Parental Reflective Functioning: An Approach to Enhancing Parent-Child Relationships in Pediatric Primary Care

Abstract

The current state of science suggests that safe, responsive, and nurturing parent-child relationships early in children’s lives promotes healthy brain and child development and protection against lifelong disease by reducing toxic stress and promoting foundational social-emotional health. Pediatric healthcare providers (HCP) have a unique opportunity to foster these relationships. However, such a role requires a shift in pediatric healthcare from a focus only on children to one that includes families and communities as well as the inclusion of children’s social and emotional health with their physical health. To foster healthy parent-child relationships, HCPs must develop the expertise to integrate approaches that support family’s socioemotional health into pediatric primary care. This article suggests ways in which pediatric HCPs can integrate a focus on parental reflective functioning into their clinical work, helping parents to understand some of the thoughts and feelings that underlie their children’s behavior.

A Home Visiting Parenting Program and Child Obesity: A Randomized Trial

“…, 24,25 In this interdisciplinary, relationship-based program, we aim to develop and enhance parent-child attachment and maternal reflective functioning (RF) and to promote a range of positive parenting behaviors. 26,27 RF, the mother's capacity to understand her child's behavior in light of thoughts, feelings, and intentions, can be addressed in primary care pediatric settings as well as more intensive programs 28 and has been linked with higher rates of secure attachment and more sensitive caregiving. 26, 29 -34…”

Prenatal Reflective Functioning and Development of Aggression in Infancy: the Roles of Maternal Intrusiveness and Sensitivity

“…Parental RF or parental mentalizing refers to the parent’s capacity to understand his or her own mental states (defined as beliefs, desires, feelings, intentions, and thoughts), the ability to keep the child’s mental states in mind, and the awareness that an individual’s behavior is a reflection of mental states (Ordway et al 2015; Slade 2005). During pregnancy maternal RF starts to develop, as the mother-to-be prepares for the birth of the baby by making room for the infant both in mind and in practice (Slade et al 2009).…”

“…The reflective parent’s empathic responses will promote the infant’s sense that emotions are acceptable and manageable, which, in turn, will enable the infant to develop a capacity to self-regulate, and lead to better psychosocial adjustment later in life (Ordway et al 2015). When parents act on incorrect assumptions about their child’s mental states, this might result in the child feeling confused and being misunderstood by his/her parents.…”

Mentalizing Family Violence Part 1: Conceptual Framework

“…This experience of how other people mentalize is internalized, enabling us to enhance our own capacity for empathizing and better engage in interactive social processes (conversely, poor mentalizing begets poor mentalizing; Fonagy, Gergely, Jurist, & Target, 2002;Sharp & Fonagy, 2008). The relationship between attachment and mentalizing is also bidirectional, in that difficulty reflecting on mental states is likely to adversely affect attachment relationships, and a poor attachment relationship-the experience of not being sensitively responded to-undermines the natural development of the capacity to mentalize, a cycle of behavior that will be familiar to clinicians (Grienenberger, Kelly, & Slade, 2005;Ordway, Webb, Sadler, & Slade, 2015).…”