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Development and Preliminary Evaluation of Family Minds: A Mentalization-based Psychoeducation Program for Foster Parents

Abstract

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.

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References

  • 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.

  • Allen, J. G., Fonagy, P., & Bateman, A. (2008). Mentalizing in clinical practice. Washington, DC: American Psychiatric Publishing.

    Google Scholar 

  • Arnow, B. A. (2004). Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization. Journal of Clinical Psychiatry, 65(Suppl 12), 10–15.

    PubMed  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.

    Article  PubMed  Google Scholar 

  • Asen, E., & Fonagy, P. (2012). Mentalization-based therapeutic interventions for families. Journal of Family Therapy, 34, 347–370. https://doi.org/10.1111/j.1467-6427.2011.00552.x.

    Article  Google Scholar 

  • Bammens, A. S., Adkins, T., & Badger, J. (2015). Psycho-educational intervention increases reflective functioning in foster and adoptive parents. Adoption and Fostering, 39(1), 38–50. https://doi.org/10.1177/030857591456506.

    Article  Google Scholar 

  • Belsky, J. (1997). Attachment, mating, and parenting: An evolutionary interpretation. Human Nature, 8, 361–381. https://doi.org/10.1007/BF02913039.

    Article  PubMed  Google Scholar 

  • Blakey, J. M., Leathers, S. J., Lawler, M., Washington, T., Natschke, C., Strand, T., & Walton, Q. (2012). A review of how states are addressing placement stability. Children and Youth Services Review, 34, 369–378.

    Article  Google Scholar 

  • Bond, M. (2004). Empirical studies of defense style: Relationships with psychopathology and change. Harvard Review Psychiatry, 12(5), 263–278. https://doi.org/10.1016/j.childyouth.2011.11.007.

    Article  Google Scholar 

  • Borelli, J. L., St John, H. K., Cho, E., & Suchman, N. E. (2016). Reflective functioning in parents of school-aged children. American Journal of Orthopsychiatry, 86, 24–36. https://doi.org/10.1037/ort0000141.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown, G. W., & Rutter, M. (1966). The measurement of family activities and relationships: A methodological study. Human Relations, 19, 241–263.

    Article  Google Scholar 

  • Brown, R. A., Lejuez, C. W., Kahler, C. W., & Strong, D. R. (2002). Distress tolerance and duration of past smoking cessation attempts. Journal of Abnormal Psychology, 111, 180–185. https://doi.org/10.1037/0021-843X.111.1.180.

    Article  PubMed  Google Scholar 

  • Chamberlain, P., Price, J. M., Reid, J. B., & Landsverk, J. (2006). Who disrupts from placement in foster and kinship care? Child Abuse and Neglect, 30, 409–424. https://doi.org/10.1016/j.chiabu.2005.11.004.

    Article  PubMed  Google 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.

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates.

    Google Scholar 

  • Creasey, G., & Reese, M. (1996). Mothers’ and fathers’ perceptions of parenting hassles: Associations with psychological symptoms, nonparenting hassles, and child behavior problems. Journal of Applied Developmental Psychology, 17(3), 393–406.

    Article  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 

  • Ensink, K., Normandin, L., Plamondon, A., Berthelot, N., & Fonagy, P. (2016). Intergenerational pathways from reflective functioning to infant attachment through parenting. Canadian Journal of Behavioural Science, 48, 9–18. https://doi.org/10.1037/cbs0000030c.

    Article  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.

    Article  Google Scholar 

  • Fonagy, P., & Target, M. (1997). Attachment and reflective function: Their role in self-organization. Development and Psychopathology, 9, 679–700.

    Article  PubMed  Google 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 

  • Gullestad, F. S., & Wilberg, T. (2011). Change in reflective functioning during psychotherapy—A single-case study. Psychotherapy Research, 21, 97–111. https://doi.org/10.1080/10503307.2010.525759.

    Article  PubMed  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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  • James, S. (2004). Why do foster care placements disrupt? An investigation of reasons for placement change in foster care. Social Service Review, 78, 601–627. https://doi.org/10.1086/424546.

    Article  Google Scholar 

  • Karrass, J., & Braungart-Rieker, J. (2004). Infant negative emotionality and attachment: Implications for preschool intelligence. International Journal of Behavioral Development, 28, 221–229. https://doi.org/10.1080/01650250344000433.

    Article  Google Scholar 

  • Kemppinen, K., Kumpulainen, K., Raita‐Hasu, J., Moilanen, I., & Ebeling, H. (2006). The continuity of maternal sensitivity from infancy to toddler age. Journal of Reproductive and Infant Psychology, 24(3), 199–212. https://doi.org/10.1080/02646830600821249.

    Article  Google Scholar 

  • Luyten, P., Mayes, L. C., Nijssens, L., & Fonagy, P. (2017). The parental reflective functioning questionnaire: development and preliminary validation. PLOS ONE, 12, e0176218 https://doi.org/10.1371/journal.pone.0176218.

    Article  PubMed  PubMed Central  Google Scholar 

  • Magaña, A. B., Goldstein, M. J., Karno, M., Miklowitz, D. J., Jenkins, J., & Falloon, I. R. H. (1986). A brief method for assessing expressed emotion in relatives of psychiatric patients. Psychiatry Research, 17, 203–212. https://doi.org/10.1016/0165-1781(86)90049-1.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  • Masten, A. S., & Coatsworth, J. D. (1998). The development of competence in favorable and unfavorable environments: Lessons from research on successful children. American Psychologist, 53, 205–220. https://doi.org/10.1037/0003-066X.53.2.205.

    Article  PubMed  Google Scholar 

  • McGraw, K. O., & Wong, S. P. (1996). Forming inferences about some intraclass correlation coefficients. Psychological Methods, 1, 30–46. https://doi.org/10.1037/1082-989X.1.1.30.

    Article  Google Scholar 

  • Midgley, N. & Vrouva, I. (Eds.), (2012). Minding the child. London: Routledge.

  • Miklowitz, D. J., Goldstein, M. J., Nuechterlein, K. H., Snyder, K. S., & Mintz, J. (1988). Family factors and the course of bipolar affective disorder. Archives of General Psychiatry, 45, 225–231.

    Article  PubMed  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 

  • Northoff, G., Bermpohl, F., Schoeneich, F., & Boeker, H. (2007). How does our brain constitute defense mechanisms? First-person neuroscience and psychoanalysis. Psychotherapy and Psychosomatics, 76, 141–153. https://doi.org/10.1159/000099841.

    Article  PubMed  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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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/10.1037/0893-3200.14.3.380.

    Article  PubMed  PubMed Central  Google Scholar 

  • Puddy, R. W., & Jackson, Y. (2003). The development of parenting skills in foster parent training. Child and Youth Services Review, 25, 987–1013. https://doi.org/10.1016/S0190-7409(03)00106-3.

    Article  Google Scholar 

  • Rostad, W. L., & Whitaker, D. J. (2016). The association between reflective functioning and parent–child relationship quality. Journal of Child and Family Studies, 25, 2164–2177. https://doi.org/10.1007/s10826-016-0388-7.

    Article  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  • Sharp, C., & Fonagy, P. (2008). The parent’s capacity to treat the child as a psychological agent: Constructs, measures and implications for developmental psychopathology. Social Development, 17, 737–754. https://doi.org/10.1111/j.1467-9507.2007.00457.x.

    Article  Google Scholar 

  • Slade, A. (2002). Moments of regulation and the development of self-narratives. Journal of Infant, Child and Adult Psychotherapy, 2, 1–10. https://doi.org/10.1080/15289168.2002.10486414.

    Article  Google Scholar 

  • Slade, A. (2005). Parental reflective functioning: An introduction. Attachment and Human Development, 7, 269–281. https://doi.org/10.1080/14616730500245906.

    Article  PubMed  Google Scholar 

  • Slade, A. (2006). Reflective parenting programs: Theory and development. Psychoanalytic Inquiry, 26(4), 640–657. https://doi.org/10.1080/07351690701310698.

    Article  Google 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.

  • 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.

  • Slade, A., Sadler, L., De Dios-Kenn, C., Webb, D., Currier-Ezepchick, J., & Mayes, L. (2005). Minding the baby: A reflective parenting program. The psychoanalytic Study of the Child, 60(1), 74–100. https://doi.org/10.1080/00797308.2005.11800747.

    Article  PubMed  Google Scholar 

  • Speltz, M., Greenberg, M., & Deklyen, M. (1990). Attachment in preschoolers with disruptive behavior: A comparison of clinic-referred and nonproblem children. Development and Psychopathology, 2(1), 31–46. https://doi.org/10.1017/S0954579400000572.

    Article  Google Scholar 

  • Sroufe, L. A. (2005). Attachment and development: A prospective, longitudinal study from birth to adulthood. Attachment & Human Development, 7(4), 349–367. https://doi.org/10.1080/14616730500365928.

    Article  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/10.1037/0736-9735.25.3.499.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  Google 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/10.1037/0012-1649.27.3.440.

    Article  Google Scholar 

  • Timmer, S. G., Urquiza, A. J., & Zebell, N. (2006). Challenging foster caregiver–maltreated child relationships: The effectiveness of parent–child interaction therapy. Children and Youth Services Review, 28, 1–19. https://doi.org/10.1016/j.childyouth.2005.01.006.

    Article  Google 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.

    Article  PubMed  Google Scholar 

  • Zeegers, M., Colonnesi, C., Stams, G. J., & Meins, E. (2017). Mind Matters: A meta-analysis on parental mentalization and sensitivity as predictors of infant-parent attachment. Psychological Bulletin, 143, 1245–1272. https://doi.org/10.1037/bul000014.

    Article  PubMed  Google Scholar 

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Acknowledgements

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.

Author Contributions

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.

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Correspondence to Tina Adkins.

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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.

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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.

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Informed consent was obtained from all individual participants included in the study.

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Adkins, T., Luyten, P. & Fonagy, P. Development and Preliminary Evaluation of Family Minds: A Mentalization-based Psychoeducation Program for Foster Parents. J Child Fam Stud 27, 2519–2532 (2018). https://doi.org/10.1007/s10826-018-1080-x

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Keywords

  • Mentalization
  • Reflective functioning
  • Foster parents
  • Psychoeducation
  • Child welfare