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Psychiatry & Psychotherapy Podcast

Reflective Functioning: The Key to Attachment with Dr. Howard Steele

Psychiatry & Psychotherapy Podcast

David J Puder

Medicine, Science, Health & Fitness

4.81.4K Ratings

🗓️ 17 May 2024

⏱️ 95 minutes

🧾️ Download transcript

Summary

In this episode, we discuss "reflective function," which is a precursor to the concept of mentalization. Reflective function is best understood not as synonymous with mentalization, but as a scale from -1 to 9, based off certain adult attachment interview questions that measure the person's ability to describe their own and others' internal states, motivations, and articulate a nuanced and unique understanding of life from 0 to 12 years old. This scale was developed by attachment researchers at the University of London, including Dr. Howard Steele and Dr. Peter Fonagy.

By listening to this episode, you can earn 1.5 Psychiatry CME Credits.

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Transcript

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0:00.0

Welcome back to the podcast. I am joined today with Dr. Howard Steele. He is a full professor

0:19.7

in psychology at the department in the new school for social research in New York City.

0:27.2

He has written multiple books on attachment. He is the chief editor of a journal article

0:34.9

called Attachment and Human Development. He was co-author in the initial reflective

0:41.6

function manual with Fonegi and he is, I would say, he's the top voice on reflective

0:52.0

function. He teaches it every year. He teaches a course on reflective function and if you've

0:58.5

been listening to this podcast for a while, you know that I have been interested in mentalization

1:04.0

based therapy, which Fonegi and Bateman created. Interestingly, I found out recently that Fonegi

1:10.5

and Dr. Steele co-authored the reflective function manual. This manual is something I became

1:16.0

very interested in because there was an article that I got exposed to I found, which was really

1:22.4

looking at what separates the best therapists versus average therapists. In this article,

1:29.1

they split therapists into three groups. They looked at their outcomes with their patients through

1:33.6

the OQ45 point, which is one of the best ways of tracking session to session change in someone.

1:41.7

So they were following a bunch of therapists' patients and they split them into three groups

1:47.6

and they found that the therapists with the highest reflective function had the best outcomes.

1:54.8

And it was 70.5 percent of what made the best therapist the best therapist. This was kind of like

2:01.3

for me, you know, usually in research when we look at common factors, we see correlations of

2:07.1

point three. This is huge. This was a huge sort of like, oh wow, I got to look at this manual.

2:13.5

And Steele was one of the authors of the manual. And so we've been in conversation about

2:19.0

reflective function. And I thought, why not bring in the expert himself, who has written books

2:25.7

on this, who does courses on reflective function. So Dr. Steele, welcome to the podcast.

2:31.5

Thank you so much for being here today. So maybe just to kind of like

...

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