Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it
Open accessAbstract
In the last decade several studies have investigated the role of parental reflective functioning (RF), defined as the parental ability to understand his/her child's mental states, on the child's development. Herein, a narrative review on parental RF is presented aimed at (1) presenting an overview of the existing empirical studies, (2) pinpointing unrequited questions, and (3) identifying future research directions. Specifically, the current review focused on (a) the impact of parental RF on the quality of caregiving and the child's attachment security, (b) the effect of parental RF on the child's emotion regulation and the child's RF, (c) maternal RF in women with a history of neglect and abuse, (d) the efficacy of mentalization-based clinical interventions, and (e) the recently developed Parental Reflective Questionnaire. The following terms "maternal RF," "paternal RF," "parental RF," "parental mentalization," "maternal mentalization," and "paternal mentalization" were searched in titles, abstracts, and main texts using Medline, Web of Science, and Scopus databases. Next, a search in Mendeley was also conducted. Inclusion criteria comprised original articles if they refer to the RF Scale (Fonagy et al., 1998) and were published in an English language, peer-reviewed journal before July, 2016. According to exclusion criteria, dissertations, qualitative or theoretical papers, and chapters in books were not taken into account. The review includes 47 studies that, taken together, supported the notion that higher parental RF was associated with adequate caregiving and the child's attachment security, whereas low maternal RF was found in mothers whose children suffered from anxiety disorders, impairment in emotion regulation, and externalizing behaviors. In addition, higher parental RF was associated with better mentalizing abilities in children. However, unexpected findings have emerged from the most recent randomized controlled trials that tested the efficacy of mentalization-based interventions in high risk samples of mothers, raising questions about the suitability of the verbal measures in capturing the mentalizing processes at the root of the parental capacity to be adequately responsive to the child's emotional needs.
AI snapshot
Written from the paper’s full text.
TL;DR
This narrative review of 47 studies concludes that higher parental reflective functioning (RF) is linked to more adequate caregiving, child attachment security, and better child emotion regulation/mentalizing, while low maternal RF is linked to child anxiety, emotion-regulation impairment, and externalizing behaviors. Mentalization-based interventions generally improve caregiving and often maternal RF, but recent RCTs raise concerns that verbal RF measures may not capture the mentalizing processes underlying responsive parenting.
Key findings
- Across 47 reviewed studies, higher parental RF was associated with adequate caregiving and child attachment security; low maternal RF was found in mothers whose children had anxiety disorders, emotion-regulation impairment, and externalizing behaviors, and higher parental RF was associated with better child mentalizing abilities.
- In high-risk samples, Ensink et al. (2014) studied 100 pregnant women with childhood abuse/neglect and found RF about traumatic experiences was lower than general childhood mentalization and was the best predictor of difficulty investing in pregnancy and lack of positive expectations about becoming a mother; Berthelot et al. (2015) found children of abused/neglected mothers were insecure in 83% of cases and disorganized in almost half.
- Mentalization-based interventions showed mixed but mostly positive results: Pajulo et al. (2012) reported RF increased from pregnancy to postnatal phase in 63% of treated substance-abusing mothers; the Mother and Toddler Program improved PDI-RF, representation quality, and caregiving, with only self-focused RF significantly improving; New Beginnings showed significant RF improvement only in the intervention group while controls decreased.
- Recent RCTs were less consistent: Sadler et al. (2013) found maternal RF improved in both Minding the Baby and standard-care groups without a significant between-group difference, except for mothers with PI-RF < 3; Fonagy et al. (2016) found no significant increase in maternal PDI-RF versus standard intervention, though the psychoanalytic parent-infant psychotherapy group showed decreased representational risk. The 18-item PRFQ had internal consistency from 0.70 to 0.82, and a 14-item prenatal version was developed.
Methods
- Narrative review; searches used the terms “maternal RF,” “paternal RF,” “parental RF,” “parental mentalization,” “maternal mentalization,” and “paternal mentalization” in titles, abstracts, and main texts via Medline, Web of Science, and Scopus, followed by a Mendeley search.
- Inclusion criteria were original articles referring to the Reflective Functioning Scale (Fonagy et al., 1998), published in English in a peer-reviewed journal before July 2016; dissertations, qualitative or theoretical papers, and book chapters were excluded.
- After exclusions, 158 papers were potentially relevant; abstracts were examined and 47 studies fully meeting criteria were selected, organized around caregiving/attachment, child emotion regulation and RF, maternal RF in neglect/abuse, mentalization-based interventions, and the Parental Reflective Functioning Questionnaire.
Limitations
- Paper-stated: no published studies were available on the association between AAI-RF and PDI-RF; paternal RF has been neglected; PDI-RF psychometric properties need investigation regarding IQ, linguistic competence, education, and child age; and verbal measures may not capture parental mentalization, warranting non-verbal/embodied measures.
- Paper-stated: RCT limitations include Sadler et al.’s young, poorly educated, mostly bilingual sample and language-dependent RFS scoring; Fonagy et al.’s concern that mental-state talk can inflate PDI-RF scores; and Pajulo et al.’s lack of a randomized controlled design.
- Evident from the text: this is a narrative review without meta-analysis or a described formal quality/risk-of-bias appraisal, and many included studies are correlational, which the paper itself notes cannot demonstrate causality between parental RF and caregiving.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 103 cited sources checked · 0 supported · 0 flagged
- Findingnone given
Higher parental reflective functioning is associated with better mentalizing abilities in children.
“higher parental RF was associated with better mentalizing abilities in children”
Quote in the paperSubstantial claim - Findingcitation
In the London Parent-Child Project, significant concordance was observed between parental and child patterns of attachment.
“significant concordance was observed between parental and child patterns of attachment”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fonagy et al., 1991b
Not checked in the free run.
- Findingown data
Low maternal reflective functioning is found in mothers whose children have anxiety disorders, impaired emotion regulation, and externalizing behaviors.
“low maternal RF was found in mothers whose children suffered from anxiety disorders, impairment in emotion regulation, and externalizing behaviors”
Quote in the paperSubstantial claim - Findingcitation
Further studies found a significant relationship between maternal reflective functioning and quality of caregiving even in clinical samples.
“Nevertheless, further studies found a significant relationship between maternal RF and quality of caregiving even in clinical samples (Borelli et al., 2012; Huth-Bocks et al., 2014; Stacks et al., 2014).”
Quote in the paperSubstantial claim0 of 3 sources checked - Findingcitation
In a low-risk sample, parental WMCI-RF predicted maternal mind-minded comments and behavioral sensitivity beyond the contributions of education and depressive symptoms.
“In a low risk sample, Rosenblum et al. (2008) found that parental WMCI-RF predicted maternal mind-minded comments and behavioral sensitivity beyond the contributions of education and depressive symptoms.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Rosenblum et al., 2008 source
Not checked in the free run.
- Findingcitation
Children of reflective mothers were more frequently assessed as secure by the Strange Situation procedure at 14 months old.
“and that the children of reflective mothers were more frequently assessed as secure by the Strange Situation procedure (Ainsworth et al., 1978) when they were 14 months old”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Slade et al., 2005 source
Not checked in the free run.
- Findingcitation
Maternal PDI-RF and behavior are closely related.
“Strong support for the hypothesis according to which maternal PDI-RF and behavior are closely related was also found by Grienenberger et al. (2005) in a low risk sample”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Grienenberger et al., 2005 source
Not checked in the free run.
- Findingcitation
Low maternal reflective functioning was associated with ambivalent-resistant and disorganized child attachment patterns.
“Conversely, low maternal RF was associated with ambivalent-resistant and disorganized child attachment patterns (Slade et al., 2005)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Slade et al., 2005 source
Not checked in the free run.
- Findingcitation
Mothers classified as secure on the AAI during pregnancy had a higher level of reflective functioning on PDI-RF when the child was 10 months old.
“In particular, Slade et al. (2005) found that mothers who were classified as secure on AAI during pregnancy had a higher level of reflective functioning on PDI-RF when the child was 10 months old”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Slade et al., 2005 source
Not checked in the free run.
- Findingcitation
Findings from the London Parent-Child Project showed a strong correlation between the capacity to reflect upon one's own history and the child's attachment security.
“findings from the London Parent-Child Project (Fonagy et al., 1991a) showed a strong correlation between the capacity to reflect upon one’s own history and the child’s attachment security”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fonagy et al., 1991a
Not checked in the free run.
- Findingnone given
Most of the reviewed studies supported the hypothesis that maternal reflective functioning is associated with more adequate maternal caregiving behavior.
“Most of the studies also supported the hypothesis according to which maternal reflective functioning is associated with a more adequate maternal caregiving behavior”
Quote in the paperSubstantial claim - Findingcitation
The two-factor structure of the PDI-RF was confirmed by a later study in a community sample of parents of school-aged children.
“The two-factor structure of the PDI-RF was confirmed by a later study (Borelli et al., 2016) in a community sample of parents of school-aged children.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Borelli et al., 2016 source
Not checked in the free run.
- Findingcitation
The significant relationship between maternal PDI-RF and parenting behavior was also found in a relatively large and mixed sample of women with and without a history of childhood maltreatment from diverse socioeconomic backgrounds.
“The significant relationship between maternal PDI-RF and parenting behavior was also found in a recent study (Stacks et al., 2014) on a relatively large and mixed sample consisting of women both with and without a history of childhood maltreatment from diverse socioeconomic backgrounds.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Stacks et al., 2014 source
Not checked in the free run.
- Findingcitation
Suchman et al. (2010a) yielded a two-factor model of parental reflective functioning in which self-mentalization and child-mentalization were two distinct, albeit related, dimensions.
“were two distinct, albeit related, dimensions”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Suchman et al., 2010a
Not checked in the free run.
- Findingcitation
There was a significant association between mothers' mentalization regarding their own early childhood attachment relationships and later parenting and infant attachment.
“Ensink et al. (2016b) also found a significant association between mothers’ mentalization regarding their own early childhood attachment relationships and later parenting and infant attachment.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ensink et al., 2016b
Not checked in the free run.
- Findingcitation
Perry et al. (2015) did not find any significant relationship between PI-RF, PDI-RF and maternal emotional availability.
“Only Perry et al. (2015) did not find any significant relationship between PI-RF, PDI-RF and maternal emotional availability in a study that, however, had some methodological flaws concerning, above all, sample size and significant delay in follow-up regarding some mother-child dyads.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Perry et al., 2015 source
Not checked in the free run.
- Findingcitation
Mothers with higher parental reflective functioning measured during pregnancy exhibited more positive behavior during free-play, teaching tasks, and the Still Face Paradigm with their 6-month-old children.
“These findings were replicated in a recent study (Smaling et al., 2016a) that found that mothers with higher parental reflective functioning, as measured during pregnancy, exhibited more positive behavior during free-play, teaching tasks, and the Still Face Paradigm (Tronick et al., 1978) with their 6-month-old children.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Smaling et al., 2016a
Not checked in the free run.
- Findingcitation
In contrast to their hypotheses, only self-mentalization was associated with maternal contingent behavior.
“they found that only self-mentalization was associated with maternal contingent behavior”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Suchman et al., 2010a
Not checked in the free run.
- Findingcitation
Low maternal AAI-RF (and not low paternal AAI-RF) was a predictor of higher levels of anxiety in a sample of clinically anxious school-aged children referred for psychological treatment.
“Esbjørn et al. (2013) found that low maternal AAI-RF (and not low paternal AAI-RF) was a predictor of higher levels of anxiety in a sample of clinically anxious school-aged children referred for psychological treatment.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Esbjørn et al., 2013 source
Not checked in the free run.
- Findingcitation
Young, pregnant, high-risk women with higher PI-RF reported significantly less aggressive behaviors in their children when they were 6, 12, and 20 months old, regardless of the maternal level of sensitivity and intrusiveness.
“Smaling et al. (2016b) demonstrated that young, pregnant, high-risk women with higher PI-RF reported significantly less aggressive behaviors in their children when they were 6, 12, and 20 months old, regardless of the maternal level of sensitivity and intrusiveness”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Smaling et al., 2016b
Not checked in the free run.
- Findingcitation
Maternal AAI-RF predicted the children's mentalization beyond maternal attachment security.
“It was observed that maternal AAI-RF predicted the children’s mentalization beyond maternal attachment security (Rosso et al., 2015)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Rosso et al., 2015 source
Not checked in the free run.
- Findingcitation
Maternal AAI-RF correlated with children's mental state talk.
“correlated with children’s mental state talk (Scopesi et al., 2015)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Scopesi et al., 2015 source
Not checked in the free run.
- Findingcitation
Maternal AAI-RF was associated with the children's reflective functioning regarding themselves in a sample of school-aged children with a history of abuse.
“and was associated to the children’s reflective functioning regarding themselves in a sample of school-aged children with a history of abuse (Ensink et al., 2015).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ensink et al., 2015 source
Not checked in the free run.
- Findingcitation
Both maternal and paternal AAI-RF significantly correlated with the children's reflective functioning in a community sample of adolescents aged 14-18.
“In a rare study which also investigated the role of paternal reflective functioning, Benbassat and Priel (2012) found that both maternal and paternal AAI-RF significantly correlated with the children’s reflective functioning in a community sample of adolescents aged 14–18.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Benbassat and Priel, 2012
Not checked in the free run.
- Findingcitation
In a sample of 100 pregnant women who had suffered from childhood abuse and neglect, reflective functioning about the traumatic experiences was lower than the general mentalization about their childhood.
“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”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ensink et al., 2014 source
Not checked in the free run.
- Findingcitation
Mothers with both higher PI-RF and no or low intrusive caregiving were more likely not to report difficulties with their children related to the child's aggressive behaviors.
“although mothers with both higher PI-RF and no or low intrusive caregiving were more likely not to report difficulties with their children related to the child’s aggressive behaviors.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Smaling et al., 2016b
Not checked in the free run.
- Findingcitation
A few empirical studies supported the notion that neither the severity of the traumatic events nor the severity of maternal PTSD symptoms predicted the levels of maternal reflective functioning about the child.
“A few empirical studies (Schechter et al., 2005; Huth-Bocks et al., 2014; Stacks et al., 2014) supported the notion that neither the severity of the traumatic events nor the severity of maternal post-traumatic stress disorder (PSTD) symptoms predicted the levels of maternal reflective functioning about the child.”
Quote in the paperSubstantial claim0 of 3 sources checked - Findingcitation
Pajulo et al. (2012) reported that RF levels increased from pregnancy (measured through PI-RF) to the post-natal phase (assessed by PDI-RF) in the majority (63%) of mothers who received the treatment.
“A recent outcome study (Pajulo et al., 2012) reported that RF levels increased from pregnancy (measured through PI-RF) to the post-natal phase (assessed by PDI-RF) in the majority (63%) of mothers who received the treatment.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Pajulo et al., 2012 source
Not checked in the free run.
- Findingcitation
Mothers whose children were later placed into foster care had lower RF, both during pregnancy and in the post-natal phase.
“Furthermore, mothers whose children were later placed into foster care had lower RF, both during pregnancy and in the post-natal phase.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Pajulo et al., 2012 source
Not checked in the free run.
- Findingcitation
High-risk mothers show lower parental reflective functioning during pregnancy when compared to low-risk women.
“especially in high-risk mothers who show lower parental reflective functioning during pregnancy when compared to low-risk women (Smaling et al., 2015).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Smaling et al., 2015 source
Not checked in the free run.
- Findingcitation
Mothers who abused alcohol and who reported more severe post-traumatic experiences showed a lower increase of RF.
“Mothers who abused alcohol and who reported more severe post-traumatic experiences showed a lower increase of RF.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Pajulo et al., 2012 source
Not checked in the free run.
- Findingcitation
At post-treatment only self-focused RF, and not child-focused RF, significantly improved in mothers who took part in the MTP compared to women who followed the PE.
“Results showed that at post-treatment only self-focused RF, and not child-focused RF, significantly improved in mothers who took part in the MTP compared to women who followed the PE.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Suchman et al., 2011 source
Not checked in the free run.
- Findingcitation
The improvement was maintained, although to a lesser extent, even after a 6-week follow-up.
“The improvement was maintained, although to a lesser extent, even after a 6-week follow-up.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Suchman et al., 2011 source
Not checked in the free run.
- Findingcitation
Mothers showed an increase in reflective functioning when responding to the PDI questions regarding the recall of a positive experience with the child and concerning the child's feelings about being rejected by the mother.
“In particular, mothers showed an increase in reflective functioning when responding to the PDI questions regarding the recall of a positive experience with the child and concerning the child’s feelings about being rejected by the mother (Baradon et al., 2008).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Baradon et al., 2008 source
Not checked in the free run.
- Interpretationreasoning
To date, the specific influence that maternal attachment security and maternal PDI-RF have on the child's attachment security and maternal caregiving behavior does not appear to be well defined.
“nevertheless, to date, the specific influence that maternal attachment security and maternal PDI-RF have on the child’s attachment security and maternal caregiving behavior does not appear to be well defined.”
Quote in the paperSubstantial claim - Interpretationcitation
Adult reflective functioning, as developed in the context of earlier relationships with parents, exerts a crucial influence on caregiving beyond the child's temperament and other personal features.
“The importance and the relevance of these studies in which parental RF was assessed before the child’s birth should be highlighted because they reveal how adult reflective functioning, as developed in the context of the earlier relationships with their parents, exerts a crucial influence on caregiving beyond the child’s temperament and other personal features.”
Quote in the paperSubstantial claim - Interpretationcitation
Taken together, the results from these studies offer strong support to the hypothesis that maternal mentalization ability is truly crucial in promoting the child's ability to develop emotion regulation, especially regarding painful affects.
“Taken together, the results from these studies offer strong support to the hypothesis according to which maternal mentalization ability is truly crucial in promoting the child’s ability to develop emotion regulation, especially regarding painful affects (Fonagy et al., 2002).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fonagy et al., 2002
Not checked in the free run.
- Premisecitation
Mentalization-based interventions were designed to overcome the limitations that behavioral and psychoeducational parenting interventions showed in improving caregiving behaviors.
“Mentalization-based interventions were designed to overcome the limitations that behavioral and psychoeducational parenting interventions showed in improving caregiving behaviors (for a review, see Suchman et al., 2006).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Suchman et al., 2006 source
Not checked in the free run.
- Interpretationreasoning
The previously reviewed correlational studies did not demonstrate a causal relationship in that parental RF is what actually promotes good parenting competency.
“In fact, the previously reviewed correlational studies did not demonstrate a causal relationship in that parental RF is what actually promotes good parenting competency.”
Quote in the paperSubstantial claim - Study design and conductnone given
The major limitation of Pajulo et al. (2012) was not having used a randomized controlled design.
“The major limitation of this study was not having used a randomized controlled design, which was instead used in the following studies we reviewed.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Pajulo et al., 2012 source
Not checked in the free run.
- Study design and conductcitation
Fonagy et al. (2016) conducted a randomized controlled trial investigating, among other outcomes, the change in maternal reflective functioning.
“A recent, randomized controlled trial (Fonagy et al., 2016) which investigated, among other outcomes, the change in maternal RF, yielded similar results and found no significant increase in maternal PDI-RF when mothers who received psychoanalytic PIP which strongly focused on the mothers’ mentalizing, were compared to mothers who only underwent standard intervention.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fonagy et al., 2016 source
Not checked in the free run.
- Premisecitation
In Fonagy et al. (2016), only mothers in the PIP group showed a significant decrease in representational risk, particularly in the Helplessness and Hostile subscales.
“In their study, only mothers in the PIP group showed a significant decrease in representational risk, particularly in the Helplessness and in the Hostile subscales.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fonagy et al., 2016 source
Not checked in the free run.
- Study design and conductcitation
Sadler et al. (2013) conducted a cluster randomized controlled trial investigating improvement in reflective functioning in mothers who received the MTB intervention and in mothers who received standard care at their local community health center when the children were 2 years old.
“Among other outcomes, a cluster randomized controlled trial (Sadler et al., 2013) investigated the improvement in reflective functioning in mothers who received the MTB intervention and in mothers who received the standard care at their local community health center when the children were 2 years old.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Sadler et al., 2013 source
Not checked in the free run.
- Premisecitation
In Sadler et al. (2013), a significantly greater improvement in maternal reflective functioning was found only in mothers in the intervention group who had absent or very low RF before the birth of the child (PI-RF < 3).
“A significantly different improvement in maternal reflective functioning was found only in mothers in the intervention group who had absent or very low RF before the birth of the child (PI-RF < 3).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Sadler et al., 2013 source
Not checked in the free run.
- Premisecitation
In Fonagy et al. (2016), there was no significant increase in maternal PDI-RF when mothers who received psychoanalytic PIP strongly focused on mentalizing were compared to mothers who only underwent standard intervention.
“A recent, randomized controlled trial (Fonagy et al., 2016) which investigated, among other outcomes, the change in maternal RF, yielded similar results and found no significant increase in maternal PDI-RF when mothers who received psychoanalytic PIP which strongly focused on the mothers’ mentalizing, were compared to mothers who only underwent standard intervention.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fonagy et al., 2016 source
Not checked in the free run.
- Premisecitation
In Rostad and Whitaker (2016), parental interest and curiosity in mental states as assessed by PRFQ were associated with the degree of satisfaction with parenting, involvement, and communication.
“Rostad and Whitaker (2016) found that parental interest and curiosity in mental states as assessed by PRFQ were associated with the degree of satisfaction with parenting, involvement, and communication.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Rostad and Whitaker, 2016
Not checked in the free run.
- Premisecitation
In Ashton et al. (2016), mothers who underwent intensive group intervention (Trauma and Attachment Group; TAG) for caregiver/child dyads showed an improvement in parental reflective functioning.
“Ashton et al. (2016) found an improvement in parental reflective functioning in mothers who underwent intensive group intervention (Trauma and Attachment Group; TAG) for caregiver/child dyads.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ashton et al., 2016
Not checked in the free run.
- Premisecitation
In Bottos and Nilsen (2014), maternal impairment in RF as assessed by PRFQ mediated the detrimental effect of maternal depression on the child's mentalizing abilities when associated with past experiences of emotional maltreatment.
“Bottos and Nilsen (2014) found that if associated with past experiences of emotional maltreatment, maternal impairment in RF as assessed by PRFQ mediated the detrimental effect of maternal depression on the child’s mentalizing abilities.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Bottos and Nilsen, 2014
Not checked in the free run.
- Premisecitation
In Paris et al. (2015), among substance-abusing mothers, PRFQ scores revealed a significant improvement only in mothers who had shown higher levels of psychological distress at the beginning of a brief dyadic parent-child intervention.
“On the contrary, in a sample of substance-abusing mothers, Paris et al. (2015) reported that PRFQ scores revealed a significant improvement only in mothers who had shown higher levels of psychological distress at the beginning of a brief dyadic parent-child intervention.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Paris et al., 2015 source
Not checked in the free run.
- Premisecitation
Higher parental RF was associated with better mentalizing abilities in children.
“Moreover, higher parental RF was associated with better mentalizing abilities in children (Benbassat and Priel, 2012; Ensink et al., 2015; Rosso et al., 2015; Scopesi et al., 2015).”
Quote in the paperSubstantial claim0 of 3 sources checked - Study design and conductcitation
Sealy and Glovinsky (2016) conducted the sole randomized controlled trial investigating parental reflective functioning in parents of children suffering from a neurodevelopmental disorder.
“The sole randomized controlled trial that investigated parental reflective functioning in the parents of children suffering from a neurodevelopmental disorder found a significant improvement in parents who received a 12-week relationship-based intervention when compared to the parents in the psychoeducational (wait-list) group (Sealy and Glovinsky, 2016).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Sealy and Glovinsky, 2016
Not checked in the free run.
- Interpretationreasoning
Taken together, the reviewed studies currently offer partial support in favor of a causal relationship between parental RF and adequate parenting.
“Taken together, the studies currently offer partial support in favor of a causal relationship between parental RF and adequate parenting.”
Quote in the paperSubstantial claim - Premisecitation
In Rutherford et al. (2016), PRFQ scores were associated with the neural correlates of infant cue perception, showing an association between PRFQ scores and parental sensitivity to the child's emotional signals.
“In their next study, Rutherford et al. (2016) demonstrated that PRFQ scores were associated with the neural correlates of infant cue perception, showing an association between PRFQ scores and parental sensitivity to the child’s emotional signals.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Rutherford et al., 2016 source
Not checked in the free run.
- Premisecitation
In the sole randomized controlled trial of parents of children with a neurodevelopmental disorder, parents who received a 12-week relationship-based intervention showed significant improvement in parental reflective functioning compared to parents in the psychoeducational (wait-list) group.
“The sole randomized controlled trial that investigated parental reflective functioning in the parents of children suffering from a neurodevelopmental disorder found a significant improvement in parents who received a 12-week relationship-based intervention when compared to the parents in the psychoeducational (wait-list) group (Sealy and Glovinsky, 2016).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Sealy and Glovinsky, 2016
Not checked in the free run.
- Premisecitation
In Rutherford et al. (2013, 2015), parental reflective functioning evaluated by PRFQ was related to the mother's tolerance of infant distress.
“Rutherford et al. (2013, 2015) found that parental reflective functioning evaluated by PRFQ was related to the mother’s tolerance of infant distress.”
Quote in the paperNot a substantial claim0 of 2 sources checked - Interpretationreasoning
The unexpected findings from the most recent randomized controlled trials reviewed in the current paper (Sadler et al., 2013; Ordway et al., 2014; Fonagy et al., 2016) could be in line with Shai and Belsky's (2011) formulations about parental embodied mentalizing.
“We argue that the unexpected findings from the most recent randomized controlled trials reviewed in the current paper (Sadler et al., 2013; Ordway et al., 2014; Fonagy et al., 2016) could be in line with Shai and Belsky’s (2011) formulations.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Shai and Belsky, 2011
Not checked in the free run.
- Premisecitation
Two studies alone (Suchman et al., 2010a; Borelli et al., 2016) investigated the factor structure of the PDI-RF, identifying two factors, namely self-mentalization and child-mentalization.
“Two studies alone (Suchman et al., 2010a; Borelli et al., 2016) investigated the factor structure of the PDI-RF, identifying two factors, namely self-mentalization and child-mentalization.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Suchman et al., 2010a
Not checked in the free run.
- cites Borelli et al., 2016 source
Not checked in the free run.
- Premisecitation
The cycle of abuse can come to an end if abused mothers are able to mentalize their past abusive experiences.
“Since a vast array of studies have demonstrated that the cycle of abuse can come to an end if abused mothers are able to mentalize their past abusive experiences, mentalization-based interventions were developed to help mothers at high risk of repeating the abusive parenting.”
Quote in the paperNot a substantial claim - Interpretationcitation
Randomized controlled trials showed that mentalization-based interventions were effective in improving caregiving.
“Randomized controlled trials showed that mentalization-based interventions were effective in improving caregiving, which is highly relevant especially regarding mothers who have a history of maltreatment and thus who are at high risk of becoming maltreating parents.”
Quote in the paperSubstantial claim - Premisecitation
The maternal ability to mentalize painful emotional experiences is especially crucial for the child's development.
“Fourthly, in our opinion some components of the parental reflective functioning, such as the painful affect mentalization versus non-painful affect mentalization, deserve more in-depth investigation since some studies (Fonagy et al., 2002; Sharp et al., 2006; Borelli et al., 2012; Rosso et al., 2015) demonstrated that the maternal ability to mentalize painful emotional experiences is especially”
Quote in the paperSubstantial claim0 of 3 sources checked
- May combine two claims. 43
- The quote only partly states this claim. 1
- Classified as probably not a substantial claim. 7
May combine two claims.
Findingown dataHigher parental reflective functioning is associated with adequate caregiving and with the child's attachment security.
“higher parental RF was associated with adequate caregiving and the child’s attachment security”
Quote in the paperSubstantial claimMay combine two claims.
FindingcitationNo other studies on parenting using the RFS were published until 2005, while RFS was extensively used in other psychological fields.
“Surprisingly, despite the noteworthy findings from the previous studies, no other studies on parenting using the RFS were published until 2005, while RFS was extensively used in several published papers regarding other psychological fields such as psychopathology and psychotherapy (for a review, Katznelson, 2014).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Katznelson, 2014 source
Not checked in the free run.
May combine two claims.
FindingcitationMothers with impaired parental reflective functioning were significantly more often inclined to disrupt affective communication with their children, exhibiting difficulty in regulating their infants' fear and distress, thus failing to provide them with a feeling of security.
“mothers with impaired parental reflective functioning were significantly more often inclined to disrupt affective communication with their children, exhibiting difficulty in regulating their infants’ fear and distress, thus failing to provide them with a feeling of security”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Grienenberger et al., 2005 source
Not checked in the free run.
May combine two claims.
FindingcitationParental reflective functioning was closely related to maternal behavior and the child's attachment security.
“The first empirical studies using PDI-RF showed that parental RF was closely related to maternal behavior and the child’s attachment security (Grienenberger et al., 2005; Slade et al., 2005).”
Quote in the paperSubstantial claim0 of 2 sources checkedMay combine two claims.
FindingcitationIn a sample of referred mothers who experienced traumatic and violent events before age 16, the quality of maternal mental representations on the WMCI was associated both with caregiving behavior and with WMCI-RF, but WMCI-RF did not correlate with atypical maternal behavior.
“In their clinical sample, the quality of maternal mental representations on the WMCI was associated both with caregiving behavior and with WMCI-RF, but the latter did not correlate with atypical maternal behavior.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Schechter et al., 2008 source
Not checked in the free run.
May combine two claims.
FindingcitationMaternal AAI-RF during pregnancy predicted parental mind-mindedness at 6 months' post-partum and infant attachment security at 12 months.
“Arnott and Meins (2007) found that maternal AAI-RF during pregnancy predicted parental mind-mindedness at 6 months’ post-partum and infant attachment security at 12 months.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Arnott and Meins, 2007
Not checked in the free run.
May combine two claims.
FindingcitationMaternal AAI-RF during pregnancy protected mothers from acting out negative caregiving behaviors (intrusive, aggressive, and withdrawn), which in turn were strongly associated with both the child's disorganization and insecurity of attachment.
“In particular, the study revealed that maternal AAI-RF during the pregnancy protected mothers from acting out negative caregiving behaviors (intrusive, aggressive, and withdrawn) which, in turn, were strongly associated with both the child’s disorganization and insecurity of attachment.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ensink et al., 2016b
Not checked in the free run.
May combine two claims.
FindingcitationIn Borelli et al. (2016), neither of the PDI-RF dimensions correlated with maternal attachment security, and only child-focused RF was associated with children's attachment security.
“However, in this study neither of the PDI-RF dimensions correlated with maternal attachment security, and only child-focused RF was associated with children’s attachment security.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Borelli et al., 2016 source
Not checked in the free run.
May combine two claims.
FindingcitationIn a high-risk sample, secure mothers demonstrated higher PDI-RF, which was in turn significantly associated with positive parental interactive behavior during play and teaching tasks with 7-month-old children.
“A more recent study (Huth-Bocks et al., 2014) found that secure mothers (assessed by the Attachment Script Assessment, ASA; Waters and Rodrigues-Doolabh, 2004, Unpublished) from a high risk sample demonstrated higher PDI-RF, and that it was in turn significantly associated with positive parental interactive behavior during play and teaching tasks with 7-month-old children.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Huth-Bocks et al., 2014 source
Not checked in the free run.
May combine two claims.
FindingcitationPreterm infants of high PDI-RF mothers showed the most negative affects as well as more self-soothing behavior during the Still Face procedure, whereas infants whose mothers were rated lower on PDI-RF exhibited the most negative affects during the reunion episode.
“Heron-Delaney et al. (2016) found that preterm infants of high PDI-RF mothers showed the most negative affects as well as more self-soothing behavior during the Still Face procedure, whereas infants whose mothers were rated lower on PDI-RF exhibited the most negative affects during the reunion-episode.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Heron-Delaney et al., 2016 source
Not checked in the free run.
May combine two claims.
FindingcitationPDI-RF correlated positively with child reflective functioning and inversely with child externalizing behaviors.
“Furthermore, PDI-RF correlated positively with child reflective functioning and inversely with child externalizing behaviors (Ensink et al., 2016a).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ensink et al., 2016a
Not checked in the free run.
May combine two claims.
FindingcitationLow 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.
“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.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ensink et al., 2014 source
Not checked in the free run.
May combine two claims.
FindingcitationChildren of abused and neglected mothers were classified as insecure in 83% of cases and disorganized in almost half of the cases, with high concordance between maternal and child attachment.
“Further support came from a recent study (Berthelot et al., 2015) that found that children of abused and neglected mothers were classified as insecure in 83% of cases and disorganized in almost half of the cases, with high concordance between maternal and child attachment.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Berthelot et al., 2015 source
Not checked in the free run.
May combine two claims.
FindingcitationMaternal unresolved state of mind regarding the trauma and low reflective functioning about the trauma independently contributed to infant disorganization of attachment.
“Furthermore, they found that maternal unresolved state of mind regarding the trauma and low reflective functioning about the trauma independently contributed to infant disorganization of attachment.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Berthelot et al., 2015 source
Not checked in the free run.
May combine two claims.
FindingcitationAt post-treatment assessment, mothers enrolled in the MTP showed higher increases in PDI-RF as well as in representation quality of the relationship with their child and in caregiving behavior.
“At post-treatment assessment, mothers enrolled in the MTP showed higher increases in PDI-RF as well as in representation quality of the relationship with their child and in caregiving behavior (Suchman et al., 2010b).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Suchman et al., 2010b
Not checked in the free run.
May combine two claims.
FindingcitationAbused mothers mostly had low reflective functioning and more than one third of the mothers in their sample were classified on the AAI as unresolved regarding trauma.
“Ensink et al. (2014) also noted that abused mothers mostly had low reflective functioning and that more than one third of the mothers in their sample were classified on the AAI as unresolved regarding trauma.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Ensink et al., 2014 source
Not checked in the free run.
The quote only partly states this claim.
FindingcitationA comparison between pre- and post-treatment RF-PDI scores showed a significant increase in reflective functioning after the New Beginnings group-intervention.
“A comparison between pre-and post-treatment RF-PDI scores showed a significant increase in reflective functioning after the group-intervention.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Baradon et al., 2008 source
Not checked in the free run.
May combine two claims.
FindingcitationAt the 6-week follow-up visit, mothers enrolled in the MTP showed a more adequate caregiving behavior and their children were more able to communicate with them.
“At the 6-week follow-up visit, mothers enrolled in the MTP showed a more adequate caregiving behavior and their children were more able to communicate with them.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Suchman et al., 2011 source
Not checked in the free run.
May combine two claims.
Interpretationnone givenRecent randomized controlled trials of mentalization-based interventions in high-risk samples of mothers have produced unexpected findings that raise questions about the suitability of verbal measures for capturing the mentalizing processes underlying parental responsiveness.
“However, unexpected findings have emerged from the most recent randomized controlled trials that tested the efficacy of mentalization-based interventions in high risk samples of mothers, raising questions about the suitability of the verbal measures in capturing the mentalizing processes at the root of the parental capacity to be adequately responsive to the child’s emotional needs.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationnone givenThe review highlighted a paucity of studies on the relationship between maternal AAI-RF and PDI-RF, and it is not clear whether AAI-RF predicts PDI-RF or what the specific impact of AAI-RF and PDI-RF on caregiving behavior is.
“In addition, the review rather surprisingly highlighted a paucity of studies on the relationship between maternal AAI-RF and PDI-RF, and thus it is not clear whether AAI-RF predicts PDI-RF or what the specific impact of AAI-RF and PDI-RF on caregiving behavior is.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningTaken together, the reviewed studies showed a strong link between maternal attachment security and PDI-RF, which in turn both play a critical role in the child's attachment security.
“Thus, taken together, these reviewed studies showed a strong link between maternal attachment security and PDI-RF, which in turn both play a critical role in the child’s attachment security.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationnone givenIn summary, the reviewed studies confirmed that parental RF plays a crucial role in the quality of caregiving and child attachment security.
“In summary, the reviewed studies confirmed that parental RF plays a crucial role in the quality of caregiving and child attachment security.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenOnly a few studies have investigated the role of parental reflective functioning on child development and psychopathology.
“To date, only a few studies have investigated the role of parental reflective functioning on child development and psychopathology.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationSeveral authors theorized that the ability to mentalize the experiences of abuse and neglect is the most important factor in the resilience process.
“Several authors (for a review Allen, 2013) theorized that the ability to mentalize the experiences of abuse and neglect is the most important factor in the resilience process.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Allen, 2013
Not checked in the free run.
May combine two claims.
PremisecitationUnresolved mothers are more likely to have disorganized children and infant attachment disorganization is a powerful predictor of later psychopathology.
“because it is well-known that unresolved mothers are more likely to have disorganized children and that infant attachment disorganization is a powerful predictor of later psychopathology (for a review, Madigan et al., 2006).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Madigan et al., 2006 source
Not checked in the free run.
May combine two claims.
PremisecitationPDI-RF scoring is influenced by mental-state talk; extensive use of mental-state talk can lead to assigning an RF score of at least 3 even when it does not indicate a genuine ability to mentalize.
“In fact, extensive use of mental state talk inevitably led to assigning an RF score of at least 3, even though the use of mental-state talk is not always indicative of a real ability to mentalize.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fonagy et al., 2016 source
Not checked in the free run.
May combine two claims.
PremisecitationIn Sadler et al. (2013), children whose mothers received the MTB intervention were significantly more securely attached and less disorganized than children whose mothers did not receive the intervention.
“Conversely, children whose mothers received the intervention were significantly more securely attached and less disorganized”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Sadler et al., 2013 source
Not checked in the free run.
May combine two claims.
PremisecitationIn a follow-up study 1-3 years after the MTB intervention, mothers who received MTB reported significantly fewer externalizing behaviors in their children, despite not reporting higher PDI-RF.
“The first follow-up study, conducted 1–3 years after the intervention, showed that mothers who received the MTB treatment reported significantly fewer externalizing behaviors in their children, despite not reporting higher PDI-RF (Ordway et al., 2014).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ordway et al., 2014 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationMaternal reflective functioning develops not only during the first years of life but also throughout adolescence, so the young age of mothers in the sample could have contributed to the unexpected findings.
“In addition, they highlighted that maternal RF develops not only during the 1st years of life, but also throughout adolescence, thus they argued that the young age of the mothers in their sample could have contributed to their unexpected findings.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Sadler et al., 2013 source
Not checked in the free run.
May combine two claims.
PremisecitationIn Sadler et al. (2013), maternal reflective functioning improved in both the MTB intervention and standard care groups, with no significant difference between mothers who received the MTB intervention and those who did not.
“Results showed that maternal RF improved in both groups without significant differences between mothers who received the MTB intervention and those who did not.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Sadler et al., 2013 source
Not checked in the free run.
May combine two claims.
PremisecitationIn the New Beginnings cluster randomized controlled trial, only mothers who took part in the group interventions showed a statistically significant improvement in reflective functioning, whereas mothers who did not receive the New Beginnings intervention showed a significant decrease in mentalizing both themselves as parents and their child.
“Results revealed that only mothers who took part in the group interventions showed a statistically significant improvement in reflective functioning, whereas mothers who did not receive the New Beginnings intervention showed a significant decrease in mentalizing both themselves as parents and their child.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Sleed et al., 2013 source
Not checked in the free run.
May combine two claims.
PremisecitationIn the New Beginnings Program, mothers showed some improvements in interaction with the child, but the degree of change in reflective functioning did not significantly correlate with the degree of change in mother-child interaction.
“Mothers in the New Beginnings Program also showed some improvements in their interaction with the child, but the degree of change in reflective functioning did not significantly correlate with the degree of change in the mother-child interaction.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Sleed et al., 2013 source
Not checked in the free run.
May combine two claims.
Study design and conductcitationSleed et al. (2013) used a cluster randomized controlled trial to test the efficacy of the New Beginnings intervention, comparing mothers in prisons where group intervention was provided with mothers in prisons where New Beginnings was not available.
“A following study (Sleed et al., 2013) used a cluster randomized controlled trial to test the efficacy of the New Beginnings; a group of mothers in prisons where group-intervention was provided was compared to a group of mothers residing in prisons where New Beginnings was not available.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Sleed et al., 2013 source
Not checked in the free run.
May combine two claims.
InterpretationcitationThe reviewed studies support the notion that parental RF is associated with adequate caregiving and the child's attachment security.
“The reviewed studies support the notion that parental RF is associated with adequate caregiving and the child’s attachment security.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationPRFQ subscales were not correlated with demographic features, whereas they were associated with parental attachment, emotional availability, and parenting stress.
“The subscales were not correlated with demographic features, whereas they were associated with parental attachment, emotional availability, and parenting stress.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Rutherford et al., 2013 source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
InterpretationcitationThe PIP intervention is effective in changing mothers' representations of their child and specifically reducing feelings of helplessness and hostility toward their child.
“Fonagy and co-workers interpreted this finding as supporting the efficacy of the PIP intervention in changing the mothers’ representations of their child and specifically reducing feelings of helplessness and hostility toward their child.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fonagy et al., 2016 source
Not checked in the free run.
May combine two claims.
InterpretationreasoningMost of the reviewed studies showed that mentalization-based clinical interventions were effective in improving maternal mentalization and quality of caregiving.
“In summary, although most of the reviewed studies showed that mentalization-based clinical interventions were effective in improving maternal mentalization and quality of caregiving, some studies raised issues which need further investigation.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationLow maternal RF was found in mothers whose children suffered from anxiety disorders, impairment in emotion regulation, and externalizing behaviors.
“Low maternal RF was found in mothers whose children suffered from anxiety disorders (Esbjørn et al., 2013), impairment in emotion regulation (Heron-Delaney et al., 2016), and externalizing behaviors (Ensink et al., 2016a; Smaling et al., 2016b).”
Quote in the paperSubstantial claim0 of 3 sources checkedMay combine two claims.
PremisecitationThe initial validation study of the P-PRFQ showed a three-factor structure (F1: Opacity of mental states; F2: Reflecting on the fetus-child; and F3: The dynamic nature of the mental states) and suggested it could be a valid and promising new instrument for assessing parental reflective functioning during pregnancy.
“The initial validation study showed a three-factor structure (F1: “Opacity of mental states”; F2: “Reflecting on the fetus-child”; and F3: “The dynamic nature of the mental states”) and suggested it could be a valid and promising new instrument for assessing parental reflective functioning during pregnancy.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Pajulo et al., 2015 source
Not checked in the free run.
May combine two claims.
PremisecitationIn the not-yet-published validation study (Luyten et al., 2009), the three-factor structure of the PRFQ was supported by exploratory and confirmatory factor analysis in two different samples for both mothers and fathers, and internal consistency was good for all subscales, ranging from 0.70 for pre-mentalizing modes to 0.82 for certainty in mental states.
“Rutherford et al. (2013) reported that in the not yet published validation study (Luyten et al., 2009, Unpublished), the three-factor structure of the PRFQ was supported by exploratory and confirmatory factor analysis in two different samples for both mothers and fathers, and that internal consistency was good for all the subscales, ranging from 0.70 for pre-mentalizing modes to 0.82 for certainty”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Luyten et al., 2009
Not checked in the free run.
- cites Rutherford et al., 2013 source
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationSole reliance on verbal processes may be unsuccessful in capturing mentalizing processes.
“Some years ago, Shai and Belsky (2011) stated that sole reliance on verbal processes may be unsuccessful in capturing mentalizing processes, thus they introduced the notion of parental embodied mentalizing, which refers to the parental ability to implicitly understand the child’s mental states through all the movements of her/his body and to attune with them through their own kinesthetic patterns.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Shai and Belsky, 2011
Not checked in the free run.
May combine two claims.
InterpretationreasoningThe reviewed studies found a significant improvement in maternal caregiving after mentalization-based treatment, and most of the studies also yielded a significant improvement in maternal RF in the mothers who received mentalization-based interventions.
“Taken together, the reviewed studies found a significant improvement in maternal caregiving after the treatment and most of the studies also yielded a significant improvement in maternal RF in the mothers who received mentalization-based interventions.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningThe PRFQ has been used in several studies in the last 3 years, thus proving to be a promising measure of general parental reflective functioning.
“To date, the AAR has only been used in two studies, whereas the PRFQ has been used in several studies in the last 3 years thus proving to be a promising measure of general parental reflective functioning, which we assume could be used as a reliable screening instrument.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The PRFQ could be used as a reliable screening instrument.
May combine two claims.
PremisecitationIn Stover and Kiselica (2014), lower PDI-RF was associated with poorer education and substance abuse, whereas a correlation between PDI-RF and parenting behavior, as investigated by self-report measures, was not found.
“They found an association between lower PDI-RF, poorer education, and substance-abuse, whereas a correlation between PDI-RF and parenting behavior, as investigated by self-report measures, was not found.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Stover and Kiselica, 2014
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationThe maternal ability to deal with her own emotional experience elicited by the relationship with her child allows her to respond sensitively to her child's emotional needs.
“Further studies are needed to replicate and to investigate more in-depth the important findings by Suchman et al. (2010a) which support the notion that it is the maternal ability to deal with her own emotional experience elicited by the relationship with her child that allows her to respond sensitively to her child’s emotional needs.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Suchman et al., 2010a
Not checked in the free run.
May combine two claims.
InterpretationreasoningTaken together, the reviewed studies offer strong support to the determinant influence of parental reflective functioning on the quality of caregiving, on the child's attachment security, on the child's emotion regulation, and on the child's reflective functioning.
“Taken together the reviewed studies offer strong support to the determinant influence of parental reflective functioning on the quality of caregiving, on the child’s attachment security, on the child’s emotion regulation, and on the child’s reflective functioning.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationcitationTwo recent studies (Sadler et al., 2013; Fonagy et al., 2016) found a general improvement in the mother-child relationship, but did not find a significant increase in PDI-RF when comparing the outcomes of mentalization-based treatment with the outcome of other interventions.
“However, two recent studies (Sadler et al., 2013; Fonagy et al., 2016) found a general improvement in the mother-child relationship, but quite notably they did not find a significant increase in PDI-RF when comparing the outcomes of mentalization-based treatment with the outcome of other interventions.”
Quote in the paperSubstantial claim0 of 2 sources checkedClassified as probably not a substantial claim. May combine two claims.
PremisecitationPDI-RF scoring is inevitably influenced by the mental state talk produced in the PDI narrative; extensive use of mental state talk inevitably led to assigning an RF score of at least 3, even though the use of mental-state talk is not always indicative of a real ability to mentalize.
“In fact, extensive use of mental state talk inevitably led to assigning an RF score of at least 3, even though the use of mental-state talk is not always indicative of a real ability to mentalize.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fonagy et al., 2016 source
Not checked in the free run.
The authors state this as an assumption.
Low reflective functioning mothers are unable to tolerate and make sense of their children’s painful emotional experience and therefore are not able to help their children regulate their distress.
“It was assumed that low reflective functioning mothers were unable to tolerate and make sense of their children’s painful emotional experience and therefore, that they were not able to help their children to regulate their distress.”
The authors state this as an assumption.
A well-developed ability to mentalize one’s own past painful abusive experiences might make the parent equipped to be sensitive to the risk of engaging in painful and frightening interactions with his/her own child.
“It was assumed that a well-developed ability to mentalize one’s own past painful abusive experiences might make the parent equipped to be sensitive to the risk of engaging in painful and frightening interactions with his/her own child (Allen, 2013).”
The authors state this as an assumption.
The development of the ability to understand one’s own as well as others’ mental states originates from an early parent-child relationship in which the child experiences the caregiver as being able to recognize his/her mental states.
“Fonagy and co-workers assumed that the development of the ability to understand one’s own as well as others’ mental states originates from an early parent-child relationship in which the child experiences the caregiver as being able to recognize his/her mental states.”
The authors state this as an assumption.
Negative caregiving is predicted by the parent’s ineffective defenses against the psychic pain related to the abusive experiences they suffered in the past, above all identification with the aggressor.
“Rather, they assumed that the latter is predicted by the parent’s ineffective defenses against the psychic pain related to the abusive experiences they suffered in the past, above all identification with the aggressor.”
The authors state this as an assumption.
The PRFQ could be used as a reliable screening instrument.
“which we assume could be used as a reliable screening instrument.”
The paper relies on this without support.
No published studies are available regarding the association between AAI-RF and PDI-RF.
“Secondly, surprisingly no published studies are available regarding the association between AAI-RF and PDI-RF.”
The paper relies on this without support.
The contribution of each of the two identified PDI factors on the quality of the mother-child relationship as well as on the child's psychological development has been insufficiently investigated.
“To date, the contribution of each of the two identified PDI factors on the quality of the mother-child relationship as well as on the child’s psychological development has been insufficiently investigated.”
The paper relies on this without support.
The developers of the PRFQ have not published the validation study.
“Although to date the developers of the PRFQ have not published the validation study, the measure, which is available from the authors upon request, has been used in a few empirical studies that herein will be briefly reviewed.”
The paper relies on this without support.
The AAR has only been used in two studies.
“To date, the AAR has only been used in two studies, whereas the PRFQ has been used in several studies in the last 3 years thus proving to be a promising measure of general parental reflective functioning, which we assume could be used as a reliable screening instrument.”
The paper relies on this without support.
The role of paternal reflective functioning on the child's development has been neglected altogether.
“Firstly, the role of paternal reflective functioning on the child’s development has been neglected altogether.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A parent's ability to reflect on their child's mental states (mentalising/reflective functioning) has been linked with the capacity to provide sensitive caregiving.
“A parent’s ability to reflect on their child’s mental states, often referred to as ‘mentalising’ or ‘reflective functioning’, has been linked with the capacity to provide sensitive caregiving [14]”
From Optimizing parenting and child outcomes following parent–child interaction therapy – toddler: a randomized controlled trial (2024) · cites this paper as [14]
Several mentalization-based programs for parents have been developed over the past 20 years, based on both individual and group interventions.
“Several mentalization-based programs for parents have been developed over the past 20 years [62,63], based on both individual and group interventions.”
From Psychoanalytic Interventions with Abusive Parents: An Opportunity for Children’s Mental Health (2022) · cites this paper as [62]
As the changes caused by COVID-19 are sudden and cover many aspects of daily life, adverse reactions tend to worsen, impairing human reflexive function.
“As the changes caused by COVID-19 are sudden and cover many aspects of our daily lives, these adverse reactions tend to worsen, impairing human reflexive function. 9”
From Social isolation and its impact on child and adolescent development: a systematic review (2022) · cites this paper as [9]
The citation lists haven’t been fetched yet
References 70 · Cited by 356
Research works printed but not linked: 4
- Fonagy, 2002, Affect Regulation, Mentalisation, and the Development of the Self.
- Lieberman, 1999, Infant-parent psychotherapy: core concepts and current approaches, Handbook of Infant Mental Health, 472
- Sadler, 2006, “Minding the baby: a mentalisation-based parenting program,” in, Handbook of Mentalisation-Based Treatment, 271
- Slade, 2004, Addendum to Fonagy, Target, Steele, and Steele Reflective Functioning Scoring Manual for Use with the Parent Development Interview.
- Authors
- Camoirano, A.
- Corresponding author
- Camoirano, Andrea
- ORCID
- Camoirano, Andrea
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2017-01-20
- Volume
- 8
- Pages
- 14-14
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC5247433
- OpenAlex
- W2575700299
- Semantic Scholar
- d8d54949a1da89627228754ea2c1e66e07a9a6a8
- Cited by
- 356
- References
- 70
- Citations by year
- 2026: 45 · 2025: 53 · 2024: 50 · 2023: 61 · 2022: 37 · 2021: 46 · 2020: 27 · 2019: 21 · 2018: 9 · 2017: 7
- FWCI
- 2.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- parental reflective functioning, mentalization, parenting, caregiving quality, attachment security, child emotion regulation, maternal mentalization, maternal anxiety disorders, externalizing problems, mentalization-based interventions, child development
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
