Music Alright, welcome back to the podcast. I am joined today with three residents. We will be discussing an amazing paper called Intergenerational Transmission of Attachment and Abused and Neglected Mother's, the role of trauma-specific reflective functioning. We have an R2, Caled Itani, we have an R3, Shariah Cherlo, and we have an R4, Fidel Shuman. Perfect pronunciation. Oh, three and a half. Better than that graduation. So this is exciting. We are doing this live. There's no video of this we're doing it live in Wooden Park, Florida and I'm excited to go through this paper with the off Yeah, same. Thank you for having us. I was just telling a Dr. Peter that you know when he first presented this article to me was it was kind of short in a way, but it's chock full of information, so much lore. It's really, really dense with a lot of, you know, other studies that are, you know, interwoven in this. And I think this kind of ties it all together very nicely. Yeah, we've talked about reflective function on this podcast. I had Dr. Steele on who was part of the manual. I had phonygion who's part of the manual. Reflective function is essentially the measurement of the adult attachment interview, in the adult attachment interview of the mentalization that's going on in the adult attachment interview. And then so this takes a step further and it looks at others. And I just want to give

that brief introduction. But I think the why is really important, like why it's worth spending

an hour and an hour and a half talking about this article. Do you guys have a why? Do you imagine

a why? Sharia? I definitely have a why. I think that it's really important to understand like

intergenerational trauma and like how it can lead into a child's life and how they function afterwards. Yeah. Yeah. For me, the big why for me is a lot of mothers or people in the community are afraid that the trauma will be passed on automatically, but a deeper understanding of this you know, this reflective function, higher reflective function, it doesn't have to be that way every single time. So it's worth exploring for sure. Yeah, and I don't think it's a hopeless message. If we know, if we can clearly say this is the problem, here's the solution. And then as a culture, as a society, I'm hoping the more and more people understand this, the more and more we can create policies to actually reverse and help. Go ahead, Caled. So for me, the mentalization process is really a love letter to our future generations because we're finding that we have the, we have like the therapeutic modes and we have

some unresolved traumas. And if we go out of our way to, you know, address those, resolve those, this will show in the future generation. And we're finding that in the infant, some of these attachment dysfunctions can develop very early on. Sometimes as early as like four months. And so if more people were aware of this, they would, you know, pay more attention to how critical this early period is. Absolutely. Yeah. Yeah, I was reading this stuff when my kids were born. And I remember reading the stillface experiment. And I was reading Edtronix book, which is a thick research book while I'm bouncing her at night. You know, for hours, because she had a call, I'm like, trying to understand

the stuff. And I think it made a huge difference. I think it made a huge difference. And it's not just mothers too. I think this study is specifically about mothers, but there are other studies about fathers. It's good to start with one study. I think there's a strong study. I think it was well done. So we're going to start with this one. But the impact on fathers and on infants is actually very important as well.

And we may have time to mention some of those things. Absolutely. So where do we want to begin? I think because it is a rather technical article, we can spend some time going into some of the very technical psychoanalytic terms that I think are foundational to kind of pursuing this text further. I think we should give an abstract before we get there. An abstract is in this is why it's important without any of the technical words if possible. Yeah. Yeah, yeah. Still down. So, and then let's get into the nitty gritty, because I feel like we're going to lose people if we jump into the fun stuff right away, which I actually had one listener reach out to me recently and they were like, actually when you say this is going to be really hard to understand, it actually inspires me to pay more attention, pull out a notebook. And so if this is hard for y'all, get the article, listen to this, try your best to understand it, then get the article, read it, and then maybe relisten to it, and you'll get it. Okay. So what's the abstract? I can talk about it in, I guess, simpler terms. So basically the study is about how our patterns and trauma can reflect onto our children and how the ways in which you interact with your children can affect their well-being in terms of, like, for example, how you react in a in a, how you think of your thoughts versus a child's thoughts when something goes wrong, for example. And something really important with this study is that it's never too late. Like, you can do this before you're pregnant, while you're pregnant, even after, and it still has lasting impact. Absolutely, yeah. And it's kind of the bounce of Shri's point as well. Something that this article kind of ends with. It's almost like a point of optimism and a big takeaway that you have mothers who experience trauma. That experiencing of trauma is important, but their ability to mentalize that trauma, that ability to kind of process that. That trauma is really what can make the big difference in their relationship with the infant later on So if anything I found this article in a sense rather hopeful and that it's kind of pointing to that very key fact Okay Appshract Yeah, I totally Agree with those points and it kind of mirrors like the attachment styles that were highlighted in the article such as like you know disorganized attachment styles and how that's built early on and how you can potentially avoid or negate some of those attachment styles from building as an infant and then later manifesting as an adult. If you have that mentalization, I guess, skill or understanding of your trauma. Right. Okay. So here's here's my attempt. Okay.

So if you have how to abuse and your high reflective function in the trauma itself. So if you were to talk about the trauma you're able to speak about it fluidly Detailed, without dissociating, without disavowed emotion. If you're able to do that, you have a very high likelihood that your child is going to have a secure attachment, an organized attachment, not a disorganized attachment stop. And disorganized attachment stop leads to future dissociation. As the simplest way. It's like a fear without solution. If on the other hand, you have abuse and you have a low reflective function when discussing the trauma, meaning low ability to mentalize what was going on, the emotions, maybe you dissociate during discussing it, that leads to a much higher likelihood of having future disorganized attachment child. And so that's my abstract. Okay, now let's go into the details on each of the terms. So definitely to understand this article and kind of articles in a similar family, we need to know about mentalization as a term and reflective functioning. And the two terms work hand in hand because reflective functioning really is a measure of mentalization. So most texts the way they tend to describe the mentalization is like the capacity to think about oneself and others. In this case, the infant as a psychological being in other words, more or less reflective of how you interact, how you perceive the emotion, how you can kind of anticipate, how you can kind of relate, how you can respond. And mentalization is correlated typically to better psychological outcomes because it's kind of related to, in a sense, how you process and how you kind of relate that back. Now, in the therapeutic practice from the literature that I was going through, there is a difference between mentalization and empathy. So, mentalization can help with empathy. And some authors even argue you need to mentalize, enable to empathize. I just thought that was a very interesting distinction that I came across. Yeah. Well, we'll put. So the ability to mentalize is to understand your own and the other person's desires, emotions, experiences, it's your ability to read a person accurately or accurately but with a little bit of hesitancy that you're not able to really read them, right? So we know that like when people with borderline personality sort of for example lose their ability to mentalize that go into psychic equivalence mode There's a fancy way of saying that their experience of the other person is reality Even if that other person is saying no, it's not reality, okay So, to be able to mentalize the other is to be able to understand the other as a separate person. And so there's a humility there that needs to be there. And then reflective function is, do you want to talk about reflective function now? I wanted to talk about like kind of the scale, like how it's determined what reflective function is in a way. So it's scored on a 11 point scale from negative one to nine. Negative one is negative reflective functioning, which would mean totally barren or rejection of mentalization. For example, if someone asked you a serious question, like, what was your parenting style, like when you were growing up, if someone just said, I didn't know, or they say, how would I know you're the psychologist? That would be a negative one. Right. It's the rejection of the question itself. So you have a why question, reflective function is really looking at the why questions. And then it's a rejection. I don't know. You tell me, you're the psychiatrist, you know, that kind of like grittiness or like, how dare you ask me? How dare you? It's not just not reflecting. It's like the negations. That's why they made it a negative one. Yeah. And then for me, I'm kind of like to bounce off that for reflective function relating to like a mother and a baby. I kind of want to look at examples of it. And if a baby's crying in front of you or like crying in front of the mother, a good person with a high reflective function could say, my baby's crying triggers my memories, but that's mine and not his, I can still comfort him. Someone with like a low reflective function could like see the crying and freeze and lash out and dissociate like you were saying, but also, you know, in that relationship with the infant inadvertently sometimes. Yeah, wow. Okay. I actually have an example that it's kind of scary. Yeah. We had these people over at our house. I'm pretty sure they're not listening. If they are, we love you guys.

Good people. But this was a scary moment, okay? So we're all around the jacuzzi and their kid falls in the jacuzzi and the mom is like one foot away. Seize the child fall in, freezes. My wife is like five feet away, sees this, goes over and grabs the child out of the pool from drowning, You know, and we like we were like, what the heck? And I was like, she dissociated. Yeah. And it was that fast. It was distress dissociation. So, you know, if you have a lot of unprocessed trauma and you dissociate very easily, you know, put a life vest on your child. take the extra precaution, but you know, this is kind of like the extreme version of it, right? But it's that. But think about like if they're talking about their adult attachment interview and they're talking about the trauma in the adult attachment interview, then they may not then they may dissociate during them talking about it. And so they're gonna get a lower score there because they're not able to reflect on their own experience and the other person's experience. They're out, they're out of it. Yeah. Okay, but keep going. I want you to go through the scores and what you want. So then nine would be exceptional reflective functioning. So unusually complex and elaborated reasoning

about mental states. So for example, if someone had asked during the adult attachment interview, did you ever feel rejected as a child? How would you think that someone would respond with a with a nine? Or the question would be, why did when you felt rejected as a child, Usually it's like during a specific story.

Why did your you felt rejected as a child during usually it's like during a specific story Why did your parents reject you because that's that's or I guess they could Enter into a deep level reflection without a demand question But the demand questions are really like the why questions and so So there are predictive questions and then there's demand questions So, the demand ones or the demand ones demand the person to reflect. Okay. And so, so, so Abraham Lincoln. Dave Dive here. Here we go. Going back in time. I don't think I mentioned this on the podcast before, but I give lectures on reflective function to some like Grand Rounds or whatnot. And this is part of it. So he wrote a letter to John Stewart. This was after I think his and died, who was like his partner. And he said, for not giving you a general summary of news, you must pardon me. It is not in my power to do so. I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on earth. Whether I shall ever be better, I cannot tell. I awfully forebode I shall not. to remain as I am is impossible. I must die or be better. It appears to me. The matter you speak of on my account, you may attend to, as you say, unless you shall hear of my condition forbidding it, I say this because I fear I shall be unable. Okay. So I give that a five. Negative one negative one to nine. Okay. Now I know a little bit about his life and so now I'm going to make it into a nine. Okay. This is my best. This is like, this is my best thing. Okay. I mean it's dark but he seems like he understands. You can feel it. It's visceral, right? Maybe it's more visceral than mine. Very curious for the nine. And's death has overwhelmed me, bringing to consciousness old feelings that I now recognize as anger. Anger I dared to admit as a boy when my father punished my scholarly ambitions instead turning the rage inward and reshaping it into persistent guilt and self-blame. Likewise now confronted with with my helplessness to save Anne, the anger returns, but again finds no outlet, no target but myself, transforming once more into deep and paralyzing melancholy for which I see no escape. It's like textbook perfect. Do you think so? Because, I mean, even like the phrase, like bringing into my consciousness

really speaks to that, you know, reflective process of occurring. So I think it's a higher score and I love, I love his own quote. I mean, I think viscerally his own quote grabs me. Yeah. But specifically, I think this is high reflective function because he's connecting the past to the the present, the impact of his father and the powerlessness there with the powerless currently. So the connectedness of those, the understanding of the internalization of anger into his depressive personality, he had a depressive personality style. So he kind of like the understanding of his psychodynamics, right? And then the the realization of why the anger is so hard to because the anger is usually you're moving towards a goal and there's an obstacle and then you get angry because you feel thwarted towards your goal. and then the anger helps you overcome the obstacle to move towards your goal. Okay. Tell me one example of anger that it's not that, and I would be very surprised. It's always that. Okay. In my mind, at this point, that could be a very low reflective function statement, by the way, kind of an, kind of an all or nothing. But in general, that's what I see. Should we score that at three? We could score that. If someone can prove me wrong,

then it would score lower, but right now it's a nine. And then that egocentric scoring of myself as a nine also brings me down lower though. So that hurts it. Okay. So what a two right now? I'm like digging myself a hole. No, you just went back up to a nine calling it ego centric in a way. But I recognize I'm doing this to humor you guys. So that actually raises my sense. There you go. Well, the humor is like the highest call in a faculty, right? No, because I'm- That's not gonna nine. Because I'm personally aware of your responses and then tailoring my response to that, which also increases your reflective function. Okay. You can see how you can play this game.

It's fun.

So in the RF manual, there's like different sorts of type.

Like basically this is an example of like how somebody would score. So like for example, like there's like self-serving RF, there's disavowl RF, there's like different things. So that exactly, like so if I say too many self-serving comments, You know, like, you know, people that always drop these like, I'm great, you know, great, I am.

That's actually a lower RF. So people with more narcissistic traits score in the threes More commonly. Yeah. Okay. BPD 2.7 eating disorders 2.7 inpatient around their prison across different prison studies like one To to low-t. So actually prison is lower, which kind of makes sense because they're moving instead of in words, they're moving in actions. Right. Yeah. Something was brought up in one of the articles we read that there was a lot of scores in the high risk population from one to two. And maybe there's there's need for a little bit more scoring more scoring like within those categories because there's so many different types of high risk population that you can't really score well. I'm yeah so explain that basically there there there's an article saying that there's like high risk populations for example like in the prison that everyone would get a one or a two how do you differentiate it so they needed to be a little bit more of like 1.5, 1.7,

like they don't need to be more to that,

to that scoring schedule, that they need to figure out.

Yeah, maybe I think if they're scoring in one or two range,

those are people that are pretty,

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