Mentalization-Based Narrative Exposure Therapy for Complex Interpersonal Trauma (MBNET)
Mentalization-Based Narrative Exposure Therapy for Complex Interpersonal Trauma (MBNET) is a structured, flexible treatment approach for problems related to having experienced complex interpersonal trauma, developed by myself in collaboration with Dr. Kae Hixson, LPC.
This is the method I use to process trauma with clients on my personal caseload, and that I train therapists in through The Kiln.
If you are a potential client hoping to get a feel for what it’s like to do MBNET, probably the best way is by listening to this episode of The Kiln podcast (also available on podcast streaming platforms) that Dr. Hixson and I recorded specifically for clients.
The Typical MBNET Client
…has experienced repeated, interrelated forms of interpersonal trauma…
…beginning in childhood…
…in the context of significant attachment relationships.
Single event traumas and interpersonal traumas taking place outside of attachment relationships are also appropriate MBNET targets, and for clients who have experienced only those forms of trauma, the MBNET process can be easily adapted.
“This approach offers an effective method for processing interpersonal trauma that I feel my previous understanding and methods were missing and unable to satisfactorily address.”
- MBNET trainee
The Method
In the MBNET framework, the client, with the assistance of the therapist, constructs a chronological narrative of their life story with a focus on interpersonally traumatic experiences.
Built on a foundation of evidence-based exposure therapy principles, working directly with clients’ trauma memories (imaginal exposure) is the backbone of MBNET. What makes MBNET different from other exposure therapy models is its focus on mentalization as the driver of interpersonal traumatization - a core concept from Dr. David Schnarch’s groundbreaking work on the role of mentalization in interpersonal trauma and his coining of the term “traumatic mind-mapping.”
The mentalization-based lens enables MBNET therapists to focus the exposure process on the moments in clients’ interpersonally traumatizing memories that had the greatest impact - something that other exposure therapy models do not equip therapists to do. This maximizes the effectiveness of the exposure process for people who have experienced complex trauma, one of our specific goals in the creation of MBNET.
Another unique aspect of MBNET is its emphasis on coherence.
Clients who have experienced complex trauma typically demonstrate fragmented, disorganized traumatic memory content as well as significant incongruities between their accounts of specific memories and their interpretations of their autobiographical experiences as a whole. Throughout the process of MBNET, clients not only transform their fragmented representations of traumatic experiences into a cohesive set of narratives with internal coherence, but also reconstruct their pre-existing broader autobiographical narrative into one that reflects the truth of what happened to them and is consistent with the actual content of their memories, leading to a cascade of beneficial outcomes.
While structured, MBNET is not a
one-size-fits-all manualized approach.
This modality contains defined points of flexibility that guide clinicians in responding to clients’ unique needs and common patterns seen in clients with a history of complex interpersonal trauma that require deviations from a typical linear protocol. MBNET accounts for the diverse array of presentations that may present challenges for therapists working with complex trauma, such as especially sticky trauma-related emotions and beliefs, clients whose memories of traumatic experiences are hazy or scant, clients with a seemingly endless number of interrelated traumatic memories, and clients that struggle to integrate or contextualize content from their memories into their greater understanding of themselves. MBNET provides practical tools for achieving successful outcomes in these scenarios.
During the process of MBNET, we typically see a dramatic improvement in client functioning.
We expect to see clients completing therapy with:
Significant reduction in trauma-related intrusive symptoms, and often in symptoms of other DSM diagnoses they may have that have been exacerbated by traumatization
Resolution of trauma-related beliefs, emotions and cognitions
Better functioning in significant relationships (this is often the area in which we see the most striking improvements, and the area that clients report makes the biggest impact on their quality of life)
A congruent, coherent autobiographical narrative that contributes to the achievement of “earned secure” attachment style
Meaningful increases in client self-efficacy, positive self-concept, and sense of aliveness
On a personal level, developing MBNET is the professional accomplishment of which I am the most proud.
Helping my clients get free of the lifelong impacts of trauma, and training other therapists to help their clients do the same using this method, is one of the greatest joys and privileges of my life. It is in practicing MBNET that I most reliably experience awe.
