A Review of Reflective Functioning Measures for Evaluating Relationship-Based Parenting Programs 2016 Graduate Student Conference ATHABASCA UNIVERSITY September 16 - 18, 2016 Edmonton, Alberta Click on the small icon in center of the holder and choose an image on the computer. When you added the image send it to back (Right click on the image > Send to Back). MONICA DE ROO Masters of Counseling Student Thesis Committee: Shawn Fraser, Gwen Rempel, Gina Wong Faculty of Health Disciplines

Theoretical Framework A mental function or capacity that allows individuals to recognize, organize and interpret the experience and intention of one’s own and other’s mental states A concept developed by Fonagy, Steele, Steele, Moran & Higgitt ₁ Reflective Functioning (RF) Develops from a child’s interactions with primary caregivers, siblings along with environmental responses, social interactions, family structure, family size, and parenting quality₁ ₂ ₃ ₄ Influences how individuals choose to react to other people’s behaviour

respond to challenging behaviour Circle of Security Parenting Program (COS-P)₅ 8-week manualized intervention Increases parent RF. be aware of their own reactions to a child’s behaviour Aims to parent RF by teaching them how to … interpret their child’s behaviour and the attachment- related need being expressed respond to challenging behaviour

What Reflective Functioning Measures are out there?

Systematic Literature Review 4 Flow Diagram Article Selection Process 3 Search Terms 14 different words/or phrases 2 Search Strategy 7 databases & 4 journals between 1990-2016 1 PRISMA Procedural Guidelines 27 item checklist & Flow Diagram 5 Results 11 different RF measures - 3 categories

Article Selection Process PRISMA Flow Diagram of the Article Selection Process 4 Flow Diagram Article Selection Process

Systematic Literature Review 5 Results 11 different RF measures - 3 categories GOLD STANDARD MEASURES BOOMING MEASURES ONE HIT MEASURES

GOLD STANDARD MEASURES Parent Development Interview₆ Click on the small icon in center of the holder and choose an image on the computer. When you added the image send it to back (Right click on the image > Send to Back). Reflective Functioning Scale₇

Parent Development Interview Interview Questions Involves: Individuals answering 45 questions Up to 2 hours Audiotaped or Videotaped Assess parental representations of the child and the parent-child relationship including joy/pleasure, anger, guilt and separation distress

Parent Development Interview Coding & Scoring The Addendum to Reflective Functioning Scoring Manual examines RF across 4 factors: awareness of the nature of mental states, the ability to tease out underlying behaviour of mental states, identifying developmental aspects of mental states, and the mental states in relation to the interviewer A trained coder rates interview passages on an eleven point Likert scale from -1 to 9 Time allocation for coding is not identified in the literature

Parent Development Interview Reliability Training 3-day training course ‘Coding Parental Reflective Functioning on the PDI’ PDI Training Institute at the City College of New York $1100 USD plus travel and accommodation Trainees practice coding over the three days are assigned a tutor from the PDI training team independently code 5 practice interview and 10 additional interviews must achieve 75% concordance with individual variable scores and 80% with overall RF scores. . Time commitment and cost of training is extensive.

BOOMING MEASURES Parent Reflective Functioning Questionnaire₈

Parent Reflective Functioning Questionnaire Questions 18 item self- report measures Examine 3 key characteristics of RF: Pre-mentalization Interest & Curiosity Certainty of Mental States Is easy to complete and administer

Parent Reflective Functioning Questionnaire Coding & Scoring Individuals rate each item from one (strongly disagree) to seven (strongly agree) Total RF scores range from 1-7 Training No training required

One Hit Measures Reflective Functioning Rating Scale₁₀ Brief Reflective Functioning Interview₁₁ Reflective Functioning Questionnaire₁₂ Caregiver Reflective Functioning Scale₁₃ Panic Specific Reflective Functioning Scale₁₄ Computerized text analysis of the reflective functioning system₁₅ Maternal Reflective Functioning Scale₁₆

One Hit Measures No primary sources Unavailable information: Interview & Self Report Questions Coding & Scoring Training

Which measure is most appropriate to utilize in evaluating the COS-P?

Careful Considerations Time Costt Applicability $

Parent Reflective Functioning Questionnaire No cost requirements for training, coding and scoring $ Quick 18-item self report to measure 3 key characteristics of RF Examines parent RF

Significance of the Study Provides a resource on the characteristics, psychometrics, strengths and weaknesses of RF measures Provides a critical review and categorization of each RF measure Uncovers the early stages of knowledge regarding parent RF and the availability of measurements. Identifies the need for networking among researchers and independent testing of measures.

References ¹Fonagy, P., Steele, M., Steele, H., Moran, G. & Higgitt, A. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 12 (3), 201-218. http:// 10.1002/1097-0355(199123)1 ²Fonagy, P., Target, M., Steele, H. & Steele, M. (1998). Reflective-functioning manual: For application to adult attachment interviews (Version 5). Retrieved from http://mentalizacion.com ³Fonay, P., Gergely, G., & Target, M. (2007). The parent-infant dyad and the construction of the subjective self. Journal of Child Psychology & Psychiatry, 48(3/4), 288-328. http:// 10.1111/j.1469-7610.2007.01727 ⁴Fonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y., Warren, F., Howard, S., Ghinai,R.,  Fearon, P., &  Lowyck, B. (2016). Development and validation of a self-report measure of mentalizing: The reflective functioning questionnaire. Plos ONE, 11(7), 1-28. http//:10.1371/journal.pone.0158678 ⁵Cooper, G., Hoffman, K., & Powell, B. (2009). COS-P © Facilitator Manual (DVD Manual 5.0): Circle of Security Parenting©: A Relationship Based Parenting Program. Spokane, WA: Marycliff Institute ₆Slade, A., Grienenberger, J., Bernbach, E., Levy, D., & Locker, A. (2005). Maternal reflective functioning, attachment, and the transmission gap: A preliminary study. Attachment & Human Development, 7(3), 283-298. http://10.1080/14616730500245880 ₇ Fonagy, P., Target, M., Steele, H. & Steele, M. (1998). Reflective-functioning manual: For application to adult attachment interviews (Version 5). Retrieved from http://mentalizacion.com ₈ Luyten,P.,  Mayes,L., NijssenL & Fonagy, P. (n.d.). The parental reflective functioning questionnaire: Development and preliminary validation. Manuscript submitted for publication ₉Moulton-Perkins, Rogoff, Luyten & Fonagy (2011). In Vospernik, P. (2015). The relationship of adaptive and pathological narcissism to attachment style and reflective functioning. (Doctoral dissertation). Retrieved from ProQuest Dissertations & Theses Global. (Order No. 3641917).

References ₁₀ Meehan, K. B., Levy, K. N., Reynoso, J. S., Hill, L. L., & Clarkin, J. F. (2009). Measuring reflective function with a multidimensional rating scale: Comparison with scoring reflective function on the AAI. Journal of the American Psychoanalytic Association, 57(1), 208-213.http://10.1177/00030651090570011008 ₁₁ Ruitimann & Meehan (2012). In Rutimann, D. D., & Meehan, K. B. (2012). Validity of a brief interview for assessing reflective function. Journal of the American Psychoanalytic Association, 60(3), 577-589. http://10.1177/0003065112445616 ₁₂Levy, Meehan & Hill (2005). In Hill, L. L., Levy, K. N., Meehan, K. B., & Reynoso, J. S. (2007). Reliability of a multidimensional measure for scoring reflective function. Journal of the American Psychoanalytic Association, 55(1), 309-313. http:// 10.1177/00030651090570011008 ₁₃Gilbert, Whelan, Marvin & Stewart, (2007). In Gilbert, J. L. (2008). Reflective functioning and caregiver behavior: Development of caregiver reflective functioning scales (CRFS) for use with the Circle of Security Intervention (COSI). (Doctoral dissertation). Retrieved from Dissertation Abstracts International. (Order No. 3323375) ₁₄Rudden, M., Milrod, B., Target, M., Ackerman, S., & Graf, E. (2006). Reflective functioning in panic disorder patients: A pilot study. Journal of the American Psychoanalytic Association, 54(4), 1339-1343. http:// 10.1177/00030651060540040109 ₁₅ Fertuck, E. A., Mergenthaler, E., Target, M., Levy, K. N., & Clarkin, J. F. (2012). Development and criterion validity of a computerized text analysis measure of reflective functioning. Psychotherapy Research, 22(3), 298-305. http://10.1080/10503307.2011.650654 ₁₆Slade & Patterson, (2005) In Daley, A. E. (2013). Reflective functioning and differentiation-relatedness during pregnancy and infant attachment outcomes at one year (Doctoral dissertation). Retrieved from ProQuest Dissertations & Theses Global. (Order No. 3589757).

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