Arietta Slade

Maternal reflective functioning, attachment, and the transmission gap: A preliminary study

Abstract The notion that maternal reflective functioning, namely the mothers capacity to hold her baby and his mental states in mind, plays a vital role in the intergenerational transmission of attachment is investigated (Fonagy, Gergely, Jurist, & Target, 2002; Fonagy et al., 1995; Slade, this volume). A parents capacity to understand the nature and function of her own as well as her childs mental states, thus allowing her to create both a physical and psychological experience of comfort and safety for her child, is proposed. In this study of 40 mothers and their babies, maternal reflective functioning is measured using the Parent Development Interview (PDI; Aber, Slade, Berger, Bresgi, & Kaplan, 1985), and scored for reflective functioning using an addendum to Fonagy, Target, Steele, & Steeles (1998) reflective functioning scoring manual (Slade, Bernbach, Grienenberger, Levy, & Locker, 2004). The relations between maternal reflective functioning and both adult (measured in pregnancy) and infant attachment (measured at 14 months) are examined. The findings indicate that relations between adult attachment and parental reflective functioning are significant, as are relations between parental reflective functioning and infant attachment. A preliminary mediation analysis suggests that parental reflective functioning plays a crucial role in the intergenerational transmission of attachment.

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

Abstract This study examines the link between mental representations and maternal behavior within the intergenerational transmission of attachment. Maternal reflective functioning was hypothesized to predict the quality of mother – infant affective communication based on the AMBIANCE measure. Each of these measures was also considered as a predictor of the quality of infant attachment. The subjects were 45 mothers and their 10 – 14-month-old infants. Results supported each of the studys major hypotheses. The AMBIANCE measure and the reflective functioning measure had a strong negative correlation. Thus, the level of disruption in mother – infant affective communication was inversely related to the level of maternal reflective functioning. The AMBIANCE measure was also shown to be a very good predictor of infant attachment. Mothers with high AMBIANCE scores were more likely to have infants classified as disorganized or resistant, whereas mothers with low AMBIANCE scores were more likely to have infants classified as secure. A linear regression analysis indicated that maternal behavior mediates the impact of maternal reflective functioning upon infant attachment. Implications for attachment theory and early intervention are explored.

Reflective Parenting Programs: Theory and Development

Recent research has indicated that parental reflective functioning or mentalization plays a crucial role in the development of a range of healthy adaptations in both parent and child. While many parenting interventions developed over the course of the last 20 years have implicitly attempted to enhance mentalization in parents, this article describes an effort to directly intervene with parents to enhance or encourage the development of reflective capacities. In this article, the broad outlines of a reflective parenting approach are described. Two reflective parenting programs are then considered, one a group intervention designed for low-risk parents, the other a home visiting intervention designed for high-risk parents and children.

Dyadic Synchrony and Toddler Compliance.

This study examined the relation between dyadic synchrony and child compliance during the toddler period. Mothers were instructed to teach their children a tea-party script. Interactions were broken into turns, and turns were coded for degree of topic-maintenance. Those turns that maintained the par

The Development and Organization of Attachment: Implications for Psychoanalysis:

As a result of John Bowlbys breach with the British Psychoanalytic Society nearly forty years ago, his work, specifically the development of attachment theory, was until recently largely expunged from the psychoanalytic record. However, thanks to developments in both psychoanalytic and attachment theories, a rapprochement has been forged, and a number of scholars are now seeking to integrate these two complementary perspectives. In this paper, the fundamental premises of attachment theory are discussed in light of their relation to psychoanalytic theory. In addition, their application to the clinical situation in both adult and child treatment is discussed.

Imagining Fear: Attachment, Threat, and Psychic Experience

Attachment theory is today considered an integral part of contemporary psychoanalytic theory and practice, and yet the theoretical and clinical implications of Bowlby’s emphasis on fear and the search for safety have been largely overlooked. From Bowlby’s perspective, the dynamic relationship between the experience of threat and attachment shapes the development and maintenance of essential relationships, the organization of psychic structure, and the nature of defenses and adaptation. This element of attachment theory—which alerts us to the ways in which the infant or child is compelled to seek safety when in a state of fearful arousal—is particularly relevant to the clinical situation. It helps us imagine moments of fearful arousal in our patients’ pasts, attend to their manifestations in the present, and understand current suffering in light of the long-term sequelae of adaptations that were crucial to survival. Finally, it helps us find language that brings alive or mentalizes these aspects of the patient’s early experience such that transformation is possible.

Mentalizing the Unmentalizable: Parenting Children on the Spectrum

This paper is aimed at exploring the idea that parents of children on the autistic spectrum must, throughout their child’s development, contend with a particular and painful paradox unique to the neurobiology of autism. This is the paradox: For no reason other than the vagaries of biology, their child has come into the world with a fundamental disability in the capacity to develop relationships, a disability that will have devastating and pervasive consequences not only for the child, but for those who love and care for him as well. These difficulties stem from a neurobiologically based inability to process social information, such as facial expressions, affects, social cues, certain elements of language, and the like (Volkmar, 2007; Volkmar et al., 2004), which in turn profoundly limit the child’s capacity to make sense of or even recognize his own or others’ mental states, that is, to mentalize (for reviews, see Allen, Fonagy, and Bateman, 2008; Sharp, 2006). From the parent’s perspective, the unique constraints of the child’s “mindblindedness” (Baron-Cohen, 1995) make him a most challenging and disorienting social partner, one who, at least until treatment has begun to take hold, brings few of the pleasures and rewards inherent in reciprocal interaction, and who, as a function of his difficulties meeting the mind of the other, elicits feelings that are at times frightening and nearly unbearable and that cannot be processed within the relationship itself. Yet, like all children, this child needs relationships to survive, on every level. But even more than most children, this child needs his parents, in particular, to initiate him into and guide him in the world of relationships and to remain stable regulators of his experience well into adulthood. Thus, the parents of children on the spectrum must not only make sense of what at first, second, and tenth glance seems incomprehensible, but they must also do so in the absence of the palpable pleasures of reciprocity and mutuality and in the presence of their own powerful and often disabling emotions. In other words, to connect with their child and help develop the relational and mentalizing capacities that are crucial to his adaptation, parents must mentalize the unmentalizable. This mentalizing paradox is complex and multifaceted. Yet there are few parents of children on the spectrum who do not hope to and indeed succeed in embracing this challenge. Indeed, the more I have tried to think through and imagine the many complexities of parenting a child on the spectrum, the more I have come to appreciate the depth, breadth, and enormous complexity of this paradox, and the more I have come to appreciate the extraordinary courage of the legions of parJournal of Infant, Child, and Adolescent Psychotherapy, 8:7–21, 2009 Copyright

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

The current state of science suggests that safe, responsive, and nurturing parent-child relationships early in childrens lives promotes healthy brain and child development and protection against lifelong disease by reducing toxic stress and promoting foundational social-emotional health. Pediatric health care providers (HCPs) have a unique opportunity to foster these relationships. However, such a role requires a shift in pediatric health care from a focus only on children to one that includes families and communities, as well as the inclusion of childrens social and emotional health with their physical health. To foster healthy parent-child relationships, HCPs must develop the expertise to integrate approaches that support the familys 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 childrens behavior.

Moments of Regulation and the Development of Self-Narratives

y assignment for this conference was to describe how attachment M theory and research have affected my clinical or research work. I was asked to do this in 15 minutes! I am someone whose work as a psychoanalytic psychologist has been forever changed by studying attachment processes, and in particular by being trained in the Strange Situation (Ainsworth et al. 1978), the Adult Attachment Interview (Main et al. 1985), and more recently, in assessing reflective functioning (Fonagy et al. 1995). After 20 years of immersion in the language of attachment theory and research, it is hard to be specific any longer about domains of influence: this is just the way I think. Where did that leave me in giving a talk? Obviously, a complete trip down memory lane was out of the question. So I choose to talk about a single idea, one that reflects the impact upon my clinical listening and understanding of not only attachment theory but also infant research. It seems appropriate to begin with an apology to Mary Main, Daniel Stern, and Peter Fonagy. Main’s ideas about the development of internal working models and the dynamics of attachment organization (Main 1995, 2000, Main et al. 1985), along with Stern’s (1977, 1985, 1997) work on the selfregulating other and the establishment of RIGS and Fonagy and colleagues’ work on the reflective function (Fonagy 2000, Fonagy et al. 2002, Fonagy et al. 1995), have completely permeated my thinking. The echoes of their work, and that of their many distinguished colleagues in both attachment and infant study (many of whom are represented in this volume), are everywhere in the thoughts described in this chapter. What I would like to talk about is how our patients’ narratives about affect, about relationships, and about careseeking reveal critical aspects of the dynamics of care and arousal in their earliest relationships. The narrative structure of our patients’ talking allows us to imagine the struggles and triumphs of their attempts to gain comfort, security, and care in their pri-

“Ghosts in the Psychoanalytic Nursery”: Response to Lieberman & Harris

In this discussion, I elaborate on the question of why fear, per se, has been relatively absent from psychoanalytic dialogues, and of how to think about the relative primacy of fear, aggression, and infantile sexuality. In response to Harris, I consider some of the ways that contemporary neuroscience and evolutionary theory deepen this discussion. And, following Lieberman, I reflect on why it can be so difficult to hold and process our patients’ fear and trauma.