Development and Preliminary Evaluation of Family Minds: A Mentalization-based Psychoeducation Program for Foster Parents
- 63 Downloads
Mentalization-based interventions show promise in improving mental health outcomes for children and parents through increasing a family's reflective functioning, or ability to mentalize. Mentalizing involves the ability to understand behavior in relation to mental states, such as thoughts and feelings, and typically develops within the context of secure attachment relationships. One area not given much consideration when training foster parents is their capacity to mentalize. This study evaluated Family Minds, a newly developed psychoeducational intervention for foster parents, designed to increase their ability to mentalize. The current paper reports on the development and preliminary empirical evaluation of Family Minds in a quasi-experimental study where 102 foster parents received either Family Minds or a typical foster parenting class, which served as a control group. Results indicate that parents who received Family Minds significantly increased their levels of reflective functioning as assessed with the Parental Reflective Functioning Questionnaire and a new Five-Minute Speech Sample procedure coded using the Reflective Functioning Scale, and revealed a tendency to show decreased levels of parenting stress on the Parenting Stress Index, while the control group showed no such improvements. These findings support the hypothesis that a short-term psychoeducational intervention may improve foster parents' ability to mentalize themselves and their children. These skills are very beneficial for foster parents, as they frequently deal with children who come into their home with challenging behaviors, attachment issues, and negative internal working models of relationships. This type of intervention has the potential to lower placement breakdowns and improve the mental health of foster children.
KeywordsMentalization Reflective functioning Foster parents Psychoeducation Child welfare
Peter Fonagy is in receipt of a National Institute for Health Research (NIHR) Senior Investigator Award (NF-SI-0514-10157) and was in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust.
T.A.: created and implemented the Family Minds intervention and the study, assisted with the data analyses, and wrote the paper. P.L. and P.F.: collaborated with the design and writing of the study. P.F.: analyzed the data and wrote part of the results and discussion. P.L.: collaborated in the writing and editing of the final manuscript.
Compliance with Ethical Standards
Conflict of Interest
P.L. and P.F. have been involved in the development, training and dissemination of mentalization-based treatments. The remaining author declares that she has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee of University College London and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Abidin, R. R. (1995). The Parenting Stress Index professional manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
- Adkins, T. & Fonagy, P. (2017). Coding Reflective Functioning in Parents using The Five Minute Speech Sample Procedure: Version 2.Google Scholar
- Allen, J. G., Fonagy, P., & Bateman, A. (2008). Mentalizing in clinical practice. Washington, DC: American Psychiatric Publishing.Google Scholar
- Asarnow, J. R., Goldstein, M. J., Tompson, M., & Guthrie, D. (1993). One-year outcomes of depressive disorders in child psychiatric in-patients: Evaluation of the prognostic power of a brief measure of expressed emotion. Journal of Child Psychology and Psychiatry, 34, 129–137. https://doi.org/10.1111/j.1469-7610.1993.tb00975.x.CrossRefPubMedGoogle Scholar
- Borelli, J. L., West, J. L., DeCoste, C., & Suchman, N. E. (2012). Emotionally avoidant language in the parenting interviews of substance‐dependent mothers: Associations with reflective functioning, recent substance use, and parenting behavior. Infant Mental Health Journal, 33, 506–519. https://doi.org/10.1002/imhj.21340.CrossRefPubMedPubMedCentralGoogle Scholar
- Cicchetti, D (Ed.) (1994). Advances and challenges in the study of the sequelae of child maltreatment (Special Issue). Development and Psychopathology, 6, 1–247.Google Scholar
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates.Google Scholar
- Dix, T. H., & Grusec, J. E. (1985). Parent attribution processes in the socialization of children. In I. Siegel (Ed.), Parental belief systems: The psychological consequences for children (pp. 201–233). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
- Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2004). Affect regulation, mentalization, and the development of the self. London, UK: Karnac Books.Google Scholar
- Fonagy, P., Steele, M., Steele, H., Moran, G. S. & Higgitt, A. C. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 12, 201–218. https://doi.org/10.1002/1097-0355(199123)12:3 201::AID-IMHJ2280120307 3.0.CO;2-7.CrossRefGoogle Scholar
- Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective-functioning manual, version 5.0, for application to adult attachment interviews. London, UK: University College London.Google Scholar
- Fonagy, G., Williams, L., Fearon, P., Asen, E., Bleiberg, E., Target, M., & Bevington, D. (2010). Mentalization-based treatment for families. London, UK: The Anna Freud Centre.Google Scholar
- George, C., Kaplan, M., & Main, M. (1985). Adult Attachment Interview. Berkeley, CA: University of California.Google Scholar
- Gottschalk, L. A., & Gleser, G. C. (1969). The measurement of psychological states through the content analysis of verbal behavior. Berkeley, CA: University of California Press.Google Scholar
- Hahlweg, K., Goldstein, M. J., Nuechterlein, K. H., Magaña, A. B., Mintz, J., Doane, J. A., & Snyder, K. S. (1989). Expressed emotion and patient-relative interaction in families of recent onset schizophrenics. Journal of Consulting and Clinical Psychology, 57, 11–18. https://doi.org/10.1037/0022-006X.57.1.11.CrossRefPubMedGoogle Scholar
- Huth-Bocks, A. C., Muzik, M., Beeghly, M., Earls, L., & Stacks, A. M. (2014). Secure base scripts are associated with maternal parenting behavior across contexts and reflective functioning among trauma-exposed mothers. Attachment and Human Development, 16, 535–556. https://doi.org/10.1080/14616734.2014.967787.CrossRefPubMedPubMedCentralGoogle Scholar
- Marshall, V. G., Longwell, L., Goldstein, M. J., & Swanson, J. M. (1990). Family factors associated with aggressive symptomatology in boys with attention deficit hyperactivity disorder: A research note. Journal of Child Psychology and Psychiatry, 31, 629–636. https://doi.org/10.1111/j.1469-7610.1990.tb00802.x.CrossRefPubMedGoogle Scholar
- Midgley, N. & Vrouva, I. (Eds.), (2012). Minding the child. London: Routledge.Google Scholar
- Muller, N., Gerits, L., & Sieker, I. (2012). Mentalization-based therapies with adopted children and their families. In N. Midgley & I. Vrouva (Ed.), Minding the child: Mentalization-based interventions with children, young people and their families (pp. 113–130). London, UK: Routledge.Google Scholar
- Ordway, M. R., Sadler, L. S., Dixon, J., & Close, N. (2014). Lasting effects of an interdisciplinary home visiting program on child behavior: Preliminary follow-up results of a randomized trial. Journal of Pediatric Nursing, 29, 3–13. https://doi.org/10.1016/j.pedn.2013.04.006.CrossRefPubMedGoogle Scholar
- Pasalich, D. S., Dadds, M. R., Hawes, D. J., & Brennan, J. (2011). Assessing relational schemas in parents of children with externalizing behavior disorders: reliability and validity of the family affective attitude rating scale. Psychiatry Research, 185, 438–443. https://doi.org/10.1016/j.psychres.2010.07.034.CrossRefPubMedGoogle Scholar
- Pinderhughes, E. E., Dodge, K. A., Bates, J. E., Pettit, G. S., & Zelli, A. (2000). Discipline responses: Influences of parents’ socioeconomic status, ethnicity, beliefs about parenting, stress, and cognitive–emotional processes. Journal of Family Psychology, 14, 380–400. https://doi.org/10.1037/0893-3126.96.36.1990.CrossRefPubMedPubMedCentralGoogle Scholar
- Rutherford, H. J., Booth, C. R., Luyten, P., Bridgett, D. J., & Mayes, L. C. (2015). Investigating the association between parental reflective functioning and distress tolerance in motherhood. Infant Behavior and Development, 40, 54–63. https://doi.org/10.1016/j.infbeh.2015.04.005.CrossRefPubMedPubMedCentralGoogle Scholar
- Rutherford, H. J., Goldberg, B., Luyten, P., Bridgett, D. J., & Mayes, L. C. (2013). Parental reflective functioning is associated with tolerance of infant distress but not general distress: Evidence for a specific relationship using a simulated baby paradigm. Infant Behavior and Development, 36, 635–641. https://doi.org/10.1016/j.infbeh.2013.06.008.CrossRefPubMedGoogle Scholar
- Sadler, L. S., Slade, A., Close, N., & Webb, D. L. (2013). Minding the baby: Enhancing reflectiveness to improve early health and relationship outcomes in an interdisciplinary home visiting program. Infant Mental Health Journal, 34, 391–405. https://doi.org/10.1002/imhj.21406.CrossRefPubMedGoogle Scholar
- Slade, A (2007). Disorganized mother, disorganized child: The mentalization of affective dysregulation and therapeutic change. In D. Oppenheim & D. Goldsmith (Eds.), Attachment theory in clinical work with children: Bridging the gap between research and practice (pp. 226–250). New York, NY: Guilford Press.Google Scholar
- Slade, A., Aber, L., Bresgi, I., Berger, B., & Kaplan, N. (2004). The parent development interview, revised. New York, NY: The City University of New York.Google Scholar
- Suchman, N., DeCoste, C., Castiglioni, N., Legow, N., & Mayes, L. (2008). The mothers and toddlers program: preliminary findings from an attachment-based parenting intervention for substance-abusing mothers. Psychoanalytic Psychology, 25, 499–517. https://doi.org/10.1037/0736-97188.8.131.529.CrossRefPubMedPubMedCentralGoogle Scholar
- Suchman, N. E., DeCoste, C., Castiglioni, N., McMahon, T. J., Rounsaville, B., & Mayes, L. (2010). The mothers and toddlers program, an attachment-based parenting intervention for substance using women: Post-treatment results from a randomized clinical pilot. Attachment and Human Development, 12(5), 483–504. https://doi.org/10.1080/14616734.2010.501983.CrossRefPubMedPubMedCentralGoogle Scholar
- Suchman, N. E., Decoste, C., Mcmahon, T. J., Rounsaville, B., & Mayes, L. (2011). The mothers and toddlers program, an attachment‐based parenting intervention for substance‐using women: Results at 6‐week follow‐up in a randomized clinical pilot. Infant Mental Health Journal, 32(4), 427–449. https://doi.org/10.1002/imhj.20303.CrossRefPubMedPubMedCentralGoogle Scholar
- Suchman, N., Mayes, L., Conti, J., Slade, A., & Rounsaville, B. (2004). Rethinking parenting interventions for drug-dependent mothers: From behavior management to fostering emotional bonds. Journal of Substance Abuse Treatment, 23, 179–185. https://doi.org/10.1016/j.jsat.2004.06.008.CrossRefGoogle Scholar
- Teti, D. M., Nakagawa, M., Das, R., & Wirth, O. (1991). Security of attachment between preschoolers and their mothers: Relations among social interaction, parenting stress, and mother’s sorts of the Attachment Q-Set. Developmental Psychology, 27, 440–447. https://doi.org/10.1037/0012-16184.108.40.2060.CrossRefGoogle Scholar
- U.S. Department of Health and Human Services. (2016). The AFCARS report. https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport23.pdf.
- Wamboldt, F. S., Wamboldt, M. Z., Gavin, L. A., Roesler, T. A., & Brugman, S. M. (1995). Parental criticism and treatment outcome in adolescents hospitalized for severe, chronic asthma. Journal of Psychosomatic Research, 39, 995–1005. https://doi.org/10.1016/0022-3999(95)00507-2.CrossRefPubMedGoogle Scholar