Music Alright, welcome back. I am joined today with Nicholas Bethelut and Julia Garan B. Sodnet. And we are going to be talking about some of their research. If you remember back to my prior episode where I discussed reflective function in mothers, and then they followed the mothers and looked at the children. The study showed that mothers with low reflective function, in specifically their trauma narratives had much higher rates of disorganized attachment, almost twice. And so this is gonna be a longer form discussion with the researchers who published that article, and we're gonna be going through trauma-based reflective function and some of the different narratives that come up. Now they score it. We're going to be talking about some of their other research as well. So welcome to the podcast. Thank you. Thank you, David. So let's see. Let's start with talking to me a little bit about the early research in this and then kind of like take me through the history of how you guys got into this and how it started. All right, you, thank you already introduced it quite well since this today you've been talking about where we documented trauma-specific reflective functioning was important for mother child attachment was the very first study on that concept of trauma specific mentalizing. So that's a work I've been doing at Investile Laval in Cabecarada with Professor Karen

and Sank in the course of my PhD dissertation, where we're working with a quite large sample of a praying at women who have experienced shallow milk treatment, so shallow abuse or on neglect. We were looking at their adaptation to Monde-Hoon, were they doing and how the relationship with their infant, eventually, be unfold. And we had access in the course of that research to narrative about their experiences with their attachment figures, so generally there are two parents. And we were coding attachment and reflective functioning. And one thing that we did notice when doing that work is that, surprisingly, several mothers were reflective quite, reflecting quite well, better than we thought at first, regarding their best experience of attachment relationships. But we did notice that when they were coming to discussing to of the Buse and the Black during that interview, their mentalizing skills kind of felt a part it was much more difficult for them to organize their tough or to reflect coherently on the impact of these experiments on their current functioning. So we can observe and decide that we should give, separate, scoring to that these specific parts of the interview on abuse and neglect, and we were doing for the other parts of the interview. And that's when we start de-flopping that idea that mentalizing trauma is not the same as

mentalizing in general attachment relationship.

Yeah, so you're scoring them and you're recognizing that in some parts of their narrative, they were scoring well, they were scoring high and other parts they were scoring lower. This is something that I recognized as well as I'm kind of investigating this in my patients and in myself actually I had my own AI done. And not all passages of your AI are the same, right? And so some people, specifically with trauma score lower. Julia, how did you get involved and tell me more about this study? Yeah, I started working with Nicolas in 2017 as a undergrad. And then we continued together through my PhD and now we still collaborate as I moved away from BLAB. But still, I'm not really far. And then I had a lot of interest in childhood maltreatment and in parenting, specifically the parent child relationship and really trying to understand the processes that are happening when people parent and the predictors of attachment security, for example. And got really fascinated when I started working with Nicholas about reflective functioning in general. And so my own dissertation focused on attachment-based reflective functioning in the adult attachment interview but really started working on this trauma specific reflective functioning as well. And just thinking about the ways that we measure reflective functioning in general. And so I think the manual, even funnogies manual,

really accounts for the fact that there might be drops in some areas.

And so the overall score is not just a mean, for example,

of scores in different questions, right?

So we have to think about the overall functioning and flavor.

But I think with this work, what we're trying to do, is really to better understand the low end of the scale, and especially in people who've experienced child maltreatment. I think it's going to be part of our time today that we're going to be talking about what these actual narratives look like, because I think that as clinicians, I'm mostly speaking to clinicians, we can start to notice in someone's narrative when they have lower RF in portions of the narrative. And it's something that I have found very helpful and kind of helps me zero into someone's story in a different way. So I'm kind of applying this primary literature that you guys are working on at clinicians, and I'm hoping that, you know, the clinicians who listen to this can kind of grow in this ability. You have this 2025 article called Characterizing the Headage Neity of disruptions in the resolution of trauma among women exposed to childhood maltreatment. You want to describe this study maybe in general and then we can get into the specifics on the different types of profiles that came through in the trauma narratives. Yeah, absolutely. If I introduce the ideas behind that study, the city is based on three very general observation. The first one is that we know trauma is quite frequent in general population. And our patients would represent at least one third to one half of our patients who have experienced severe abuse on it lecturing, dark childhood. And we know it's a very powerful determinant of mental health. And the second thing we know, as we already discussed, is that not only from our impact mental health, but it also has an intergenerational transmission. And knowing that, knowing that it's a powerful determinant of mental health, another idea, which is very important and led us to that study, is the idea of heterogeneity, this idea being that even though it's one of the most powerful risk indicators, so the thought being one of the most powerful risk indicators for later mental health problems, about a lot of people who have experienced severe abuse or an attack during a child are showing striking resilience and are doing quite well.

So something is happening during the developmental trajectory that are in the risk trajectory towards resilience or to rob depression or personal disorder or psychosis or something else. And we know very little about the developmental determinants that are in the risk trajectory towards one path or another. And the hypothesis we made is that how people have psychologically processed or resolved their traumatic experiences during the development is a core determinant of later functioning. And that's why we try to observe in a large sample of 800-parent women we were working with, all of whom have experienced some type of abuse on the lecturing their childhood, whether we could observe different profiles in the way they were thinking about their traumatic experiences and thinking about the impact of these traumatic experiences. So to do so, we use a questionnaire with the VLOPS, and as you already said, I think the very best way to capture trauma-mentalizing as a therapist or as a researcher is only to pay attention to what people are saying about their experiences, to be curious about that, to listen carefully, and generally we get a good idea whether they are reflective or not. But in research, it's not always possible to do so at least with varied our sample, such as ours. So we develop a self-report measure to capture different types of impairments and effective functioning. So that instrument is called the failure to mentalize trauma questionnaire. It's really available in English and multiple languages. And we administered that questionnaire and were able to identify different, five different profiles, five different ways people were reflecting or not about their experiments of troubled trauma. You want to do that something, Julia? No, I think that's a good introduction. And you guys also, because in this article, you have some narratives that you pull out. And so how do you, how many people did you do more of a narrative, you know, qualitative portion of the interview? Well, I, I, I couldn't, I don't know Nicholas if you had the number in my, I couldn't tell you the exact number in this specific sample that the paper we're talking about. Include, but we have about, I would say probably 250 across like different studies of, they're called trauma meaning making interviews, which we typically will use to code trauma reflective, trauma specific reflective functioning. And we've pulled from those, from participants in the paper who were, who had completed interviews to really try to illustrate what that might look like in a conversation or in an interview. Okay, okay, see. So some of the profiles are like profile one. I identified with the perpetrator. So describe this one for me. Yeah, this group of people that we identified that we're expressing two specific types of destruction and mentalizing trauma. One being justification of trauma, they were explaining that trauma was kind of a good way to behave. The ad views was deserved, for instance. And they were identified with the perpetrator as well, in meaning that it seems like the emerge out of a multi-dying relationship by defensively identifying with hostile attachment figures, probably in an attempt to cope with the fear of a vulc by trauma. So, kind of people who now are probably arson their relationship with others, may put themselves in try to be in control in their relationship with others and by doing so the the are less afraid of being abused or neglect again being the one in control. So that that's one group with the observed one type of profile with the observed in that study. Okay. Yeah. So this is either they're justifying trauma, they're identifying the perpetrator, and then you have some great example comments like, and I think this is kind of helpful to talk through. This is the kind of thing that we would hear actually in therapy sessions too, right? So like, one of the questions does that experience affect you now that you are older? So that maybe you're asking the person this, does this experience the trauma affect you in your older? No, no. No, but if I see him in the street, I won't hesitate to spit on him. When I was younger, I used to hide from him. Now I'm old enough. If I see him on the street, I'll spit on him or run him over with my car. So talk to me, why is that identifying with the perpetrator? Probably people hearing us already have ideas above that since I think it's quite clear in that example that there's a lot of anger anger toward the the perpetrator which which is something you can absolutely understand I mean people have been experiencing quite severe abuse or netlac may still have conflicting thoughts ideas and negative emotion regarding people who commit these experiences.

The first thing which makes it clear

that it's not reflective functioning

is that when we ask that person,

if she think that the experience effect

or now that she's older, she says no.

I've said yes, I think it makes me so very angry about these experiences. We would have seen it completely differently, but she says no, it doesn't affect me at all. But if I see him, I will run over him with my car. So we see two different parts here that cannot relate with one another are very conflicting and that make it clear that it's not reflective functioning. The type of

disruption we observe here is totally in the form of undergoing anger toward that person and

feeling justified to revenge. Yeah, it's, I thought about this in terms of like the stages of grief, right? Where if they're caught in the state of anger, right? Still wanting to spit on the person, run them over the car. It's like they're moving from putting to words, how it impacted them to action, right? So it's like, it's a denial that it impacts them, but it's still, they would still act upon the emotion that's underneath that isn't completely processed. Yeah, yeah, absolutely. And what is concerning, when we observe that type of situation, if we let it go and don't do nothing about that, is that we know that this specific profile, so people having such responses, highly correlates with specific types of symptoms and difficulties in their own life, including here externalised behaviours, including intimate partner violence, perpetration. So it's not only about the narrative when they think about trauma, it's something that unfold in their own life and their current relationship as well. So because the reflective function is low, they're moving to action, they're moving to violence when they're having emotions, right? Okay, let me read a couple more of these narratives here. I tell my kids, Mommy is going to get mad and she can give big slaps, big slaps on the butt. But if it's on the butt or the fingers, it doesn't hurt. It's not that strong. So, you know, she cries, but she cries just because she feels something else, not because, you know, she really is not used to it. Maybe that one, I don't know. Does that make sense? Did I read that okay? Yeah, yeah, absolutely. It's confusing to me. I mean, there's something about the confusing nature, which is a little bit. So tell me what this means or what the cons, maybe how this makes sense to Julia. Oh, I think the context is, the question is about how, if my influence, how the participant, then parents, her kids. So I think that context might be helpful here in understanding this specific citation, right? And so kind of thinking, talking about repetition of Todd maltreatment behaviors, right? So it's her kids now. And so a different way of seeing perhaps this identification with being a perpetrator or really this active cycle even in this case here, which is why I think we had used it as an example of this profile as well. Not fully organized, which I think we see a lot in lower reflective functioning narratives

as well, which is why maybe it leaves you David with a bit of a confusion there.

Yeah.

Yeah, it was like, I'm like, am I reading this correctly?

But there's a little bit of that confusion there, right?

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