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Mentalising Change — MRCPsych Paper B MCQ

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ModeratePsychotherapyMentalising ChangeMRCPsych Paper B

A patient with borderline personality disorder is receiving a structured psychodynamic psychotherapy. Initially, she was certain that a friend's delayed reply meant deliberate rejection. She later recognises that her fear may shape this interpretation, considers several possible intentions and feelings that could explain the friend's behaviour, and remains curious rather than deciding which interpretation is certainly correct. Which therapeutic change mechanism is most specifically demonstrated?

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Correct answer: A — Improved mentalising capacity

The correct answer is **B, improved mentalising capacity**. Mentalising is the ability to understand behaviour in terms of mental states, including thoughts, emotions, beliefs and intentions, while recognising that another person's mind cannot be known with certainty. The patient's increased curiosity, awareness that her own fear affects interpretation, and ability to hold several perspectives are characteristic targets of mentalisation-based treatment. Cognitive restructuring is the closest distractor, but it usually involves evaluating and modifying the content or accuracy of dysfunctional thoughts; the emphasis here is on reflective understanding of self and other rather than determining the objectively correct interpretation. Behavioural activation increases engagement with rewarding activity, exposure targets learned fear and avoidance, and free association facilitates relatively unrestricted expression of thoughts in psychoanalytic work.

Reference: National Collaborating Centre for Mental Health. Borderline Personality Disorder: The NICE Guideline, section 5, Mentalisation-based therapy. NICE CG78, 2009; guideline last reviewed 30 July 2024. https://www.nice.org.uk/guidance/cg78/evidence/full-guideline-pdf-242147197