Skip to main content
SpringerLink
Log in

A Case-Series of Reflective Family Play: Therapeutic Process, Feasibility, and Referral Characteristics

  • Original Paper
  • Published:
Journal of Child and Family Studies Aims and scope Submit manuscript

Abstract

Evidence-based interventions for infants and preschoolers, and their families, have largely focused on the mother-child dyad. In response to the increasing need to diversify treatment approaches in the under six population and include the whole family system, we have developed a new treatment approach called Reflective Family Play (RFP). A manualized, whole-family therapy, RFP allows for the involvement of two parents and siblings when working with infants or young children. In this case-series, we used a qualitative chart review to examine the therapeutic process, acceptability, and feasibility of RFP for 22 families with children ages 0–6, who participated in RFP. We also sought to better understand the referral characteristics of those families who participated in RFP by comparing them to families who were referred to and participated in an established dyadic approach during the same time-period. Session-by-session coding of clinician chart notes revealed evidence of positive shifts throughout the RFP process, including more whole-family play, improvements in coparenting, and better parental mentalization. Parents reported improvements in presenting concerns in all but one case. Improvements in coparenting, sibling relationships, and family alliance were also reported by parents after RFP. Clinical implications and directions for future research are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Abidin, R. R. (2012). Parenting stress index. 4th edn. Lutz, FL: Psychological Assessment Resources.

    Google Scholar 

  • Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA Preschool forms and profiles. Burlington, VT: University of Vermont, Department of Psychiatry.

    Google Scholar 

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms & profiles. Burlington, VT: University of Vermont, Department of Psychiatry.

    Google Scholar 

  • Asen, E., & Fonagy, P. (2012). Mentalization‐based therapeutic interventions for families. Journal of Family Therapy, 34(4), 347–370. https://doi.org/10.1111/j.1467-6427.2011.00552.x.

    Article  Google Scholar 

  • Bakermans-Kranenburg, M., van IJzendoorn, M. H., & Juffer, F. (2003). Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin, 129(2), 195–215. https://doi.org/10.1037/0033-2909.129.2.195.

    Article  PubMed  Google Scholar 

  • Barrett, M. S., Chua, W., Crits-Christoph, P., Gibbons, M. B., & Thompson, D. (2008). Early withdrawal from mental health treatment: implications for psychotherapy practice. Psychotherapy: Theory, Research, Practice, Training, 45(2), 247–267. https://doi.org/10.1037/0033-3204.45.2.247.

    Article  Google Scholar 

  • Byng-Hall, J. (2002). Relieving parentified children’s burdens in families with insecure attachment. Family Process, 41(3), 375–388. https://doi.org/10.1111/j.1545-5300.2002.41307.x.

    Article  PubMed  Google Scholar 

  • Cohen, N. J., Lojkasek, M., Muir, E., Muir, R., & Parker, C. J. (2002). Six-month follow-up of two mother-infant psychotherapies: convergence of therapeutic outcomes. Infant Mental Health Journal, 23(4), 361–380. https://doi.org/10.1002/imhj.10023.

    Article  Google Scholar 

  • Cohen, N., Muir, E., Lojkasek, M., Muir, R., Parker, C., Barwick, M., & Brown, M. (1999). Watch, Wait, and Wonder: testing the effectiveness of a new approach to mother-infant psychotherapy. Infant Mental Health Journal, 20(4), 429–451.

    Google Scholar 

  • Cookston, J. T., Braver, S. L., Griffin, W. A., DeLuse, S. R., & Miles, J. C. (2006). Effects of the dads for life intervention on interparental conflict & coparenting in the two years after divorce. Family Process, 46(1), 123–137.

    Google Scholar 

  • Cornett, N., & Bratton, S. C. (2014). Examining the impact of child parent relationship therapy (CPRT) on family functioning. Journal of Marital and Family Therapy, 40(3), 302–318.

    PubMed  Google Scholar 

  • Favez, N., Frascarolo, F., Carneiro, C., Montfort, V., Corboz-Warnery, A., & Fivaz-Depeursinge, E. (2006). The development of the family alliance from pregnancy to toddlerhood and children outcomes at 18 months. Infant and Child Development, 15, 59–73. https://doi.org/10.1002/icd.430.

    Article  Google Scholar 

  • Favez, N., Lavanchy-Scaiola, C., Tissot, H., Darwiche, J., & Frascarolo, F. (2011). The family alliance assessment scales: steps toward validity and reliability of an observational assessment tool for early family interactions. Journal of Child and family Studies, 20, 23–37. https://doi.org/10.1007/s10826-010-9374-7.

    Article  Google Scholar 

  • Favez, N., Lopes, F., Bernard, M., Frascarolo, F., Lavanchy Scaiola, C. L., Corboz‐Warnery, A., & Fivaz‐Depeursinge, E. (2012). The development of family alliance from pregnancy to toddlerhood and child outcomes at 5 years. Family Process, 51(4), 542–556. https://doi.org/10.1111/j.1545-5300.2012.01419.

    Article  PubMed  Google Scholar 

  • Fivaz-Depeursinge, E., & Corboz-Warnery, A. (1999). The primary triangle: a developmental systems view of mothers, fathers, and Infants. New York, NY: Basic Books.

    Google Scholar 

  • Fivaz-Depeursinge, E., Corboz-Warnery, A., & Keren, M. (2004). Treating parent-infant relationship problems: strategies for intervention. In A. J. Sameroff, S. C. McDonough & K. L. Rosenblum (Eds.), The primary triangle: treating infants in their families (pp. 123–151). New York, NY: Guilford Press.

    Google Scholar 

  • Fivaz-Depeursinge, E., & Philipp, D. A. (2014). The baby and the couple: understanding and treating young families. East Sussex, UK: Routledge Press.

    Google Scholar 

  • Fonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y. W., Warren, F., & Howard, S. et al. (2016). Development and validation of a self-report measure of mentalizing: the reflective functioning questionnaire. PLoS One, 11(7), e0158678

    PubMed  PubMed Central  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(3), 201–218.

    Google Scholar 

  • Frank, K., & Esbensen, A. J. (2015). Fine motor and self‐care milestones for individuals with down syndrome using a retrospective chart review. Journal of Intellectual Disability Research, 59(8), 719–729. doi:http://dx.doi.org.ezproxy.library.yorku.ca/10.1111/jir.12176.

    PubMed  Google Scholar 

  • Garfield, S. L. (1994). Research on client variables in psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change. 4th edn. (pp. 190–228). Oxford, NY: John Wiley & Sons.

    Google Scholar 

  • Gearing, R. E., Mian, I. A., Barber, J., & Ickowicz, A. (2006). A methodology for conducting retrospective chart review research in child and adolescent psychiatry. Journal of the Canadian Academy of Child and Adolescent Psychiatry / Journal Délelőtt l’Académie Canadienne Délelőtt Psychiatrie Délelőtt l’Enfant Et Délelőtt l’Adolescent, 15(3), 126–134.

    Google Scholar 

  • George, C., Kaplan, N., & Main, M. (1984). The Adult Attachment Interview. Berkeley: University of California. 1985, 1996.

    Google Scholar 

  • Gray, L., & Davey, E. (Producers). (2016). WS more or less: the world’s most diverse city. [Audio Podcast]. Retrieved from http://www.bbc.co.uk/programmes/p03v1r1p

  • Grienenberger, J., Kelly, K., & Slade, A. (2005). Maternal reflective functioning, mother-infant affective communication, and infant attachment: exploring the link between mental states and observed caregiving behavior in the intergenerational transmission of attachment. Attachment & Human Development, 7(3), 299–311. https://doi.org/10.1080/14616730500245963.

    Article  Google Scholar 

  • Guerney, Jr., B. (1964). Filial therapy: description and rationale. Journal of Consulting Psychology, 28, 304–310.

    PubMed  Google Scholar 

  • Hoffman, K. T., Marvin, R. S., Cooper, G., & Powell, B. (2006). Changing toddlers’ and preschoolers’ attachment classifications: the circle of security intervention. Journal of Consulting and Clinical Psychology, 74(6), 1017–1026.

    PubMed  Google Scholar 

  • Johnson, S.M. & Lee, A.C. (2000). Emotionally focused family therapy: restructuring attachment. In C.E. Bailey, Children in therapy, (pp. 112–133). New York: Norton.

  • Jones, C. W., Lindblad-Goldberg, M., (2002). Ecosystemic structural family therapy. In: In F. W. Kalsow, R. F. Massey, S. D. Massey, (eds.) Comprehensive handbook of psychotherapy (Vol 3): interpersonal/humanistic/existential. (pp. 3–33). New York, NY: John Wiley and Sons.

  • Juffer, F., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2017). Pairing attachment theory and social learning theory in video-feedback intervention to promote positive parenting. Current Opinion in Psychology, 15, 189–194.

    PubMed  Google Scholar 

  • Katznelson, H. (2014). Reflective functioning: a review. Clinical Psychology Review, 34(2), 107–117. https://doi.org/10.1016/j.cpr.2013.12.003.

    Article  PubMed  Google Scholar 

  • Keaveny, E., Midgley, N., Asen, E., Bevington, D., Fearon, P., & Fonagy, P., et al. (2012). Minding the family mind: the development and initial evaluation of mentalization-based treatment for families. In N. Midgley & I. Vrouva (Eds.), Minding the child: mentalization-based interventions with children, young people and their families (pp. 98–112). New York, NY: Routledge/Taylor & Francis Group.

    Google Scholar 

  • Keren, M. (2010). Using the Lausanne Triadic Play in an infant mental health unit. Paper presented at the 12th World Congress for the World Association for Infant Mental Health, Leipzig, Germany.

  • Keren, M., Koster, T., Dolberg, D., Danin, K., & Feldman, R. (2010). Family functioning and interactive patterns in the context of infant psychopathology. Journal of Family Psychology, 24(5), 597–604.

    PubMed  Google Scholar 

  • Kozlowska, K., & Hanney, L. (2002). The network perspective: an integration of attachment and family systems theories. Family Process, 41(3), 285–312. https://doi.org/10.1111/j.1545-5300.2002.41303.x.

    Article  PubMed  Google Scholar 

  • Lieberman, A. F., Weston, D. R., & Pawl, J. H. (1991). Preventive intervention and outcome with anxiously attached dyads. Child Development, 62(1), 199–209. https://doi.org/10.2307/1130715.

    Article  PubMed  Google Scholar 

  • Lindblad-Goldberg, M., Dore, M. M., & Stern, L. (1998). Creating competence from chaos: a comprehensive guide to home-based services. 1st edn. New York: W.W. Norton.

    Google Scholar 

  • Lorion, R. P., & Felner, R. E. (1986). Research on mental health interventions with the disadvantaged. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change. 3rd ed (pp. 739–776). New York: Wiley.

    Google Scholar 

  • Lubrano, A., Laghi, F., & Malagoli, M. (2011). Assessing family coordination in divorced families. The American Journal of Family Therapy, 39(4), 277–291.

    Google Scholar 

  • Mazzoni, S., & Lubrano Lavadera, A. (2013). Le Jeu Trilogique de Lausanne (LTP) en clinique: Application dans le contexte d’interventions de soutien à la relation parents enfants. In N. Favez, F. Frascarolo-Moutinot & H. Tissot (Eds.), Naître et grandir au sein de la triade: Le développement de l’alliance familiale (pp. 193–210). Brussels: De Boeck.

    Google Scholar 

  • McDonough, S. C. (2000). Interaction guidance: an approach for difficult-to-engage families. In C. H. Zeanah, Jr. (Ed.), Handbook of infant mental health (pp. 485–493). New York, NY, US: Guilford Press.

    Google Scholar 

  • McHale, J., & Irace, K. (2010). Focused Coparenting Consultation: helping parents coordinate to support children. Independent Practitioner, 30, 164–170.

    Google Scholar 

  • McHale, J. P., Kuersten-Hogan, R., Lauretti, A., & Rasmussen, J. L. (2000). Parental reports of coparenting and observed coparenting behavior during the toddler period. Journal of Family Psychology, 14(2), 220–236. https://doi.org/10.1037/0893-3200.14.2.220.

    Article  PubMed  Google Scholar 

  • McHale, J., Salman Engin, S., & Coovert, M. (2015). Improvements in unmarried African American parents’ rapport, communication and problem-solving following a prenatal coparenting intervention. Family Process, 54(4), 619–629.

    PubMed  Google Scholar 

  • McHale, J. P., Waller, M. R., & Pearson, J. (2012). Coparenting interventions for fragile families: What do we know and where do we need to go next? Family Process, 51(3), 284–306.

    PubMed  Google Scholar 

  • Meschino, D., Philipp, D. A., Israel, A., & Vigod, S. (2015). Maternal-Infant mental health: postpartum group intervention. Archives of Women’s Mental Health, 19(2), 243–251. https://doi.org/10.1007/s00737-015-0551-y.

    Article  Google Scholar 

  • Midgley, N. & Vrouva, J. (Eds.) (2012). Minding the Child: Mentalization based treatments with children, young people and their families.. New York, NY: Routledge.

    Google Scholar 

  • Mikulincer, M., Florian, V., Cowan, P. A., & Cowan, C. P. (2002). Attachment security in couple relationships: A systemic model and its implications for family dynamics. Family Process, 41(3), 405–434. https://doi.org/10.1111/j.1545-5300.2002.41309.x.

    Article  PubMed  Google Scholar 

  • Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Minuchin, P. (1985). Families and individual development: provocations from the field of family therapy. Child Development, 56(2), 289–302.

    PubMed  Google Scholar 

  • Motz, A. (2016). Addressing shame and violence in an abusive father. In G. Byrne (Moderator), In search of missing babies: Innovative applications of Mentalization Based Treatment (MBT) with infants and families at risk – enabling parents to mentalize and hold their infants in mind. Symposium conducted at the 15th Association of Infant Mental Health Congress, Prague, Czech Republic.

  • Muir, E., Lojkasek, M., & Cohen, N. (1999, 2002). Watch, wait and wonder: a manual describing a dyadic infant-led approach to problems in infancy and early childhood. Toronto, ON: The Hincks-Dellcrest Institute.

  • Paris, R., Herriott, A., Holt, M., & Gould, K. (2015). Differential responsiveness to a parenting intervention for mothers in substance abuse treatment. Child Abuse & Neglect, 50, 206–217.

    Google Scholar 

  • Philipp, D. A. (2012). Reflective family play: a model for whole family intervention in the infant and preschool clinical population. Infant Mental Health Journal, 33(6), 599–608. https://doi.org/10.1002/imhj.21342.

    Article  PubMed  Google Scholar 

  • Philipp, D. A., Hayos, C., Fivaz-Depeursinge, E., & Tissot, H. (2013). Reflective family play: whole family treatment with an attachment and family systems focus. In N. Favez, F. Frascarolo & H. Tissot (Eds.), Le bébé au sein de la triade: le développement de l’alliance familiale. Bruxelles, Belgique: De Boeck.

    Google Scholar 

  • Philipp, D. A., & Hayos, C. (2015). Reflective family play. A manual for family based intervention with infants and young children. Toronto, ON: The Hincks-Dellcrest Institute.

    Google Scholar 

  • Roos, J., & Wearde, Al (2009). What do we mean by “socialization to the model”? a delphi study. Behavioural and Cognitive Psychotherapy, 37, 341–345.

    PubMed  Google Scholar 

  • Rusconi-Serpa, S., Rossignol, A. S., & McDonough, S. C. (2009). Video feedback in parent-infant treatments. Child and Adolescent Psychiatric Clinics of North America, 18(3), 735–751. https://doi.org/10.1016/j.chc.2009.02.009.

    Article  PubMed  Google Scholar 

  • Sadler, L. S., Slade, A., Close, N., Webb, D. L., Simpson, T., Fennie, K., & Mayes, L. C. (2013). Minding the baby: enhancing reflectiveness to improve early health and relationship outcomes in an interdisciplinary home‐visiting program. Infant Mental Health Journal, 34(5), 391–405. https://doi.org/10.1002/imhj.21406.

    Article  PubMed  Google Scholar 

  • Satir, V. (1972). Peoplemaking. Palo Alto, CA: Science & Behavior Books.

    Google Scholar 

  • Seifer, R., & Dickstein, S. (2000). Parental mental illness and infant development. In C. H. Zeannah, Jr. (Ed), Handbook of Infant Mental Health. 2nd Ed. (pp. 145–160). New York, NY: Guilford Press.

    Google Scholar 

  • Slade, A., Grienenberger, J., Bernbach, E., Levy, D., & Locker, A. (2005a). Maternal reflective functioning, attachment, and the transmission gap: a preliminary study. Attachment & Human Development, 7(3), 283–298. https://doi.org/10.1080/14616730500245880.

    Article  Google Scholar 

  • Slade, A., Sadler, L., De Dios-kenn, C., Webb, D., Currier-Ezepchick, J., & Mayes, L. (2005b). Minding the baby: a reflective parenting program. The Psychoanalytic Study of the Child, 60, 74–100.

    PubMed  Google Scholar 

  • Sparks, W. A., Daniels, J. A., & Johnson, E. (2003). Relationship of referral source, race, and wait time on preintake attrition. Professional Psychology: Research and Practice, 34(5), 514–518. https://doi.org/10.1037/0735-7028.34.5.514.

    Article  Google Scholar 

  • Sprenkle, D. H. (2012). Intervention research in couple and family therapy. A methodological and substantive review and an introduction to the special issue. Journal of Marital and Family Therapy, 38(1), 3–29.

    PubMed  Google Scholar 

  • Stern, D. (1995). The Motherhood Constellation: A unified view of parent-infant psychotherapy. London: Karnac.

    Google Scholar 

  • Talbot, J., & McHale, J. (2002). Family-level emotional climate and its impact on the flexibility of relationship representations. In P. Erdman, T. Caffery & J. Carlson (Eds.), Attachment and family systems: conceptual, empirical and therapeutic relatedness (pp. 31–64). New York: Taylor & Francis.

    Google Scholar 

  • Talbot, J., Baker, J., & McHale, J. (2009). Sharing the love: coherence of mind forecasts coparenting adjustment during early infancy. Parenting: Science and Practice, 9, 56–77. https://doi.org/10.1080/15295190802656760.

    Article  Google Scholar 

  • Vassar, M., & Holzmann, M. (2013). The retrospective chart review: important methodological considerations. Journal of Educational Evaluation for Health Professions, 10, 12 https://doi.org/10.3352/jeehp.2013.10.12.

    Article  PubMed  Google Scholar 

  • Von Sydow, K., Retzlaff, R., Eher, S., Haun, M. W., & Schweitzer, J. (2013). The efficacy of systemic therapy for childhood and adolescent externalizing disorders: a systematic review of 47 RCT. Family Process, 52(4), 576–618.

    Google Scholar 

  • Viera, A. J., & Garrett, J. M. (2005). Understanding interobserver agreement: the kappa statistic. Family Medicine, 37(5), 360–363.

    PubMed  Google Scholar 

  • Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2), 190–195. https://doi.org/10.1037/0735-7028.24.2.190.

    Article  Google Scholar 

  • Willis, A. B., Haslam, D. R., & Bermudez, J. M. (2016). Harnessing the power of play in Emotionally Focused Family Therapy with preschool children. Journal of Marital and Family Therapy, 42(4), 673–687.

    PubMed  Google Scholar 

Download references

Author Contributions

D.P. collaborated with the study design and wrote the paper. K.C. collaborated to develop the study’s coding system, completed data analyses, wrote the methods and results sections, and collaborated in editing the final manuscript. C.H. collaborated with the study design, writing, and editing the manuscript.

Author information

Authors and Affiliations

  1. SickKids Centre for Community Mental Health (SickKids CCMH) and the University of Toronto, Toronto, ON, Canada

    Diane A Philipp

  2. Department of Psychology, York University, Toronto, ON, Canada

    Kristina Cordeiro

  3. SickKids Centre for Children’s Mental Health (SickKids CCMH), Toronto, ON, Canada

    Christie Hayos

Authors
  1. Diane A Philipp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristina Cordeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christie Hayos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Diane A Philipp.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

Ethics approval was obtained from a committee of the Ethics and Review board of SickKids Centre for Community Mental Health (CCMH), formerly the Hincks-Dellcrest Centre.

Informed Consent

Informed was not required for this retrospective chart review.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Philipp, D.A., Cordeiro, K. & Hayos, C. A Case-Series of Reflective Family Play: Therapeutic Process, Feasibility, and Referral Characteristics. J Child Fam Stud 27, 3117–3131 (2018). https://doi.org/10.1007/s10826-018-1192-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10826-018-1192-3

Keywords

Search

Navigation