Mentalizing in psychotherapy: patients’ and therapists’ reflective functioning during the psychotherapeutic process / Mentalizando en psicoterapia: funcionamiento reflexivo de pacientes y terapeutas durante el proceso psicoterapéutico

Abstract

There has been a growing interest in mentalization in clinical research given its relationship with normal and psychopathological functioning and its explanatory potential as a mechanism of psychotherapeutic change. This study uses the Reflective Functioning Scale (RFS) to identify and characterize mentalization manifestations in psychotherapeutic interaction. Method: the RFS was applied to a sample of relevant episodes — 44 sessions from five different psychotherapy processes carried out with adult patients who had different diagnoses. Results: we observed a higher probability of reflective functioning (RF) passages in relevant events than in neutral segments. There were no differences in the RF passages according to episode or actor type, but there were in RF Failures, which is more likely in patients and during rupture episodes. Discussion: although certain modifications are necessary, the RFS can be applied to clinical material, and it is a promising strategy for the study of mentalization within psychotherapy.     

Mentalization in children and mothers in the context of trauma: An initial study of the validity of the Child Reflective Functioning Scale

This study examined the validity of the Child Reflective Functioning Scale (CRFS: Ensink, Target, & Oandason, 2013, Child reflective functioning scale scoring manual: for application to the Child Attachment Interview. London, UK: Anna Freud Centre – University College London), a measure designed to assess reflective functioning (RF) or mentalization during middle childhood. Participants were 94 mother–child dyads divided into two subgroups; 46 dyads where children had histories of intrafamilial (n = 22 dyads) or extrafamilial (n = 24 dyads) sexual abuse, and a community control group composed of 48 mother–child dyads. RF of children and their mothers was assessed using videotaped and transcribed data gathered using the Child Attachment Interview and the Parent Development Interview (PDI: Slade, Aber, Bresi, Berger, & Kaplan, 2004, The parent development interview‐Revised. New York, NY: The City University of New York). The findings indicate that the CRFS proved reliable, with excellent intraclass correlation coefficients for general RF, as well as RF regarding self and others. Significant differences in RF were found between sexually abused children and the control group, and also between children who had experienced intrafamilial and extrafamilial sexual abuse. This provides support for the discriminant validity of the CRFS. Furthermore, maternal RF was associated with child RF. Both abuse and maternal RF made significant contributions to predicting children's RF regarding themselves, but child sexual abuse was the only variable that made a significant contribution to explaining variance in children's RF regarding others.     

The Role of Reflective Functioning in Predicting Marital and Coparenting Quality

Reflective functioning (RF) is a measure of mentalization—the capacity to think about one’s own and others’ thoughts and feelings and to understand the connections between mental states and behaviors. Previous research indicates a decline in marital quality across the transition to parenthood, and some studies have found that parents are less happy than non-parents. Thus, researchers have called for research into possible moderators of these patterns. RF may help couples navigate this transition by more easily taking each other’s (and the infant’s) perspective and understanding each other’s behaviors. Much of the research on RF has focused on mothering behavior; research has not yet examined associations between RF and other family interactions. We examined associations between RF and marital and coparenting quality for both wives and husbands. Reflective functioning was coded from Adult Attachment Interviews conducted during pregnancy. We assessed marital quality at 3.5 months, and coparenting quality at 13 months, after the birth of the target child. Wives’ higher RF was associated with higher levels of positive—and lower levels of negative—marital and coparenting interactions. Wives who were better able to reflect on their early experiences with their parents were involved in marital interactions that were more positive and supportive and less conflicted and undermining. Husbands’ RF did not predict marital or coparenting quality. These findings highlight the importance of reflective functioning in understanding family functioning.     

Childhood obesity and parental reflective functioning: Is there a relation?

Background/ObjectiveIn recent decades, the prevalence of childhood obesity has increased, with the major implications for public health. However, the factors that contribute to obesity in children are still poorly understood. The present study aimed to investigate the role of parental reflective functioning (PRF) in childhood obesity.MethodIn a cross-sectional design, 120 sets of parents of 60 children (n = 30 with obesity, age range 6–11) were recruited by local paediatricians. Parents completed the Parental Reflective Functioning Questionnaire. Children's and parents’ weight (assessed by BMI), as well as their socio-economic status (SES), were assessed to explore the contribution of PRF in the prediction of children's weight, controlling for parents’ weight and SES.Resultst-test showed significant differences with medium effect sizes in BMI, SES and PRF between parents of children with and without obesity. The best model resulted from hierarchical multiple regression analyses and showed that mothers’ PRF predicted children's BMI above and beyond the prediction by parents’ BMI and SES.ConclusionsLow maternal PRF could be an important target for intervention strategies, highlighting the need to consider parental responses to children's emotions in the treatment of childhood obesity, particularly in parents with low SES and high BMI.     

Parents’ reactions to children’s stuttering and style of coping with stress

PurposeThe aim of the research was to determine: (a) how parents react to their child’s stuttering, (b) what stress coping strategies they utilise, as well as (c) whether stress coping style depends on parents’ reaction to their child’s stuttering.MethodsThe research involved 23 mothers and 23 fathers of children who stutter (CWS) at the age of three to six years old. The Reaction to Speech Disfluency Scale (RSDS), developed by the authors, was used in the research. To determine the parents’ coping the Coping Inventory in Stressful Situations (CISS) by N.S. Endler and D.A Parker was applied.ResultsThe strongest reactions are observed on the cognitive level. Stronger cognitive, emotional and behavioural reactions are observed in the mothers towards their disfluently speaking sons and in the fathers towards their daughters. Having analysed the profiles of coping styles, it can be noticed that the task-oriented coping is most frequently adapted by the fathers. The mothers most often use the avoidance-oriented coping. No relevant correlation was observed between the fathers’ coping style and their reactions to the child’s disfluent speech. As far as the mothers are concerned, it has been proved that an increase in behavioural reactions correlates with the avoidance-oriented coping.ConclusionThe cognitive reactions of the parents’ towards their child’s stuttering were most frequent, while the emotional ones were the least frequent. Confronted with a stressful situation, the fathers most often adapt the task-oriented coping, whereas the mothers use the avoidance-oriented coping. Educational objectives: the reader will be able to (1) learn what the key reactions of parents to their children’s stuttering are, (2) describe stuttering as a stress factor for the parents, (3) describe the factors which influence parents’ reactions to their child’s stuttering and their coping style.     

The Parental Reflective Functioning Questionnaire in Mothers and Fathers of School-Aged Children

Research on parental reflective functioning (PRF)—defined as parents’ capacity to comprehend the developing mind of their child, reflect upon it, and hold in mind the inner life of the child—has mostly involved mothers of infants and young children, and rarely fathers and parents of school-aged children. The present study sought to extend research on PRF by examining aspects of the construct that are still scarcely explored, such as the role of gender and attachment; to investigate whether there were differences between mothers’ and fathers’ PRF and whether there were differences in PRF related to the gender and age of the child; and, finally, to assess the association between PRF and each parent’s attachment style. The Parental Reflective Functioning Questionnaire (PRFQ) and the Attachment Style Questionnaire (ASQ) were administered to a community sample of mothers and fathers of 385 children aged 3–10 years. A multi-group factor analysis supported the hypothesized three-factor model among both fathers and mothers. Univariate and multivariate analyses of variance showed that mothers had higher levels of interest and curiosity in their children’s mental states than fathers. Parents of daughters showed higher pre-mentalizing modes than parents of sons. Parents of preschool children showed less nonmentalizing modes than parents of children aged 8–10. Correlations between PRFQ and ASQ showed that both mothers’ and fathers’ interest in thinking about their child’s internal experience and in taking the child’s perspective were correlated with higher levels of secure attachment style. Research implications are discussed.     

Parents’ competitive stressors in professional German youth soccer academies: A mixed-method study

ObjectiveThis study was designed to identify parents’ competitive stressors in German elite youth soccer academies as well as their stressor-specific appraisals and emotions.Design and method330 parents (M_age = 46.0, SD = 6.2 years) completed a mixed-method online survey to indicate stressors encountered at their child’s competitions. Parental self-disclosed stressors were analyzed using qualitative content analysis (Mayring, 2014). Psychometric assessment of parents’ primary and secondary appraisal (PASA; Gaab, 2009) and emotions (SEQ; Jones et al., 2005) were subsequently used to conduct a stressor-specific analysis.Results and conclusionFrequency analysis yielded 831 competitive stressors of which the majority (47%) pertained to the own child, followed by those concerning other soccer parents (18%) or the child’s coach (15%). Univariate Analysis of Variance revealed coach-related stressors to be perceived significantly more as a challenge (primary appraisal) in contrast to situations with other soccer parents. Parents’ competency beliefs (secondary appraisal) were highest for stressors involving other soccer parents. Multivariate Analysis of Variance showed a significant difference in parents’ emotional experiences with coach-related stressors eliciting the highest anger scores. Parents’ stress experiences were characterized by circular causality and interdependency, suggesting a relational approach to stress for future studies. Implications are discussed to further guide theoretical advancements in the field of parental stress as well as to shape interactions and relationships within academy youth soccer.     

Parents’ experiences of family food routines in adolescent elite-level swimming

ObjectiveParents have an important role in their child’s food routines and eating behaviour and face additional demands when that child is an athlete. Yet little is known about how parents manage providing food for their athletic child, in addition to the wider family, within the context of elite-level youth sport.MethodsSemi-structured interviews were conducted with sixteen parents (mothers = 11; fathers = 5) of elite level adolescent swimmers (i.e., competing at UK national level or above; child mean age = 15.4 years) to explore their experiences of family food routines and eating behaviour. Reflexive Thematic Analysis was used to analyse the data.ResultsParents outlined the importance of ‘optimal’ fuelling for their athletic child. Parents had an active role in their child’s eating behaviour and shaping their food choices but expressed uncertainty regarding the volume of food their child should consume and concerns regarding their child’s future relationship with food. Meticulous organisational and logistical strategies were employed to meet the extensive food requirements of their adolescent elite swimmer in the face of intensive training schedules. Such schedules also impacted food routines for the wider family (i.e., fewer family mealtimes), and on the quality of parents’ own diets.ConclusionThe findings highlight that clearer guidance is needed for parents of elite adolescent swimmers in relation to quantities of food intake and how to support a positive future relationship with food (specifically during any periods of transition in their training or out of the sport). The findings also identify a novel organisational stressor for parents in elite youth sport, in managing and prioritising their own diet. Further research is needed to explore the extent to which parental diet may be impacted by supporting an adolescent athlete.     

Comparing stuttering attitudes of preschool through 5th grade children and their parents in a predominately rural Appalachian sample

BackgroundTheories relating to young children’s social cognitive maturity and their prevailing social groups play important roles in the acquisition of attitudes. Previous research has shown that preschool and kindergarten children’s stuttering attitudes are characterized by stronger negative beliefs and self reactions than those of parents. By contrast, 12 year-old children’s stuttering attitudes have been shown to be similar to their parents’ attitudes. Other research indicates that parental stuttering attitudes are no different from attitudes of adults who are not parents.PurposeThe purpose of this study was to explore children’s stuttering attitudes of preschool through 5th grade children and to compare them to their parents’ attitudes.MethodChildren and parents from a rural Appalachian elementary school and child/parent pairs from other areas in the region responded to child and adult versions of the Public Opinion Survey of Human Attributes–Stuttering (POSHA–S/Child and POSHA–S). Seven grade levels were included: preschool, kindergarten, 1^st grade, 2^nd grade, 3^rd grade, 4^th grade, and 5^th grade.ResultsConfirming earlier research, younger children’s attitudes toward stuttering were considerably less positive than those of their parents. As children matured up to the fifth grade, however, their stuttering attitudes progressively were more positive. Parents’ stuttering attitudes were quite consistent across all seven grade levels.ConclusionsConsistent with theories of attitudinal development, between the ages of 4 and 11 years, children’s measured attitudes toward stuttering improved and gradually approximated the attitudes of their parents and the general public.     

The (Neglected) role of the father in Children's mental health

BackgroundAlthough the bulk of the literature on child development, historically, has focused on the significant role of the mother, less attention has been given to that of the father. Therefore, more attention has been given to fathers’ roles in the last 20–30 years.AimThe aim of the current review was to explore the role of the father on a child's development.MethodsAn extensive literature search using 'Psycharticles', ‘PsychInfo’, and ‘Google Scholar’ databases using terms like 'father's role', 'child/children's', 'child development', and 'mental health' was conducted to achieve the objective of the study.ResultsFathers were found to play a significant role in nurturing their children. Fathers are considered to be important for the development of the child's autonomy, the shaping of gender identity, and the development of the moral system of the child. Usually, he is the one who establishes the feeling of security in the child's mind. He is considered to be the protector and defender of the family Freud's position is that the father is the symbol of security, power, and authority for the child.ConclusionAlthough the original aim of the research was to draw a line between parents' roles in the family and shed light on the father's role, the findings suggest that the fundamental concept in nurturing children depends on the complementary roles of parents as children need their parents equally.     

Self-reported reflective functioning and father–child interactions in a sample of fathers who have used intimate partner violence

Reflective functioning (RF) has been found to be associated with mother–child interactions, but less is known about the association of fathers’ self and child-focused RF and father–child relationships.  Fathers who have histories of intimate partner violence (IPV) are known to have poor RF, which may impact their father–child interactions.  The current study was designed to examine how types of RF are associated with father–child relationships.  Pretreatment assessments and recorded, coded father–child play interactions were used to examine associations among fathers’ history of adverse childhood experiences (ACES), RF and coded father-child play interactions in a sample of 47 fathers with a history of IPV use in the last 6 months with their coparent.  Fathers’ ACES and their child's mental states (CM) were associated with father-child dyadic play interactions.  Fathers with greater ACES and higher scores on CM had the most dyadic tension and constriction during play interactions.  Those with high ACES but low CM had scores similar to those with low ACES and low CM.  These results indicate that fathers who have used IPV and have a history of significant adversity may benefit from interventions to increase their child-focused RF and further improve their interactions with their children.     

Parents’ and psychotherapists’ goals prior to psychodynamic child psychotherapy

In order to explore goals of parents and psychotherapists prior to child psychotherapy, the following questions were asked: (1) How are goals for psychotherapy formulated? (2) How can similarities and differences between parents’ and psychotherapists’ goals be understood? Questionnaires regarding psychodynamic child psychotherapies (n = 33) with parallel parental work were analysed using qualitative methodology. The child psychotherapists’ goals were often connected to the intrapsychic and relational development of the child. The parental therapists formulated goals focused on providing support to parents. The parents’ goals, on the other hand, concerned to a great extent giving the child help and to a lesser degree receiving help for themselves. They expressed their expectations concerning the child’s psychological development with a more everyday use of language, often with an emphasis on general psychological wellbeing. The study also indicated that parents had limited knowledge about the therapy’s implementation and framework. Some clinical conclusions could be made. Negotiating goals prior to parental and child psychotherapy can help create realistic expectations and promote a beneficial therapy situation.     

‘And when you were a child?’: how therapists working with parents alongside individual child psychotherapy bring the past into their work

When a child is offered psychotherapy, it is common that regular meetings will be offered to the parents. However, there are debates in the literature about the degree to which such parent work should include a focus on the parents’ own childhood experiences. This study aimed to examine the way that those offering parent work as part of a study evaluating the treatment of adolescent depression dealt with this issue in their work with parents, both in the study and in routine clinical practice. Design: five therapists were interviewed on the subject of working with parents’ childhood experiences within parent work parallel to child psychotherapy. Data were analysed qualitatively, using Interpretative Phenomenological Analysis. Findings: participants described the need to consider the different parameters of this work to individual adult therapy; in addition, participants felt that it was necessary to negotiate permission to work on the parents’ childhood experiences. They also spoke of making use of insight into the repetition of the parents’ history, the analysis of parental projections and offering containment within the relationship; this varies from the ‘transference work’ of individual therapy and a different style of interpretation was described. Conclusions: there is a need to give more attention to the neglected field of working with parents alongside individual child psychotherapy, especially at a time when such work is under threat within many public services. There are particular technical issues related to work with parents’ own childhood histories that are different to how one might work in individual therapy with a parent.     

Finding the Body of the Mind: Integrating Occupational Therapy’s Theories of Mutual Regulation and Dysregulation into Psychotherapy

ABSTRACT

A child’s state of emotional dysregulation is often the explicit complaint of parents, teachers, and others involved in child referrals. Psychoanalytic and, more recently, neuropsychoanalytic thinking along with attachment research have created a foundation for understanding the biological and relational development of parent and child emotional engagement. In particular, these perspectives have clarified the nature of what Donald Winnicott termed impingements on the potential space between parent and child. An important addition to the understanding of biological and relational impingements on parent-child emotional dynamics comes from the field of occupational therapy (OT), which views sensory-motor regulatory capacities as forming the basis for quality relating and engaging. From an OT perspective, impingements on relating and adaptive functioning result from compromised regulation of arousal, affect, attention, and activity level on the part of the child, the parent, and/or the child/parent “fit.” Sensory integration and sensory processing theories offer additional frameworks for understanding and communicating with parents about patterns of mutual dysregulation in the parent-child relationship. When integrated with psychodynamic formulations, these ideas from OT research and practice can provide parents with new, more effective and flexible narratives of their children’s inner lives and behavior, and of their own narratives as parents.     

Role of parental emotional support in illusion of scholastic incompetence

IntroductionSelf-perceptions of competence are involved in motivational processes explaining that although pupils’ capacities are comparable, their academic achievement differs greatly. In general, pupils with an illusion of scholastic incompetence exhibit a set of negative characteristics concerning their academic functioning.ObjectiveThis article seeks to better understand the links between emotional support from parents and children's under-evaluation of their own scholastic competence.MethodSelf-reports from 626 pupils in Grades 4 and 5 (mean age: 10 years, 8 months) and one of their parents were analysed.ResultsPupils with an illusion of incompetence perceive the emotional support provided by their parents as less available and less unconditional. This difference is not echoed in their parents’ own report of the emotional support they think they give their child. However, parents of children with an illusion of incompetence do report reacting to their children's actions with criticism and disapproval more often than other parents.ConclusionThe quality of parental emotional support as perceived by the children predicts the bias they have when evaluating their own scholastic competence. Their parents’ perception also predicts this bias, albeit more modestly.     

Coping and care-related stress in parents of a child with autism spectrum disorder

Background and Objectives: Parenting a child with Autism Spectrum Disorder (ASD) is challenging and can result in elevated levels of parenting stress. This study investigated the relationship between parent-ratings of their child’s ASD symptoms and two conceptually different measures of parenting stress: One specific to the ASD context and the other a general stress measure applicable to the broader caregiving context. Additionally, the influence of coping style on the relationship between child’s ASD symptoms and parenting stress was investigated.

Design and Methods: Using an internet survey, parents (N?=?178) caring for a child with ASD reported on coping strategies, completed two measures of parenting stress, and assessed their child’s ASD symptoms.

Results: Parenting stress increased with severity of the child’s ASD symptoms, but the strength of this relationship depended on whether a general or disorder-specific measure of parenting stress was used. Regression analyses indicated that some coping strategies moderated the impact of ASD symptom severity on the parent’s care-related stress, but moderation depended on how stress was conceptualized.

Conclusion: This study reinforces the importance of identifying the coping strategies of parents of children with developmental disorders, and highlights the consequences of using different conceptual approaches to measure parenting stress.     

Measuring Parents’ Elaborative Reminiscing: Differential Links of Parents’ Elaboration to children’s Autobiographical Memory and Socioemotional Skills

ABSTRACT

Parents’ elaboration plays an important role in autobiographical memory and socioemotional development. Two types of coding approaches have been used to assess parents’ elaboration: a frequency-based coding (absolute frequencies of different types of elaborative utterances) and a scale-based coding (a 5-point scale based on relative frequencies of types of questions). We examined whether these two coding approaches were related and whether they were differentially associated with child autobiographical memory and socioemotional skills. Sixty-eight preschoolers (M = 50.32) reminisced about positive and negative past events, with their parents and with a researcher. Parents’ elaboration was assessed using the frequency- and scale-based coding approaches. Child autobiographical memory and emotion references were assessed in shared recall (parent–child conversations). Child autobiographical memory was also assessed in independent recall (researcher-child conversations). Child emotion regulation was assessed using the Challenging Situation task. The two coding approaches were moderately related. Parents’ elaboration was related to child autobiographical memory and emotion references in shared recall, regardless of the coding approach. Whereas the frequency-based coding was uniquely related to child memory in the independent recall, the scale-based coding was uniquely related to child emotion regulation. Implications of using diverse coding approaches to understand the role of parents in child development are discussed.     

Therapeutic Action in the Work of a Playful Clinician: A Reflection on Dr. Silber’s Reimagining of Humpty Dumpty

ABSTRACT

In my discussion of Dr. Silber’s paper, Reimagining Humpty Dumpty: The Therapeutic Action of Play, I mirror Dr. Silber’s playful posture in her use of the Humpty Dumpty fable to talk about children and their care by society. My reflections on Dr. Silber’s therapeutic work with her two young patients focus on her co-creating meaning with each child’s parents as well as with the child. I discuss that by holding in her mind both the subjectivities of the child and his parents, Dr. Silber is able to practice a fundamentally relational therapy. I would have liked to have heard more about her emotional reactions in her work with both cases as another important dimension of her work. Finally, I emphasize through my play with Humpty Dumpty several ways that society can support children and families that are essential for their development: parental leave, developmentally approptiate expectations for children in school, and the facilitation and protection children’s open ended time and ability to play.     

Examination of the Eyberg Child Behavior Inventory Discrepancy Hypothesis

ABSTRACT

This study examined the Eyberg Child Behavior Inventory (ECBI) discrepancy hypothesis, which asserts that a discrepancy in score elevations on the ECBI Intensity and Problem Scales is related to problematic parenting styles. The Intensity Scale measures the frequency of child disruptive behavior, and the Problem Scale measures parent perception of their child's behavior as problematic. In a sample of 216 female caregivers of 3-to7-year-old children, the magnitude of discrepancy between T scores on the two ECBI scales was found to predict parental tolerance for child misbehavior. A one-standard-deviation difference in ECBI T scores identified (a) parents intolerant of their child's misbehavior when the Problem score was highest and (b) overly permissive parents when the Intensity score was highest.     

Parents’ moral intentions towards antisocial parent behaviour: An identity approach in youth sport

ObjectivesGrounded in personal and social identity theory, the purpose of this study was to examine whether parents’ personal and social identity perceptions influence their moral intentions towards antisocial parent behaviour in a youth sport setting.DesignParents of competitive youth ice hockey players (N = 437) read a vignette that either described a parent from the participant’s own team (i.e., ingroup), or a parent from an opposing team (i.e., outgroup) acting antisocially towards an athlete from the participant’s own team, an opposing athlete, or their own child. Parents were asked whether they would respond to the antisocial behaviour in the form of direct or indirect criticism or report the behaviour to the coach or to the league.ResultsParents were more likely to directly criticize ingroup parents than outgroup parents and they were more likely to indirectly criticize outgroup parents than ingroup parents. Further, parents with stronger social identities reported higher intentions to indirectly criticize an outgroup parent. There were no main effects for reporting behaviour (to coach or league), and personal identity did not moderate relationships with moral intentions towards antisocial behaviour.ConclusionBy providing parents with a situation that includes antisocial parent behaviour in the immediate youth sport environment, novel insight was gathered with regard to what contextual elements might drive parents’ intention to criticize, but not report antisocial behaviour.