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Abstract

This article introduces an innovative mentalization-based treatment (MBT) parenting intervention for families where children are at risk of maltreatment. The Lighthouse MBT Parenting Programme aims to prevent child maltreatment by promoting sensitive caregiving in parents. The programme is designed to enhance parents' capacity for curiosity about their child's inner world, to help parents 'see' (understand) their children clearly, to make sense of misunderstandings in their relationship with their child and to help parents inhibit harmful responses in those moments of misunderstanding and to repair the relationship when harmed. The programme is an adaptation of MBT for borderline and antisocial personality disorders, with a particular focus on attachment and child development. Its strength is in engaging hard to reach parents, who typically do not benefit from parenting programmes. The findings of the pilot evaluation suggest that the programme may be effective in improving parenting confidence and sensitivity and that parents valued the programme and the changes it had helped them to bring about.

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... It is evident that, even in the event of childhood adversity, one's RF capacity can continue to develop through secure therapeutic relationships (Kretchmar et al., 2005) and group-based psychosocial interventions (Pajulo et al., 2012). Among existing group-based interventions targeting parental RF, some show positive evidence supporting the effectiveness of the interventions in terms of improving parental RF (Enav et al., 2019;Huber et al., 2015), whereas other interventions did not yield positive evidence (Bain, 2014;Byrne et al., 2019). These inconsistent findings may be attributed to the variability in RF measurements and study samples across studies. ...
... These inconsistent findings may be attributed to the variability in RF measurements and study samples across studies. For example, Byrne et al. (2019) found that participants reported in qualitative interviews that they improved in regard to reflective capacity in terms of understanding their children's thinking and feeling, but this improvement was not captured by the quantitative measurement of parental RF. Bain (2014) attempted to replicate a mentalization-based intervention adapted from the UK in a group of homeless women in South Africa, but failed to demonstrate significant improvement in parental RF. ...
... Among the selected studies, four studies examined mentalizing-based parenting programs for foster parents (Adkins et al., 2018), at-risk parents (Byrne et al., 2019), parents of children with autism spectrum disorder (Enav et al., 2019), and separated parents (Hertzmann et al., 2016). Four studies examined the Circle of Security (Powell et al., 2013) or the Circle of Security -Parenting program (Cooper et al., 2009) for high-risk parents (Huber et al., 2015), low-income caregivers (Rostad, 2014), and general mothers (Kohlhoff et al., 2016;Maupin et al., 2017). ...
Article
Although parenting interventions aiming to improve parental RF have been developed, there have been conflicting results in regard to intervention effectiveness. This meta-analytic review seeks to synthesize the available evidence that group-based parenting interventions improve parental RF, in order to provide conclusive evidence regarding their effectiveness. A systematic search was performed to retrieve relevant studies published before November 2019. A total of 15 studies met the selection criteria, of which 3 studies were randomized controlled trials (RCTs). The studies yielded a significant intervention effect with a small pooled effect size (Hedge's g = 0.279, p = 0.002) on parental RF. However, the pooled effect size of the 3 RCTs was non-significant (pooled effect size: Hedge's g = 0.189, p = 0.244), indicating that current best evidence is limited. As the heterogeneity test was significant (Q = 32.486, df = 14, p = 0.003), which suggests the presence of heterogeneity among the selected studies, a series of moderator analyses were performed to examine factors that may influence intervention effects. Interventions that involved children in middle childhood had a larger effect size than those involving children in infancy and early childhood.
... Parents' mentalizing abilities are consistently associated with better caregiving, parental satisfaction, parental self-efficacy, and healthy communication between family members (Byrne et al., 2018;Camoirano, 2017;Kalland et al., 2016;Rostad & Whitaker, 2016;Slade, 2005). Parents with higher RF appreciate their children's behaviors in terms of their mind state and comprehend the interaction between their own mental states and that of the child, which is associated with more optional parent-child relationships (Slade, 2002). ...
... Interventions to enhance parental RF have demonstrated empirical support across multiple parenting groups, including for high-risk, hard-to-reach parents (Byrne et al., 2018), parents of children with neurodevelopmental disorders (Enav et al., 2019;Sealy & Glovinsky, 2016), substance-abusing mothers (Suchman, DeCoste, Castiglioni, Legow, & Mayes, 2008), pregnant young mothers and mothers in prisons (Sleed, Baradon, & Fonagy, 2013). These intervention efforts demonstrate that parents with significant challenges to caregiving are able to increase RF as well as demonstrate that these changes support children's outcomes. ...
Article
Family Minds is a brief group psychoeducational parenting intervention designed to increase the reflective functioning (RF) and mentalization skills of foster parents. RF is important for foster parents who have to build relationships with children whose adverse experiences increase their risk for psychosocial challenges. A randomized controlled trial (RCT) for Family Minds was conducted in Texas with 89 foster parents. The main aims of this study were to examine whether the intervention could significantly increase the RF/mentalization skills of the foster parents and decrease their parenting stress. After 6 weeks, compared with the control group, intervention foster parents improved their RF via a lowering of pre-mentalizing and also significantly decreased parenting stress related to parent–child dysfunctional interactions. Other measures of RF and parenting stress showed no significant differences between groups. Foster child behavior was not significantly different between groups, although data at 6 months showed a possible lowering of internalizing symptoms for children of intervention parents. This RCT provides some encouraging evidence that Family Minds may increase RF in foster parents, improve parental sensitivity and their ability to emotionally regulate, decrease parenting stress related to challenging interactions with their foster children, and possibly decrease children's internalizing behavior.
... The Lighthouse Parenting Program is a 20-week Mentalization-Based Treatment (MBT) designed for high-risk parents of infants aged 0-2 years (Byrne et al., 2018). This intervention is designed to increase sensitive parenting and prevent child maltreatment through increasing parents' capacity to mentalize their child's internal states. ...
... Studies on the PALS program have found results for maternal and child behavioral outcomes, especially for high risk women (Landry et al., 2008). The Lighthouse Parenting Program was able to improve parental self-efficacy (Byrne et al., 2018). Minding the Baby has been effective at improving maternal reflective functioning and child attachment (Sadler et al., 2013;Slade et al., 2020). ...
Article
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The period of infancy and early childhood is a critical time for interventions to prevent future mental health problems. The first signs of mental health difficulties can be manifest in infancy, emphasizing the importance of understanding and identifying both protective and risk factors in pregnancy and the early postnatal period. Parents are at a higher risk of developing mental health problems during the perinatal period. An understanding of the evidence around prevention and intervention for parental anxiety and depression is vital to the process of prevention of early mental health disorders in infants and young children. Here we review the existing prevention and treatment interventions in the early years focusing on the period from conception to 3 years – the majority targeting parents in order to improve their mental health, and that of their infants. Elements of successful programs for parents include psychoeducation and practical skills training, as well as work on the co-parenting relationship, developing secure attachment, and enhancing parental reflective functioning. While both targeted and universal programs have produced strong effect sizes, universal programs have the added benefit of reaching people who may otherwise not have sought treatment. In synthesizing this information, our goal is to inform the development of integrated models for prevention and novel early intervention programs as early in life as possible.
... These negative effects of parental mental illness on parenting behavior have been demonstrated across a variety of parental diagnoses like depression [4•], bipolar disorder [22], anxiety disorders [23], substance-use disorders [24], personality disorders in general [7], and BPD in particular [25][26][27]. Regardless of the exact underlying psychopathology, a reduced ability to correctly infer the child's mental states such as emotions or psychological needs may additionally aggravate negative parenting behavior [6] and further heighten the risk for neglect, maltreatment, and abuse [28,29]. ...
... A program that combines the three elements recommended by Marston et al. [100], incorporates video feedback, and thereby focuses on parental mentalization capabilities is the lighthouse parenting program [28] which is currently conducted and investigated in a study of our work group that aims to understand and break the intergenerational cycle of abuse (UBICA) in mentally ill parents [102]. The group program specifically focuses on social support via peer-to-peer exchange (informal social support) and further incorporates social counseling (formal social support). ...
Article
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Purpose of Review Parental mental disorders, particularly borderline personality disorder (BPD), impair parenting behavior. Consequently, the children exhibit an elevated risk for psychopathology across their lifespan. Social support for parents is thought to moderate the relationship between parental mental illness and parenting behavior. It may dampen negative effects and serve as starting point for preventive interventions. This paper provides a literature overview regarding the impact of social support on the sequelae of parental mental illness and BPD for parenting behavior. Recent Findings Current literature highlights the increased burden of families with a mentally ill parent and associated changes in parenting behavior like increased hostility and affective dysregulation, especially in the context of parental BPD. Literature further demonstrates the powerful impact of social support in buffering such negative outcomes. The effect of social support seems to be moderated itself by further factors like socioeconomic status, gender, or characteristics of the social network. Summary Social support facilitates positive parenting in mentally ill parents and may be particularly important in parents with BPD. However, social support is embedded within a framework of influencing factors, which need consideration when interpreting scientific results.
... Parents' mentalizing abilities are consistently associated with better caregiving, parental satisfaction, parental self-efficacy, and healthy communication between family members (Byrne et al., 2018;Camoirano, 2017;Kalland et al., 2016;Rostad & Whitaker, 2016;Slade, 2005). Parents with higher RF appreciate their children's behaviors in terms of their mind state and comprehend the interaction between their own mental states and that of the child, which is associated with more optional parent-child relationships (Slade, 2002). ...
... Interventions to enhance parental RF have demonstrated empirical support across multiple parenting groups, including for high-risk, hard-to-reach parents (Byrne et al., 2018), parents of children with neurodevelopmental disorders (Enav et al., 2019;Sealy & Glovinsky, 2016), substance-abusing mothers (Suchman, DeCoste, Castiglioni, Legow, & Mayes, 2008), pregnant young mothers and mothers in prisons (Sleed, Baradon, & Fonagy, 2013). These intervention efforts demonstrate that parents with significant challenges to caregiving are able to increase RF as well as demonstrate that these changes support children's outcomes. ...
Preprint
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Family Minds is a group psychoeducational parenting intervention designed to increase reflective functioning (RF). RF involves parents’ capacity to understand their child’s mind and behavior. RF is important for foster parents who have to build relationships with children whose adverse experiences increase risk for psychosocial challenges. An RCT for Family Minds was conducted with 89 foster parents. It was hypothesized that compared to the control group: (1) intervention foster parents would show a greater increase in RF, (2) a greater decrease in parenting stress, and (3) intervention foster children would show a greater decrease in psychosocial difficulties. Family Minds was administered in three, three-hour modules across 4-6 weeks. When compared with the control group, after six weeks the intervention foster parents showed a significantly greater increase in RF and a greater decrease in parenting stress. Foster child behavior was not significantly different between intervention and control groups, however, exploratory analysis at six months showed possibly lower internalizing symptoms for children of intervention parents. This RCT demonstrated the effectiveness of Family Minds to increase RF in foster parents, decrease parenting stress, and possibly decrease children’s internalizing behavior. In only three sessions, Family Minds is an effective way to support foster families.
... The PDI and Parental Reflective Functioning Questionnaire (PRFQ; Luyten et al., 2009) were used by Hertzmann et al. (2016) in their study of MBT-PT, a programme adapted for use with inter-parental conflict. Byrne et al. (2019) also used the PDI in the Lighthouse Study for families where children were at risk of maltreatment. Enav et al., (2019) also used the PDI for parents of children with autism. ...
... but non-significant improvement in parental self-efficacy. Finally, Byrne et al. (2019) reported that parents who completed treatment indicated significant reductions in self-reported parenting stress and higher levels of parental self-efficacy. No significant findings were found concerning measures of general anxiety and low mood. ...
Article
Objectives Over the past decade, mentalization-based treatment (MBT) approaches have been developed specifically for children, adolescents and families. This study provides a systematic review of MBT applicable to both children and families. Method Five databases were searched to identify reports of MBT studies published up to February 2020. Studies were screened and reported according to PRISMA guidelines. Results A total of 34 studies were included in this review. Of these, 14 focused on parent–child dyads, two on child therapy, seven applied the approach to parenting, four evaluated the application of MBT to the school environment and seven focused on adolescent populations. Conclusion Despite methodological shortcomings and heterogeneity in design, the existing literature does provide tentative support for the use of MBT approaches for these populations, specifically in increasing mentalizing/reflective functioning. Further controlled and methodologically rigorous studies are required.
... In contrast, some randomized controlled trials seeking to enhance PRF have not shown significant improvements in PRF among treatment groups when compared to control groups (Byrne et al., 2019;Fonagy et al., 2016). Perhaps a more nuanced approach to examining for whom PRF improves is needed to better guide promotion of PRF in interventions. ...
... Findings regarding the duration of intervention are mixed. Among interventions that are shorter in duration (20 sessions or less), some are effective at improving PRF Salo et al., 2019;Suchman et al., 2010Suchman et al., , 2017, while others show no change in PRF (Byrne et al., 2019). Likewise, some longer-term interventions are effective at increasing PRF (Sadler et al., 2013;Slade et al., 2020;Stacks et al., 2019), while others are not (Fonagy et al., 2016). ...
Preprint
This study examined changes in parental reflective functioning (PRF) among mothers enrolled in Infant Mental Health-Home Visiting (IMH-HV) and explored whether parental risk, treatment dosage or therapist experience predicted change in PRF. Participants included 75 mothers and their children who were enrolled in IMH-HV delivered by Community Mental Health therapists. Results indicated significant improvements in PRF from baseline to 12-months. Maternal demographic and psychosocial risk, therapist experience and treatment dosage were not directly associated with changes in PRF. However, Mothers who received more treatment sessions from therapists with six or more years of experience demonstrated the greatest improvements in PRF, while mothers who received more treatment sessions from therapists who had been practicing IMH for less than 15 months showed a decline in PRF. Therapists working with very high-risk families may need specific training and ongoing reflective supervision over a period of years to promote improvement in PRF.
... BPD is not mentioned as a diagnosis nor is there a measure reported of changes to parenting or relationship with infant. An additional program providing benefit to high-risk and vulnerable parents, although not necessarily to mothers with BPD, was reported by Byrne et al. (2019). Their Lighthouse program uses an adaption of mentalization-based therapy for personality disorders (Bateman and Fonagy 2013) in order to improve both the parent's and child's attachment styles. ...
... This 20-week group therapy program aims to help parents make sense of, and positively influence, misunderstandings with their children and foster an active curiosity about their child's inner world as well as to reflect on their own thoughts, feelings, and reactions. Pilot findings suggest the program is effective in improving both parenting confidence and sensitivity (Byrne et al. 2019). ...
Article
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A pilot study with women with borderline personality disorder (BPD) and their infants showed promising results. This clinical research program sought to discover whether ongoing implementation confirmed preliminary results in relation to maternal mental health and, in addition, whether parenting and the mother-infant relationship showed sufficient improvement. Women with BPD and their infants were referred to a 25-week group program of Mother-Infant Dialectical Behavior Therapy (MI-DBT). During groups, infants were provided care by childcare workers while mothers took part in a skills training session. Mothers and infants then reunited and took part in an activity together that incorporated skills taught in the teaching session. Sixty-nine of 98 women commencing MI-DBT completed the program, demonstrating a 71% completion rate. Women showed improvement on all measures of mental health including depression, anxiety, and BPD symptoms. While women reported improvement in parenting confidence, an objective measure of the mother-infant relationship showed continuation of concerning relationships in a significant percentage. MI-DBT was found to be effective at improving mothers’ mental health, both at the initial site and in community settings, with different clinicians and with different childcare options. While there were some improvements found in measures of the mother’s perception of the infant-parent relationship, there were no significant improvements in currently used observational measures of the interaction or the infant’s social-emotional development, suggesting that additional intervention such as infant-parent therapy may be needed to augment the benefits of MI-DBT to improve outcomes in these areas.
... The relevance of studying mentalization as a mechanism in trajectories of risk and resilience following CM is further supported by the fact that this ability can be improved through therapeutic interventions. Indeed, numerous mentalization-based treatments benefit from empirical support for various disorders (Balestrieri, interventions were also shown efficient in prenatally (Pajulo, Pajulo, Jussila, & Ekholm, 2016) and postnatally (Byrne et al., 2018;Camoirano, 2017;Sadler et al., 2013) supporting parenting in high risk samples. ...
Article
Background: Childhood maltreatment impacts parenting and has intergenerational consequences. It is therefore crucial to identify clinically responsive resilience-promoting factors in pregnant women and expecting men with history of childhood maltreatment. Mentalization, or reflective functioning, appears as a promising concept to understand risk and resilience in the face of childhood maltreatment. Objective: This study evaluated the multivariate relationship between exposure to childhood maltreatment, reflective functioning, psychological symptoms and parental attitude in expecting parents. Methods: Two hundred and thirty-five pregnant women and 66 expecting fathers completed self-report assessment measures of childhood trauma, reflective functioning, depression, post-traumatic stress disorder, parental sense of competence and antenatal attachment. Twenty-eight percent (n = 85) of the community sample reported personal histories of childhood maltreatment. Results: Structural equation modeling indicated that reflective functioning (a) partially mediated the association between childhood maltreatment and psychological symptoms during pregnancy and (b) independently predicted participants' perception of parental competence and psychological investment toward the unborn child. Conclusion: Overall, this study provides empirical evidence of the protective role of reflective functioning during the prenatal period in parents with histories of childhood maltreatment.
... There is also growing evidence for MBT interventions that focus on the family and broader social context, consistent with the social-ecological approach outlined in this review. Several naturalistic studies and RCTs have supported the effectiveness of MBT in substance-abusing mothers and their infants (Suchman et al. 2018); fostered and adopted children (Redfern et al. 2018); mothers living in underserved, poor, urban communities with children at high risk of maltreatment (Byrne et al. 2019, Slade et al. 2020); individuals supporting a family member with BPD (Bateman & Fonagy 2019a); and school-based preventive intervention programs (Fonagy et al. 2009). These types of system-level interventions might be most effective at addressing the problems that nonmentalizing social environments (e.g., neighborhoods beset by crime and violence, schools with a culture of bullying) tend to generate, by creating a mentalizing climate as a counterweight against competitive, hostile, and aggressive wishes and tendencies. ...
Article
Mentalizing is the capacity to understand others and oneself in terms of internal mental states. It is assumed to be underpinned by four dimensions: automatic–controlled, internally–externally focused, self–other, and cognitive–affective. Research suggests that mental disorders are associated with different imbalances in these dimensions. Addressing the quality of mentalizing as part of psychosocial treatments may be helpful for individuals with various mental disorders. We suggest that mentalizing is a helpful transtheoretical and transdiagnostic concept to explain vulnerability to psychopathology and its treatment. This review summarizes the mentalizing approach to psychopathology from a developmental socioecological evolutionary perspective. We then focus on the application of the mentalizing approach to personality disorders, and we review studies that have extended this approach to other types of psychopathology, including depression, anxiety, and eating disorders. We summarize core principles of mentalization-based treatments and preventive interventions and the evidence for their effectiveness. We conclude with recommendations for future research. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 16 is May 7, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... Reflective functioning refers to a parent's ability to reflect on their own and their child's internal states [75], an ability that has been found to predict more sensitive parenting necessary for secure attachment [76]. In the last 18 months (see Table 1 for more information) there have been five evaluations reported of programs that focus on this aspect of parenting, including the Minding the Baby Program with a community sample of pregnant mothers [77 & ], the Lighthouse Mentalisation-Based Treatment Parenting with a sample of parents at risk of disorganised attachment [78], the Mentalisation Intervention with a sample of caregivers of children with Autism [79] and the PRF Psycho-Educational Program with four parents of a child with separation anxiety (case studies) [80]. A Video Intervention Therapy program is currently underway [81]. ...
... This should be viewed in the context of the wider evidence base on parenting programs. Evaluations of therapeutic interventions have found positive effects on parent reflective functioning, sensitive parenting, parent stress and, to a lesser extent, child attachment and externalizing problems (Luyten et al., 2017;Byrne et al. 2019). However, collectively the evidence is somewhat mixed and limited by the relative dearth of trials and a failure always to measure child outcomes. ...
Article
Objective The aim of the study was to evaluate the implementation and effectiveness of a therapeutic parenting program that targets parents of children aged 6 to 11 years identified as having behavioral and emotional difficulties. The intervention comprises two parts, delivered sequentially: a 10-12-week group-based program for all parents, and one-to-one sessions for up to 12 weeks with selected parents from the group-based element. Methods/Design In a randomized controlled trial, 264 participants were allocated to the Inspiring Futures program (intervention) or services as usual (control) arms with follow-up assessments at 16 (post-group program) and 32 (post-one-to-one sessions) weeks. The primary outcome was the parent-rated Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score at 32 weeks. Secondary outcomes included parent-rated SDQ subscales, parent coping strategies, empathy in parenting and parenting skills. Results All 264 participants were included in outcome analyses. There was no statistically significant effect on SDQ Total Difficulties (standardized mean difference: -0.07; 95% CI: -0.30 to 0.16; p = 0.54). There were no sub-group effects. Only 1 of 40 comparisons between the trial arms for secondary outcomes across both follow-ups was statistically significant at the 5% level. The mean number of group sessions attended by intervention arm participants was 6.1 (out of 10 to 12) and only 1 in 20 intervention arm participants received one-to-one support. Independent observation indicated scope to improve fidelity in terms of adherence, quality and participant responsiveness. Conclusions The intervention is not more effective than services as usual at improving targeted outcomes. This may be related, in part, to implementation issues but arguably more to the inability of a non-behavioral intervention to improve caregiving adequately, particularly when it is not targeted at new parents who have experienced trauma or deprivation early in life or subsequently.
... Reflective functioning refers to a parent's ability to reflect on their own and their child's internal states [75], an ability that has been found to predict more sensitive parenting necessary for secure attachment [76]. In the last 18 months (see Table 1 for more information) there have been five evaluations reported of programs that focus on this aspect of parenting, including the Minding the Baby Program with a community sample of pregnant mothers [77 & ], the Lighthouse Mentalisation-Based Treatment Parenting with a sample of parents at risk of disorganised attachment [78], the Mentalisation Intervention with a sample of caregivers of children with Autism [79] and the PRF Psycho-Educational Program with four parents of a child with separation anxiety (case studies) [80]. A Video Intervention Therapy program is currently underway [81]. ...
Article
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Purpose of review: To review recent studies on emotion-focused parenting interventions to provide clinicians with knowledge about how these approaches might be used in prevention and treatment of mental health difficulties for children, adolescents and their families. Recent findings: A number of emotion-focused parent interventions are reported in the literature, including emotion coaching/communication parenting programs, emotion-focused family therapy, attachment-focused parenting interventions (including those that address parental reflective functioning/mentalization), mindfulness parenting programs and behavioral programs with added emotion components. All target emotions or emotional communication to assist parents and children understand and work through emotional experiences so they are less likely to impede healthy functioning. These interventions target four main domains: exploring family of origin or early attachment/relational experiences with emotion, targeting parents' own emotion awareness and regulation, shifting parents responses to or communication with their children when emotions occur, and promoting parents' skills for assisting children to regulate emotions and behavior. This review from the last 18 months found 50 studies that evaluated programs addressing these domains. Summary: Whilst the dominant approach in evidence-based parenting programs has been teaching behavioral strategies, it has been recognized that a focus on emotion-related processes is important. This is especially when working to improve the attachment relationship or when parents and children experience emotion dysregulation. This review demonstrates extensive evidence to support emotion-focused parenting interventions.
... Specifically, children whose mothers participated in the intervention were significantly more securely attached and less disorganized following intervention than children whose mothers did not participate in the intervention (Sadler et al., 2013). Moreover, parents were more sensitive to their children's cues and reported to be less stressed and more self-secure regarding their parenting style following intervention, compared to parents who did not participate in the intervention (Byrne et al., 2019). Finally, mothers reported that their children exhibited fewer externalizing behavioral problems (Ordway et al., 2014) and more self-regulation post intervention, compared to mothers who did not participate in the intervention (Camoirano, 2017;Halfon & Bulut, 2019;Moretti et al., 2015;Suchman et al., 2016a). ...
Article
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Parental reflective functioning (PRF) is a core element in the parent–child relationship. This study set out to investigate changes in PRF following the DUET program, a 12-week group intervention program. We proposed that the DUET intervention would enhance maternal reflective capacities, resulting in better mother-child emotional availability, better child self-regulation, and decreased child behavioral problems. Seventy mothers completed the DUET group intervention. Of these mothers, nine mothers were first allocated to the waiting-list group and thereafter were included in an intervention group. PRF was measured using observation (mind-mindedness) and an interview (PDI). Following the intervention, a significant improvement was evident in PRF, in parental beliefs about feeling, and in parental sense of efficacy. In addition, the mother–child interaction was more positive, child behavioral problems decreased, and child self-regulation increased. This improvement remained stable over a period of 6 months. Clinical and future directions of this study are discussed.
... The earliest intervention is prevention of the onset of BPD by broad prevention programs. An example is preventing the transgenerational transmission of BPD, like mentalization-based treatment for parents (MBT-P) [68]. Early treatment programs target adolescents with emerging signs of BPD, such as Helping Young People Early-Cognitive Analytic Therapy (HYPE-CAT) [69]. ...
Article
Full-text available
Purpose of Review To provide an update of a life span perspective on borderline personality disorder (BPD). We address the life span course of BPD, and discuss possible implications for assessment, treatment, and research. Recent Findings BPD first manifests itself in adolescence and can be distinguished reliably from normal adolescent development. The course of BPD from adolescence to late life is characterized by a symptomatic switch from affective dysregulation, impulsivity, and suicidality to maladaptive interpersonal functioning and enduring functional impairments, with subsequent remission and relapse. Dimensional models of BPD appear more age neutral and more useful across the entire life span. There is a need for age-specific interventions across the life span. Summary BPD symptoms and impairments tend to wax and wane from adolescence up to old age, and presentation depends on contextual factors. Our understanding of the onset and early course of BPD is growing, but knowledge of BPD in late life is limited. Although the categorical criteria of DSM allow for reliable diagnosis of BPD in adolescence, dimensional models appear both more age neutral, and useful up to late life. To account for the fluctuating expression of BPD, and to guide development and selection of treatment across the life span, a clinical staging model for BPD holds promise.
... Given factors complicating bonding and women's common experiences of separation, psychological support may benefit sex-working mothers and their children, increasing the likelihood of them remaining together (Golding, 2007). Evidence-based interventions should be utilized that acknowledge the impact of complex trauma on mother and child, for example, child-infant psychotherapy (Ghosh Ippen et al., 2011) and mentalization-based parenting approaches (Byrne et al., 2019). This is likely to help women to mentalise themselves as mothers, their child, and their relationship (Markin, 2013). ...
Article
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Many females engaged in sex work are mothers, often experiencing poverty, violence, marginalization, and psychological distress, factors also found to affect parental bonds. However, little is known about how this context impacts the bonding process. Given the ubiquity of sex work across geographical territories, understanding the relationship it has with mother-child bonding is an important international consideration in providing healthcare for sex working mothers and their children. Therefore, in this study we sought to explore women's experiences of bonding with their children in the context of sex work. We interviewed six women in the UK who were sex working during the first two years of their child's life about their bonding experiences and analyzed transcripts using Interpretative Phenomenological Analysis. We identified four themes were identified: (1) the complex process of bonding; (2) the role of powerlessness on bonding; (3) the powerful impact of receiving help, and (4) new perspectives of the body and sex work following motherhood. Findings contribute to the research literature on bonding by emphasizing the value of supportive care and the importance of social context, indicating specific factors to inform psychological support among sex working women.
... Children raised by these parents are more psychologically well-adjusted, intrinsically motivated, self-reliant, and display selfconfidence. [37,38] 7. Spiritual parenting: It is about respecting a child's individuality and creating the space for the child to develop their own beliefs based on their unique personality and individual potentials. It is not about teaching children something external, like a specific belief system or dogma. ...
Article
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Dental anxiety plays a crucial role in managing the children in the dental setup. Anxiety can occur due to various factors; multiple studies have stated that parenting styles affect children's dental anxiety and behaviour. These parenting styles can also influence the child's personality, psychological and social development. Hence, the present review is intended to summarize various parenting styles and attitudes that could affect the paediatric patient behaviour in the dental office. Furthermore, a wide range of new parenting styles which are not yet reported in the literature is also discussed.
... An evaluation of the LP published in 2019 (Byrne et al., 2019) found positive results for improvements in mother self-efficacy, parental stress, and parental sensitivity during playful interactions. The qualitative interviewing displayed some evidence of enhanced mentalizing capacity, suggesting encouraging evidence for improvement over time. ...
Thesis
Aims: This paper explores the parental representations of the child, through the case study of one member of the Lighthouse Project (LP), a mentalization-based intervention for parents of young children aged 1–2 years old, involved with the child welfare system as a result of their child’s maltreatment. Methods: A single mother’s representations of the child are analysed during the programme, through a qualitative lens. Narrative Processes Coding System (NPCS) and Thematic Analysis (TA) are used in combination, to elicit the mother’s representations by identifying language modes and themes from her narratives about both her own and other children. Findings: The maternal representations of the child appeared to be less negative as the programme reached its end. The mother’s reflexive language grew significantly in the middle phase of the programme and regressed during the last phase. However, the combined use of NPCS and TA showed an overall richer and less negative portrayal of the child during the ending phase. Conclusion: These findings suggest that during the course of the programme, the mother’s journey, through her representations of the child, was characterised by progressions and regressions. There was also an emotional richness in the last phase of the programme that indicates the mother’s engagement in the group and her overall positive journey towards the development and the strengthening of a less negative representation of the child. Despite its limitations, this study hopes to provide insights for clinicians establishing and promoting interventions that aim to empower parents to clearly see their children.
... According to Wang (2021), parents who experienced child maltreatment show a prementalizing mode, which was found to imply the tendency to misread their children's state of mind and to erroneously attribute malevolent intentions to them (Luyten et al., 2017a,b). Another study (Byrne et al., 2019) also found that parental mentalization deficit can predispose parents to make hostile misattributions about the child's intentions, which in turn may result in non-accidental injury, physical punishment or emotional abuse. Richey et al. (2016) noted that parents may, for instance, injure the crying or upset child because he/she is persuaded that the child is intentionally and malevolently getting on his/her nerves. ...
Article
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Mentalization is considered an essential ability for social cognition as well as a crucial competency in parenting to further the development of internal structures that are decisive for self organization and affect regulation in children. Yet, few empirical studies have investigated whether, and to what extent, parents who maltreat their children poorly mentalize. The aim of this research was to study the mentalization ability in a group of parents who maltreated their children and had been referred by the Courts for Child Custody and Parenting Plan Evaluation (Group 1), and in a comparison, non-clinical group of parents (Group 2). Adult Attachment Interview (AAI), rated in terms of both the Berkeley AAI System and the Reflective Functioning Scale was administered. Group 1 had severely impaired reflective functioning (RF) in 83.3% of cases, whilst impaired RF was found in only 12.5% of Group 2 parents. For the most part, parents in Group 1 showed Negative Reflective Functioning, systematically resisting taking a reflective stance, and the parents who most severely maltreated their children showed distorted and/or self-serving passages associated with a particular type of dismissing pattern of attachment (DS2) based on the derogation of attachment. The frequent occurrence of derogation in these parents likely explains how much the devaluation of relationships and attachment needs, presumably acquired during childhood with defensive purposes and in order to exclude the pain and perception of emotional weakness from awareness, hinders the capacity to care for children in the full respect of their needs.
... Most interventions that have integrated parenting into treatment for adults with personality pathology are largely skills-based and psychoeducational and do not directly address the attachment relationship [38,52,72]. Mentalization-based treatment (MBT; [15]), an evidence-based treatment that is grounded in attachment theory and considers the parent's caregiving experiences, has been adapted for parents with BPD (MBT-P; [42]) and for families at risk of child maltreatment [8]. While there is an emerging evidence base for these interventions in dyads with young children, there is a need for further evaluation of their efficacy for dyads with adolescents. ...
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Background Research on parent-level factors linked to adolescent attachment security would inform interventions to prevent or reduce youth psychopathology and other negative outcomes. The current study examined one relevant parent-level variable: maternal interpersonal problems. Interpersonal problems, a key characteristic of personality pathology, are well described by the interpersonal circumplex (IPC) and have been shown to be associated with maladaptive adult attachment in close/romantic relationships; however, studies have not examined relationships with offspring attachment. Therefore, the first aim of the current study was to examine the relationship between maternal interpersonal problems and adolescent attachment insecurity. Based on previous evidence that parents’ recalled bonding with caregivers is associated with the quality of bonding and attachment with offspring, the second aim was to examine whether mothers’ recalled bonding with their own mothers partially explained this relationship. Methods Participants included 351 psychiatric inpatient adolescents (Mage = 15.26, 64.1% female) and their biological mothers. Logistic regressions tested whether maternal interpersonal problems were associated with Child Attachment Interview classifications (secure vs. insecure; secure vs. preoccupied vs. dismissing; not disorganized vs. disorganized). A mediation model (N = 210) tested whether the relationship between maternal interpersonal problems and adolescent attachment was mediated by the mother’s recalled maternal bonding. Results Maternal interpersonal problems were associated with insecure (vs. secure), dismissing (vs. secure), and preoccupied (vs. secure) attachment. There was no significant relationship between maternal interpersonal problems and disorganized attachment. Mediation analyses showed that maternal interpersonal problems were indirectly related to adolescent attachment security via the mother’s recalled maternal care, though only a small amount of variance (7%) in adolescent offspring attachment was accounted for by the model. Conclusions Results provide the first evidence that maternal interpersonal problems are associated with higher likelihood of insecure attachment in adolescents. Therefore, researchers could consider drawing upon the IPC literature to further examine mechanisms of intergenerational risk and to tailor interventions aimed to improve parent-child relations and attachment. Additionally, findings highlight the mediating role of the mothers’ recalled experiences with caregivers in the transmission of risk, suggesting attachment-based or mentalization-based interventions may be helpful for mothers with interpersonal problems and personality pathology.
... This should be viewed in the context of the wider evidence base on parenting programs. Evaluations of therapeutic interventions have found positive effects on parent reflective functioning, sensitive parenting, parent stress and, to a lesser extent, child attachment and externalizing problems (Luyten et al., 2017;Byrne et al. 2019). However, collectively the evidence is somewhat mixed and limited by the relative dearth of trials and a failure always to measure child outcomes. ...
Article
Objective: The aim of the study was to evaluate the implementation and effectiveness of a therapeutic parenting program that targets parents of children aged 6 to 11 years identified as having behavioral and emotional difficulties. The intervention comprises two parts, delivered sequentially: a 10-12-week group-based program for all parents, and one-to-one sessions for up to 12 weeks with selected parents from the group-based element. Methods/Design: In a randomized controlled trial, 264 participants were allocated to the Inspiring Futures program (intervention) or services as usual (control) arms with follow-up assessments at 16 (post-group program) and 32 (post-one-to-one sessions) weeks. The primary outcome was the parent-rated Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score at 32 weeks. Secondary outcomes included parent-rated SDQ subscales, parent coping strategies, empathy in parenting and parenting skills. Results: All 264 participants were included in outcome analyses. There was no statistically significant effect on SDQ total difficulties (standardized mean difference:-0.07; 95% CI:-0.30 to 0.16; p = 0.54). There were no subgroup effects. Only 1 of 40 comparisons between the trial arms for secondary outcomes across both follow-ups was statistically significant at the 5% level. The mean number of group sessions attended by intervention arm participants was 6.1 (out of 10 to 12) and only 1 in 20 intervention arm participants received one-to-one support. Based on independent observation, mean adherence, quality and participant responsiveness scores indicated scope to improve fidelity. Conclusions: The intervention is not more effective than services as usual at improving targeted outcomes. This may be related, in part, to implementation issues but arguably more to the inability of a non-behavioral intervention to improve caregiving adequately, particularly when it is not targeted at new parents who have experienced trauma or deprivation early in life or subsequently.
... Findings that mentalizing, and the capacity to reflect on traumatic experiences in particular (i.e., trauma-specific reflective functioning), provide an important buffer between trauma, features of PTSD such as dissociation, and intergenerational transmission of trauma (43), have further substantiated the mentalizing approach to trauma. Moreover, there is increasing evidence for the effectiveness of preventive interventions rooted in MBT for families at risk for maltreatment and abuse (44)(45)(46)(47). Yet, no study to date has directly investigated the impact of trauma on outcomes of MBT among individuals with borderline personality disorder. ...
Article
Objective: Recent meta-analyses suggest that many patients with borderline personality disorder have a history of complex trauma. Although trauma is central in mentalization-based approaches to the understanding of borderline personality disorder, surprisingly little is known about the effects of trauma on outcomes of mentalization-based treatment (MBT). This article investigates the prevalence and impact of childhood trauma among patients with borderline personality disorder participating in a randomized controlled trial (RCT) comparing day hospital MBT (MBT-DH) and intensive outpatient MBT (MBT-IOP). Methods: All 114 patients from the original multicenter RCT in the Netherlands were included in this study. Childhood trauma was assessed at baseline (with the Childhood Trauma Questionnaire), and its impact on symptom severity, interpersonal functioning, and borderline pathology was investigated through multilevel modeling for 36 months after the start of treatment. Results: Childhood trauma was common among patients with borderline personality disorder referred to MBT, with more than 85% meeting cutoff criteria for substantial childhood trauma. Childhood trauma had little impact on outcomes of either MBT-DH or MBT-IOP in terms of improved borderline personality disorder features or interpersonal functioning. However, patients with substantial childhood trauma seemed to improve more rapidly with MBT-DH, as compared with MBT-IOP, in terms of symptom severity. In addition, patients with a history of emotional neglect showed more rapid changes in symptoms of borderline personality disorder with MBT-DH compared with MBT-IOP. Conclusions: Findings are discussed in the context of a social communicative approach to borderline personality disorder, with a focus on the need to address trauma in MBT.
Article
Objectives Mental health professionals who work with children face various challenges, requiring them to consider factors that aim to promote healthy adaptation in their clients. There is a growing body of literature showing that child attachment pattern, as well as mentalizing ability in both children and their parents, are related to various indicators of well-being including mental health. However, studies assessing these constructs in clinical samples are sparse. Method Forty-nine children (2-6 years of age) and their parents were recruited through the Clinique spécialisée 0-5 ans of the Hôpital en santé mentale Albert-Prévost (HSMAP). A two-hour laboratory visit was carried out where parents and children completed individual and parent-child dyad tasks and filled out questionnaires. Various dimensions of parent and child functioning were assessed including the mother-child attachment relationship and parents’ mentalization ability. Results Preliminary results indicated that child attachment pattern was related to children’s behavioral and executive functioning as well as parents’ psychiatric symptoms and parenting-related stress. Moreover, parents in our sample had lower levels of mentalizing abilities than those found in normative samples. Parents’ mentalizing ability was related to the presence of psychiatric symptoms, parenting-related stress, and a history stressful life events. Conclusion These results highlight the need for mental health professionals working in a child psychiatric clinic to consider the child’s attachment pattern and the mentalization ability of children and their parents, throughout the assessment process and subsequent implementation of interventions. In the last section of the manuscript, we present different ways we have integrated these concepts into our clinical work with children and parents referred to HSMAP. © Département de psychiatrie de l’Université de Montréal, 2020.
Article
The ability to mentalize is central in the context of the parent-child relationship. The parental competence to see the child's mental state as an independent individual is an essential prerequisite for perceiving and interpreting child signals appropriately. These abilities are crucial but not always available under elevated stress levels when confronted with a child’s affects and parenting challenges. Despite the clinical and conceptual relevance of mentalization with borderline personality disorder (BPD) and affective disorders, the subject has rarely been systematically addressed in parents. This review provides a systematic overview of parental mentalization in mothers with affective disorders or BPD and its impact on the quality of maternal interactive behaviour. The findings generally revealed a negative association between mothers’ parental mentalization and depression or BPD, which varied greatly depending on the mentalization constructs. Both psychiatric diagnosis and current severity of symptoms were found to be relevant. However, some positive aspects of mentalization were not markedly impaired. Further, a lower mentalizing ability was associated with reduced sensitive behaviour in depressed mothers. The results contribute to a better understanding of the association between mentalization and maternal psychopathology and help refine early interventions in parent-child settings.
Article
Parental reflective functioning refers to the parents' ability to reflect on the internal mental states of their children, which will make them respond more sensitively to their children´s need. The relation between parental reflective functioning and child emotion regulation has been considered a key factor in early childhood parenting but further research is needed about this relationship throughout child's development. The aim of this paper was to analyze this interaction considering the early childhood development stages. Three hundred and eighty one mothers of babies between 0 and 26 months of age participated in the study. The PRFQ and ASQ:SE-2 questionnaires were administered to assess parental reflective functioning and child emotion regulation, respectively. Results showed that maternal RF and child emotion regulation do not follow a linear process according to the childhood development stages, and also that the maternal PM dimension generates a conditional effect in children's emotion regulation. These results highlight the importance of paying attention to specific early childhood developmental stages to understand how maternal reflective functioning influences child´s ability to calm and adjust to her/his environment.
Article
Despite the longstanding theoretical association in the attachment literature between maternal trauma history and disturbances in the mother–infant interaction, few studies have investigated mechanisms of transmission of traumatogenic relational patterns in high‐risk mother–infant dyads. This study investigated interrelationships among maternal trauma history, distorted maternal representations (DMRs, i.e. disturbed thoughts and feelings about the infant and self‐as‐parent), maternal mentalisation (i.e. capacity to conceive of self and other's intentions in terms of mental states including thoughts, feelings, and desires), and quality of interaction in a clinical sample of mothers with Borderline Personality Disorder (BPD) features and their infants (N = 61). Measures used included the Childhood Trauma Questionnaire, Parent Development Interview, Mother–Infant Relationship Scale, Borderline Symptom Checklist‐23, and the Emotional Availability Scales. The results indicated BPD features mediated the relationship between maternal trauma history and DMRs predicting disturbance in interaction. In addition, analyses showed that maternal mentalisation had a buffering effect between DMRs and maternal non‐hostility and yet the severity of BPD features moderated the relationship between mentalisation and DMRs. The findings suggest postpartum borderline pathology may adversely impact the experience of being a parent for women with a relational trauma history including deficits in mentalisation (i.e. hypermentalising) and disturbances in the mother–infant interaction. Implications for research and clinical practice are discussed.
Article
Objectives Mental health professionals who work with children face various challenges, requiring them to consider factors that aim to promote healthy adaptation in their clients. There is a growing body of literature showing that child attachment pattern, as well as mentalizing ability in both children and their parents, are related to various indicators of well-being including mental health. However, studies assessing these constructs in clinical samples are sparse. Method Forty-nine children (2-6 years of age) and their parents were recruited through the Clinique spécialisée 0-5 ans of the Hôpital en santé mentale Albert-Prévost (HSMAP). A two-hour laboratory visit was carried out where parents and children completed individual and parent-child dyad tasks and filled out questionnaires. Various dimensions of parent and child functioning were assessed including the mother-child attachment relationship and parents' mentalization ability. Results Preliminary results indicated that child attachment pattern was related to children's behavioral and executive functioning as well as parents' psychiatric symptoms and parenting-related stress. Moreover, parents in our sample had lower levels of mentalizing abilities than those found in normative samples. Parents' mentalizing ability was related to the presence of psychiatric symptoms, parenting-related stress, and a history stressful life events. Conclusion These results highlight the need for mental health professionals working in a child psychiatric clinic to consider the child's attachment pattern and the mentalization ability of children and their parents, throughout the assessment process and subsequent implementation of interventions. In the last section of the manuscript, we present different ways we have integrated these concepts into our clinical work with children and parents referred to HSMAP.
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In recent years many studies have been done in the field of the ability of mentalization and parental reflective function and its role in the development of different kinds of psychological disorders. The ability of mentalization shows parents’ understanding of their child’s mental state which will ultimately lead to the acquiring of this ability by the child during his or her development. This study is a review of the interventions based on mentalization, empirical studies in the field of parental reflective function, and especially the role of parental mentalization ability on children’s disorders and problematic behavior. For this reason, all the available articles until 2019 considering the inclusion and exclusion criteria has been studied. The phrases mentalization, reflective function, parental reflective function, and interventions based on mentalization have been searched for in reliable databases of scientific articles. Eventually, the collected articles has been studied and the similarities and differences between them has been discussed. Keywords: mentalization, parental reflective function, interventions based on mentalization
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This review provides a qualitative comparative analysis of theoretical and methodological aspects of 27 studies in which the results of the implementation of programs involved in child maltreatment are presented with an attachment perspective. The studies were examined following the Scottish Intercollegiate Guidelines Network. It was found that the programs promote the development of maternal sensitivity, mentalization or reflective functioning and empathy, however, the underlying mechanisms are not differentiated according to the type of abuse to intervene. Likewise, it was found that despite the recognition of the mother's violent childhood experiences as one of the main predisposing factors for child abuse, it is a variable that is scarcely considered in the programs examined. These findings indicate the importance of developing intervention programs that consider a cumulative ecological risk perspective.
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In former parts of this tripartite article, the parental mentalization concept and its operationalized referent (Parental Reflective Functioning) were described. In addition, we explained the assessment methods and interventions based on parental reflective functioning. In this part, 13 Reflective Functioning-based interventions which are the most important and most famous ones in this field are defined. These include parenting programs and family-centered interventions and they are designed for different groups and various ages. The effectiveness of these interventions was confirmed in different studies.
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The massive development of information technology based on big data, internet, and artificial intelligence has brought fundamental changes to human patterns and lifestyles, especially after the COVID-19 pandemic that hit globally, has added to a large and complex problems in parenting, as well as demanding people to take care of their children. Parents must be able to adapt and reposition themselves with new and effective forms of parenting, this can increase parental anxiety. To determine the level of parental anxiety, this research was conducted using a quantitative descriptive method through the distribution of questionnaires based on the GAD-7 instrument. This study focuses on efforts to capture the level of parental anxiety and the need for a new form of parenting. The results can be the basis for further research to find and develop new forms of parenting. The results of research on 669 parents living in West Java, Indonesia, showed that the level of parental anxiety was 63.08% at the level of moderate and severe anxiety. The level of parental satisfaction regarding the form of parenting used is at a low level of 67.12%, while the level of parental interest in the new form of parenting is at a very high level of 98.51%. The need for the latest form of parenting that can respond to the challenges and demands of the times is very necessary to minimize parental anxiety.
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Recently, attachment-informed researchers and clinicians have begun to show that attachment theory offers a useful framework for exploring group psychotherapy. However, it remains unclear whether patients with differing attachment classifications would behave and speak in distinct ways in group therapy sessions. Aim: In this study, we conducted an exploratory analysis of the discourse of patients in group therapy who had independently received different classifications with gold standard interview measures of attachment in adults. Each patient participant attended one of three mentalization-based parenting groups. Before treatment, the Adult Attachment Interview (AAI) or the Parent Development Interview (PDI) were administered to each patient, and interviews were transcribed and coded to obtain the patient’s attachment classification. Groups included 2, 5, and 5 patients, respectively, and any session was led by at least two co-therapists. A total of 14 group sessions were transcribed verbatim. Sessions were analysed through a semi-inductive method, in order to identify markers that would typify patients of different attachment classifications in session. Through transcript excerpts and narrative descriptions, we report on the differing ways in which patients of different attachment classifications communicate in group psychotherapy, with the therapist and with each other. Our work provides useful information for group therapists and researchers regarding how differences in attachment status may play out in group sessions.
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OBJECTIVE: To synthesize recent evidence from systematic and comprehensive reviews on the effectiveness of universal and selective child maltreatment prevention interventions, evaluate the methodological quality of the reviews and outcome evaluation studies they are based on, and map the geographical distribution of the evidence. METHODS: A systematic review of reviews was conducted. The quality of the systematic reviews was evaluated with a tool for the assessment of multiple systematic reviews (AMSTAR), and the quality of the outcome evaluations was assessed using indicators of internal validity and of the construct validity of outcome measures. FINDINGS: The review focused on seven main types of interventions: home visiting, parent education, child sex abuse prevention, abusive head trauma prevention, multi-component interventions, media-based interventions, and support and mutual aid groups. Four of the seven - home-visiting, parent education, abusive head trauma prevention and multi-component interventions - show promise in preventing actual child maltreatment. Three of them - home visiting, parent education and child sexual abuse prevention - appear effective in reducing risk factors for child maltreatment, although these conclusions are tentative due to the methodological shortcomings of the reviews and outcome evaluation studies they draw on. An analysis of the geographical distribution of the evidence shows that outcome evaluations of child maltreatment prevention interventions are exceedingly rare in low- and middle-income countries and make up only 0.6% of the total evidence base. CONCLUSION: Evidence for the effectiveness of four of the seven main types of interventions for preventing child maltreatment is promising, although it is weakened by methodological problems and paucity of outcome evaluations from low- and middle-income countries.
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The studies reported here aimed to test the proposal that mind-mindedness is a quality of personal relationships by assessing mind-mindedness in caregiver–child dyads where the relationship has not spanned the child’s life or where the relationship has been judged dysfunctional. Studies 1 and 2 investigated differences in mind-mindedness between adoptive parents (ns 89, 36) and biological parents from the general population (ns 54, 114). Both studies found lower mind-mindedness in adoptive compared with biological parents. Study 2’s results showed that this group difference was independent of parental mental health and could not fully be explained in terms of children’s behavioral difficulties. Study 3 investigated differences in mind-mindedness in foster carers (n=122), parents whose children have been the subject of a child protection plan (n=172), and a community sample of biological parents (n=128). The level of mind-mindedness in foster carers and parents who were involved with child protection services was identical and lower than that in the community sample; children’s behavioral difficulties could not account for the difference between the two groups of biological parents. In all three studies, non-biological carers’ tendency to describe their children with reference to pre-adoption or placement experiences was negatively related to mind-mindedness. These findings are in line with mind-mindedness being a relational construct.
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This article sets out the relevance of recent theoretical developments in the areas of mentalizing, attachment and epistemic trust in relation to group therapy. It begins with an account of the role of mentalizing in the attachment context in the development of epistemic trust—defined as trust in the authenticity and personal relevance of interpersonally transmitted knowledge about how the social environment works. It then explains the particular way in which this emphasis on social communication is pertinent to group therapy and its function as a training ground for mentalizing and the initial experimentation with the opening of epistemic trust in a social context. The article finishes with an account of how mentalization-based group work is undertaken.
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Child physical abuse is an issue of global concern. Conservative estimates set global prevalence of this type of maltreatment at 25%, its consequences and cost to society escalating with increasing frequency and severity of episodes. Syntheses of the evidence on parenting programs for reducing rates of physical abuse recidivism have, to date, not been able to establish effectiveness. Paucity of data and inconsistent inclusion criteria in past reviews made meta-analysis often impossible or uninformative. The current systematic review updates prior reviews and overcomes some of the methodological issues they encountered by pooling trial-level data from a well-defined scope of trials of parenting interventions aimed at preventing the reabuse of children by parents with substantiated or suspected physical abuse history. Randomized controlled trials and rigorous non-randomized designs were sought via nine online databases, two trial registries, several clearinghouses and contact with experts. A total of fourteen studies of variable quality were included in this review, four of which had outcomes that enabled meta-analysis. Overall, this review presents evidence supporting the effectiveness of parenting behavioral programs based on social learning theory for reducing hard markers of child physical abuse recidivism. Meta-analysis found that the absolute risk reduction in risk of recidivism was 11 percentage points less for maltreating parents who undergo parenting programs (RD = -0.11, 95% CI [-0.22, -0.004], p = 0.043, I2 = 28.9%). However, the pooled effect size was not statistically significant when calculated as a risk ratio (0.76, 95% CI [0.54, 1.07], I2 = 38.4%). Policy makers and practitioners should be made aware that this intervention method is backed by promising evidence featuring modest yet significant reductions in hard markers of child physical abuse, even though the methodological robustness of these findings should be further explored in future research.
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Background A significant proportion of children in the social care system in England present with mental health problems, with the majority experiencing some form of emotional and behavioural difficulties. The most effective treatments for these children are currently unknown, partly due to a lack of robust, controlled studies. Researchers have identified a number of obstacles to conducting well-designed research with this population, making the need to test the feasibility of a randomised controlled trial especially important. Methods/design This protocol outlines a two-arm, randomised control feasibility trial to explore the acceptability and credibility of mentalization-based treatment (MBT) as a treatment for reducing emotional and behavioural difficulties in looked after children and to test the possibility of addressing a number of methodological challenges to conducting high-quality research with this population. MBT is a relatively new intervention which, in the adaptation of the model tested here, includes many of the features of therapy identified in NICE guidelines as necessary to support children in care. The two arms are MBT and usual clinical care (UCC). The study will take place in Hertfordshire Partnership University NHS Foundation Trust with follow-up at 12 and 24 weeks. Discussion This study will aim to ascertain whether it is worthwhile and feasible to progress to testing the intervention in a full-scale definitive randomised controlled trial (RCT). This study therefore has the potential to improve our understanding of the obstacles to conducting high-quality research with this very vulnerable population, and in the medium term, could help to improve the stability of foster placements and the emotional well-being of children in care. Trial registration ISRCTN90349442
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Child maltreatment is a global problem affecting both high income (HICs) and low and middle income countries (LMICs). However research has shown that children who live in the world’s poorest countries and communities are more likely to suffer from abuse and neglect. There is some evidence that parenting interventions can assist in the prevention of child maltreatment, but most of this research has been conducted in HICs. The main aim of this review was to examine the evidence from previous systematic reviews on the role of parenting programmes in the prevention of violence against children in both HICs and LMICs. A comprehensive internet search was conducted for published and unpublished reviews. After reviewing abstracts and full texts against established criteria for inclusion in the study, 28 reviews (20 systematic reviews/meta-analyses and 8 comprehensive reviews) were used in the analyses. The findings suggest that parenting programmes have the potential to both prevent and reduce the risk of child maltreatment. However, there is lack of good evidence from LMICs where the risk of child maltreatment is greatest. Implications for policy and future research are discussed, especially for the LMIC context.
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Background Antisocial personality disorder (ASPD) is an under-researched mental disorder. Systematic reviews and policy documents identify ASPD as a priority area for further treatment research because of the scarcity of available evidence to guide clinicians and policymakers; no intervention has been established as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment which specifically targets the ability to recognise and understand the mental states of oneself and others, an ability shown to be compromised in people with ASPD. The aim of the study discussed in this paper is to investigate whether MBT can be an effective treatment for alleviating symptoms of ASPD. Methods This paper reports on a sub-sample of patients from a randomised controlled trial of individuals recruited for treatment of suicidality, self-harm, and borderline personality disorder. The study investigates whether outpatients with comorbid borderline personality disorder and ASPD receiving MBT were more likely to show improvements in symptoms related to aggression than those offered a structured protocol of similar intensity but excluding MBT components. ResultsThe study found benefits from MBT for ASPD-associated behaviours in patients with comorbid BPD and ASPD, including the reduction of anger, hostility, paranoia, and frequency of self-harm and suicide attempts, as well as the improvement of negative mood, general psychiatric symptoms, interpersonal problems, and social adjustment. ConclusionsMBT appears to be a potential treatment of consideration for ASPD in terms of relatively high level of acceptability and promising treatment effects. Trial registrationISRCTN ISRCTN27660668, Retrospectively registered 21 October 2008
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There is a dearth of good-quality research investigating the outcomes of psychoanalytic parent-infant psychotherapy (PIP). This randomized controlled trial investigated the outcomes of PIP for parents with mental health problems who also were experiencing high levels of social adversity and their young infants (<12 months). Dyads were clinically referred and randomly allocated to PIP or a control condition of standard secondary and specialist primary care treatment (n = 38 in each group). Outcomes were assessed at baseline and at 6-month and 12-month follow-ups. The primary outcome was infant development. Secondary outcomes included parent-infant interaction, maternal psychopathology, maternal representations, maternal reflective functioning, and infant attachment. There were no differential effects over time between the groups on measures of infant development, parent-infant interaction, or maternal reflective functioning. Infant attachment classifications, measured only at the 12-month follow-up, did not differ between the groups. There were favorable outcomes over time for the PIP-treated dyads relative to the control group on several measures of maternal mental health, parenting stress, and parental representations of the baby and their relationship. The findings indicate potential benefits of parent-infant psychotherapy for improving mothers' psychological well-being and their representations of their baby and the parent-infant relationship.
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The present study aimed to review recent literature on universal violence and child maltreatment prevention programs for parents. The following databases were used: Web of Science, PsycINFO, PsycARTICLES, PubMed, LILACS, and SciELO. The keywords included the following: (Parenting Program or Parent Training or Parent Intervention) and (Maltreatment or Violence or Violence Prevention). For inclusion in this review, the programs had to be structured, working in groups of parents aiming to improve parenting practices. Twenty-three studies were included, and 16 different types of parenting programs were identified. Ninety-one percent of the studies were conducted in developed countries. All the programs focused on the prevention of violence and maltreatment by promoting positive parenting practices. Only seven studies were randomized controlled trials. All studies that evaluated parenting strategies (n=18), reported after the interventions. The programs also effectively improved child behavior in 90% of the studies that assessed this outcome. In conclusion, parenting educational programs appear to be an important strategy for the universal prevention of violence and maltreatment against children. Future studies should assess the applicability and effectiveness of parenting programs for the prevention of violence against children in developing countries. Further randomized control trials are also required.
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Through the collaboration and partnership working of key professionals within maternity services, Child and Adolescent Mental Health Services (CAMHS), health visiting, GP services and Oxford Primary Care Trust (PCT), an innovative new service has been established which addresses the needs of women with mild to moderate mental health problems in pregnancy and the perinatal period—the Infant Parent Perinatal Service (IPPS). The partnership model of working has created firm pathways across service providers and has resulted in a forum for ongoing opportunity and creativity which continues to seek and develop new ways of improving mental health care for vulnerable women in pregnancy and the perinatal period. It is now well recognized that not only the physical but also the mental and emotional health of a woman while pregnant and in her infant’s early years will have a lifelong effect (Department of Health, 2011: 10). The IPPS project has been recognized nationally, receiving second place in the 2009 British Journal of Midwifery awards for ‘team of the year’ and a highly commended second place in the Royal College of Midwives 2010 awards for excellence in partnership working.
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Mentalizing-the capacity to understand others' and one's own behavior in terms of mental states-is a defining human social and psychological achievement. It involves a complex and demanding spectrum of capacities that are susceptible to different strengths, weakness, and failings; personality disorders are often associated with severe and consistent mentalizing difficulties (Fonagy & Bateman, 2008). In this article, we will argue for the role of mentalizing in the therapeutic relationship, suggesting that although mentalization-based treatment may be a specific and particular form of practice, the "mentalizing therapist" is a universal constituent of effective psychotherapeutic interventions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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Mentalizing, in particular the successful attribution of complex mental states to others, is crucial for navigating social interactions. This ability is highly influenced by external factors within one's daily life, such as stress. We investigated the impact of stress on the brain basis of mentalization in adults. Using a novel modification of the Reading the Mind in the Eyes Test (RMET-R) we compared the differential effects of two personalized stress induction procedures: a general stress induction (GSI) and an attachment-related stress induction (ASI). Participants performed the RMET-R at baseline and after each of the two inductions. Baseline results replicated and extended previous findings regarding the neural correlates of the RMET-R. Additionally, we identified brain regions associated with making complex age judgments from the same stimuli. Results after stress exposure showed that the ASI condition resulted in reduced mentalization-related activation in the left posterior superior temporal sulcus (STS), left inferior frontal gyrus and left temporoparietal junction (TPJ). Moreover, the left middle frontal gyrus and left anterior insula showed greater functional connectivity to the left posterior STS after the ASI. Our findings indicate that attachment-related stress has a unique effect on the neural correlates of mentalization.
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Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
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Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise the evidence relating to the possible relationship between child physical abuse, emotional abuse, and neglect, and subsequent mental and physical health outcomes. A systematic review was conducted using the Medline, EMBASE, and PsycINFO electronic databases up to 26 June 2012. Published cohort, cross-sectional, and case-control studies that examined non-sexual child maltreatment as a risk factor for loss of health were included. All meta-analyses were based on quality-effects models. Out of 285 articles assessed for eligibility, 124 studies satisfied the pre-determined inclusion criteria for meta-analysis. Statistically significant associations were observed between physical abuse, emotional abuse, and neglect and depressive disorders (physical abuse [odds ratio (OR) = 1.54; 95% CI 1.16-2.04], emotional abuse [OR = 3.06; 95% CI 2.43-3.85], and neglect [OR = 2.11; 95% CI 1.61-2.77]); drug use (physical abuse [OR = 1.92; 95% CI 1.67-2.20], emotional abuse [OR = 1.41; 95% CI 1.11-1.79], and neglect [OR = 1.36; 95% CI 1.21-1.54]); suicide attempts (physical abuse [OR = 3.40; 95% CI 2.17-5.32], emotional abuse [OR = 3.37; 95% CI 2.44-4.67], and neglect [OR = 1.95; 95% CI 1.13-3.37]); and sexually transmitted infections and risky sexual behaviour (physical abuse [OR = 1.78; 95% CI 1.50-2.10], emotional abuse [OR = 1.75; 95% CI 1.49-2.04], and neglect [OR = 1.57; 95% CI 1.39-1.78]). Evidence for causality was assessed using Bradford Hill criteria. While suggestive evidence exists for a relationship between maltreatment and chronic diseases and lifestyle risk factors, more research is required to confirm these relationships. This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence. Please see later in the article for the Editors' Summary.
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Relations between nonmaternal child care and ratings of maternal sensitivity and child positive engagement during mother–child interaction at 6, 15, 24, and 36 months were examined for 1,274 mothers and their children participating in the National Institute of Child Health and Human Development(NICHD) Study of Early Child Care. In longitudinal analyses that controlled for selection, child, and family predictors, child care was a small but significant predictor of maternal sensitivity and child engagement. For the whole sample, including families who did and did not use child care, more hours of child care predicted less maternal sensitivity and less positive child engagement. For children who were observed in child care, higher quality child care predicted greater maternal sensitivity, and more child-care hours predicted less child engagement. The effects of child care on mother–child interaction were much smaller in the analytical models than the effects of maternal education but were similar in size to the effects of maternal depression and child difficult temperament. Patterns of association with child care did not differ significantly across ages of assessment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Maternal maltreatment history and current parenting stress are associated with parenting difficulties. However, researchers have not investigated the mechanism by which these variables are interlinked. We hypothesized that parenting stress mediates the relation between history of maltreatment and parenting behavior. We assessed a community sample of 291 mothers as they interacted with their 16-month old infants in the home. Maternal history of maltreatment and parenting stress were assessed via self-report inventory; maternal sensitivity toward the infant was assessed with 2h of direct behavioral observation. Mothers who reported more maltreatment in childhood were less sensitive with their infants; mothers who reported more current parenting stress were also less sensitive. Parenting stress mediated between maternal maltreatment history and current parental behavior. Findings are consistent with an interpretation of parenting stress as a pathway through which maternal history of maltreatment may be linked to decreased maternal sensitivity.
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This meta-analysis included 66 studies (N = 4,176) on parental antecedents of attachment security. The question addressed was whether maternal sensitivity is associated with infant attachment security, and what the strength of this relation is. It was hypothesized that studies more similar to Ainsworth's Baltimore study (Ainsworth, Blehar, Waters, & Wall, 1978) would show stronger associations than studies diverging from this pioneering study. To create conceptually homogeneous sets of studies, experts divided the studies into 9 groups with similar constructs and measures of parenting. For each domain, a meta-analysis was performed to describe the central tendency, variability, and relevant moderators. After correction for attenuation, the 21 studies (N = 1,099) in which the Strange Situation procedure in nonclinical samples was used, as well as preceding or concurrent observational sensitivity measures, showed a combined effect size of r(1,097) = .24. According to Cohen's (1988) conventional criteria, the association is moderately strong. It is concluded that in normal settings sensitivity is an important but not exclusive condition of attachment security. Several other dimensions of parenting are identified as playing an equally important role. In attachment theory, a move to the contextual level is required to interpret the complex transactions between context and sensitivity in less stable and more stressful settings, and to pay more attention to nonshared environmental influences.
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Child abuse and neglect are important causes of child morbidity and death. We assessed potentially detrimental parental actions induced by infant crying in 3259 infants aged 1-6 months, in the Netherlands. In infants aged 6 months, 5.6% (95% CI 4.2-7.0) of parents reported having smothered, slapped, or shaken their baby at least once because of its crying. The risks of detrimental actions were highest for parents from non-industrialised countries, those with either no job or a job with short working hours, and those who judged their infant's crying to be excessive. Clinicians should be aware of the risks of abuse in children known to cry a lot and should target interventions at parents to help them cope with this crying.
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This study provides an exploration of factors implicated in the intergenerational cycle of child maltreatment. Families with newborns where at least one of the parents was physically and/or sexually abused as a child (AP families) were compared in terms of risk factors to families where the parents had no childhood history of victimization (NAP families). The mediational properties of risk factors in the intergenerational cycle of maltreatment were then explored. Information was collected by community nurses as a part of the 'health visiting' service. Data was collated across 4351 families, of which 135 (3.1%) had a parent who self-reported a history of abuse in childhood. The health visitor visited each family at home when the child was 4 to 6 weeks of age to assess the presence of risk factors. Within 13 months after birth, 9 (6.7%) AP families were referred for maltreating their own child in comparison to 18 (.4%) NAP families. Assessments found a significantly higher number of risk factors for AP families. Mediational analysis demonstrated that the presence of three significant risk factors (parenting under 21 years, history of mental illness or depression, residing with a violent adult) provided partial mediation of the intergenerational continuity of child maltreatment, explaining 53% of the total effect. Prevention may be possible, once a history of parental childhood abuse has been identified, by offering services in priority to those families where a parent is under 21 years, has a history of mental illness/depression and/or there is a violent adult residing in the household. However, it must also be acknowledged that these factors do not provide a full causal account of the intergenerational transmission and consideration should be given to additional factors, such as parenting styles (see Part II of this mediational model, Dixon, Hamilton-Giachritsis, and Browne, 2004).
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There is much to digest in a 30 year longitudinal study of the developing person (Sroufe, Egeland, Carlson, & Collins, 2005a). The following paper summarizes some key points regarding the place of infant attachment in the developmental course. It is argued that understanding the role of attachment entails grasping the organizational nature of the attachment construct and embracing a non-linear transactional model. Using such concepts, attachment history was shown in the Minnesota study to be clearly related to the growth of self-reliance, the capacity for emotional regulation, and the emergence and course of social competence, among other things. Moreover, specific patterns of attachment had implications for both normal development and pathology. Even more important than such linkages, however, study of the place of early attachment in later adaptation reveals much about developmental processes underlying both continuity and change. Findings are over-viewed concerning the complex links between attachment and ultimate outcomes and the preservation of early patterns even during times of change. In all, these findings have implications both for future research and for clinical application.
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Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
Chapter
When we mentalize we are engaged in a form of (mostly preconscious) imaginative mental activity that enables us to perceive and interpret human behavior in terms of intentional mental states (e.g., needs, desires, feelings, beliefs, goals, purposes, and reasons) (Allen, Fonagy, & Bateman, 2008). Mentalizing must be imaginative because we have to imagine what other people might be thinking or feeling. We can never know for sure what is in someone else’s mind (Fonagy, Steele, Steele, & Target, 1997). Moreover, perhaps counterintuitively, we suggest that a similar kind of imaginative leap is required to understand our own mental experience, particularly in relation to emotionally charged issues. We shall see that the ability to mentalize is vital for self-organization and affect regulation. The ability to infer and represent other people’s mental states may be uniquely human. It seems to have evolved to enable humans to predict and interpret others’ actions quickly and efficiently in a large variety of competitive and cooperative situations. However, the extent to which each of us is able to master this vital capacity is crucially influenced by our early experiences as well as our genetic inheritance. In this chapter, we discuss the evolutionary function of attachment relationships, arguing that their major evolutionary advantage is the opportunity that they give infants to develop social intelligence, as well to acquire the capacity for affect regulation and attentional control. We outline the neurobiological substrates that may link secure attachment and mentalization or social cognition, and describe how secure attachment facilitates both the release of hormones enhancing social sensitivity in mothers and the activation of reward processing regions of the brain in mothers’ interactions with their infants, even when the infant is upset. We review evidence from the developmental literature on the social influences on attachment and mentalization. We then describe how our understanding of ourselves and others as mental agents grows out of interpersonal experience, particularly the child-caregiver relationship (Fonagy, Gergely, Jurist, & Target, 2002), and how the development of the ability to mentalize may be compromised in children who have not benefited from the opportunity to be understood and thought about in this way by a sensitive caregiver. Such individuals are then at greater risk of developing personality pathology, particularly if early neglect is compounded by trauma. Finally we offer some reflections on the challenges of mentalizing in family interactions.
Article
In the current study associations between parents' experiences of childhood maltreatment and their perceptual, behavioral and autonomic responses to infant emotional signals were examined in a sample of 160 parents. Experienced maltreatment (both physical and emotional abuse and neglect) was reported by the participants and, in approximately half of the cases, also by their parents. During a standardized infant vocalization paradigm, participants were asked to squeeze a handgrip dynamometer at maximal and at half strength while listening to infant crying and laughter sounds and to rate their perception of the sounds. In addition, their heart rate (HR), pre-ejection period (PEP), and vagal tone (RSA) were measured as indicators of underlying sympathetic and parasympathetic reactivity. Results indicated that participants did not differ in their perceptions of the infant vocalizations signals according to their maltreatment experiences. However, maltreatment experiences were associated with the modulation of behavioral responses. Experiences of neglect during childhood were related to more handgrip force during infant crying and to less handgrip force during infant laughter. Moreover, a history of neglect was associated with a higher HR and a shorter PEP during the entire infant vocalization paradigm, which may indicate chronic cardiovascular arousal. The findings imply that a history of childhood neglect negatively influences parents' capacities to regulate their emotions and behavior, which would be problematic when reacting to children's emotional expressions.
Article
This study examined the relations between child maltreatment and reactive and proactive functions of aggression, and whether hostile attribution biases partially accounted for these associations in a sample of 339 college students (M age = 19, 51% male). Child maltreatment was associated with reactive, but not proactive, aggression, and instrumental hostile attribution biases accounted for this association. Relational hostile attributions were correlated with both reactive and proactive aggression, but did not play a role in the link between child maltreatment and reactive aggression.
Article
Background: Consistent with evidence from high-income countries (HICs), we previously showed that, in an informal peri-urban settlement in a low-middle income country, training parents in book sharing with their infants benefitted infant language and attention (Vally, Murray, Tomlinson, & Cooper, ). Here, we investigated whether these benefits were explained by improvements in carer-infant interactions in both book-sharing and non-book-sharing contexts. We also explored whether infant socioemotional development benefitted from book sharing. Methods: We conducted a randomized controlled trial in Khayelitsha, South Africa. Carers of 14-16-month-old infants were randomized to 8 weeks' training in book sharing (n = 49) or a wait-list control group (n = 42). In addition to the cognitive measures reported previously, independent assessments were made at base line and follow-up of carer-infant interactions during book sharing and toy play. Assessments were also made, at follow-up only, of infant prosocial behaviour in a 'help task', and of infant imitation of doll characters' nonsocial actions and an interpersonal interaction. Eighty-two carer-infant pairs (90%) were assessed at follow-up. (Trial registration ISRCTN39953901). Results: Carers who received the training showed significant improvements in book-sharing interactions (sensitivity, elaborations, reciprocity), and, to a smaller extent, in toy-play interactions (sensitivity). Infants in the intervention group showed a significantly higher rate of prosocial behaviour, and tended to show more frequent imitation of the interpersonal interaction. Improvements in carer behaviour during book sharing, but not during toy play, mediated intervention effects on all infant cognitive outcomes, and tended to mediate intervention effects on infant interpersonal imitation. Conclusions: Training in book sharing, a simple, inexpensive intervention that has been shown to benefit infant cognitive development in a low-middle income country, also shows promise for improving infant socioemotional outcomes in this context. Benefits are mediated by improvements in carer-infant interactions, particularly in book-sharing contexts.
Article
Mentalizing is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes. It is a profoundly social construct in the sense that we are attentive to the mental states of those we are with, physically or psychologically. Given the generality of this definition, most mental disorders will inevitably involve some difficulties with mentalization, but it is the application of the concept to the treatment of borderline personality disorder (BPD), a common psychiatric condition with important implications for public health, that has received the most attention. Patients with BPD show reduced capacities to mentalize, which leads to problems with emotional regulation and difficulties in managing impulsivity, especially in the context of interpersonal interactions. Mentalization based treatment (MBT) is a time-limited treatment which structures interventions that promote the further development of mentalizing. it has been tested in research trials and found to be an effective treatment for BPD when delivered by mental health professionals given limited additional training and with moderate levels of supervision. This supports the general utility of MBT in the treatment of BPD within generic mental health services.
Article
This is the first report from a study of outcomes for 114 children from 49 families assessed in an expert multi-disciplinary service during care proceedings. The study investigated the extent of children’s adaptation following judicial decisions made in the proceedings and what factors might be involved in changes in the children’s adaptation and well-being. We also aimed to investigate the reliability of the expert placement and treatment recommendations made to the court. The original assessment reports for the court were independently coded using a comprehensive child adaptation measure (Target and Fonagy, 1992). At follow-up, mean time of 26 months after their assessment, the researchers re-employed the child adaptation measure in semi-structured interviews with carers in birth, adoptive, foster and kinship placements. The data were independently coded and the results compared with the child’s original score as a measure of change in adaptation post proceedings in their substitute family or birth family. Researchers also collected information about the children’s placement(s) and any support or treatment received. The study found that children’s well-being significantly improved by an average of +6.7 points between initial assessment ( M = 68.13; SD = 9.86) and follow-up ( M = 74.82; SD = 7.84), ( t (67) = −5.0, p < .001, d = 0.76). Children whose global adjustment scores were clinically concerning at the time of assessment hardly improved their scores (.44), compared to children whose global adjustment scores were within the normal range at the time of assessment. Interestingly, the majority (88%) of expert placement recommendations had been accepted and implemented. However, less than 50% of the children and only 30% of parents received the support and treatment recommended in the experts’ reports in the proceedings. The implications for both policy and practice in working with children and their families during and after care proceedings are explored.
Article
Antisocial personality disorder (ASPD) is a common condition with major public health implications. Yet effective treatment remains elusive. In this paper the major descriptive symptoms of ASPD are considered using a mentalizing framework. Mentalizing is the implicit or explicit perception or interpretation of the actions of others or oneself as intentional, that is, mediated by mental states or mental processes. It is considered as four intersecting dimensions: automatic/controlled or implicit/explicit; internally/externally based; self/other orientated; and cognitive/affective process. People with ASPD show problems with self/other mentalizing particularly in terms of empathic understanding of others. Their focus is biased toward external mentalizing with little regard for the internal mentalizing of others. The translation of this understanding into a clinical treatment program is discussed. The program is based on the current, evidence-based, mentalization-based treatment (MBT) for borderline personality disorder but with adaptations targeting the mentalizing difficulties of people with ASPD. A group and individual program is used. Some clinical interventions are exampled in the paper.
Article
Can different therapists, motivated by different theories and working in different settings, find a single measure - a 'core' - for monitoring their work? This paper introduces the Clinical Outcomes in Routine Evaluation (CORE) outcome measure, its philosophy, practice and utility. The measure is brief and acceptable to clients and therapists. It covers well being, problems/symptoms, life functioning and risk to self and others. It is easy to score by hand and is computer scannable. It measures individual differences on entry into therapy and change. Analyses of over 2,000 responses show good reliability and convergent validity against longer and less general measures; small gender effects; large clinical/non-clinical differences and good sensitivity to change. Referential clinical and non-clinical distributions and reliability enable calculation of clinically significant and reliable change criteria. Two short forms are available for frequent use within therapy and a centrally supported system will scan ...
Article
The objective of this study is to evaluate the effectiveness of parenting programs in reducing child maltreatment and modifying associated factors as well as to examine the moderator variables that are linked to program effects. For this meta-analysis, we searched nine electronic databases to identify randomized controlled trials published before September 2013. The effect sizes of various outcomes at different time points were computed. From the 3,578 studies identified, we selected 37 studies for further analysis. The total random effect size was 0.296. Our results showed that parenting programs successfully reduced substantiated and self-reported child maltreatment reports and reduced the potential for child maltreatment. The programs also reduced risk factors and enhanced protective factors associated with child maltreatment. However, the effects of the parenting programs on reducing parental depression and stress were limited. Parenting programs produced positive effects in low-, middle-, and high-income countries and were effective in reducing child maltreatment when applied as primary, secondary, or tertiary child maltreatment intervention. In conclusion, parenting programs are effective public health approaches to reduce child maltreatment. The evidence-based service of parenting programs could be widely adopted in future practice. © The Author(s) 2015.
Article
Child mental health is of great concern requiring effective and appropriate parenting interventions. This pilot study was the first attempt to examine the intermediate effects of an ongoing parenting home visiting program, Minding the Baby (MTB) on parental reflective functioning (RF) and child behavior. Results indicated that the women who participated in the MTB intervention described their children-when assessed post-intervention-as having significantly fewer externalizing child behaviors. However, there was no significant difference between the two groups on parental RF from the end of the intervention to follow-up. The central finding that children who participated with the MTB program were reported to have significantly fewer externalizing behaviors following the intervention has important clinical and public health implications. Recommendations for the design of future follow-up studies and for further exploration of parental RF as it relates to the MTB outcomes are discussed.
Article
OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
Article
This study tests the idea that mothers' self-efficacy beliefs mediate the effects on parenting behavior of variables such as depression, perceptions of infant temperamental difficulty, and social-marital supports. Subjects were 48 clinically depressed and 38 nondepressed mothers observed in interaction with their 3–13-month-old infants (M= 7.35 months). As predicted, maternal self-efficacy beliefs related significantly to maternal behavioral competence independent of the effects of other variables. When the effects of self-efficacy were controlled, parenting competence no longer related significantly to social-marital supports or maternal depression. In addition, maternal self-efficacy correlated signficantly with perceptions of infant difficulty after controlling for family demographic variables. These results suggest that maternal self-efficacy mediates relations between maternal competence and other psychosocial variables and may play a crucial role in determining parenting behavior and infant psychosocial risk.
Article
The present study examined the extent to which parental belief in the value of corporal punishment moderates the association between level of parenting stress and physical child abuse potential. Based on existing theory, it was expected that levels of parenting stress would be positively associated with physical child abuse potential among parents who reported high levels of belief in the value of corporal punishment. Forty-one parents (25 general population and 16 at-risk parents) were assessed for belief in the value of corporal punishment, level of parenting stress, and physical child abuse potential using self-report measures. After removal of respondents due to response distortion or missing data, the final sample consisted of 31 parents with valid and complete protocols. Based on their responses on the study measures, respondents were categorized as either high or low on belief in corporal punishment and parenting stress. Level of parenting stress was positively associated with physical child abuse potential. As expected, the interaction of parenting stress and belief in the value of corporal punishment was significant. Level of parenting stress was positively associated with physical child abuse potential among parents who reported high levels of belief in the value of corporal punishment. In contrast, level of parenting stress was not associated with physical child abuse potential among parents who reported low belief in the value of corporal punishment. The present findings are consistent social information processing and stress and coping models of the etiology of physical child abuse, and underscore the importance of considering both parental cognitions and levels of parenting stress in assessing potential for physical child abuse.
Article
Can different therapists, motivated by different theories and working in different settings, find a single measure - a "core" - for monitoring their work? This paper introduces the Clinical Outcomes in Routine Evaluation (CORE) outcome measure, its philosophy, practice and utility. The measure is brief and acceptable to clients and therapists. It covers well being, problems/symptoms, life functioning and risk to self and others. It is easily scored by hand and computer scannable. It measures individual differences on entry into therapy and change. Analyses of over 2,000 responses show good reliability and convergent validity against longer and less general measures; small gender effects; large clinical/non-clinical differences and good sensitivity to change. Referential clinical and non-clinical distributions and reliability enable calculation of clinically significant and reliable change criteria. Two short forms are available for frequent use within therapy and a centrally supported system will scan questionnaires and provide standardised reports and raw data. [Abstract, p. 247]
Article
Mentalization is the process by which we implicitly and explicitly interpret the actions of ourselves and others as meaningful based on intentional mental states (e.g., desires, needs, feelings, beliefs, and reasons). This process is disrupted in individuals with comorbid antisocial (ASPD) and borderline personality disorder (BPD), who tend to misinterpret others' motives. Antisocial characteristics stabilize mentalizing by rigidifying relationships within prementalistic ways of functioning. However, loss of flexibility makes the person vulnerable to sudden collapse when the schematic representation is challenged. This exposes feelings of humiliation, which can only be avoided by violence and control of the other person. The common path to violence is via a momentary inhibition of the capacity for mentalization. In this article, the authors outline their current understanding of mentalizing and its relation to antisocial characteristics and violence. This is illustrated by a clinical account of mentalization-based treatment adapted for antisocial personality disorder. Treatment combines group and individual therapy. The focus is on helping patients maintain mentalizing about their own mental states when their personal integrity is challenged. A patient with ASPD does not have mental pain associated with another's state of mind; thus, to generate conflict in ASPD by thinking about the victim will typically be ineffective in inducing behavior change.
Article
Child maltreatment remains a major public-health and social-welfare problem in high-income countries. Every year, about 4-16% of children are physically abused and one in ten is neglected or psychologically abused. During childhood, between 5% and 10% of girls and up to 5% of boys are exposed to penetrative sexual abuse, and up to three times this number are exposed to any type of sexual abuse. However, official rates for substantiated child maltreatment indicate less than a tenth of this burden. Exposure to multiple types and repeated episodes of maltreatment is associated with increased risks of severe maltreatment and psychological consequences. Child maltreatment substantially contributes to child mortality and morbidity and has longlasting effects on mental health, drug and alcohol misuse (especially in girls), risky sexual behaviour, obesity, and criminal behaviour, which persist into adulthood. Neglect is at least as damaging as physical or sexual abuse in the long term but has received the least scientific and public attention. The high burden and serious and long-term consequences of child maltreatment warrant increased investment in preventive and therapeutic strategies from early childhood.
Article
In this paper the effectiveness of preventive or therapeutic interventions aiming at enhancing parental sensitivity and children's attachment security is addressed. Sixteen pertinent studies have been reviewed, and 12 studies have been included in a quantitative meta-analysis (N = 869). Results show that interventions are more effective in changing parental insensitivity (d = .58) than in changing children's attachment insecurity (d = .17). Longer, more intensive, and therapeutic interventions appear to be less effective than short-term preventive interventions. Interventions which are effective at the behavioral level may not necessarily lead to changes in insecure mental representations of the parents involved. The implications of changes at the behavioral level (sensitivity; attachment) without accompanying changes at the representational level will be discussed.
Article
To determine if Reactive Attachment Disorder (RAD) can be reliably identified in maltreated toddlers in foster care, if the two types of RAD are independent, and to estimate the prevalence of RAD in these maltreated toddlers. Clinicians treating 94 maltreated toddlers in foster care were interviewed regarding signs of attachment disorder at intake in an intervention program. Using categorical and continuous measures, both types of RAD can be reliably identified in maltreated toddlers. Both continuous scores and categorical diagnoses indicated that a substantial minority of maltreated young children do exhibit signs of attachment disorders sufficient to meet criteria in DSM-IV and ICD-10. The two types were moderately convergent and at times co-occurred in the same child. Prevalence of RAD in this high-risk sample was 38-40%. Indiscriminate/disinhibited RAD was identified in children with and without an attachment figure. Within this maltreated group, toddlers whose mothers had a history of psychiatric disturbance were more likely to be diagnosed with attachment disorders. RAD may be reliably identified in maltreated toddlers. Emotionally withdrawn/inhibited and indiscriminate/disinhibited types of RAD are not entirely independent.
Article
Physical abuse and neglect of children are significant problems and changing parenting practices may be an important means of addressing them. This review examines the extent to which parenting programmes (relatively brief and structured interventions that are aimed at changing parenting practices) are effective in treating physically abusive or neglectful parenting. A total of seven studies of mixed quality were included in the review. The findings show that there is insufficient evidence to support the use of parenting programmes to reduce physical abuse or neglect (i.e. using objective assessments of abuse such as reports of child abuse; children on the children protection register etc). There is, however, limited evidence to show that some parenting programmes may be effective in improving some outcomes that are associated with physically abusive parenting. There is an urgent need for further rigorous evaluation of the effectiveness of parenting programmes that are specifically designed to treat physical abuse and neglect, either independently or as part of broader packages of care.
The parent development interview revised
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Slade, A., Aber, J. L., Bresgi, I., Berger, B., & Kaplan, M. (2004). The parent development interview revised. New York: The City University of New York.
Parenting stress index: Professional manual
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Parenting Stress Index: Third Edition: Professional Manual
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Abidin, R. R. (1995). Parenting Stress Index: Third Edition: Professional Manual. (Third ed.). Odessa, FL: Psychological Assessment Resoures, Inc.
Restoring mentalizing in attachment relationships: Treating trauma with plain old therapy
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Allen, J. G. (2013). Restoring mentalizing in attachment relationships: Treating trauma with plain old therapy: American Psychiatric Pub.
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Chen, M., & Chan, K. L. (2015). Effects of Parenting Programs on Child Maltreatment Prevention: A Meta-Analysis. Trauma, Violence, & Abuse, 17(1), 88-104. doi: 10.1177/1524838014566718
Relationships among parental beliefs in corporal punishment, reported stress
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Crittenden, P. M., & Bonvillian, J. D. (1984). The relationship between maternal risk status and maternal sensitivity. American Journal of Orthopsychiatry, 54(2), 250. Crouch, J. L., & Behl, L. E. (2001). Relationships among parental beliefs in corporal punishment, reported stress, and physical child abuse potential..
Minding the child: Mentalization-based interventions with children, young people and their families
  • P Fonagy
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Fonagy, P., & Allison, E. (2012). What is mentalization? The concept and its foundations in developmental research. In N. Midgley & I. Vrouva (Eds.), Minding the child: Mentalization-based interventions with children, young people and their families (pp. 11-34). London, England: Routledge.
Affect regulation, mentalization and the development of the self
  • P Fonagy
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Fonagy, P., Gergely, G., & Jurist, E. L.. (2004). Affect regulation, mentalization and the development of the self. London: Karnac Books.