Parenting Behavior and Representations Among Women in Methadone Treatment

Background.  Parents who misuse drugs are at risk for problematic parenting, including referral to the child welfare system.  Many therapeutic interventions for high-risk parents focus on repairing and reframing the representations parents have of their children (e.g., Lieberman, 1997).  Yet little is known about how parental representations are related to actual parenting behavior.  The goal of this paper is to examine whether representations substance-dependent women have of their young children are associated with the women’s behavior with their children. 

Methods.  One hundred and fifty urban African-American women in methadone treatment for heroin dependence participated in the study.  All had primary custody of a 3-to-5-year-old child. Women were interviewed using the Working Model of the Child Interview (WMCI) (Zeanah, et al., 1986), an hour-long semi-structured interview that probes for the mother’s experiences with and perceptions of her child and her emotional responses to her child.  Transcribed interviews were coded by two reliable coders into three representation typologies (balanced, disengaged, or distorted) and were rated on Likert scales for multiple emotional tones in the narratives. 

Mothers and children were videorecorded for 45 minutes in a laboratory living room while they engaged in free play, worked on puzzles, played with play dough, prepared and ate a snack, and cleaned up the play and eating area.  Videorecordings were coded for maternal sensitivity, teaching, and harshness by reliable masked raters using the Parent-Child Observation Guide (Bernstein, et al., 2005). 

Results.  The opioid-dependent mothers in this sample were at high-risk for problematic representations of their children compared to low-risk samples.  42% of the women’s transcripts were coded as having representations of their children that were disengaged, 38% distorted, and only 20% balanced.  Mothers with balanced representations – those who provided rich contextualized descriptions of their children’s positive and negative behavior – showed the most sensitivity in interacting with their children.  Mothers who had disengaged representations – those who provided thin or emotionally disconnected descriptions of their children’s behavior  – showed the least sensitivity in interaction. 

Structural Equation Modeling was used to confirm the factor structure of the emotional themes and parenting behavior variables and to examine variable interrelations.  Mother expression of positive emotional themes (pride, joy) was related to parenting sensitivity, teaching and lack of harshness (standardized coefficients averaging .35).  Mother expression of negative emotional themes (anger, frustration) was related to parenting harshness (standardized coefficient =.24).  Mother expression of worry themes (anxiety, guilt) was unrelated to observed parenting behavior. 

All analyses controlled for maternal demographic, mental health, and substance abuse variables and for child age and gender.

Conclusions and Implications.  Substance-misusing mothers may benefit from parenting interventions that help them develop rich, balanced, and contextualized characterizations of their children’s behavior.  Although interventions for drug-using parents often focus on reducing harsh parenting behavior and eradicating negative views of the child, the present data suggest that an important aspect of intervention should also be helping parents develop a positive connection to the child, learn to enjoy interaction with the child, and feel pride in the child’s development.