1. A Review of Reflective Functioning Measures for Evaluating
Relationship-Based Parenting Programs
2016 Graduate Student Conference
ATHABASCA UNIVERSITY
September , 2016
Edmonton, Alberta
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MONICA DE ROO Masters of Counseling Student
Thesis Committee: Shawn Fraser, Gwen Rempel, Gina Wong
Faculty of Health Disciplines

2. 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

3. 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

4. What Reflective Functioning Measures are out there?

5. Systematic Literature Review4
Flow Diagram
Article Selection Process 3
Search Terms
14 different words/or phrases 2
Search Strategy
7 databases & journals between 1
PRISMA Procedural Guidelines
27 item checklist
& Flow Diagram 5
Results
11 different RF measures - 3 categories

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

7. Systematic Literature Review5
Results
11 different RF measures - 3 categories
GOLD STANDARD MEASURES
BOOMING
MEASURES
ONE HIT
MEASURES

8. GOLD STANDARD MEASURES
Parent Development Interview₆
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Reflective Functioning Scale₇

9. 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

10. 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

11. 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.

12. BOOMING MEASURES Parent Reflective Functioning Questionnaire₈

13. 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

14. 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

15. 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

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

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

18. Careful Considerations
Time
Costt
Applicability $

19. 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

20. 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.

21. 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),
²Fonagy, P., Target, M., Steele, H. & Steele, M. (1998). Reflective-functioning manual: For application to adult attachment interviews (Version 5). Retrieved from
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), /j
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), http//: /journal.pone
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),
₇ Fonagy, P., Target, M., Steele, H. & Steele, M. (1998). Reflective-functioning manual: For application to adult attachment interviews (Version 5). Retrieved from
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 ).

22. 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),
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),
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), /
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 )
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),
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),
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 ).

23. Questions ?
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