Parental reflective functioning: analysis and promotion of the concept for paediatric nursing

Abstract

Aim To identify the definitional elements of parental reflective functioning (RF) and develop a framework for nurses to apply this concept in their clinical work with families. Background: In recent years, researchers have concluded that parental RF is a key mechanism in the development of child attachment security leading to lifelong mental and physical health benefits. Despite its clinical relevance, little has been published in the nursing literature on this concept. Design Concept analysis. Methods The Walker and Avant (2011) method of concept analysis and the Whittemore and Knafl (2005) method of integrative review were used. A search of the literature published from 1989 to 2013 was conducted using edited texts and online databases - Scopus, CINAHL, PubMed, and PsychInfo. Among the 85 sources, 31 empirical studies, 17 book chapters, 32 review papers, and 5 case studies were identified concerning parental RF. Results The concept of RF, defined as the capacity to envision the mental states of self and other, was first described in 1989 by Fonagy. Slade (2005) expanded the concept specifically for parents (i.e. parental RF). Results of this concept analysis describe seven defining attributes and five antecedent conditions. Consequences of parental RF are related to a child’s attachment early in life and behavior later in life. A model case is provided to contextualize the concept. To date, there are three measures for parental RF. Conclusions While parental RF has been predominately featured in psychology and parenting interventions, the potential consequences of secure attachment and longer term children’s behavioral outcomes suggest that the concept has global implications for pediatric nurses and primary health care clinicians. Relevance to clinical practice Parental RF offers exciting and promising opportunities for pediatric health and new approaches for those who provide pediatric health care.

Lasting Effects of an Interdisciplinary Home Visiting Program on Child Behavior: Preliminary Follow-Up Results of a Randomized Trial

“…Parental reflective functioning (RF) is defined as a parent’s capacity to envision the mental states of herself and her child (Slade, 2005) and refers to the awareness that an individual’s behavior is a reflection of mental states (thoughts, feelings, intentions, desires) (Ordway, Sadler, Dixon, & Slade, in review; Slade, 2002). According to Fonagy and colleagues (2002), one’s capacity for RF is central to self-organization and affect regulation.…”

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

“…Maternal RF seems an interesting candidate for incorporation in prevention and intervention programs (Katznelson 2014; Ordway et al 2014a, b). The primary aim of any RF-based program must be the development of a reflective stance in parents (Slade 2007b).…”

“…The primary aim of any RF-based program must be the development of a reflective stance in parents (Slade 2007b). This is based on the presumption that helping mothers develop a reflective stance would enable them to become more sensitive, regulating, and autonomy-promoting parents, resulting in a positive effect on a range of developmental outcomes in the infant (Ordway et al 2014a, b; Sadler et al 2013; Slade 2007b). Three areas are of particular interest for interventions aiming to enhance RF during pregnancy: 1) mentalizing about the self as a mother; 2) mentalizing the baby as having a separate mind; and 3) mentalizing about the emerging relationship with the fetus (Markin 2013).…”

“…For example, clinical care and counseling may include the clinician modeling a reflective stance, reviewing recorded mother-infant interactions, and putting emotions that underlie behaviors into words for mother or infant (Slade 2007b). The ability to reflect on the child’s mental states in relation to their behavior may provide parents an outline that can help them learn that, when confronted with child-rearing issues (e.g., tantrums, aggression), trying to understand their child’s mental states can help determine how to respond (Ordway et al 2014b). The present study underlines this notion by providing evidence for the existence of associations between (prenatal) RF and infant physical aggression over time.…”

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

“…As mentioned earlier, an important element of the RF approach is the understanding that human minds are opaque (Fonagy, Target, Steele, & Steele, 1998; Ordway, Sadler, Dixon, & Slade, 2014b). The concept of opacity may be challenging for HCPs who have been trained to “know what to do” when parents come to them with their concerns.…”