Parental Reflective Functioning Research Articles

PATERNAL AND MATERNAL REFLECTIVE FUNCTIONING IN THE WESTERN AUSTRALIAN PEEL CHILD HEALTH STUDY.

While past research on the care of infants has been mostly with mothers, in recent times there has been a renewed attention to the father-infant relationship. This study examined differences between mother and father parental reflective functioning (PRF) or parental mentalizing; that is, the parental capacity to reason about their own and their children's behaviors by taking into consideration intentional mental states. Data were collected from 120 couples with a 1-year-old child who were participants in the West Australian Peel Child Health Study. Parental mentalizing was assessed using the Parental Reflective Functioning Questionnaire (PRFQ; Luyten, Mayes, Nijssens, & Fonagy, ). Results showed that mother and father mentalizing with their children was independent and that mothers scored slightly higher levels of mentalizing than did fathers. Paternal mentalizing was weakly associated with family income and father education, and was more strongly associated with family functioning than with maternal mentalizing. Implications for theorizing on PRF and fatherhood more generally are discussed.

The importance of parental verbal and embodied mentalizing in shaping parental experiences of stress and coparenting

Parental mentalizing—recognizing that children are separate psychological entities, who have their own thoughts, wishes, and intentions that motivate their behaviors—is traditionally considered a verbal, linguistic capacity. This paper aimed to examine the relation between parental verbal mentalizing (parental reflective function; PRF) and its nonverbal form—parental embodied mentalizing (PEM)—and how both constructs contribute to parents’ subjective experience of parenting, namely parental stress and coparental alliance. 68 mothers and their three-months-old babies were observed to assess PEM, interviewed to code PRF, and completed self-reports of coparental alliance and parental stress. PEM was found to be positively correlated with PRF. Mediation analyses revealed that higher PEM, but not PRF, was associated with lower parental stress, mediated by positive reports of coparental alliance. The findings support adopting a multifaceted approach when studying parental mentalizing, both in terms of assessing parental mentalizing beyond its verbal expressions to include also embodied aspects, as well as investigating its impact beyond infant development to include the familial context within it operates. Conceptual, empirical and clinical implications are discussed.

Parental reflective functioning as a moderator of child internalizing difficulties in the context of child sexual abuse

The objective was to examine pathways from child sexual abuse (CSA) and maternal mentalizing to child internalizing and externalizing difficulties and to test a model of MRF as a moderator of the relationships between CSA and child difficulties. The sample was comprised of 154 mothers and children aged 2–12 where 64 children had experienced CSA. To assess parental mentalizing the Parental Development Interview was rated with the Parental Reflective Functioning Scale. Child internalizing and externalizing difficulties were assessed with the Child Behavior Checklist (CBCL). Results indicate that there were significant inverse relationships between maternal mentalizing and child internalizing and externalizing difficulties. When maternal mentalizing was considered together with CSA, only maternal mentalizing was a significant predictor of child difficulties. Furthermore, maternal mentalizing moderated the relationship between CSA and child internalizing difficulties. These findings provide evidence of the importance of the parents’ mentalizing stance for psychiatric symptoms of children aged 2–12, as well as children's recovery from CSA. The clinical implications of the findings are discussed.

The parental reflective functioning questionnaire: Development and preliminary validation.

This paper reports on three studies on the development and validation of the Parental Reflective Functioning Questionnaire (PRFQ), a brief, multidimensional self-report measure that assesses parental reflective functioning or mentalizing, that is, the capacity to treat the infant as a psychological agent. Study 1 investigated the factor structure, reliability, and relationships of the PRFQ with demographic features, symptomatic distress, attachment dimensions, and emotional availability in a socially diverse sample of 299 mothers of a child aged 0–3. In Study 2, the factorial invariance of the PRFQ in mothers and fathers was investigated in a sample of 153 first-time parents, and relationships with demographic features, symptomatic distress, attachment dimensions, and parenting stress were investigated. Study 3 investigated the relationship between the PRFQ and infant attachment classification as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. Exploratory and confirmatory factor analyses suggested three theoretically consistent factors assessing pre-mentalizing modes, certainty about the mental states of the infant, and interest and curiosity in the mental states of the infant. These factors were generally related in theoretically expected ways to parental attachment dimensions, emotional availability, parenting stress, and infant attachment status in the SSP. Yet, at the same time, more research on the PRFQ is needed to further establish its reliability and validity.

Parental Reflective Functioning: Theory, Research, and Clinical Applications

ABSTRACTThis paper reviews recent theoretical, empirical, and clinical work related to parental reflective functioning (PRF) or parental mentalizing. PRF refers to the capacity of the parent to envision his or her child as being motivated by internal mental states such as feelings, wishes, and desires, and to be able to reflect on his or her own internal mental experiences and how they are shaped and changed by interactions with the child. This paper first briefly discusses the historical and theoretical background of this concept and its purported role in child development, with a focus on the development of child attachment, affect regulation, and mentalizing. It then reviews recent thinking and research in four areas: (1) the neurobiology underlying PRF, (2) the multidimensionality of PRF, (3) the relationship between PRF and trauma, and (4) the broader relevance of attention to internal mental states for the development of epistemic trust as the basis of an evolutionary inbuilt capacity for learning from and within social communication. It closes with a brief review of the background of, and empirical evidence supporting, interventions rooted in theoretical considerations concerning the importance of PRF, as well as suggested directions for future research and clinical practice.

Manifestation of Trauma: The Effect of Early Traumatic Experiences and Adult Attachment on Parental Reflective Functioning.

There are many risk factors that make the transition to parenthood difficult, even in the best of circumstances. One such risk factor is the experience of parental childhood trauma, which has the potential to affect the parent/child relationship, both in terms of attachment style parental reflective functioning. This study aims to expand on the line of research concerned with the effects that trauma has once that child transitions into adulthood and into parenthood by looking at the role that the experience of trauma and adult attachment has in relation to parental reflective functioning. This study assessed mothers (N = 125) by using the CTQ (childhood experience of trauma), ECR (adult attachment), and the PRFQ (parental RF). Our study found that in the presence of physical neglect, insecure attachment had a particularly deleterious effect on maternal reflective functioning. This relationship was not as strong in the absence of physical neglect.

Psychodynamic and Neuroscientific Perspectives on Motherhood

ABSTRACTPsychoanalytic perspectives on parenting and child development have been well articulated in the literature. With advances in neuroimaging methods, recent interest has focused on the neural circuits that may support caregiving in human subjects. In this issue, we consider the value of psychodynamic and neuroscientific perspectives as they pertain to the complex but critical transition to motherhood, and the value of this interdisciplinary approach to probing parental reflective functioning and pathways to the intergenerational transmission of trauma.

Trauma and Parenting: Informing Clinical Practice with Recent Research Findings

Post-traumatic stress disorder (PTSD) is a common consequence of interpersonal violence (IPV). Maternal IPV-related PTSD has been shown to interfere with the mothers’ ability to join with their children in mutual emotion regulation, a pre-requisite for the development of self-regulation. Studies have shown that parental reflective functioning (PRF; i.e., the attribution of mental states that may be inferred to motivate interactive behavior) and maternal sensitivity (MS) are protective factors. Both PRF and MS are associated with secure child-parent attachment. The stronger these factors are at baseline, the more they improve the chances of a mother with IPV-PTSD seeking help in order to benefit quickly from both physical and mental health assessment and intervention. Pediatricians should routinely assess the history of IPV in the family environment taking into account the parent-child relationship, through observing parent-child interaction and listening to how the parent talks about her child and other important attachment relationships. Health professionals can learn to support and model PRF with traumatized parents.

Assessing Reflective Parenting in Interaction With School-Aged Children

ABSTRACTThe aim of this study was to examine whether it was possible to develop a reliable and valid assessment of reflective parenting implicit in interaction with school-aged children using an adaptation of the Squiggle paradigm developed by Winnicott (1968) and a manualized coding system (Normandin, Leroux, Ensink, Terradas, & Fonagy, 2015). A total of 158 mother–child dyads participated when children were age 5 to 12. Of this group, 89 children had experienced sexual abuse. Interrater reliability using the manualized coding system was excellent. The factor analysis identified a reflective parenting stance factor, in addition to an affectionate support factor and a negative parenting factor. Furthermore, there was a medium strength relationship between the mother's reflective parenting stance evident in her interactions with her child and parental reflective functioning assessed using the Parent Development Interview (Slade, Aber, Bresgi, Berger, & Kaplan, 2004), suggesting the parental reflective stance is a good indicator of parental reflective functioning in interaction. With regard to parent reports of child internalizing and externalizing behaviors, the reflective parenting stance was the only predictor of internalizing difficulties and a significant predictor of externalizing difficulties in addition to sexual abuse.

Mentalizing Makes Parenting Work: A Review about Parental Reflective Functioning and Clinical Interventions to Improve It.

In the last decade several studies have investigated the role of parental reflective functioning (RF), defined as the parental ability to understand his/her child’s mental states, on the child’s development. Herein, a narrative review on parental RF is presented aimed at (1) presenting an overview of the existing empirical studies, (2) pinpointing unrequited questions, and (3) identifying future research directions. Specifically, the current review focused on (a) the impact of parental RF on the quality of caregiving and the child’s attachment security, (b) the effect of parental RF on the child’s emotion regulation and the child’s RF, (c) maternal RF in women with a history of neglect and abuse, (d) the efficacy of mentalization-based clinical interventions, and (e) the recently developed Parental Reflective Questionnaire. The following terms “maternal RF,” “paternal RF,” “parental RF,” “parental mentalization,” “maternal mentalization,” and “paternal mentalization” were searched in titles, abstracts, and main texts using Medline, Web of Science, and Scopus databases. Next, a search in Mendeley was also conducted. Inclusion criteria comprised original articles if they refer to the RF Scale (Fonagy et al., 1998) and were published in an English language, peer-reviewed journal before July, 2016. According to exclusion criteria, dissertations, qualitative or theoretical papers, and chapters in books were not taken into account. The review includes 47 studies that, taken together, supported the notion that higher parental RF was associated with adequate caregiving and the child’s attachment security, whereas low maternal RF was found in mothers whose children suffered from anxiety disorders, impairment in emotion regulation, and externalizing behaviors. In addition, higher parental RF was associated with better mentalizing abilities in children. However, unexpected findings have emerged from the most recent randomized controlled trials that tested the efficacy of mentalization-based interventions in high risk samples of mothers, raising questions about the suitability of the verbal measures in capturing the mentalizing processes at the root of the parental capacity to be adequately responsive to the child’s emotional needs.

Parental Reflective Functioning Moderates the Relationship Between Difficult Temperament in Infancy and Behavior Problems in Toddlerhood

High levels of infant negative affect are associated with behavior problems in toddlerhood, which in turn are a risk factor for chronic behavior problems throughout childhood, especially in the context of poor parenting and psychosocial risk. Studies suggest that sensitive parenting may buffer temperamental risk in infancy by supporting self-regulation and emotion regulation (Gottman, Katz, & Hooven, 1997). Parental reflective functioning (RF) (Slade, 2005) underlies sensitivity and is a target for early interventions aimed at supporting parenting and child development. In this study, we examine whether RF-that is, the capacity of a parent to put oneself in the mind of the other (child) and see the child's behaviors as driven by his/her mental state-will protect against the effects of infant negative affect on toddler behavior problems after controlling for psychosocial risk.Early Onset of Behavior ProblemsBehavior problems in early childhood may originate from temperamental risk that is exacerbated by other parenting and psychosocial risks. Behavior problems are described in two broad domains-internalizing behavior and externalizing behavior-and each type can follow different developmental trajectories. Internalizing behavior problems have been defined as behaviors directed inward toward the self. Evidence suggests that children with internalizing behavior problems are often identified as being socially withdrawn in interactions with peers and teachers (Eisenberg et al., 2001) and are at risk for later psychopathology, including depression and anxiety. Externalizing behavior problems are defined as problematic behaviors, including hyperactivity and increased levels of aggression, directed toward the external environment (Achenbach, 1992). Some children exhibit internalizing and externalizing disorders simultaneously. One typical trajectory of behavior problems peaks in toddlerhood and decreases throughout preschool (Alink et al., 2006; Hill, Degnan, Calkins, & Keane, 2006; Tremblay, 2004). Whereas some problem behaviors during this period are developmentally appropriate, as many as 25% of young children exhibit clinically significant levels of behavior problems, and a subgroup of these children struggle with chronic behavior problems (Campbell, 1995). It is important to understand factors that predict high and chronic levels of behavior problems in childhood because they are targets for early intervention. Infants with high levels of negative affect may be regarded as showing a difficult temperament and may be at risk for early-onset behavior problems.Infant Temperament and Behavior ProblemsTemperament is involved in personality and behavior (Nigg, 2006). Infant temperament has been described as a biologically engrained pattern of behavior associated with an individual's reactivity and ability to endure new situations, people, and experiences (Rothbart & Derryberry, 1981). Several studies suggest three overarching dimensions of infant and toddler temperament: extroversion-surgency, negative affect, and effortful control (Casalin, Luyten, Vliegen, & Meurs, 2012; Gartstein, Knyazev, & Slobodskaya, 2005; Gartstein & Rothbart, 2003). Casalin and colleagues (2012) found that these dimensions of temperament demonstrated stability over a 1-year period from infancy to toddlerhood. Further, dimensions of infant temperament have been linked to later personality traits and psychopathology. High levels of negative affect, in particular, have been linked to internalizing and externalizing behavior problems in childhood and more serious behavioral and emotional problems over time, including antisocial behavior throughout adulthood (Caspi, Henry, McGee, Moffitt, & Silva, 1995; Egger & Angold, 2006; Eisenberg et al., 2000; Gartstein, Putnam, & Rothbart, 2012; Morris et al., 2002; Rubin, Burgess, Dwyer, & Hastings, 2003). The negative-affect dimension includes negative emotions such as fear, anger, frustration, and sadness (Rothbart & Derryberry, 1981). …

39.3 THE ROLE OF MATERNAL PREMENTALIZING MODES OF FUNCTIONING AND LOW-RANGE REFLECTIVE FUNCTIONING IN THE DEVELOPMENT OF CHILD TRAUMATIC STRESS WITHIN A CONTEXT OF VIOLENCE EXPOSURE

This presentation explores the question of whether the attachment-related measures of prementalizing modes of functioning (PMMF) and/or low parental reflective functioning (PRF) among mothers with histories of interpersonal violence exposure and related PTSD would 1) be associated with a specific pattern of maternal neural activity on fMRI; and 2) predict greater posttraumatic stress symptoms among their children one year after initial assessment.

39.4 EMOTION PROCESSING AND PSYCHOPATHOLOGICAL RISK IN THE PARENTAL BRAIN: PSYCHOSOCIAL INTERVENTION INCREASES ACTIVITY AND DECREASES STRESS

The mother-child relationship, central to social-emotional development, is impaired by trauma exposure and mental illness. Affected mothers are at risk for diminished parenting skills and sensitivity, placing children at risk for negative psychosocial outcomes. Certain neurological functioning, known to support parenting, is also defective with mental illness (including “perception and understanding of others/empathy” and “approach motivation”) and may be treatable. Mom Power is an attachment-based intervention that improves parental reflective functioning and emotion regulation toward reducing depression, posttraumatic stress, and caregiving helplessness. This study contributes to mechanistic understandings of parental brain function in mental health, illness, and intervention.

Parental reflective functioning among mothers with eating disorder symptomatology

ObjectiveReflective Functioning is a vital aspect of parental aptitude and its absence, especially in the presence of psychopathology, can impair attachment. This study sought to clarify the relationship of parental RF among mothers with eating disorder symptomatology. MethodWe assessed 59 mothers for ED symptomatology using the Eating Disorder Examination Questionnaire (EDE-Q) and RF through the Parental Reflective Functioning Questionnaire (PRFQ). Bivariate and multivariate analyses compared PRFQ subscales between symptomatic and asymptomatic mothers, using a clinical cutoff score of 4 on the EDE-Q subscales. RESULTS: Greater weight and shape concerns were found to significantly predict higher RF (p=0.023; p=0.026). DiscussionThis finding could indicate a similar pattern seen among individuals with bulimia nervosa; individuals have higher RF scores, although affect regulation may still be limited. More research is needed with a larger sample to define the relationship between ED symptomatology and RF and identify potential mediators and moderators.

Development and Validation of a Self-Report Measure of Mentalizing: The Reflective Functioning Questionnaire.

Reflective functioning or mentalizing is the capacity to interpret both the self and others in terms of internal mental states such as feelings, wishes, goals, desires, and attitudes. This paper is part of a series of papers outlining the development and psychometric features of a new self-report measure, the Reflective Functioning Questionnaire (RFQ), designed to provide an easy to administer self-report measure of mentalizing. We describe the development and initial validation of the RFQ in three studies. Study 1 focuses on the development of the RFQ, its factor structure and construct validity in a sample of patients with Borderline Personality Disorder (BPD) and Eating Disorder (ED) (n = 108) and normal controls (n = 295). Study 2 aims to replicate these findings in a fresh sample of 129 patients with personality disorder and 281 normal controls. Study 3 addresses the relationship between the RFQ, parental reflective functioning and infant attachment status as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. In both Study 1 and 2, confirmatory factor analyses yielded two factors assessing Certainty (RFQ_C) and Uncertainty (RFQ_U) about the mental states of self and others. These two factors were relatively distinct, invariant across clinical and non-clinical samples, had satisfactory internal consistency and test–retest stability, and were largely unrelated to demographic features. The scales discriminated between patients and controls, and were significantly and in theoretically predicted ways correlated with measures of empathy, mindfulness and perspective-taking, and with both self-reported and clinician-reported measures of borderline personality features and other indices of maladaptive personality functioning. Furthermore, the RFQ scales were associated with levels of parental reflective functioning, which in turn predicted infant attachment status in the SSP. Overall, this study lends preliminary support for the RFQ as a screening measure of reflective functioning. Further research is needed, however, to investigate in more detail the psychometric qualities of the RFQ.

Parental reflective functioning and the neural correlates of processing infant affective cues

ABSTRACTParental reflective functioning refers to the capacity for a parent to understand their own and their infant’s mental states, and how these mental states relate to behavior. Higher levels of parental reflective functioning may be associated with greater sensitivity to infant emotional signals in fostering adaptive and responsive caregiving. We investigated this hypothesis by examining associations between parental reflective functioning and neural correlates of infant face and cry perception using event-related potentials (ERPs) in a sample of recent mothers. We found both early and late ERPs were associated with different components of reflective functioning. These findings suggest that parental reflective functioning may be associated with the neural correlates of infant cue perception and further support the value of enhancing reflective functioning as a mechanism in parenting intervention programs.

The Significance of Parental Reflective Function in the Adjustment of Young Adults

Reflective function is the capacity to reflect on one’s own thoughts and feelings, and those of others. Parental reflective function has been found significant for children’s social and emotional development. However, research has mostly been restricted to mothers and to early stages of development, and there is a paucity of observations on the effects of parental reflective function in later stages. The aim of the present study is to explore the significance of mothers’ and fathers’ reflective function for the adjustment of their children during early adulthood. It is an extension of a previous study that examined the significance of parental reflective function for adolescent adjustment. During home visits, 105 adolescents aged 14–18 years reported on indices of parental behavior (involvement, warmth, and control), and their fathers and mothers were interviewed in order to assess their reflective function. Three to five years later, the participants, now aged 18–22 years, reported on level of symptoms, self-perception, self-descriptions and romantic relations. The findings indicated that parental reflective function, but not parental behaviors that express warmth and control, predicted adjustment during early adulthood. Similar to our previous finding, parental reflective function was associated with both desirable outcomes and possible costs among young adults: higher levels of self-descriptions and romantic relations, on the one hand, and more internalizing problems and less positive self-perception, on the other. It is concluded that parental reflective function affects their children’s adjustment also during early adulthood. However, the benefits of reflective function are inextricably linked to its costs.

Parental reflective functioning in fathers who use intimate partner violence: Findings from a Norwegian clinical sample

Few studies have examined fathering in an intimate partner violence (IPV) context outside the US. The present study included 36 Norwegian men who were voluntarily participating in therapy after perpetrating acts of IPV. They were interviewed with the revised Parent Development Interview, which is designed to assess parental reflective functioning (parental RF), and screened for alcohol- and substance-use habits and trauma history. At the group level, participants exhibited poor parental RF, high relational trauma scores, and elevated alcohol intake. Parental RF did not correlate with education level, alcohol or substance use, or compound measures of trauma history. There was a moderate negative relationship between having experienced physical abuse in childhood and parental RF.

STRENGTHENING THE REFLECTIVE FUNCTIONING CAPACITIES OF PARENTS WHO HAVE A CHILD WITH A NEURODEVELOPMENTAL DISABILITY THROUGH A BRIEF, RELATIONSHIP-FOCUSED INTERVENTION.

This randomized controlled trial examined the reflective functioning capacities of caregivers who have a child with a neurodevelopmental disorder between the ages of 2 years 0 months and 6 years 11 months. Children with a neurodevelopmental disorder receive a range of diagnoses, including sutism; however, they all exhibit social communication challenges that can derail social relationships. Forty parent-child dyads in Barbados were randomly assigned to either a developmental individual-difference, relationship-based/floortime(DIR/FT) group (n = 20), or a psychoeducational (wait-list) group (n = 20) with parental reflective functioning measured before and after a 12-week DIR/FT treatment intervention. Results revealed significant gains in parental reflective functioning in the treatment group, as compared to the psychoeducational (wait-list) group, after the 12-week relationship-focused intervention.

The Association Between Reflective Functioning and Parent–Child Relationship Quality

Research consistently links adult and infant attachment styles, yet the means by which attachment is transmitted is relatively elusive. Recently, attention has been directed to the psychological underpinnings of caregiver sensitivity—originally thought to be the mechanism of transmission—as indicated by caregivers’ ability to keep in mind children’s mental states when interpreting children’s behavior, or reflective functioning. Unfortunately for researchers, extant measures of reflective functioning are time-consuming and require extensive observation and coding. A self-report measure could help facilitate the study and assessment of reflective functioning in research and clinical settings. This study investigated the relationship between parental reflective functioning and multiple aspects of the parent–child relationship, by using a new, self-report measure of reflective functioning. Participants were 79 caregivers (M age = 31.8 years) who completed self-report measures assessing reflective functioning, parent–child relationship characteristics, perceived rejection in early relationships, attachment anxiety and avoidance in current close relationships, depression, and substance use. The results indicated that reflective functioning is a strong predictor of parent–child relationship quality (i.e., parental involvement, communication, parent satisfaction, limit setting, and parental support), independent of other potential indicators. Findings support parental reflective functioning as a contributor to the quality of parent–child relationship and suggest that a parent’s capacity to reflect on the mental states of his or her child in parent–child interactions may provide a key target for interventions that aim to improve parent–child relationships.