Academic journal article Journal of Prenatal & Perinatal Psychology & Health

Role of Maternal Reflective Ability for Substance Abusing Mothers

Academic journal article Journal of Prenatal & Perinatal Psychology & Health

Role of Maternal Reflective Ability for Substance Abusing Mothers

Article excerpt

ABSTRACT: This paper reports on a study designed to explore factors contributing to better outcomes for substance abusing pregnant and parenting women in residential treatment, and, as a result, contribute to better outcomes for their children. The setting was three live-in units focusing in supporting both abstinence from substances and mother-child relationship. Participants were 18 mother-baby pairs in treatment from perinatal phase to 4 months of child's age. Pilot results demonstrated more sensitive maternal interaction tended to be associated with higher pre-and postnatal reflective functioning and better child developmental scores at 4 months of child's age. Reflective functioning (RF) refers to the essential human capacity to understand behavior in light of underlying mental states and intentions. An indicated conclusion is that enhancement of maternal reflective ability seems an important focus in developing the content and effectiveness of interventions for substance abusing mothers.

KEY WORDS: substance abuse, pregnancy, motherhood, early parenting intervention


Clinical and theoretical background

Substance-abusing pregnant and parenting women typically are a group characterized by cumulative psychosocial risk factors (Grella, Joshi, & Hser, 2000; Mayes & Truman, 2002; Pajulo, 2001; Suchman, Mayes, Conti, Slade, & Rounsaville, 2004). In addition to substance effects per se, all these factors have a cumulative negative effect on the well-being of the mother and the child and on the quality of their relationship. Quality of early care and postnatal caregiving environment combined with the neurophysiological vulnerability of the exposed child are considered most important for the prognosis of child development and psychosocial outcome in later years (Carmichael Olson, O'Connor, & Fitzgerald, 2001; Lester & Tronick, 1994; Mayes & Truman, 2002; Suchman, McMahon, Slade, & Luthar, 2005).

A substance abusing mother and her exposed child are difficult regulatory partners for each other: the exposed infant often has an impaired ability to regulate his states, and the mother usually has a reduced capacity to read the child's communicative signals (Beeghly & Tronick, 1994). This combination easily leads to viciously negative cycle that culminates in withdrawal from interaction and increased risk for child neglect and abuse (Kalland, 2001).

There is an ongoing debate in Finnish society about the rights of the pregnant women compared to the rights of her unborn child. One question regards the need for change in legislation to allow taking the substance abusing pregnant woman into institution-based treatment against her will, in order to protect the child. One severe problem, however, is that referral to treatment does not work even with those mothers who would enter the treatment voluntarily, and that there are far too few treatment places for mother-child couples together. Even more importantly, the content of the interventions, which should be specifically designed for parenting women together with their children, has not received enough attention. Objective research is strongly needed to be used in the process of developing the content of the treatment.

During the last 10 years, British psychoanalysts have increasingly drawn attention to the importance of the concept of reflective functioning in human development. We propose that this concept has a strong relevance in the situation of substance abusing parents. The term reflective functioning (RF) refers to the psychological processes underlying an individual's capacity to understand oneself and others in terms of mental states (feelings, beliefs, intentions and desires), and to reason about one's own and others' behavior in relation to these (Fonagy, Gergely, Jurist, & Target, 2002). In addition to being a metacognitive capacity, reflective functioning refers to the ability to hold, regulate, and experience emotions. …

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