Cindy DeCoste

The Mothers and Toddlers Program, an attachment-based parenting intervention for substance using women: Post-treatment results from a randomized clinical pilot

This is a report of post-treatment findings from a completed randomized pilot study testing the preliminary efficacy of the Mothers and Toddlers Program (MTP), a 12 week attachment-based individual parenting therapy for mothers enrolled in substance abuse treatment and caring for children ages birth to 36 months. Forty-seven mothers were randomized to MTP versus the Parent Education Program (PE), a comparison intervention providing individual case management and child guidance brochures. At post-treatment, MTP mothers demonstrated better reflective functioning in the Parent Development Interview, representational coherence and sensitivity, and caregiving behavior than PE mothers. Partial support was also found for proposed mechanisms of change in the MTP model. Together, preliminary findings suggest that attachment-based interventions may be more effective than traditional parent training for enhancing relationships between substance using women and their young children.

Reflective functioning in mothers with drug use disorders: implications for dyadic interactions with infants and toddlers.

In this study, we examined maternal reflective functioning as a bi-dimensional construct in a sample of 47 mothers with drug use disorders caring for infants and toddlers. We first tested a two-factor solution with scale items from the Parent Development Interview and confirmed the presence of two related but distinct dimensions: self-mentalization and child-mentalization. We then tested predictions that (a) self-mentalization would be associated with overall quality of maternal caregiving and that (b) child-mentalization would be associated with (i) maternal contingent behavior and (ii) child communication. Results partially supported hypotheses (a) and (bii). Unexpectedly, self-mentalization alone was associated with maternal contingent behavior. Findings suggest that self-mentalization may be a critical first step in improving mother-child relations involving mothers with drug use disorders. Implications for theory and practice are discussed.

Mothering From the Inside Out: Results of a second randomized clinical trial testing a mentalization-based intervention for mothers in addiction treatment

Mothers with histories of alcohol and drug addiction have shown greater difficulty parenting young children than mothers with no history of substance misuse. This study was the second randomized clinical trial testing the efficacy of Mothering From the Inside Out (MIO), a 12-week mentalization-based individual therapy designed to address psychological deficits commonly associated with chronic substance use that also interfere with the capacity to parent young children. Eighty-seven mothers caring for a child between 11 and 60 months of age were randomly assigned to receive 12 sessions of MIO versus 12 sessions of parent education (PE), a psychoeducation active control comparison. Maternal reflective functioning, representations of caregiving, mother-child interaction quality, and child attachment were evaluated at baseline and posttreatment and 3-month follow-up. Mother-child interaction quality was assessed again at 12-month follow-up. In comparison with PE mothers, MIO mothers demonstrated a higher capacity for reflective functioning and representational coherence at posttreatment and 3-month follow-up. At 12-month follow-up, compared to PE cohorts, MIO mothers demonstrated greater sensitivity, their children showed greater involvement, and MIO dyads showed greater reciprocity. As addiction severity increased, MIO also appeared to serve as a protective factor for maternal reflective functioning, quality of mother-child interactions, and child attachment status. Results demonstrate the promise of mentalization-based interventions provided concomitant with addiction treatment for mothers and their young children.

Ego Development, Psychopathology, and Parenting Problems in Substance‐Abusing Mothers

The authors examined maternal ego development in relation to psychopathology and parenting problems in a sample of substance abusing mothers. Given predilections at higher levels of ego development for introspection and guilt, the authors expected mothers at higher levels to report more psychopathology. Given predilections at lower levels of ego development for dichotomous perceptions and limited conceptions of causation, the authors expected mothers at low levels to report more problematic parenting behaviors. Intelligence was expected to correlate but not overlap with ego development. Subjects were 182 mothers who expressed interest in a randomized clinical trial for a new parenting intervention. Measures included the Washington University Sentence Completion Task--Short Form, the Parental Acceptance-Rejection Questionnaire, the Brief Symptom Inventory and the Kaufman Brief Intelligence Test. Results of correlation and multivariate analyses of variance confirmed predictions. Implications for future development of interventions for substance abusing mothers are discussed.

Therapist–client language matching: Initial promise as a measure of therapist–client relationship quality.

While research suggests that the therapeutic alliance is important in predicting outcomes of psychotherapy, relatively little is known about the development of the alliance or the moment-to-moment components of the relationship and how they combine to create an alliance, which may represent a serious limitation in existing methods of measurement. Language style matching (LSM), or the degree to which unconscious aspects of an interactional partner’s language mimic that of the other partner, is a promising, unobtrusive measure of interaction quality that could provide novel insight into the therapist–client alliance. In this article, we present a theoretical argument regarding the trajectory of therapist–client LSM across therapy sessions, as well as potential precursors and consequences of LSM. We then report on a pilot test of our hypotheses that examined how LSM, clients’ relational histories, and clients’ symptoms were associated within a therapeutic context. Using a small sample of substance dependent mothers (N = 7, 100% Caucasian women) enrolled in a randomized controlled trial of psychodynamic psychotherapy lasting 12 sessions, we examined client and therapist LSM across 4 of the 12 sessions. We found that, on average, LSM decreases over the course of treatment. Furthermore, greater client interpersonal problems prospectively predict lower early LSM in therapist–client dyads, which in turn predicts greater posttreatment psychiatric distress. Results generate questions for future research and support further investigations of LSM as one index of the quality of interactions between therapist and client.

Does improvement in maternal attachment representations predict greater maternal sensitivity, child attachment security and lower rates of relapse to substance use? A second test of Mothering from the Inside Out treatment mechanisms

In this study, we replicated a rigorous test of the proposed mechanisms of change associated with Mothering from the Inside out (MIO), an evidence-based parenting therapy that aims to enhance maternal reflective functioning and mental representations of caregiving in mothers enrolled in addiction treatment and caring for young children. First, using data from 84 mothers who enrolled in our second randomized controlled trial, we examined whether therapist fidelity to core MIO treatment components predicted improvement in maternal reflective functioning and mental representations of caregiving, even after taking fidelity to non-MIO components into account. Next, we examined whether improvement in directly targeted outcomes (e.g., maternal mentalizing and mental representations of caregiving) led to improvements in the indirectly targeted outcome of maternal caregiving sensitivity, even after controlling for other plausible competing mechanisms (e.g., improvement in maternal psychiatric distress and substance use). Third, we examined whether improvement in targeted parenting outcomes (e.g., maternal mentalizing, mental representations of caregiving and caregiving sensitivity) was associated in improvement in child attachment status, even after controlling for competing mechanisms (e.g., improvement in maternal psychiatric distress and substance use). Finally, we examined whether improvement in maternal mentalizing and caregiving representations was associated with a reduction in relapse to substance use. Support was found for the first three tests of mechanisms but not the fourth. Implications for future research and intervention development are discussed.