ISTDP Meets Mentalization: Treating Fragility

ISTDP Meets Mentalization: Working with Fragility

Overview

In this workshop, we explore how the principles of Mentalization-Based Treatment (MBT) can enrich and stabilize work with fragile patients in Intensive Short-Term Dynamic Psychotherapy (ISTDP).

Fragile patients often experience emotional flooding, dissociation, or cognitive collapse when affect rises too quickly. While ISTDP offers powerful tools for mobilizing emotion and dismantling defenses, therapists can sometimes miss the subtle signals that mentalization has broken down. Integrating a mentalizing stance allows us to slow down, restore reflection, and re-establish a sense of safety and connection—creating the conditions where deep emotional work becomes possible.

This workshop bridges the emotional immediacy of ISTDP with the reflective depth of MBT, offering a practical framework for maintaining contact and attunement with fragile patients.

Led by Javier, an accredited supervisor and trainer in both MBT and ISTDP, this event provides a rare opportunity to learn from a clinician who works fluently across both models.

Learning Objectives

By the end of this workshop, participants will be able to:

1. Identify markers of fragility and recognize when a patient’s capacity for mentalization has broken down.
2. Integrate MBT principles into ISTDP to support stability and reflective functioning during emotional activation.
3. Use a mentalizing stance to repair therapeutic ruptures and maintain the patient’s sense of agency and safety.
4. Formulate fragility within the ISTDP framework, linking defensive structure, anxiety pathways, and mentalizing capacity.
5. Develop strategies for balancing emotional intensity with reflective awareness in fragile-spectrum work.