Abstract
The aim of this study was to examine preliminary evidence of the validity of the Trauma Reflective Functioning Scale and to investigate reflective functioning (RF) and attachment in pregnant women with histories of trauma, with a particular focus on the capacity to mentalize regarding trauma and its implications for adaptation to pregnancy and couple functioning. The Adult Attachment Interview was used to assess attachment, unresolved trauma and mentalization (measured as RF) regarding relationships with attachment figures (RF-G) and trauma (RF-T) in 100 pregnant women with histories of abuse and neglect. The majority (63%) of women had insecure attachment states of mind and approximately half were unresolved regarding trauma. Furthermore, the majority of women manifested deficits specific to RF-T. Their RF-T was significantly lower than their RF-G; the findings indicate that women with histories of childhood abuse and neglect do not manifest a generic inhibition of reflectiveness, but a collapse of mentalization specific to trauma. Low RF-T, indicative of difficulty in considering traumatic experiences in mental state terms, was associated with difficulty in investment in the pregnancy and lack of positive feelings about the baby and motherhood. In addition, low RF-T was also associated with difficulties in intimate relationships. Results of a regression analysis with RF indicated that RF-T was the best predictor of investment in pregnancy and couple functioning. In sum, the study provides preliminary evidence that RF-T can be reliably measured and is a valid construct that has potential usefulness for research and clinical practice. It highlights the importance of mentalization specifically about trauma and suggests that it is not the experience of trauma per se, but the absence of mentalization regarding trauma that is associated with difficulties in close relationships and in making the transition to parenthood.
Highlights
CHARACTERISTICS OF CHILDHOOD ABUSE AND NEGLECT All the women reported some type of maltreatment in the Childhood Experience of Care and Abuse (CECA) interview
There was no association between the dose of maltreatment and reflective functioning (RF)-T [β = 0.07, t(35) = 0.48, p = 0.64] or relationships with attachment figures (RF-G) [β = −0.04, t(55) = −0.43, p = 0.67] in the women in this sample
We expected that women with childhood abuse or neglect (CA&N) histories would manifest significant deficits in mentalization about traumatic experiences compared to mentalization about attachment relationships
Summary
The transition to motherhood is recognized as being an important developmental period of psychic transformation and potential reworking of unresolved issues, such as childhood abuse or neglect (CA&N), that might have an impact on the future role of parent (Slade et al, 2009; Raphael-Leff, 2010; Ammaniti et al, 2013). Fraiberg et al (1975) evocatively referred to these unresolved traumatic experiences as “ghosts in the nursery.” In spite of the growing body of research on the impact of abuse and neglect on infant attachment, there is surprisingly little research regarding the long-term implications of CA&N for adult attachment and reflective functioning (RF) to inform prospective parents and mental health professionals. Whereas Fraiberg et al (1975) conceptualized “ghosts in the nursery” in terms of the voices of the past and a haunting presence left by trauma, Fonagy (1993) viewed the concept as an absence of mentalization about emotionally painful experiences of fear and helplessness that makes the parent vulnerable to identifying with the aggressor rather than responding to the distress of the infant. This absence of mentalization was conceptualized as a deficit in mentalization about attachment relationships. It remains important to clarify whether mentalization capacities about attachment relationships are compromised globally following CA&N or whether deficits in mentalization are specific to www.frontiersin.org
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