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A French psychoanalyst called Pierre Marty first wrote about the concept of mentalisation in the 1960s (Marty, 1991). However, the work of Peter Fonagy, Anthony Bateman, and Margaret Target led to our current understanding of mentalisation.ÌýTheir work aimed to develop our understanding of processes of change in child psychoanalysis (Fonagy & Target, 1998) and mentalisation-based treatment for adults living with complex emotional needs, often described by services as a diagnosis of ‘borderline personality disorder’ (Bateman & Fonagy, 2004).Ìý

Mentalisation-based treatment is now a well-evidenced manualised adult therapy (Malda-Castillo et al., 2019), with the first trial currently under way with children (Midgley et al., 2023). Mentalisation-based treatment has had a transformative impact on clinical practice worldwide, withÌýnearly 15,000Ìýpractitioners in 22 countries now using mentalisation-based approaches to support better mental health for adults and children (University College London, 2024).Ìý

What is mentalisation-based art therapy?ÌýÌý

Mentalisation-based art therapy combines art therapy with mentalisation-based treatment principles in a structured, evidence-based approach. Combining mentalisation principles with artmaking can help clients externalise emotions and mental states.ÌýÌý

Unlike some traditional approachesÌýto art therapy that have been referred to as ‘non-directive’ÌýwhereÌýthe therapist might take a more passive stance (McNeilly, 1983), this approach is actively collaborative. The art therapist and client work together using artwork to think about thoughts and feelings.Ìý

Bringing mentalisation-based treatment and art therapy together has beenÌýpublicly supportedÌýby Peter Fonagy:Ìý

Over the past twenty years, the literature on mentalisation-based art therapy has been growing.ÌýNeilÌýSpringhamÌýhas been a pioneer in this field, developing foundational work with adults that has influenced practice across the professionÌý(SpringhamÌýet al., 2012, 2014, 2017, 2018;ÌýSpringham, 2019)ÌýDevelopments include practice with adultsÌý(Franks & Whitaker, 2007; Havsteen-Franklin & Camarena Altamirano, 2015; Thorne, 2016; Chilvers et al., 2021; Schwaiger & Williamson, 2021) and more recently with children and young people (Moore & Marder, 2019; McDonald et al., 2024), alongside general frameworks for practice (Havsteen-Franklin, 2016, 2019) and theoretical development (Czamanski-Cohen & Weihs, 2016; Verfaille, 2016;ÌýSpringhamÌý& Huet, 2018; McDonald, 2022).Ìý

Within art therapy, mentalisation theory has been further developed through two key frameworks. TheÌýbodymindÌýmodel (Czamanski-Cohen & Weihs, 2016) explains how artmaking and creative expression makes internal states visible and discussable. The ostensive communication theory of art therapy (SpringhamÌý& Huet, 2018) describes how therapists use deliberate, marked communication, including through art, to signal intention and invite joint attention.Ìý

Why mentalisation-based art therapy is relevant todayÌý

Many people struggle to pause and think when emotions run high. WhetherÌýit’sÌýchildren becoming overwhelmed in classrooms or adults finding their relationships breaking down, responding to stress by ‘acting out’ rather than ‘thinking through’ is a common challenge. Recent studies also suggest that childhood maltreatment is associated with lower mentalising capacity (Yang & Huang, 2024).Ìý

For children, mentalisation-based art therapy fills a crucial gap. Many young people struggle to articulate complex feelings into words, especially thoseÌýwho’veÌýexperienced difficult life events. Children can also become overwhelmed by the very act of discussing their emotions. Art offers a familiar, non-threatening medium that children naturally engage with.Ìý

There is growing recognition of the need for therapeutic support in educational settings, with art therapists increasingly working in schools. However, until recently thereÌýweren’tÌýmany structured, evidence-based approaches specifically designed for this context.Ìý

For adults living with complex emotional needs, the combination of emotional expression through art and structured reflection offers a meaningful opportunity to see things from different perspectives. The approach recognises that intense emotions can temporarily overwhelm our thinking and provides practical tools for developing the ability to step back and considerÌýwhat’sÌýhappening internally. Developing these reflective skills can support emotional wellbeing when navigating life’s challenges.Ìý

Mentalisation-based art therapy in different contextsÌý

The approach has now been adapted for different populations and settings.Ìý

Alex’s research focuses on art therapy with primary school children experiencing social,ÌýemotionalÌýand mental health difficulties (McDonald & Drey, 2018; McDonald et al., 2019; McDonald &ÌýHolttum, 2020; McDonald, 2022; McDonald et al., 2024). Recognising that children’s capacity to mentalise is still developing, sessions combine artmaking with structured elements like ‘detective work’, where the child and art therapist look for clues about thoughts and feelings in the artworks, and use child-friendly tools like art therapy journals.Ìý

SamanthaÌýrunsÌýmentalisation-based art therapy groups in NHS settings for adults with complex emotional needs. Her groups provide what participants describe as a ‘training ground’ for practising mentalising skills in a supportive environment where intense emotions can be explored safely and with curiosity (Chilvers et al., 2021).Ìý

What makes both approaches distinct is the active, structured framework. Rather than waiting for insights to emerge, therapists actively use specific techniques, photography, journalling and collaborative reflection to help people develop practical skills to better understand their own and others’ thoughts, feelings and intentions. Art therapists are well positioned for this work, already practised at helping people to use creative means to express what may feel inexpressible.Ìý

How mentalisation-based art therapy can helpÌý– what children, teachers and adults sayÌýÌý

Across different settings and age groups, mentalisation-based art therapy is making a difference to people’s lives.ÌýÌý

TeachersÌýdescribe how mentalisation-based art therapy helped children developÌýtheirÌýÌýconfidenceÌýandÌýcapacity to understand and manage their emotions:Ìý

Children in primary schoolsÌýdescribe how mentalisation-based art therapy helped them feel safer and calmer:Ìý

Adults in mental health servicesÌýdescribe how mentalisation-based art therapy helped themÌýmakeÌýlife-changing shifts in their capacity toÌýexpress themselves and think things through:Ìý

Moving forwardÌý

Mentalisation-based art therapy is showing promising results across different settings. By combining artmaking with structured approaches to understanding mental states, it offers people,Ìýwhether children or adults,Ìýpractical pathways to better understand themselves and others, manage difficult emotions, and build stronger relationships.Ìý

For art therapists,ÌýwhileÌýthe evidence-base is growing,Ìýit provides frameworks that are both theoretically grounded and creatively flexible, adapting to different contexts whileÌýmaintainingÌýthe creative heart of art therapy.ÌýÌý

ReferencesÌý

Bateman, A., & Fonagy, P. (2004).ÌýPsychotherapy for borderline personality disorder: Mentalization-based treatment. Oxford University Press.Ìý

Chilvers, S., Chesterman, N., & Lim, A. (2021). ÌýInternational Journal of Art Therapy

Czamanski-Cohen, J., & Weihs, K. L. (2016). .ÌýThe Arts in Psychotherapy

Fonagy, P. (2012). International Journal of Art TherapyÌý

Fonagy, P., & Target, M. (1998). , Psychoanalytic Dialogues

Franks, M., & Whitaker, R. (2007). , International Journal of Art Therapy

Havsteen-Franklin, D. (2016). Mentalization-based art psychotherapy. In J. A. Rubin (Ed.),ÌýApproaches to Art Therapy (3rd ed., pp. 144-163). Routledge

Havsteen-Franklin, D. (2019). Mentalization-based creative arts therapies. In A. W. Bateman & P. Fonagy (Eds.),ÌýHandbook of mentalizing in mental health practiceÌý(2nd ed., pp. 197-212). American Psychiatric Association Publishing.Ìý

Havsteen-Franklin, D., & Camarena Altamirano, J. (2015). , International Journal of Art Therapy

Malda-Castillo, J., Browne, C., & Perez-Algorta, G. (2019). , Psychology and Psychotherapy: Theory, Research and Practice

Marty, P. (1991).ÌýMentalisation et psychosomatique.ÌýLaboratoireÌýDelagrange.Ìý

McDonald, A. (2022). .ÌýThe Arts in Psychotherapy

McDonald, A., & Drey, N. S. J. (2018). .ÌýInternational Journal of Art Therapy: Inscape

McDonald, A., & Holttum, S. (2020). , International Journal of Art Therapy

McDonald, A., Holttum, S., & Drey, N. S. J. (2019). International Journal of Art Therapy

McDonald, A., Kavermann, S., Holttum, S., Lloyd, B., Zubala, A., Bourne, J., & Hackett, S. S. (2024). , International Journal of Art Therapy

McNeilly, G. (1983). ÌýThe Arts in Psychotherapy

Midgley, N., Mortimer, R., Carter, M., Casey, P., Coffman, L.,ÌýEdbrooke-Childs, J., Edridge, C., Fonagy, P., Gomes, M., Kapoor, A., Marks, S., Martin, P.,ÌýMoltrecht, B., Morris, E.,ÌýPokorna, N., & McFarquhar, T. (2023). , PLOS ONE

Moore, K., & Marder, K. (2019).ÌýMentalizing in group art therapy:ÌýInterventions for emerging adults. Jessica Kingsley Publishers.ÌýÌý

Schwaiger, T., & Williamson, E. (2021). , The Arts in Psychotherapy

Springham, N. (2019). Mentalisation-based art therapy with personality disorder. In A. W. Bateman & P. Fonagy (Eds.),ÌýHandbook of mentalizing in mental health practiceÌý(2nd ed., pp. 181-195). American Psychiatric Association Publishing.Ìý

Springham, N., & Camic, P. M. (2017). , International Journal of Art TherapyÌý

Springham, N., Findlay, D., Woods, A., & Harris, J. (2012). ÌýInternational Journal of Art Therapy

Springham, N., & Huet, V. (2018). , Art Therapy

Springham, N., Thorne, D., & Brooker, J. (2014). , International Journal of Art Therapy

Thorne, D. (2016). Portrait of self and other: Developing a mentalization-focused approach to art therapy within a personality disorder service. In V. Huet (Ed.),ÌýTime-Limited Art PsychotherapyÌý(pp. 92-118). Routledge.Ìý

University College London. (2024). Ìý

Verfaille, M. (2016).ÌýMentalizing in arts therapies.ÌýKarnacÌýBooks.Ìý

Yang, L., & Huang, M. (2024). .ÌýChild Abuse & Neglect