Exploring maternal reflective functioning as a predictor of mother-child dyadic behaviour over time in a clinical context

Submitted: October 14, 2021
Accepted: April 2, 2022
Published: April 27, 2022
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The current study examined 20 participants from group attachment based intervention (GABI), who completed the adult attachment interviews (AAI; George, et al., 1985) as part of a RCT to test the efficacy of GABI compared with treatment as usual, in order to explore the possible benefits higher RF for treatment outcome in terms of interactive mother and child behaviour. Mothers’ AAIs were analyzed using the reflective functioning (RF) rating scale (Fonagy, et al., 1998), yielding overall RF scores, prompted/demand RF scores, and spontaneous RF scores, and parent-child dyadic interactive behaviour was coded utilizing the coding interactive behaviour (CIB: Feldman, 1998) manual. Children’s age ranged from 2-25 months, mean=14 months. 86.7% of the sample identified English as their primary language, with 13.3% identified speaking both Spanish and English. RF in AAIs obtained at intake from some GABI mothers was expected to be linked to the quality of the parent-child interaction (observed with the CIB), at intake (T1), at end-of treatment T2), and at sixmonth follow-up (T3). Results confirmed this impression insofar as lower overall RF was linked to T1 levels of higher intrusiveness from mothers. At end of treatment (T2), mothers’ higher spontaneous RF scores were significantly linked to maternal praising (of the child), child positive affect, child alertness. At 6-month follow up (T3), mother’s spontaneous RF scores correlated significantly and positively with maternal elaborating with child positive affect. Discussion focuses on the importance of assessing RF in parents entering therapy with their children as it may provide insight into what parent or child behaviours may be targeted. And the RF scores will highlight which mothers need special attention to stimulate their interest and attention to attachment-related processes in themselves, and in their children.



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Allen, J. (2006). Mentalizing in practice. In J. Allen & P. Fonagy (Eds.), Handbook of mentalization-based treatment (pp. 3-30). Hoboken, NJ: Wiley & Sons. DOI: https://doi.org/10.1002/9780470712986
Bateman, A., & Fonagy, P. (2016). Mentalization-Based Treatment for Personality Disorders: A practical guide. New York: Oxford University Press. DOI: https://doi.org/10.1093/med:psych/9780199680375.001.0001
Beebe, B., Lachman, F., Markese, S., & Bahrick, L. (2012). On the origins of disorganized attachment and internal working models: Paper I. A dyadic systems approach. Psychoanalytic Dialogues, 22, 253-272. doi:10.1080/ 10481885.2012.666147. DOI: https://doi.org/10.1080/10481885.2012.666147
Berthelot, N., Ensink, K., Bernazzani, O., Normandin, L., Luyten, P., & Fonagy, P. (2015). Intergenerational Transmission Of Attachment In Abused And Neglected Mothers: The Role Of Trauma-Specific Reflective Functioning. Infant Mental Health Journal, 36(2), 200-212. doi:10.1002/imhj.21499. DOI: https://doi.org/10.1002/imhj.21499
Bowlby, J. (1969). Attachment and Loss: Vol. 1 Attachment. New York, NY: Basic Books.
Bowlby, J. (1973). Attachment and loss. Volume II: separation. New York: Basic Books.
Bowlby, J. (1980). Attachment and loss, Volume HI: loss. New York: Basic Books.
Bowlby, J. (1983). Attachment and loss: Retrospect and prospect. Annual Progress in Child Psychiatry & Child Development, 29-47.
Bretherton, 1. (1985). Attachment theory: retrospect and prospect. In I. Bretherton & E. Waters (Eds), Growing points in attachment theory: monographs for the society for research in child development, 50(1/2), 3-35. doi:10.2307/3333824. DOI: https://doi.org/10.2307/3333824
Diamond, D., Clarkin, J.F., Levy,K.N., Meehan, K.B., Cain,N.M., Yeomans, F.E. & Kernberg, O.F. (2014) Change in Attachment and Reflective Function in Borderline Patients with and without Comorbid Narcissistic Personality Disorder in Transference Focused Psychotherapy, Contemporary Psychoanalysis, 50, 1-2, 175-210, doi:10.1080/00107530.2014.880316. DOI: https://doi.org/10.1080/00107530.2014.880316
Dollberg, D., Feldman, R., Tyano, S., & Keren, M. (2013). Maternal repre- sentations and mother-infant relational behaviour following parent-infant psychotherapy. Journal of Infant, Child and Adolescent Psychotherapy, 12, 190-206. doi:10.1080/15289168.2013.821884. DOI: https://doi.org/10.1080/15289168.2013.821884
Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W., & Anda, R. F. (2003). Childhood abuse neglect and household dysfunction and the risk of illicit drug use: The Adverse Childhood Experiences Study. Pediatrics, 111, 564-572. DOI: https://doi.org/10.1542/peds.111.3.564
Feldman, R. (1998). Coding interactive behaviour manual. Unpublished manual, Bar-Ilan University, Ramat Gan, Israel.
Feldman, R. (2012c). Parenting behaviour as the environment where children grow. In L. C. Mayes & M. Lewis (Eds.), The Cambridge handbook of environment in human development (pp. 535-567). New York: Cambridge University Press. DOI: https://doi.org/10.1017/CBO9781139016827.031
Feldman, R. (2015). Mutual influences between child emotion regulation and parent–child reciprocity support development across the first 10 years of life: Implications for developmental psychopathology. Development and Psychopathology, 27(4pt1), 1007-1023. doi:10.1017/s0954579415000656. DOI: https://doi.org/10.1017/S0954579415000656
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). The relationship of adult health status to childhood abuse & household dysfunction. American Journal of Preventive Medicine, 14, 245-258. DOI: https://doi.org/10.1016/S0749-3797(98)00017-8
Fonagy, P. (2006). The mentalization-focused approach to social development. In J. Allen & P. Fonagy (Eds.), Handbook of mentalization-based treatment (pp. 53-100). Hoboken, NJ: Wiley & Sons.
Fonagy, P., & Bateman, A. W. (2006). Progress in the treatment of borderline personality disorder. British Journal of Psychiatry, 188, 1-3. DOI: https://doi.org/10.1192/bjp.bp.105.012088
Fonagy, P., Gergely, G., Jurist, E.L., & Target, M. (2002). Affect regulation, mentalization and the development of the self. New York: Other Press.
Fonagy, P., Luyten, P., & Strathearn, L. (2011). Borderline personality disorder, mentalization, and the neurobiology of attachment. Infant Mental Health Journal, 32, 47-69. DOI: https://doi.org/10.1002/imhj.20283
Fonagy, P., Steele, H., Moran, G., Steele, M., & Higgitt, A. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 13, 200-217. DOI: https://doi.org/10.1002/1097-0355(199123)12:3<201::AID-IMHJ2280120307>3.0.CO;2-7
Fonagy, P., Steele, M., Steele, H., Higgitt, A., & Target, M. (1994). The Emanuel Miller Memorial Lecture 1992 The Theory and Practice of Resilience. Journal of Child Psychology and Psychiatry,35(2), 231-257. doi:10.1111/j.1469-7610.1994.tb01160.x. DOI: https://doi.org/10.1111/j.1469-7610.1994.tb01160.x
Fonagy, P., & Target, M. (1996). Playing with reality: I. Theory of mind and the normal development of psychic reality. International Journal of Psycho-Analysis, 77, 217-234.
Fonagy, P., & Target, M. (1997). Attachment and reflective function: Their role in self-organization. Development and Psychopathology, 9, 679-700. doi:10.1017/S0954579497001399. DOI: https://doi.org/10.1017/S0954579497001399
Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective- functioning manual, version 5.0, for application to adult attachment interviews. London: University College London. DOI: https://doi.org/10.1037/t03490-000
George, C., Kaplan, N., & Main, M. (1985). Adult Attachment Interview (2nd ed.). Unpublished manuscript, University of California, Berkeley. DOI: https://doi.org/10.1037/t02879-000
Lo, C.K.M., & Wong, S.Y. (2020) The effectiveness of parenting programs in regard to improving parental reflective functioning: a meta-analysis, Attachment & Human Development, doi:10.1080/14616734.2020.1844247. DOI: https://doi.org/10.1080/14616734.2020.1844247
Main, M., Goldwyn, R., & Hesse, E. (2003). Adult attachment classification system (Version 7.2). Unpublished manuscript, University of California, Berkeley.
Main, M., Goldwyn, R., & Hesse, E. (2008). The Adult Attachment Interview: Scoring and Classification Sys- tem, Version 8. Manuscript in preparation, University of California, Berkeley.
Main, M., & Hesse, E. (1990). Parent’s unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behaviour the linking mechanism? In M.T. Greenberg, D. Cicchetti, & E.M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161-182). Chicago: University of Chicago Press.
Main, M., Hesse, E., & Goldwyn, R. (2008). Studying differences in language use in recounting attachment history. In H. Steele, & M. Steele (Eds.), Clinical applications of the Adult Attachment Interview (pp. 31-68). New York, NY: Guilford Press.
Main, M., Kaplan, N. & Cassidy, J. (1985). Security in infancy, childhood and adulthood: a move to the level of representation. In I. Bretherton and E. Waters (Eds), Crowing points in attachment theory: monographs for the society for research in child development, 50, 66-106. DOI: https://doi.org/10.2307/3333827
Main, M., & Solomon, J. (1990). Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. In M. Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment in the preschool years (pp. 121-160). Chicago: University of Chicago Press.
Murphy, A., Steele, H., Bate, J., Nikitiades, A., Allman, B., Bonuck, K., Meissner, P., & Steele, M. (2015). Group attachment-based intervention. Family & Community Health, 38(3), 268-279. doi:10.1097/fch.0000000000000074. DOI: https://doi.org/10.1097/FCH.0000000000000074
Sharp, C., & Fonagy, P. (2008). The parent’s capacity to treat the child as a psychological agent: Constructs, measures and implications for developmental psychopathology. Social Development, 17(3), 737-754. doi:10.1111/ sode.2008.17.issue-3. DOI: https://doi.org/10.1111/j.1467-9507.2007.00457.x
Sharp, C., Fonagy, P., & Goodyer, I. G. (Eds.). (2008). Social cognition and developmental psychopathology. Oxford, England: Oxford University Press. DOI: https://doi.org/10.1093/med/9780198569183.001.0001
Slade, A., Holland, M. L., Ordway, M. R., Carlson, E. A., Jeon, S., Close, N., & Sadler, L. S. (2020). Minding the Baby®: Enhancing parental reflective functioning and infant attachment in an attachment-based, interdisciplinary home visiting program. Development and psychopathology, 32(1), 123-137. DOI: https://doi.org/10.1017/S0954579418001463
Steele, H., & Steele, M. (2008). On the origins of reflective functioning. In F. Busch (Ed.), Mentalization: Theoretical considerations, research findings, and clinical implications. Psychoanalytic Inquiry Book Series, 29. (pp. 133-158). New York: The Analytic Press.
Steele, H., Murphy, A., Bonuck, K., Meissner, P., & Steele, M. (2019). Randomized Control Trial Report on the effectiveness of group attachment-based intervention (Gabi©): Improvements in the parent-child relationship not seen in the Control Group. Development and Psychopathology, 31(1), 203-217. doi:https://doi.org/10.1017/s0954579418001621. DOI: https://doi.org/10.1017/S0954579418001621
Steele, M., Steele, H., Bate, J., Knafo, H., Kinsey, M. Bonuck, K., Meisner, P. & Murphy, A. (2014). Looking From the Outside In: The Use of Video in Attachment-Based Interventions. Attachment & Human Development, 16, 402-415. DOI: https://doi.org/10.1080/14616734.2014.912491
Suchman, N.E., DeCoste, C., Leigh, D. & Borelli, J. (2010). Reflective functioning in mothers with drug use disorders: Implications for dyadic interactions with infants and toddlers, Attachment & Human Development, 12:6, 567-585. doi:10.1080/14616734.2010.501988. DOI: https://doi.org/10.1080/14616734.2010.501988
Toth, S., Cicchetti, D., Macfie, J., & Emde, R. (1997). Representations of self and other in the narratives of neglected, physically abused, and sexually abused preschoolers. Development and Psychopathology, 9(4), 781-796. doi:10.1017/S0954579497001430. DOI: https://doi.org/10.1017/S0954579497001430
Zayde, A., Prout, T. A., Kilbride, A., & Kufferath-Lin, T. (2021). The Connecting and Reflecting Experience (CARE): theoretical foundation and development of mentalizing-focused parenting groups. Attachment & Human Development, 23(3), 293-309. DOI: https://doi.org/10.1080/14616734.2020.1729213

How to Cite

Myers, L., Steele, H., Steele, M., & Murphy, A. (2022). Exploring maternal reflective functioning as a predictor of mother-child dyadic behaviour over time in a clinical context. Research in Psychotherapy: Psychopathology, Process and Outcome, 25(1). https://doi.org/10.4081/ripppo.2022.594

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