla Sharp. Dr. Sharp, welcome to the Carlat Psychotherapy Podcast. 

Dr. Carla Sharp: Thank you, Abi. It's a great pleasure to speak with you today and with your audience, and thank you for the invitation to participate in this podcast series on personality disorders. 

What is Mentalization? 

Abigail Rasol: To start off, in talking about mentalization-based treatment, I think we really need to talk about what this term mentalization means. So can you just briefly explain what mentalizing is, what role it plays in psychological functioning more generally, and also how disruptions in mentalization show up in or characterize borderline personality disorder? 

Dr. Carla Sharp: Mentalizing is a term that's actually been around for a long time, originally in the psychoanalytic literature to denote a capacity for symbolization. What do we mean with symbolization? We mean the capacity to represent reality in our minds. So at its very basic level, mentalization means a representational capacity, something we do in our minds, a mental activity. And what is this thing that we do in our minds? We imagine the mental states of other people, and we imagine the impact things are having on us, and we consider alternative perspectives in both of those things. We consider what might be going on for another person in their minds, and we're also considering what might be going on in our minds. It’s this dual process of imagining the mental states of other people, but also the impact of events and other people and conversations, and even the impact of our own thinking and feeling on ourselves. You can almost mentalize just with yourself in the room, but you can also mentalize with another person in the room or multiple people or society. It is this imaginative mental activity of making sense of self and other, usually in interpersonal interactions, but also just more generally. So it's a mental activity. That's the core idea that I want to get across in its definition. It's something we do with our minds, and it helps us distinguish us, I always think, from animals, because they don't have that capacity. It's almost part of consciousness if you think about it. It's part of being able to think about and reflect on and articulate with language what might be going on inside ourselves, but also inside other people. 

Learning to Mentalize: the Serve and Return 

Abigail Rasol: What is the role that mentalizing plays in Borderline Personality Disorder, and why is it so important that there is a whole treatment built around it? 

Dr. Carla Sharp: It turns out that people with personality disorders—and that is across the board, all personality disorders—and, in fact, all people with psychopathology, have difficulties in mentalizing. Let's zoom in on personality disorder more broadly, and BPD in particular. And there I'll quickly just talk about how mentalizing develops, because then it'll make sense why people with BPD have the particular kind of mentalizing problems that they do. Mentalizing develops in the serve-and-return interactions with your caregivers in the first instance. And with caregivers, I mean your mom and your dad, perhaps an older sibling, perhaps the nanny, perhaps the daycare staff, and even perhaps society at large. In the serve and return – and what do I mean by serve and return? I mean when we're in an interaction with someone, there's a ping pong game happening. I serve the ball to you, and you have to return that ball for us to have a game. If one of us is not returning the ball or hitting it out of the court, the rally stops and we're not interacting with each other anymore. Serve and return is a very important unit for us to understand human interaction and relationships. So we learn mentalizing in the serve and return with others. Wherever the serve and return happens, we are getting feedback on ourselves. So as babies we act upon the world. The world feeds back, and the quality of that feedback is important, the process of that feedback is important. Let’s imagine a baby crying. The baby needs a diaper change. The baby's wet and uncomfortable. And a caregiver is there to say, "Oh, no, what's going on?" So I'm marking the distress. I'm mirroring the stress to some extent, but I'm also already modulating it. I'm regulating it. I’m saying,"We can fix this. I'm with you. You're not alone." Over time, with many serves and returns, you can think about mentalizing as muscle memory building up, that I can understand my feelings. I can understand why I'm distressed. I can understand and connect the events that I'm in, the context that I'm in with the feelings inside my body. A lot of research shows that people with BPD don't have those early experiences of marked mirroring. They don't grow up in attachment environments where the caregiver feels okay to slow down with them, the caregiver feels competent to interact with a child in that sort of slowed down reflective way. And the feedback that they start getting is one of, "You're overwhelming me," or, "I can't help you here, you're on your own. You need to figure this out by yourself." And over time, that representational capacity doesn't develop normally. And then people with BPD can't mentalize. So they're in a situation, they're overwhelmed with emotion, something is happening, and they don't have those tools that they would have learned with a parent that says, “Let's just slow down for a moment. What's going on? What feelings are coming up for you?" They don't have that capacity to slow down in the moment and reflect on what's going on for them and for the other person. And what typically happens in BPD is that people go over urgently into action. It's a sort of urgency to act, to fix it, to rectify it, and without a reflective moment. And that gets them into trouble and leads to impulsive behaviors. It could be a range of impulsive behaviors from self-harm to suicide, to saying something or doing something to someone that they regret. People with BPD regret their impulsive interpersonal behaviors terribly because it's actually not in accordance with their values or what they wanted to do or the intentions behind it. So that is the kind of mentalizing deficit or impairment that we see in BPD, is just not being able to slow down. 

BPD: A Failure to Mentalize 

Abigail Rasol: So, is the idea behind MBT that the core deficit underlying BPD, and perhaps personality disorders more broadly, is a failure or collapse of mentalizing—and that by strengthening a patient’s capacity to mentalize, we are essentially treating the disorder? Is that the core idea? 

Dr. Carla Sharp: That's exactly right. For people who have not had a serve and return developed – that muscle memory of mentalizing – we have to do that in therapy. And so the core goal of the therapy is to do the serve and return, do the serve and return, over and over again, and to rebuild that muscle memory. If you think about types of therapies out there, MBT follows an implicit therapy approach. It's not that we, like in CBT, have skills. Although mentalizing itself is a skill, we begin in MBT with the serve and return, and we slow it down. We begin to teach that muscle memory so that people can generalize it outside of the therapy room. If you think about the arc of therapy in MBT, you really begin with a dyad, therapist-client dyad, and you begin to practice and build muscle memory. But eventually what you want to see is really the generalization of what happened in the therapy in the outside world. 

Learning the Serve and Return: MBT In Practice 

Abigail Rasol: I would love it if you could take us into the therapy room and what MBT looks like in-session. You've put a lot of focus on sort of the purpose of the work is really to practice the serve and return and to foster this independent ability to mentalize. How do you do that in practice? 

Dr. Carla Sharp: First of all, I will describe MBT the way I do it and the way I supervise it. And what's great about MBT, and I think all of these sorts of implicit psychotherapies and psychodynamic therapies in general, is that it's a set of principles that we apply, but it's not a manual that we follow. And because it's not a manual that we follow, we all look different when we do it, and it should be like that because we take very seriously the therapist's use of self. So what I'll try to do is walk you through a sort of session the way I would do it and then I'll try and pull out the commonalities that we do want to see in a good MBT session. One of the important things, as I mentioned, is therapist use of self. We want to see authentic use of self. If you see me doing MBT and you know me outside of therapy, you should recognize that that's Carla. That was consistent with how Carla would do it. And when I supervise students, I really try to help them develop who they are in the context of the psychotherapy, because you need to tap into yourself in order to do MBT well. 

Experience Near: Focusing on Specifics 

Dr. Carla Sharp: The second thing is that it's experience near. And what we mean by that – and this helps us to understand the structure of an MBT session – is that we want to talk about specifics. In MBT, we follow what we call the mentalizing loop. We want to connect affect and thought and experience, internal experience, external experience when we talk about a particular event. That means that we can't talk in generalities, so it needs to be specific, and that's what we mean with experience near. I like to start a session by asking a client, "What matters for you today? What do you want to talk about today?” With young people, I often use the idea of a thermometer. "What pushed up your thermometer? What made you hot? What upset you?" I like to have a very particular concrete experience, because people tend to pull you to generalities. “My mom had a go at me again," and then they go into how the mom had a go at them many times before, and we get to generalities. I would move the client away from that. I say, "I know. I know your mom's a pain in the butt. But I want to hear what happened last week. Walk me through what happened last week." And the client says, "I came home. She said I needed to do my college applications, and she just doesn't trust me. You know she's never trusted me before. You know that time.." And they go on and they fall into what we would call psychic equivalence, where what's in their mind is true, and it doesn't necessarily relate to reality. So my first job is to keep them in the here and now, to slow them down, to say, "Hang on. I can see you're angry." So we make use of affect. We validate. When a person is in psychic equivalence – that's one of our pre-mentalizing modes that we want to pull people out of – we use empathic validation. I say, "I can see you're angry, but let's just take a deep breath. Okay, I want to know what happened last week. Tell me what happened last week with the college applications." And then she calms down, and she says, "I said to my mom, 'Mom, I have been working on my college applications. Then I’ll say, “And what did your mom say?" “She said show it to me. I said to her ‘you don't trust me.’” “Okay,” I’ll say, “Let's slow that down again. When she said 'show it to me,' what was it that you were feeling at the time?" So we’re working our way through the mentalizing loop. We get the event. We want to see it as clearly as we can, as if it's in a movie. Until I have a clear picture in my own mind, I don't move on. I keep stopping her. I keep asking, "Wait, I can't see it clearly. Where was she? What were you doing? Where were you sitting, at the kitchen table?" Once I have a clear picture, I can say, "Okay, wow, I can see why you got so angry. I can see what happened. Now this makes sense to me." So I use empathic validation. 

Empathic Validation 

Dr. Carla Sharp: Empathic validation usually brings down the arousal levels, and now we can start thinking. We always say in MBT – and you can say this to the client as well – that when it's too hot in the room, we can't think. Now that we have a clear picture we can ask,"Okay, so what do you think was going on for your mom?" So now I will see if this adolescent or this client can mentalize the other person at this moment. Sometimes they can't. “She's just an asshole. She's just a dragon in my life." When I hear that, I know that’s non-mentalizing. When we blame, when we label, that's non-mentalizing. So I would use empathic validation again. “She's really upset you, and I'm on your side here." In MBT, especially with young people, we're not scared to take their side. We say, "I'm sitting in your chair now. I can see this is really hard. But let's just try for a moment. Why would your mom say that? What would your dad say if he were here?" So now if we can't use the teenager's mind to mentalize mom, we can borrow from someone else's mind. So we can say, "What would your dad think? Why would he think your mom would say that?" "I think my dad would say she's worried about money. This is a money issue for them. They worry that if I don't get into the right college, they can't afford it.” Now we think about that for a moment. We pause. I think. Now I can put my mind on the table, and I can say, “I can see your dad's potential point of view here. What about your mom's point of view?" “Yeah, I do know about the money, but why doesn't she just trust me?" Okay, so it's that piece that hurts the most. It's the piece that she doesn't trust you. So now we've worked over what it felt like. We've reflected. We're still busy working our way through the mentalizing loop, and we're starting to make sense of it. We're starting to make sense of self and other. “What does it say about you that your mom doesn't trust you, wants to see the evidence of your college application?" “It means that I'm a failure, and, you know I am a failure. She's never been satisfied with me. I've never been the daughter that she wanted, and that's what it means." “Okay. I can see why this hurts so much. Let's unpack that a little bit. How does it feel talking about it now? 

Affect Elaboration: The Arc of the Therapy Session 

Dr. Carla Sharp: This is a very important question in the mentalizing loop. And usually at this point, the client will become very sad. And she will say, "I feel ashamed. I feel like I have let my parents down." And this is a very important moment in the arc of the therapy session because now the therapist needs to work with the affect, and the therapist needs to say, "This is so sad for me. I can feel it myself." Sometimes I would feel tearful in a session resonating with the pain. Because this is the core. If we think about BPD, unlovability, defectiveness, the fact that I've never been enough, the fact that I've never lived up to people's expectations, and I hate myself for it. And that internal distress, really feeling it with a client, really staying there with a client. This is, I find when I supervise and as a therapist, it's the hardest part because it's the most personal, it's the most intimate but it's very important, this affect elaboration that then occurs. Let's look at this affect some more. “What does it mean about you? We've gone through the mentalizing loop. We now understand why it had this impact on you and why you flew off the handle. I get it. I get it. How are you going to manage it going forward?” So now we're getting to a different perspective. It's the final piece in the mentalizing loop. 

The Serve and Return with Oneself 

Abigail Rasol: Given the inherently interpersonal nature of mentalizing and exploring that mentalization, would you say that sort of all of the work or most of the work that you're doing on a session-to-session basis in MBT is focusing on relationships in this person's life? 

Dr. Carla Sharp:  Relationships with others, but also relationship with self. Critical. So you do a serve and return with yourself every day, and beginning to unpack the serve and return with oneself is as important, perhaps even more important. I'll talk about an older patient, who will use a different, much more sophisticated way of talking about herself and mourning for herself, being very sad for where she's at in her life and the wasted years of engaging in relationships in a productive way. We would use the same techniques – empathic validation, clarification. “Tell me more about that. What does that say about you?” I sometimes like the idea of thinking forward. “How does this affect thinking forward about yourself? Where are you going?" So It's not just, I would say, the serve and return with others, but also the serve and return with self, making sense of yourself, forgiving yourself, having compassion with yourself, understanding yourself, and then managing yourself differently in a new way. Can you give yourself a break? Can you begin to be kinder to yourself? If we get to that last point in the mentalizing loop of the different perspective and doing things differently. 

Determining Session Material and Course 

Abigail Rasol: To go back to the structure of the session, building off of our TFP episode, there’s a strong emphasis on the patient coming in and free associating. The patient is responsible for deciding what they want to discuss in the session that week, which is obviously quite different from more cognitive behavioral therapies, where the structure and focus of the session are often laid out much more clearly. So, where does MBT fall in terms of the patient’s role? What are they expected to bring to the session, and what is their responsibility in the treatment? And how is the direction of the session determined collaboratively between the patient and therapist? 

Dr. Carla Sharp: If a patient brings in something that is not experience-near, we will take it to experience-near. So for instance, if the patient comes in and says, “I just don't know where I'm going in my life," I would say,"Can you give me a specific example of how that showed up this week?" That would be my question to make it experience-near. And usually, they would say something like, “I went to a job interview. They offered me the job, but I don't want it. I don't want it." Now I can say,"Oh, wow, okay. Let's walk me through that. " So I'll keep them experience-near, but if they begin to pull me into theorizing or intellectualizing about why, we can do this year in, year out nothing's going to change. That is a way of preventing change. That is a defense mechanism against not bringing change into your life. So we do need to get back to the here and now. 

Pre-Mentalizing Modes 

Abigail Rasol: You've mentioned pretend mode, You've mentioned teleological mode. What exactly are those? I believe they fall under the category of what you call pre-mentalizing modes, so can you take us through those a little bit? 

Psychic Equivalence 

Dr. Carla Sharp: So we call them pre-mentalizing modes because developmentally children do this. If we think about psychic equivalence, what is the three-year-old version of psychic equivalence? It is dressing up in an Elsa costume and absolutely feeling and believing that you are Elsa in that moment. She’s dancing and she feels it in her body, she feels it in her fabric, so that is psychic equivalence, what is in my mind is real. As we get older and we have more prefrontal cortex, we don't get lost in our minds in that way anymore. We know that what's in our minds is a representation of reality, and therefore it can change, and it's fickle. It's not necessarily to be believed. So that's psychic equivalence. We call it a pre-mentalizing mode because before mature mentalizing developed, kids had magical thinking and they were in psychic equivalence, and that's great and appropriate. But when we're 25 or 27, you need to be able to decouple what's in your mind from reality. So that's psychic equivalence. 

Teleological Mode 

Dr. Carla Sharp: The other one is teleological mode. Again, it's a pre-mentalizing mode. It's developmentally appropriate. What does it mean? It is that we use physical, concrete activities or signs to make sense of what is in the mind. So if we think about it developmentally, a star chart to potty train a kid would be that if you can pee, you'll get a star, and the star is a physical reward that helps reinforce the behavior. What does it look like for adults? Cutting is a good example of teleological mode. I can't use my mind to feel something, so I'm going to use something physical to deal with something in my mind. That's the teleological mode. 

Pretend Mode 

Dr. Carla Sharp: Finally, pretend mode is also developmentally appropriate. That is when we start pretending and we're aware that we're pretending. And for adult clients, they are not aware that they're in pretend mode. It's when there is a sense that they're not authentically relating to whatever they are telling you. A good example is a woman talking about something horrible happening to her, but she has a very flat affect. That means that she's not connecting with the emotion in it. She cannot say, "This was very shameful,” or, “I'm enraged." Whatever the feeling is, she's not connecting with that feeling, and that means that she's in pretend mode. Again, pretend mode is developmentally appropriate at certain ages. Kids play pretend, and it's got an inauthentic quality when they do that. So we called them pre-mentalizing modes originally because they were developmentally appropriate at a particular time in development. But in adults, they are called non-mentalizing modes because mentalizing has stopped. As a mentalizing therapist, you try and get your client out of those three modes whenever they come up, and there are different strategies for each one of them. 

Abigail Rasol: Would you say that one of your chief responsibilities, at least in the beginning of a session when you're listening to how the client's narrative of the day is playing out, is to identify which of those pre-mentalizing modes they're falling into and then work from there? 

Dr. Carla Sharp: I always tell supervisees to not get hung up on which of the three mentalizing modes. They do have different interventions, but I find that especially at the beginning of learning MBT, getting hung up on exactly which mentalizing mode, I don't think it's a prerequisite to know which one.. Because your first step as an MBT therapist, when someone stops, you just need to realize when someone stopped mentalizing. 

Identifying Pre-Mentalizing Modes 

Abigail Rasol: And how do you realize that? What are some of the telltale signs? 

Dr. Carla Sharp: You realize that when it sounds like the person is saying something that is not creating an understanding of their own experience or someone else's experience. Let's say, for instance, blaming. You're talking about what happened with your mom, and then you use a derogatory term, or you say, “She's just like that. There's nothing that can be done." So I think anything that closes up dialogue or a reasonable reflective understanding of what's going on would be a non-mentalizing response. With psychic equivalence, people get upset. And with teleological mode, they just shut it down. So it's got to do with the arousal in the room too. And with pretend mode, the therapist feels bored. The therapist checks out and sort of starts realizing that they haven't been present in the room. So we do use the therapist's response, and you're checking in with yourself, you're checking in with your own affect. Where am I? Am I being sucked into a psychic equivalence situation here? Am I being asked to do something that would fix the situation for teleological mode, or am I just drifting off in a sort of pretend mode, intellectualizing, theorizing about things that actually don't make a whole lot of sense? So first thing is just to determine whether mentalizing is happening or is mentalizing not happening. And I haven't talked a lot about this, but also if you get upset as the therapist, sometimes that's also a good sign that not necessarily the patient's mentalizing has fallen apart, but your own mentalizing has fallen apart. If you start feeling upset about something, or you feel put upon, or you feel words are put in your mouth that you didn't say, you also need to stop it, because then your mentalizing has gone offline. And then you have to say,"Hang on, something's happening between us, and I just need a moment to gather myself, what did you say just then?" And ask them to repeat it, to clarify, to give yourself some time to mentalize yourself in the moment. I hope that makes sense. 

Uncertainty: The Mentalizing Stance 

Abigail Rasol: Absolutely. And you touched on an important point that I had a question about as well in terms of where the therapist and the therapist as a person fits into this whole picture. And I know that, at least from what I've read, a big part of the therapist's role in MBT is both to model this mentalizing stance and also to come from a more not knowing place. And I'm curious both how you model that in practice and also why that is so important in a successful MBT treatment? 

Dr. Carla Sharp: A mentalizing stance is a stance of uncertainty. It sounds counterintuitive because one feels really vulnerable going through life having to tolerate uncertainty. But I would say that the mark of a very high-functioning human being is someone who can tolerate uncertainty and who is comfortable in that uncertain place, because that gives us flexibility to adapt and resilience to withstand what life is going to throw at you. So how does one model a not-knowing, curious stance? By truly not knowing. This is the hardest thing for therapists to learn, especially more experienced ones. I like to use the metaphor of a fingerprint. Every single human being on this earth has a different fingerprint, and I think it's an extraordinary idea that none of our internal experiences are exactly like anybody else's. We just cannot assume or even really imagine the internal world of another person. But we can ask and ask again, and in that process we communicate a desire to know what it feels like to be in your skin. In that process, the person feels understood, recognized, and heard. It is in slowing down and really getting the full picture that the client begins to feel this person is actually really wanting to know me. And through that, they begin to build the serve and return that they can then begin to generalize to other people. 

Signs of Progress: Growth of Mentalizing Capacity 

Abigail Rasol: How can a therapist that is working with MBT tell that their client's independent capacity to mentalize has strengthened to a point that they are able to function and go out into the real world outside of therapy in an adaptive and healthy way? 

Dr. Carla Sharp: One, you begin to see evidence of mentalizing capacity in the session. They are able to mentalize themselves better, they're able to slow down, they can manage their own arousal better in the session. They can also mentalize you. It's a beautiful thing when a client begins to mentalize you in an authentic way. So that's number one, evidence of mentalizing capacity in the session. Two, they are busy generalizing and mentalizing outside the session. They begin to tell you how they're able to slow down in interactions with other people. And then number three, their symptoms get better. They stop self-harming. They don't have suicidal thoughts. They don't have big emotional blowouts with people or themselves. They will just be better. 

Abigail Rasol: I think that's a great note to close on. Thank you so much for joining us, Dr. Sharp. This was a really enlightening session, I think, especially for a lot of folks who have not heard about MBT. 

Dr. Carla Sharp: My pleasure. Thank you, Abi. 

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References 

Allen, J. G., Fonagy, P., & Bateman, A. W. (2008). Mentalizing in clinical practice. American Psychiatric Publishing. 

Bateman, A. W., Constantinou, M. P., Fonagy, P., & Holzer, S. (2021). Eight-year prospective follow-up of mentalization-based treatment versus structured clinical management for people with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 12(4), 291–299. https://doi.org/10.1037/per0000422 

Bateman, A. W., & Fonagy, P. (2004). Mentalization-based treatment of BPD. Journal of Personality Disorders, 18(1), 36–51. 

Bateman, A. W., & Fonagy, P. (2006). Mentalization-based treatment for borderline personality disorder: A practical guide. Oxford University Press. 

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Fonagy, P., & Bateman, A. W. (2008). The development of borderline personality disorder—A mentalizing model. Journal of Personality Disorders, 22(1), 4–21. 

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Sharp, C., & Fonagy, P. (2008). The parent's capacity to treat the child as a psychological agent: Constructs, measures and implications for developmental psychopathology. Social Development, 17(3), 737–754. 

Sharp, C., & Fonagy, P. (2015). Practitioner review: Borderline personality disorder in adolescence—Recent conceptualization, intervention, and implications for clinical practice. Journal of Child Psychology and Psychiatry, 56(12), 1266–1288. https://doi.org/10.1111/jcpp.12449 

Sharp, C., & Kalpakci, A. (2015). Mentalization in borderline personality disorder: From bench to bedside. Personality Disorders: Theory, Research, and Treatment, 6(4), 347–355. https://doi.org/10.1037/per0000106 

Sharp, C., & Rossouw, T. (2024). Mentalization-based treatment for adolescents (MBT-A). Psychodynamic Psychiatry, 52(4), 542–562. https://doi.org/10.1521/pdps.2024.52.4.542 

Sharp, C., Venta, A., Vanwoerden, S., Schramm, A., Ha, C., Newlin, E., Reddy, R., & Fonagy, P. (2016). First empirical evaluation of the link between attachment, social cognition and borderline features in adolescents. Comprehensive Psychiatry, 64, 4–11. https://doi.org/10.1016/j.comppsych.2015.07.008 

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Quek, J., Melvin, G. A., Bennett, C., Gordon, M. S., Saeedi, N., & Newman, L. K. (2019). Mentalization in adolescents with borderline personality disorder: A comparison with healthy controls. Journal of Personality Disorders, 33(2), 145–163. 

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The Carlat CME Institute is accredited by the ACCME to provide continuing medical education for physicians. Carlat CME Institute maintains responsibility for this program and its content. Carlat CME Institute designates this enduring material educational activity for a maximum of one half (.50) AMA PRA Category 1 Credits^TM. Physicians or psychologists should claim credit commensurate only with the extent of their participation in the activity. This activity is available for CME credit for a defined period based on the date of publication, in accordance with accreditation requirements. The post-test must be completed prior to the expiration date; after that time, CME credit will no longer be available.