Social mentalizing informs the theory and practice of mentalization-based treatment for adolescents (MBT-A). Adolescence is, among other things, a time for establishing a self-identity and learning about how to interact effectively with a peer group. A focus on balancing mentalizing in peer and family interactions is crucial, with special attention to hypermentalizing and the alien self. Involvement of families and schools in treatment is necessary. MBT-A includes individual, family, and group therapy, and its overall aim is to develop the patient’s independence. Crucial aspects of achieving this goal include building up relational stability and supporting the patient’s sense of agency and autonomy within their relational networks.

MBT for avoidant personality disorder (AvPD) targets hypermentalizing and hypomentalizing modes along with the problems associated with mentalizing problems found in the polarities of self/other mentalizing which become apparent when the patient engages with their social world. Reducing overuse of the self is central to treatment. The experience of shame is activated during social interaction, and therefore avoidance of social situations maintains a sense of personal comfort and safety. The chapter discusses ways to help the patient to overcome this. Clinician counter-responsiveness, which often relates to feelings of helplessness and hopelessness, can also interfere with engagement and treatment, as the patient may avoid interaction in therapy.