Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale

Abstract

The aim of this study was to examine preliminary evidence of the validity of the Trauma Reflective Functioning Scale and to investigate reflective functioning (RF) and attachment in pregnant women with histories of trauma, with a particular focus on the capacity to mentalize regarding trauma and its implications for adaptation to pregnancy and couple functioning. The Adult Attachment Interview was used to assess attachment, unresolved trauma and mentalization (measured as RF) regarding relationships with attachment figures (RF-G) and trauma (RF-T) in 100 pregnant women with histories of abuse and neglect. The majority (63%) of women had insecure attachment states of mind and approximately half were unresolved regarding trauma. Furthermore, the majority of women manifested deficits specific to RF-T. Their RF-T was significantly lower than their RF-G; the findings indicate that women with histories of childhood abuse and neglect do not manifest a generic inhibition of reflectiveness, but a collapse of mentalization specific to trauma. Low RF-T, indicative of difficulty in considering traumatic experiences in mental state terms, was associated with difficulty in investment in the pregnancy and lack of positive feelings about the baby and motherhood. In addition, low RF-T was also associated with difficulties in intimate relationships. Results of a regression analysis with RF indicated that RF-T was the best predictor of investment in pregnancy and couple functioning. In sum, the study provides preliminary evidence that RF-T can be reliably measured and is a valid construct that has potential usefulness for research and clinical practice. It highlights the importance of mentalization specifically about trauma and suggests that it is not the experience of trauma per se, but the absence of mentalization regarding trauma that is associated with difficulties in close relationships and in making the transition to parenthood.

Fact or fiction? A longitudinal study of play and the development of reflective functioning

“…From a theoretical perspective, certain types of play facilitating the imagination of the roles and perspective of others may be more likely to facilitate the development of mentalization. At the same time, mentalization regarding self can be expected to be more closely related to the mother's (or primary caregiver's) interest in the subjectivity of the child, as reflected in previous findings that maternal RF predicts children's RF regarding themselves (Ensink et al, 2014).…”

“…Play, reflective functioning, and sexual abuse Mentalization is a potential resilience factor in the context of abuse Ensink, Berthelot, Bernazzani, Normandin, & Fonagy, 2014;Fonagy, Steele, Steele, Higgitt & Target, 1994); however, sexual abuse has a negative impact on mentalization and RF in children . Play is also affected in the context of traumatic experience (Alessandri, 1991;Cunningham, Fill, & Al-Jamie, 1999;Fonagy & Target, 2000).…”

“…In reaction to trauma, the child voluntarily sacrifices thinking about mental states to maintain positive representations and relationships with abusive attachment figures. Sexually abused children show deficits in mentalization regarding self and others (Ensink et al, 2014) as well as the inability to complete play narratives (Tessier, 2013), yet research on the association between play and later mentalization capacities in the context of sexual abuse is lacking.…”

Mentalizing Makes Parenting Work: A Review about Parental Reflective Functioning and Clinical Interventions to Improve It

“…Thus, it became crucial to empirically investigate parental reflective functioning in mothers who were abused in their childhood. Ensink et al (2014) hypothesized that it is specifically the ability to mentalize one’s own past traumatic experiences rather than the mother’s general mentalizing capacity that prevents her from inadequate caregiving. In a sample of 100 pregnant women who had suffered from childhood abuse and neglect, they found that reflective functioning about the traumatic experiences was lower than the general mentalization about their childhood, and that low mentalization about the traumatic experiences was the best predictor of the difficulty to invest in the pregnancy as well as of the lack of positive expectations about becoming a mother.…”

When Is Truth Relevant?

“…The capacity to envision mental states in others grows out of a process of self-understanding, which in turn depends on the other's capacity to perceive the self as thinking and feeling (Sharp and Fonagy 2008). A secure caregiver-child relationship would be expected to facilitate this virtuous cycle, particularly as the security of the relationship is enhanced by the caregiver's capacity to mentalize the child (Berthelot et al 2015;Ensink et al 2014;Fonagy and Target 2005). Thus, to the extent that truth and mentalizing are linked in the experience of mutual understanding, secure attachment could almost be seen as coterminous with the experience of truth, or at least as a key route toward this experience.…”