Brief Psychoeducation Intervention Increases Reflective Functioning in Foster Parents: Results from a Randomized Controlled Trial of Family Minds

Background and Purpose

Mentalization, or reflective functioning, develops within the context of a secure, attached relationship and involves the ability to understand behavior in relation to mental states such as thoughts and feelings.  One area not given much consideration when training foster parents is their state of mind regarding attachment or their capacity to mentalize. Foster parents who have low reflective functioning are more likely to be emotionally triggered by their foster children and thus might parent in an insensitive manner. It could be very beneficial for foster parents to improve upon their mentalizing skills, as they would be less likely to jump to conclusions about their foster children’s negative behaviors and intentions, and as a result, will be more likely to interact with them in a therapeutic manner. Family Minds is a brief, psychoeducational intervention developed specifically for foster parents to increase their reflective functioning.  Recently, a quasi-experimental study evaluated this intervention and results indicated the intervention significantly increased foster parents’ mentalization as well as lowered parenting stress (Adkins, Luyten & Fonagy, 2018).  Due to these very promising results, the purpose of this study was to conduct a Randomized Controlled Trial (RCT) of this intervention to more rigorously evaluate its’ effectiveness.   

Methods

This study was conducted from January 2017 to April 2018 and included 61 foster parents in Texas, who were randomly assigned to the intervention group and or a control group. A total of 35 foster parents received the intervention and 26 control group foster parents received a typical educational training.  Participants had an average age of 44 years and the majority were Caucasian (70%). Pre/post data were collected measuring reflective functioning (Parental Reflective Functioning Questionnaire) and parenting stress (PSI).

Results

Multivariate analyses revealed significant differences between the groups post training on the Pre-Mentalizing scale of the PRFQ (F(1, 54) = 6.87, p = .01, d = 0.72).  Although the groups did not show any differences in their reflective functioning on the pre-test, by the post-test the intervention parents increased their ability to mentalize, while control group parents lowered their mentalizing abilities. There was also a significant difference between groups post training on the PSI, specifically the Child Dysfunctional Interaction scale (F(1, 50) = 4.21, p = .04, d = 0.58). 

Conclusions and Implications

The results of this RCT demonstrate you can increase parents reflective functioning using a brief psychoeducational intervention. Family Minds is unique in that it has managed to take a psychoanalytic concept and operationalize it within a psychoeducational format.  Furthermore, it is a practical and cost effective way for social workers to improve parents’ mentalizing skills. These skills are particularly important for foster parents who care for children who have been traumatized and are more likely to display insecure attachments.  Parents with high reflective functioning are less likely to become defensive and are more likely to parent sensitively and in a manner that leads to secure attachment.  This presentation will describe the Family Minds intervention and discuss the results of the RCT in more detail.