A Framework for MBT Formulations: The Narrative Formulation and MBT Passport

Mentalization-based treatment (MBT) has been developed to treat people with complex presentations who may have diagnoses of personality disorder. Whilst psychological formulation is deemed central to the approach, MBT has no standardised approach to formulation. This article therefore proposes a diagrammatic formulation (the “MBT passport”), the elements of which can also be used to construct a narrative MBT formulation. Two fictional case studies exemplify the approach. We consider factors around co-production of MBT formulations and the use of the MBT Passport to manage ruptures within therapy. Common challenges are a therapist/client reluctance to share in a group, that formulations are overly focused on the past to the exclusion of the present, and that formulations are delivered to (rather than ‘owned by’) the client. Processes to mitigate or remedy these situations are suggested.