Journal of Contemporary Psychotherapy

, Volume 46, Issue 4, pp 217–225 | Cite as

Mentalization-Based Treatment in Clinical High-Risk for Psychosis: A Rationale and Clinical Illustration

  • Martin Debbané
  • Jallal Benmiloud
  • George Salaminios
  • Alessandra Solida-Tozzi
  • Marco Armando
  • Peter Fonagy
  • Anthony Bateman
Original Paper


Developmental clinical research in recent years has highlighted the value treating psychotic disorders at the earliest stage to reduce long-term morbidity. It is now suggested that treatment during the clinical high risk states (CHR), preceding by 1–4 years the onset of psychotic disorders, may delay or prevent the onset of psychosis, and contribute to a more positive prognosis. In this article, we wish to provide a rationale and clinical illustration of mentalization-based treatment (MBT) as an indicated preventive treatment for CHR. We will first review the notion of high-risk for psychosis, providing a trans-theoretical developmental framework for conceptualizing the clinical progression from sub-clinical towards clinical psychotic states. Second, we address the commonalities and differences between the constructs of mentalization and metacognition, and discuss their relevance in preventive psychotherapeutic treatment for CHR. Thirdly, we provide a clinical illustration of MBT to emerging psychosis. Finally, we conclude by discussing the specific contributions of MBT approach in youths at CHR, and the necessary research for evaluating its relevance in the context of risk for developing psychosis.


Mentalizing Schizophrenia Schizotypy Psychodynamic Prevention 



We would like to thank Deborah Badoud, Yasmina Lakeshaft Lachat, and Larisa Morosan for their help on the manuscript.


This work was funded by a Swiss National Science Foundation Grant (100019-159440) awarded to M.D.

Compliance with Ethical standards

Conflict of interest

None of the authors declare any conflict of interest.

Informed Consent

The patient described in this manuscript gave her full consent after reading the excerpts of text relating to her treatment.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Martin Debbané
    • 1
    • 2
    • 3
  • Jallal Benmiloud
    • 2
  • George Salaminios
    • 3
  • Alessandra Solida-Tozzi
    • 5
  • Marco Armando
    • 2
  • Peter Fonagy
    • 3
    • 4
  • Anthony Bateman
    • 3
    • 4
  1. 1.Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational SciencesUniversity of GenevaGenevaSwitzerland
  2. 2.Office Médico-Pédagogique Research Unit, Department of PsychiatryUniversity of Geneva School of MedicineGenevaSwitzerland
  3. 3.Research Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
  4. 4.Anna Freud CentreLondonUK
  5. 5.Department of Psychiatry, Service of General PsychiatryLausanne University Hospital (CHUV)LausanneSwitzerland

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