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Mentalization Based Parent Intervention: An Introduction to the Core Programs of the
Center for Reflective Parenting with Implications for Clinical Practice
John F. Grienenberger, Ph.D.
[email protected] Co-Executive Director, Center
for Reflective Parenting Los Angeles, California
www.reflectiveparenting.org
IDC Herzliya School of Psychology January 30, 2012
John F. Grienenberger, Ph.D. Diane Reynolds, MFT
Founder, Reflective Parenting Program Founder, Mindful Parenting Groups
Co-Executive Director Co-Executive Director
Center for Reflective Parenting Center for Reflective Parenting
[email protected] [email protected]
www.reflectiveparenting.org
Center for Reflective Parenting Core Programs
• Mindful Parenting Groups
- Groups for Parents and Infants, Toddlers, or
Preschoolers from 3 months to 3+ years
- Qualified by California Institute of Mental Health as a
Community Defined Evidence Based Practice
• Reflective Parenting Program
- Curriculum Based Experiential Workshops for
Parents, Prenatal through Adolescent Years
- Qualified by California Institute of Mental Health as a
Community Defined Evidence Based Practice
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Reflective Parenting Program:
Outcomes
• Beck Depression Inventory – N of 89, 28% decrease in depressive symptoms
– p < .001, Effect Size = .39 (medium)
• Parenting Stress Index – N of 89, 7% decrease in parenting stress
– p < .001, Effect Size = .29 (small)
• Achenbach Child Behavior Checklist – N of 71, 12% decrease in Total Problems
– p < .001, Effect Size = .45 (medium)
Center for Reflective Parenting Core Programs
• Inside Stories: Five Chapters in Mindful and
Reflective Parenting
- Workshops for Parents, Preschool through
Elementary Years
• Reflective Teacher Training
- Four week Teacher Training, introducing a Reflective
Approach in the Classroom for Preschool through
Elementary Years
Parental Reflective Functioning and Cultural Diversity
• The ability to reflect is an ordinary capacity, not limited by education, socioeconomic status, race or ethnicity
• A reflective approach is relevant to all cultures, and allows room for differences in cultural / familial values
• There may also be culturally based emphases, strengths, and limitations in relation to parental reflective capacity
• The manner in which the model is adapted to specific populations is flexible
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“The best way to help young men and women become successful parents…is [to] seek always to teach by example, not precept; discussion, not instruction.”
(John Bowlby, 1988)
Core Elements of CRP Programs
•Mindfulness – Structured mindfulness exercises within workshop
•Reflection (mentalizing) – Within workshops
– Take Home Reflection (homework)
•Observation
Esther Bick, 3rd from left, middle row;
John Bowlby, far left of middle row.
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Goals of Reflective Parenting Workshops
and Mindful Parenting Groups
• Gradually move from implicit mentalization /
non-conscious mentalization to explicit /
deliberate and conscious reevaluation
• Integrate thinking and feeling (work to
overcome the defensive split between affect
and cognition)
• Help parents begin to see parenting as a
puzzle, thus requiring flexibility and creativity
• Value of understanding misunderstandings
• What is important is curiosity, inquisitiveness, awareness that knowledge is fallible
• Understanding that ruptures, negative feelings, and bad behavior are inevitable and surviving these without adding fuel to the fire is more important than completely preventing their occurrence
Goals of Reflective Parenting Workshops
and Mindful Parenting Groups
Development of a Reflective Stance
• Group leader adopts a reflective stance
in relation to the parent and the child.
• This allows the parent to experience in
relation to the therapist (or the group)
what we want her to evoke when
responding to the child
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The Reflective or Mentalizing
Clinician (Fearon et al., 2006)
• Is comfortable talking about feelings and internal
experiences
• Is highly respectful of the feelings of others
• Is inquisitive about what those feelings might be
as well as what thoughts, meanings, and related
experiences are attached to them.
• ―Facilitates wondering‖ about mental states (in
the child, in the mother, in the self) – modeling
curiosity and openness, making connections
• Reframes non-mentalizing narratives
The Reflective or Mentalizing
Clinician • Assumes that every individual’s actions (the
parent, child, spouse) are entirely understandable if the feeling that motivates them is fully recognized.
• Encourages the parent to take a pause and reflect
• Responds positively to parental attempts to make sense of mental states
• Recognizes the challenge of doing this at times of high intensity affective arousal
Groups consist of 4 to 6 parent-child
couples plus at least 2 group facilitators
One or both parents may attend
Children are grouped developmentally, from
3 months to 3+ years of age
Mindful Parenting Groups: Innovative, Experiential Groups for Parents
and Infants, Toddlers, and Preschoolers
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The Mindful Parenting Group model consists
of three Core Components…
• Child-Centered Observation
• Flexible Responsiveness in Facilitation
of Social Interactions
• Parent-Centered Reflection
…each of which is a primary pathway for
enhancing parental reflective capacity.
Child-Centered Observation
(20 minutes)
Facilitation of Social Interactions
(concurrent)
Parent-Centered Reflection
(30+ minutes)
−“So, what are we noticing today?”
−“What’s the feeling here?”
−“What are the children showing us?”
Mindful Parenting Group Structure
Mindful Parenting Group Facilitators…
• Help cultivate and enhance parents’ reflective
capacity
• Facilitate children‟s exploration of their physical
and social environment
• Model respectful use of language and respectful
ways of being with children
• Model boundary and limit setting
• Help parents and children organize feelings and
learn to tolerate anxiety, frustration, novelty and
uncertainty
• Create a relaxed, safe, and relatively non-
prohibitive environment within which to learn
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Mindful Parenting Groups
Core Components: OBSERVATION
Core Components of
Mindful Parenting Groups
Child-Centered Observation:
• Draw attention to ebb and flow of
attachment and exploration
• Develop mindfulness of mental states
and behaviors in parent and child, and
how they are interconnected
• Slow parent down and strengthen capacity to come close to child’s
subjective, affective experience
• Suspension of premature conclusions
and judgment
• Mindful attention to minute details of
experience
• Bearing witness to (rather than
reacting to) intense affects
Cultivating an
Observational Stance
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Child-Centered Observation
Role of Facilitator
• Assist parent in learning to respect and follow child’s lead in contact-seeking and
exploratory behaviors
– Parents exercise patience and curiosity about what
children may present this day
– Parents observe ebb and flow of attachment and
exploration, and the relationship between the two
– Parents learn to facilitate rather than direct child’s
behavior, feelings, play, and experiences
– Parents note and reflect upon their expectations,
working to free themselves of premature conclusions about children’s mental states and behaviors
Mindful Parenting Groups
Core Components:
FACILITATION
Facilitation of Social Interactions:
Allow space for child to self-regulate
whenever possible; help parent understand and work the edge of child’s capacity to self-
regulate alongside child’s need for mutual-
regulation
When facilitating, utilize a continuum of
flexible responsiveness, moving from least
amount of facilitation to most
Core Components of
Mindful Parenting Groups
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Facilitating Contact with
Infants/Toddlers
Model flexible responsiveness:
When triggered, some parents may be
inclined to respond with the maximum
response to a child who may be able to be
regulated with a more reflective, measured
response—e.g., where the parent leads with
wonder and curiosity, rather than reactivity
and alarm
Flexible Responsiveness
Toddler falls Mother observes
and feels kinetic
fall of toddler
Mother walks
closer
Toddler sees
mother
observing
Mother nods
acknowledgment of toddler’s fall
Mother: ‘I saw that’
Mother kneels
down
Mother touches
child
Mother holds
child Mother narrates: “You were running
and you lost your balance.”
Toddler
turns to and
reaches for
mother
Toddler begins
to feel regulated
THE END OF OUR STORY:
If needed, mother and child go to find an icepack, bandages, etc.
Anywhere along this continuum, from least amount of facilitation
to most, the child can indicate that his needs are met
• Use hand(s) or body to slow activity,
interaction, or conflict
–Facilitator comes close to mediate between two
infants who have rolled very close to each other
–Facilitator puts hand physically between child who is
hitting and child they intend to hit
–Facilitator offers object to child to arousal or alert
a low-arousal child or to make contact (slowly rolling
a ball to child)
–Facilitator offers object to child to arousal or calm
high-arousal child (introducing silks or large pillows)
Utilizing Nonverbal, Gestural Means of Making Contact / Communicating
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Facilitation of Social Interactions:
Model respectful language and ways of being
with children
Strengthen parent’s capacity to come close to child’s subjective, affective experience
Promote narration of child’s experience
Core Components of
Mindful Parenting Groups
• Simply share verbally the experience of observing: “I saw that.” “I see you.”
• Utilize language that articulates concrete physical reality: “That’s a hard toy.” “You found a soft
place to snuggle in mommy’s lap.”
• Mindful (and tentative) use of feeling-language: “…having some sad feelings about Caleb not
coming today…”
• Language used to name intentions (what is wanted / not wanted): “…wanting mommy to
come back from the washroom now…”
Promote Narration of Child’s Experience:
• Assist parents with mutual regulation of child’s emotional experience
– Help parent tolerate increased arousal and affect in child and self
– Discourage hurried action to down-regulate child
– Model facilitation with flexible responsiveness
• Assist parents in allowing space for child to self-regulate
– Slow anxious reactivity
– Help parents wait to see what child’s needs are
– Point out child’s competencies and resilience
Facilitation of Social Interactions
Role of Facilitator
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Mindful Parenting Groups
Core Components:
REFLECTION
Parent-Centered Reflection:
• You are hosting a „Reflective Party‟:
- Utilize language of observation and reflection
“I wonder… I noticed… I was thinking about… I’m curious… I’m
really struck by...”
- Make inquiries from a place of observational
wonder
“I was watching closely when Avery and Tai rolled together—I
really didn’t know what would happen next! I couldn’t help but
wonder what they were experiencing, and feeling…when Tai
stroked Avery’s cheek, and her fingers landed in his mouth and
he began to mouth them... What were you feeling?”
Core Components of
Mindful Parenting Groups
Reflective Parenting Program
parenting workshops, prenatal to adolescents
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The Reflective Parenting Program
Model
• A developmental parenting program
• A program that incorporates attachment theory and research and a mentalization based approach
• A program utilizing group discussion as well as various developmentally driven curricula including: -Prenatal -Early Childhood (0 to 3)
-Preschool -School Aged (6 to 12)
-Adolescence -Special Populations (e.g. Adoption)
Cycles of Non-Mentalizing Interactions (Fearon, Target, et al, 2006)
POWERFUL EMOTION
POOR MENTALIZING
INABILITY TO UNDERSTAND
OR EVEN PAY ATTENTION
TO FEELINGS OF OTHERS
OTHERS SEEM INCOMPREHENSIBLE
TRY TO CONTROL OR
CHANGE OTHERS OR
ONESELF
FRIGHTENING, UNDERMINING,
FRUSTRATING, DISTRESSING
OR COERCIVE INTERACTIONS
Turning Cycles of Non-Mentalizing Interactions
into Cycles of Reflective Interactions
POWERFUL EMOTION
HOLDING / MENTALIZING
ENVIRONMENT OF GROUP
CONTAINMENT OF
NEGATIVE AFFECT
CHILD SEEN AS SEPARATE
BUT RELATED TO SELF
CURIOSITY ABOUT AND
WISH TO UNDERSTAND CHILD’S MENTAL STATES
SENSITIVE, RESPONSIVE,
AND ATTUNED PARENTING
IMPROVED PARENTAL
MENTALIZATION
INCREASED SELF-
UNDERSTANDING
CHILD DEVELOPS
REFLECTIVE CAPACITY &
IS BETTER ABLE TO SELF-
REGULATE HIS EMOTIONS
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Schedule of RPP Workshop Topics
• Workshop 1 - Introduction
• Workshop 2 -Temperament
• Workshop 3 - Responding to Children‟s Distress
• Workshop 4 - Issues of Separation
• Workshop 5 - Play and Parental Involvement
• Workshop 6 - Discipline I
• Workshop 7 - Discipline II
• Workshop 8 - Dealing with Anger & Big Feelings I
• Workshop 9 - Dealing with Anger & Big Feelings II
• Workshop 10 - Overview and Goodbye
RPP Group Structure
• Mindfulness Exercise
• Review of Take Home Reflection
• Presentation of Curriculum Topics
• Discussion and Exploration
• Various Jumping Off Points and Exercises – Role Plays
– Handouts (e.g. cartoons, temperament chart, etc.)
– Storytelling Technique
– Writing Exercises
• Introduction of Next Take Home Reflection
Take Home Reflection
• Helps parents keep the group’s principles in mind, through practice, during the week
• Helps parents practice reflective activities in manageable blocks of time
• Helps parents hold the group’s supportive emotional environment in mind
• Helps parents take time for observation and thought about themselves and their children
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RPP Workshops: Video Excerpts
Foundations of Mindful
and Reflective Parenting
Transforming
Non-Reflective
States of Mind
in Clinical Work
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Unresolved / Hostile States of Mind in Pre-MPG PDI
Can you tell me about a time in the last week
when you felt really angry as a parent?
―She started screaming hysterically when I told her to
go potty and I got angry and, and… I, I, I, (long
pause) snatched her up a little (pause) roughly
(laughs) [uncontained hostility] …and then I was like,
okay, just go put her in bed. But I calmed down right
away. I am a completely even-tempered person
[incongruent]. Sometimes I just snatch her up. We
decided not to yell at her, so I snatch her up. You
know, I wasn’t angry, I was frustrated [incongruent]. I
tell people when I don’t like it, it’s just how I am [self-
serving]…‖
“Sometimes I grab her with real force, although usually she’s crying about as hard as she ever could cry so I don’t think it gets worse for her whatever I do really [minimizing].”
The interviewer then asked a follow-up question
about the impact of her anger on Billie and
Samantha responded:
―She tries to find the best in everything, I was
expressing my frustration but in a nice way
[incongruent] and she was happy about it [self-
serving, minimizing impact on child].”
Unresolved / Hostile States of Mind in Pre-MPG PDI
Secure States of Mind in Post-MPG PDI
Can you tell me about a time in the last week when you felt really guilty as a parent?
“Yeah, it was in the potty training, she went in her pants for the third time. Then I got her to sit on the potty and I said ‘B., I want you to go on the potty’. I felt that I was being negative, and I don’t think that is a good way of doing it. So I felt guilty about that, I felt my tone of voice was saying, ‘I don’t like you.’ I was using that tone of voice you save for people you don’t like, and I felt pretty guilty about that.”
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Post-MPG PDI—continued
What kind of effect did these feelings have
on your daughter?
―Well, the guilty feelings I don’t think she is
aware of, but the anger she is pretty sensitive
to. When I first got her, I wasn’t handling my
anger very well. Sometimes I would get too
rough with her, like I said, I would grab her.
She is very responsive, and I remember a
turning point for me was when she saw my
face one time and I could see that she was
scared.
Post-MPG PDI—continued
―It diffused me just like that, the idea that she
was afraid of me. Now I am working on my
tone of voice, but sometimes I am not so
successful. I wasn’t sure about the potty
incident, but I did feel guilty about it. I think
she may have looked a little hurt. I imagine
she probably was hurt by it. So I think that my
guilty feelings have helped me to work on
managing my anger, because I see the impact
of my angry feelings on her. ‖
John F. Grienenberger, Ph.D. Diane Reynolds, MFT
Founder, Reflective Parenting Program Founder, Mindful Parenting Groups
Co-Executive Director Co-Executive Director
Center for Reflective Parenting Center for Reflective Parenting
[email protected] [email protected]
www.reflectiveparenting.org