foundations of mindful and reflective parenting: targeting...

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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]


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


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


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


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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


• 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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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


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]


foundations of mindful and reflective parenting: targeting...

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