Reflective Functioning on the Parent Development Interview: Validity and reliability in relation to socio-demographic factors

he Reflective Functioning coding of the Parent Development Interview (PDI-RF) is a widely used method for assessing a caregivers’ capacity for mentalization. However, little is known about its psychometric properties. The aim of this study was to examine the distributions and discriminant and criterion validity of the PDI-RF scale in relation to a number of demographic and socioeconomic factors. Mothers of infants and toddlers (N = 323) from low, medium, and high-risk samples were interviewed with the PDI and transcripts were coded for RF. Demographic and socio-economic data were recorded. The PDI-RF scale showed high inter-rater reliability, internal consistency, and criterion validity. Modest associations with some sociodemographic variables and PDI-RF were found, but together these only accounted for a small amount of variance in the measure, suggesting adequate discriminant validity. Overall, the scale had good psychometric properties, although some caveats for its use were identified

New Beginnings for mothers and babies in prison: a cluster randomized controlled trial

Mothers in prison represent a high-risk parenting population. New Beginnings is an attachment-based group intervention designed specifically for mothers and babies in prison. This cluster randomized trial examined the outcomes for 88 mothers and babies participating in the New Beginnings program and 75 dyads residing in prisons where the intervention did not take place. Outcomes were measured in terms of parental reflective functioning, the quality of parent-infant interaction, maternal depression, and maternal representations. Mothers in the control group deteriorated in their level of reflective functioning and behavioral interaction with their babies over time, whereas the mothers in the intervention group did not. There were no significant group effects on levels of maternal depression or mothers' self-reported representations of their babies over time. An attachment-based intervention may mitigate some of the risks to the quality of the parent-infant relationship for these dyads

RANDOMIZED CONTROLLED TRIAL OF PARENT-INFANT PSYCHOTHERAPY FOR PARENTS WITH MENTAL HEALTH PROBLEMS AND YOUNG INFANTS

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

Mentalization-Based Interventions for Children Aged 6-12 and Their Carers: A Narrative Systematic Review

The ability to mentalize is an important developmental capacity that facilitates effective social and emotional functioning. Mentalization-Based Treatment (MBT), which aims to improve mentalizing capacity, is widely used in adults and in parent-infant therapy, but adaptations of MBT for middle childhood are less well documented. A systematic search of key databases was carried out using a PICO model. Papers were included if they explicitly described a mentalization-based approach to work with children aged between 6 and 12 and/or their caregivers. Where outcomes were reported, quality was assessed. A narrative synthesis of the literature was conducted. Sixty-two publications were included, reporting on 29 unique mentalization-informed interventions for middle childhood. Although the majority were formulated as direct therapeutic work with children and their families, several MBT interventions work with whole systems, such as schools or children’s social care. Only 22 papers reported outcomes and many were of poor quality, lacking in assessment of child mentalizing or child-reported outcomes. A broad range of mentalization-based interventions are available for middle childhood, demonstrating wide-reaching applicability. Better quality research is needed to examine the evidence base for these treatments

The Assessment of Relational Risk in Early Parent-Infant Relationships

This thesis provided an in-depth methodological study of the assessment of risk in early parent-infant relationships via caregivers’ representations of their infant and their relationship with them. Three approaches to the assessment of relational risk were examined in detail: parent-report questionnaires, parental Reflective Functioning (RF), and a newly developed coding system for assessing risk in parents’ representations of their relationship with their infant: the Assessment of Representational Risk (ARR). The validity and reliability of these measures were investigated in high- and low-risk parent-infant samples in relation to socio-demographic factors, parental psychopathology, adult attachment, and parent-infant interactions. Parent-report methods were found to be problematic for the assessment of parent-infant relationships in clinical samples. Mothers’ ratings of their infants were strongly related to their own level of distress and unrelated to observer or clinician ratings of infant interactive behaviour. The Reflective Functioning and ARR coding systems, both of which are applied to parents’ narratives about their relationship with their babies in semi-structured interviews, provided meaningful, reliable and valid tools for assessing the quality of the parent-infant relationship in various ways. The ARR identified three typologies of parental representations of the parent-infant relationship that may impinge on the parent-infant relationship: Hostile, Helpless and Narcissistic. These representations modified the prediction of later parent-infant interaction from parental reflective functioning and adult attachment style. The Assessment of Representational Risk is an easily accessible new tool for parent-infant assessments that provided a useful adjunct to the RF coding system. The methodological, theoretical and clinical implications of the findings were discussed

‘Trust me, we can sort this out’: a theory-testing case study of the role of epistemic trust in fostering relationships

Novel psychological theories are often conceived in a general or heuristic form that can benefit from development and granulation through context-specific theory testing. Here, a theory-testing single case study methodology, adapted from an approach developed in the field of psychoanalysis, is presented. The study exemplifies this methodology though an interrogation of the explanatory value of a relatively new child development theory, the theory of epistemic trust, in the context of the relationship between a foster carer (“John”) and a young person in their care (“Buster”). Using in-depth interview material, the ways and extent to which the theory of epistemic trust could aid understanding of this fostering relationship are examined. We discuss the implications for the development of the theory of epistemic trust and the applications of these findings to social work contexts. The strengths and limitations of this theory-testing case study approach are explored

The Evidence-Base for Psychodynamic Interventions with Children Under 5 Years of Age and Their Caregivers: A Systematic Review and Meta-Analysis

Experiences in the first years of life can shape a range of outcomes throughout the lifespan. Effective early interventions have the potential to offset negative outcomes associated with early adversity. A broad range of psychodynamic interventions are available to children under five and their caregivers but there is a lack of research synthesizing the current evidence for their effectiveness. This paper presents a systematic review and meta-analysis of the evidence for the effectiveness of psychodynamic interventions for children under 5 years of age and their caregivers. Following a systematic search of 10 databases and screening for eligibility, 77 papers were included in the review. Most studies reported positive outcomes on a range of parent and infant domains. The meta-analyses of controlled studies found significant effects of psychodynamic interventions compared to control conditions on parental reflective functioning, maternal depression, infant behavior, and infant attachment. No significant differences between psychodynamic and control interventions were found for parental stress, and parent-infant interactions. Very few studies were rated as good quality and further high-quality research is needed

A psychotherapeutic baby clinic in a hostel for homeless families: practice and evaluation

A pilot baby clinic in a hostel for homeless families has been established to address the specific attachment and developmental needs of infants living in temporary accommodation. The aim of this study was to assess whether this clinic model was associated with more positive outcomes than mainstream community services in terms of infant development and parent-infant interactions

Young families under stress: outcomes and costs of Home-Start support

Supporting parents is central to the current government’s approach to improving children’s lives. However, little is as yet known about the effectiveness and cost-effectiveness of family support services. This study evaluates one of these – Home-Start – which is currently one of the largest family support organisations in the UK. Established over thirty years ago, it offers volunteer home visiting support to families with children under five years of age.Comparing a study group of young families who received Home-Start support with a comparison group who did not, the study explores the mothers’ views and needs at the outset of the study. It reports their views one year later, and considers the outcomes at that stage. The economic situation of the families and their receipt of services over time are analysed, and the cost-effectiveness of Home-Start is addressed. The concluding chapter summarises the key findings of the study.The authors found that although the mothers who had received the support of a Home-Start volunteer obviously valued the service, there was no clear evidence that it had made a positive difference to them in terms of outcomes, relative to those of the families in the comparison group. They suggest that the results did not therefore point to a cost-effectiveness advantage for Home-Start. Given that the support was offered only on a low intensity basis (one home visit per week), the authors suggest that a longer term follow up would be advisable before reaching firm conclusions about the impact of the service