Trauma-Specific Reflective Functioning (T-RF): 5 Trauma Mentalization Profiles & Impact on Parenting

In this episode, Dr. David Puder explores Trauma-Specific Reflective Functioning (T-RF) with researchers Dr. Nicholas Berthelot and Dr. Julia Garron-Bissonnette. Discover how childhood trauma affects mentalization and learn about the five distinct trauma mentalization profiles identified in mothers with histories of maltreatment: identification with the perpetrator, functionally grandiose, absorbed in trauma, global failures in mentalization, and those with no major failures who show remarkable resilience. The conversation examines how these different ways of processing trauma significantly impact parenting, attachment security, and the intergenerational transmission of trauma. By listening to this episode, you can earn 1.25 Psychiatry CME Credits. https://www.psychiatrypodcast.com/cme-program Link to blog https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-268-trauma-specific-reflective-functioning-t-rf-5-trauma-mentalization-profiles-amp-impact-on-parenting Link to YouTube video https://youtu.be/cMKU5Ycub7I

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:13David Puder?

  All right, welcome back. I am joined today with Nicolas Bethelou and Julia Garron-Bissoudnet. 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,

• 0:44David Puder?

  and specifically their trauma narratives, had much higher rates of disorganized attachment, almost twice. And so this is going to be a longer form discussion with the researchers who published that article. And we're going to be going through trauma-based reflective function, and some of the different narratives that come up, how they score it. We're going to be talking about some of their other research as well. So, welcome to the podcast.

• 1:14Speaker 01

  Thank you.

• 1:15Speaker 02

  Thank you, David.

• 1:18David Puder?

  So, let's see, let's start with, talk 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.

• 1:36Speaker 02

  All right, I think you already introduced it quite well. Since the study you've been talking about where we documented that 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 Université Laval in Quebec, Canada, with Professor Carolyn Sank in the course of my PhD dissertation, where we were working with quite large sample of pregnant women who have experienced childhood malt treatment, or childhood abuse on a direct. We were looking at their adaptation to motherhood.

• 2:21Speaker 02

  How were they doing? And how the relationship with their infant eventually unfold? And we had access in the course of that research to a 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 reflecting quite well, better than we thought at first regarding their past experience of attachment relationships.

• 3:00Speaker 02

  But we did notice that when they were coming to discussing childhood abuse and neglect during that interview, their mentalizing skills kind of felt apart. It was much more difficult for them to organize their tough or to reflect currently on the impact of these experiences on their current functioning. So we kind of observed and decided that we should give separate scoring to these specific parts of the interview on abuse and neglect than we were doing for the other parts of the interview.

• 3:38Speaker 02

  And that's when we started developing that idea that mentalizing trauma is not the same as mentalizing in general attachment relationships.

• 3:49David Puder?

  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.

• 4:21David Puder?

  Julia, how did you get involved? And tell me more about this study.

• 4:26Speaker 01

  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 the lab. But still I'm not really far. And then I had a lot of interest in childhood maltreatment and parenting, and 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 Nicolas about reflective functioning in general. And so my own dissertation focused on attachment-based reflective functioning

• 5:10Speaker 01

  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 Fonagy's manual, really accounts for the fact that there might be drops in some areas. And so the overall score is not, is not just a mean, for example, of scores in different questions, right? So we have to think about the whole, the overall functioning and flavor. But I, 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.

• 5:55David Puder?

  I think, 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 I, 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, I'm kind of applying this primary literature that you guys are working on to clinicians. And I'm hoping that, you know, The clinicians who listen to this can kind of grow in this ability.

• 6:39David Puder?

  You have this 2025 article called "Characterizing the Heterogeneity 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.

• 7:06Speaker 02

  Yeah, absolutely. If I introduce the ideas behind that study, that study is based on three very general observations. The first one is that we know trauma is quite frequent in the in general population and in our patients, it present at least one third to one half of our patients who have experienced severe abuse or neglect during their childhood. And we know it's a very powerful determinant of of mental health. The second thing we know, as we already discussed, is that not only trauma impacts mental health, but it also has an intergenerational transmission.

• 7:51Speaker 02

  And knowing that, knowing that it's a powerful determinant of 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, childhood trauma being one of the most powerful risk indicators for later mental health problem, about half of people who have experienced severe abuse or neglect during their childhood are showing striking resilience and are doing quite well. So something is happening during the developmental trajectory that are in the risk trajectory

• 8:31Speaker 02

  toward resilience or to raw depression or personality disorder or psychosis or something else. And we know very little about the developmental determinants that are in the risk trajectory toward one path or another. And the hypothesis we made is that our

• 8:50Speaker 02

  People have psychologically processed or resolved their traumatic experiences during development is a core determinant of later functioning. And that's why we tried to observe in a large sample of 800 pregnant women we were working with, all of whom having experienced some type of abuse on their leg during 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 we develop since, as you already said, I think the very best way to capture trauma mentalizing

• 9:34Speaker 02

  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 a very large sample such as ours. So we develop a self-report measure to kind of capture different types of impairments in reflective functioning. So that instrument is called the Failure to Mentalize Trauma Questionnaire. It's freely available in English and multiple languages. And we administered that questionnaire and were able to identify

• 10:18Speaker 02

  five different profiles, five different ways people were reflecting or not about their experience of childhood trauma. You want to add something, Julia?

• 10:30Speaker 01

  No, I think that's a good introduction.

• 10:33David Puder?

  But 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?

• 10:46David Puder?

  A qualitative portion of the interview.

• 10:49Speaker 01

  Well, I I I couldn't, I don't know Nicholas, if you have the number in mind. I couldn't tell you the exact number in this specific sample that the paper we're talking about.

• 10:59David Puder?

  Okay.

• 11:00Speaker 01

  Include, but we have about, I would say probably two hundred and fifty across the different studies of, they're called trauma, trauma meaning making interviews, which we typically will use to code trauma reflective, trauma specific reflective functioning. And we 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.

• 11:31David Puder?

  Okay, okay, I see. The, so some of the profiles are like, um, profile one, I identified with the perpetrator. So describe, describe this one for me.

• 11:45Speaker 02

  Yeah, this, uh, uh, group of people that we identified that were expressing two specific types of disruption in mentalizing trauma. One being justification of trauma, they were explaining that trauma was kind of a a good way to, to behave, the abuse was deserved, for instance. And they were identified with the perpetrator as well in, meaning that, um, the, seems like they emerged out of a malt treating relationship by defensively identifying with hostile attachment figures, probably in an attempt to cope with the fear involved by trauma.

• 12:28Speaker 02

  So kind of people who, um, now are probably, um,

• 12:36Speaker 02

  arshing their relationship with others, uh, may put themselves in, try to be in control in their relationship with, with others and by doing so, they, they are less afraid of being abused or, or neglect again, being the one in, in control. So that, that's one group we did observe, one type of profile we did observe in that study.

• 13:01David Puder?

  Okay, yeah, so this is either they're justifying trauma, they're identifying with the perpetrator. And then you have some great example comments like of, and I think this is kind of helpful to talk, 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, does this experience, the trauma affect you when you're 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.

• 13:46David Puder?

  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?

• 14:00Speaker 02

  Probably all the 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 perpetrator, which, which is something you can absolutely understand. I mean, people have been experiencing quite severe abuse or are in a lack, may still have conflicting thoughts, ideas and negative emotion regarding people committed these experiences. What the first thing which make it clear that it's not reflective functioning is that when we ask that person, if she think that the experience affect her now that she's older, she, she says no.

• 14:44Speaker 02

  If, if 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 in 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.

• 15:24David Puder?

  Yeah, it's um, I've 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.

• 15:57Speaker 02

  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 that we know that this specific profile, so people having such responses, highly correlates with the specific types of symptoms and difficulties in their own life, including here externalized behaviors, 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.

• 16:36David Puder?

  So that because the reflective function is low, they're moving to action, they're moving to violence when they're having emotions, right? Okay, let's, let me read a couple more of these, 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.

• 17:19David Puder?

  Maybe that one, I don't know. Does that make sense? Did I read that okay?

• 17:23Speaker 02

  Yeah, yeah, absolutely.

• 17:25David Puder?

  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 con, maybe how this makes sense to you, Julia.

• 17:37Speaker 01

  I think the context is, the question is about how it might influence how the participant then parents her kids. So I think that context might be helpful here in understanding this, this specific citation, right? And so kind of thinking, talking about repetition of child maltreatment behaviors, right? So are his her kids now. And so a different way of seeing perhaps this identification with being a perpetrator or really this active cycle even if in this case here, which is why I think we had used it as an example of this, of this profile as well.

• 18:20Speaker 01

  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.

• 18:32David Puder?

  Yeah, it was like, I'm like, am I reading this correctly? But there's a little bit of that confusion there, right? Yeah, I'll read another one. "I gave my father a punch. Ta-ka! I gave him a black eye."

• 18:44David Puder?

  There's laughter, a little signal there. That was one hell of a show.

• 18:49David Puder?

  And so it's kind of like this rejoicing of the violence.

• 18:56Speaker 01

  It's excitement flavor, right? Yeah.

• 18:59Speaker 02

  Yeah. So that's another good example. So that identification with the perpetrator may take different forms, different colors. And the previous example we just saw was a clear repetition of the abuse. The mother was saying, "I hit my daughter," but she's crying not because it hurts. She's crying because she's not used to it. So that's what we see as unconscious repetition. But in that current example, it's clearly excitement when talking about.

• 19:28Speaker 02

  Difficult life experiences. So the person is laughing, saying that was one hell of a show, discussing an argument with her father where she hit him. So again, the problematic aspect here is not that she has experienced that type of situation or that she's angry at her father. It's that she's talking about that in a way which makes it funny experiences and she's excited to tell us about that and wants to tell us more. So that's the main point there.

• 20:02David Puder?

  Hmm. Interesting. Okay, I'll read another. I pity the next guy who tells me my lunch is not ready. Sit down. I will give you your lunch. I'll fill his lunchbox directly in his mouth, you know? And then there's laughter. I am not your slave. No, it doesn't work that way. I like talking about that. I find it fun. It lets off the steam. So there's, so describe what's going on in this story here, something about.

• 20:40Speaker 02

  Uh, it's probably a situation that she was expressing, explaining an argument she had with her partner. And probably her partner said that his lunch was not ready and she gets very mad and she expressed it that way, that the next time she will fill his lunchbox directly in his mouth and she's laughing and she tells us, I like talking about that. So that's another good example, I think, that most people will discuss that type of situation, that type of argument with ambivalent feelings. They would not be excited talking about that. They would be shy about these experiences.

• 21:25Speaker 02

  They, they wouldn't certainly not be comfortable. But, but she's in totally opposite direction. She's particularly comfortable talking about such experiences, being violent or expressing violent fantasy regarding her partner, which, which is the thing that makes it particularly concerning here.

• 21:48David Puder?

  Okay, yeah, there's a little bit of almost like sadism in the enjoyment of the kind of the hurting of the others in this type of persona. Also, I'm thinking like this sounds some the defenses seem a little bit more like grandiose or, you know, like a little bit narcissistic flavor, a little, you know, psychopathic, like the power, wanting power, wanting control, that kind of like identified with the perpetrator, ending up with this kind of spectrum of thought process.

• 22:26Speaker 02

  Yeah, totally. And I want to underline here that that these narrative, these examples we're talking about, these are real examples that that came from participants we met in our studies, which were not people recruited because they had severe mental health problems. These were people that were recruited only because they were expecting a child. So these are women from the community. But we see from these examples that when we ask about their child trauma, when we ask about these experiences, we have access to something particular. And in clinical practice, it tells us that it will be very important at one point in

• 23:09Speaker 02

  the process to to pay attention to these experiences, pay attention to how the people talk, mentalize, reflect, feel when she's talking about difficult life experiences, since we may observe distinct processes that we do not observe when she's talking or he's talking about other types of experiences.

• 23:30David Puder?

  Okay, let's let's go on to profile two, functionally grandiose. There's some grandiosity. They develop this this kind of representation of themselves that is invulnerable to the effects of the trauma, or having the strength to move on.

• 23:53David Puder?

  There's an avoiding of discussing painful emotions. Tell me about this, this type.

• 23:58Speaker 02

  Yeah, these are many people who say trauma doesn't impact me at all. It does no effect. I was strong enough to suffer that without any impact. It may be true in some instance, but they are characterized by that representation that it had no effect, no impacts over time. And because they were strong enough to undergo it without any types of difficulty. And that profile is especially intriguing since they are distancing from, definitely from trauma, from their emotions.

• 24:41Speaker 02

  And it reflects when we look at their mental health or their symptoms through the absence of symptoms as well. So they seem like being, in fact, resilient as they do not express any post-traumatic stress disorder, nor depression, anxiety, which fits with the fact that they are emotionally distant as well from their experiences. So we still have to understand more about that part of our subgroup, follow them over time and to see what happens when the child is there. For instance, since they are all parents, so we'll be particularly interested in looking at their parent-child relationship.

• 25:27Speaker 02

  So because they will be with a child, which of course will express vulnerability. And they are definitely a group of people who are not comfortable with vulnerability. So we'll be personally interested to see what happens when they are confronted with the child who's crying, expressing distress, that type of thing.

• 25:51David Puder?

  Let me go through some of the, kind of the narratives here to kind of make this a little bit more real. So this person said, I remember talking about it with my sister. I used to tell her, I know that if it were you.

• 26:11David Puder?

  You would have never been able to make it through. Me, I'm capable of confronting every situation, even the most painful ones, in a positive way, not a negative way. So it's kind of like there was some abuse and then this person is talking to their sister and they're saying, if it was you, you would have crumbled. Me, I can confront anything. I can move through it. I can push, I could, I could bear this. Yeah. Julia, what do you think when you hear this?

• 26:46Speaker 01

  Well, I think, I was thinking about what Nicholas said a bit earlier about how it might be that they're, they, they are doing well and that they, you know, are in a resilient trajectory. And, but I think with examples like these, we really see that this is not really a reflective process, right? That the participant is showing us they're not really walking us through, perhaps, how they develop that resilience and how they were, they were able to face those experiences. And so I think that's what's lacking here when we're looking at something like reflective functioning, right?

• 27:26Speaker 01

  And I think the vignettes are really helpful for, for kind of illustrating that piece.

• 27:32David Puder?

  Yep. It's like they, there's that jump to resilience without the ability to mentalize the process, right? Because it's very different if someone was like, you know, yeah, when it happened, I was at first very numb and disconnected from it and think about it. And then I, I went through a phase where I was angry now. And then, you know, I was really sad that it happened and it felt, you know, like I had to really rectify my understanding of my father and why he would do that. And then subsequently, you know, I've been able to kind of move past it where it doesn't bother me as much. I don't think about it as much. I have compassion for the, myself as a child, having gone through this.

• 28:18David Puder?

  So they're they're showing kind of the the mentalizing journey?

• 28:22Speaker 01

  Exactly. Yes. And you understand how this adaptation came about. So it doesn't have that grandiosity aspect to it.

• 28:32Speaker 02

  Hmm. Absolutely. I think your example is quite quite great, David. And there are some people who are not able to express that in such nice words, but at least will say, I'm surprised that I made it through and that I'm doing well today. And so so they will express a kind of curiosity about the process and they will understand that developing well in the context of our childhood is is kind of surprising. There's there's something that happened that the help them make make it true. But as you said, I think it was the right words. There's a jump from the treatment to the resilience without an understanding of of the process.

• 29:14David Puder?

  And I think as as therapists, what I would say is that it it may be that if someone is a little bit more grandiose in the the in the jump, right? We may think to ourselves like, oh, we don't really need to talk to them about this, or this trauma's resolved in their brain, but it's it might not be resolved. I have this one set of brothers that I know really well. One could tell you about the trauma, could tell you how it impacted them. The other one doesn't even remember. They're like, I don't I don't remember that happening. And but but I'm it's that's in the past. You don't need to even think about

• 29:56David Puder?

  the past. The past isn't even important to think about. But they both went through the trauma, right? They both went through the same thing. Let me read the second one here. I put a cross on that. There are other things in my life that I think you have to go on not live in the past. When you go through such experiences, you have to be able to say, OK, that's enough, and put the cross on that. Yeah, Julia, what do you what do you hear when you hear this?

• 30:28Speaker 01

  I think this is kind of an active rejection, right? And thinking about those experiences. And so a little bit of a different illustration than the one we just looked at for this, for this specific profile. But I think still this idea of not really going into the vulnerability or going into affects or thoughts or feelings that might arise when they think about experiences.

• 31:00Speaker 02

  Hmm. Absolutely. That's a good example of kind of overinvestment in cognitive reasoning. And it's not a good understanding of the human mind. That the day you decide that it's enough, it's enough and you won't think about that anymore. It won't affect you anymore. It doesn't work that way. And but she kind of expressed that people have to have that ability. And she implies that she has that strong ability to just decide to let things go. And from that moment, it doesn't impact her anymore.

• 31:34David Puder?

  It's a super, in my mind, it's like a superficial spirituality too, right? There's a difference between someone who's really done the work. There's maybe some spiritual aspects that have helped them through work. This is more of like a, like a hypomanic defense of sorts with, that's combined with spirituality, where it's like, you just put a cross on it. That's good. That's all you need to do. You know, no need to feel anything. You can move on from it.

• 32:06David Puder?

  Okay, so that's number two, functional grandiose. Number three is absorbed in trauma.

• 32:14David Puder?

  Tell me about this one.

• 32:17Speaker 02

  Yeah, that particular subgroup presents several of the impairments in mentalizing trauma. We assess through the questionnaires, one being identification with the victim, the other one being disorganization of thought, the other one being absorption in trauma and avoidance. So it's a subgroup of people who have a tendency to take responsibility for the trauma or to consider the abusive behaviors as being deserved. When they think about these experiences, they have very important problems in reasoning

• 33:00Speaker 02

  that take the form of depersonalization or even destructive behaviors when they are connected with trauma-related emotions. So their discord and narrative becomes very confused, very disorganized. There's a clear interference of memories of trauma with the monitoring of thought and behaviors. So they may become dysregulated, highly dysregulated. They may have the urge to, for instance, cut themselves when they think about the trauma. And they have very negative thoughts and emotions when they are discussing these experiences.

• 33:43Speaker 02

  So the types of difficulties we see here are highly fit with the diagnostic criteria for a post-traumatic stress disorder. So it really relates to people. When they think about trauma, they get absorbed in these experiences.

• 34:03David Puder?

  Julia, anything you would add to it before we maybe read some of these comments?

• 34:08Speaker 01

  Really, I think this is a good description. I think it's a little bit. If we think about the scales of the questionnaire, so the questionnaire includes seven scale. And so this profile shows a little more impairments across different scales than the two we just looked at, which were a little bit more specific in terms of one or two types of impairments. So this one might be a little bit more global. We have one that's even more global, the last profile. I'm sure we'll get to it. But this one includes a little bit more of these disruptions.

• 34:41David Puder?

  When I heard, so the first one, I was thinking like, there's a little bit of that almost like sadism with the second one, I'm thinking more of like the narcissism or narcissistic defenses, you know narcissistic personality style. With this third one, I'm thinking more depressive personality style, dependent personality style, you know, they blame themselves for the trauma when they are, or dissociative personality style. And so maybe I'll read one of these, you know, when he took his belt, and then there's like a 10 second pause, and folded it in two and made noise with, another six second

• 35:24David Puder?

  pause, scared, another four second pause, it scared us.

• 35:31David Puder?

  But he never hit us with it. It was scary as hell. And then, you want a reason to cry? And he takes his belts and he comes to me and, oh, we cried even more. It was, it scared us. He was really strict.

• 35:51David Puder?

  So, yeah, when you hear this, I'm, I'm hearing the pauses, you know, is, is there dissociation in that? Almost like the telling of it, it's like so distressing, there's a little bit of that dissociation. Sometimes I'll hear pauses in people's stories when they're, when they're going through something like that. There's a lot of fear. Maybe, so what are your thoughts on this one?

• 36:14Speaker 02

  Yeah, I think your, your comments were right on it. These are probably good examples of illustrations of dissociative processes. So probably the, just thinking about trauma was, was highly painful. And this obsessive process interferes with, with the way she, she talked about these experiences. So as you said, she has difficulty organizing her past. She's still quite afraid and we can see it when, when hearing or reading through the narrative. There's a long pause, she's switching from past to present. At one point, she, she's talking in the father's word when she was experiencing the trauma.

• 36:59Speaker 02

  So that, that's a good example of, of that probably.

• 37:04Speaker 02

  Still highly vivid traumatic representation that that comes with dissociative defenses.

• 37:11David Puder?

  Mm hmm. I don't see this person blaming themself for the trauma or for what happened there.

• 37:19Speaker 02

  No, no, this this profile are possibly vulnerable to blaming themselves for our experiences, but you're you're right. We do not see it in that narrative.

• 37:32David Puder?

  Not in this narrative, yeah. And then the other thing I would say is like, it's when I hear a narrative like this, I often think to myself, well, there's more there. That's not being said yet, you know, like this could be, sometimes there's more of a surfacing narrative of, you know, there's no actual hitting in this narrative, for example. So but there's dissociation. There's the fear as if there was going to be hitting. That, okay, so that's one of them. Here's the other one. Talking about verbal abusive stepfather. Okay, so that's the context. I started my period when I was like 10 and I had quite important, important mood swings.

• 38:15David Puder?

  I was like around fourth grade and then he really didn't know how to deal with me. He really did his best, but I was so difficult.

• 38:27Speaker 02

  So probably then you see the the tendency to feel that they are to blame for the trauma. That we were not seeing in the previous example, but it's more clearly here.

• 38:42David Puder?

  Right. So there's a little bit of like the blaming, yeah, he was doing his best. There's a little bit of that idealization of him, devaluation of the herself, you know, I was the one with mood swings. I was difficult to deal with. I was so difficult. This is around, this is in the context of maybe before this passage, there was some discussion of his verbal abusive words or something. Okay. Yeah.

• 39:12Speaker 01

  Yes.

• 39:14David Puder?

  Yeah.

• 39:14Speaker 02

  And it's being disconnected from the developmental experience of what it is to be a ten years old girl having her a period. I mean, eh, it's, it's a complex experience and, and when the response you have is verbal abuse, at least we, we, we would have expect not, that her to say that, uh, she was the one being difficult and that she deserved that her father or stepfather treating her this way, uh, and, and being more grown in the complex experiences that she had at the time and how she would have expect that the caring parent would have responded.

• 39:55David Puder?

  Yep.

• 39:57David Puder?

  Yeah, it's like, uh, sometimes I'll hear someone tell something traumatic that happened to them and then subsequently they're trying to make less of the badness of the person that caused the trauma to them, right? And it's really hard as a kid, having a parent that you don't idealize, right? That you don't look up to. So maybe it was like psychologically easier or maybe psychologically more beneficial in the relationship to take the blame, even if the other parent was to blame, right? Let's say the stepfather was to blame, he was, he was a jerk, he was an asshole, but if she had that narrative of him, life would be so much worse.

• 40:42David Puder?

  And so this person

• 40:43Speaker 02

  Mm hmm.

• 40:45David Puder?

  figures out ways psychologically to make herself bad and make him good continually, uh, cause that makes the less, that makes less trauma coming towards her. Uh, but it's not a high reflective function position because she hasn't been able to, as an adult now. Kind of see how that was adaptive for her growing up to idealize him. And how it was adaptive for her to go bad on herself. Now, it's not adaptive, it's maladaptive, but it was historically adaptive.

• 41:25Speaker 02

  Yeah, you're totally right. And I think that what you raise here is important, that probably we would have the different expectations if we were to assess trauma-specific reflective functioning with children or adolescents that are still living with their parents. Then when we're evaluating reflective functioning with adults who aren't that dependent anymore of their parents for survival. So of course, I totally agree with you that when you're a child in that particular situation, kind of shutting down, mentalizing, or taking responsibility on yourself is important for survival. You don't want to have a representation of your parents as being dangerous.

• 42:10Speaker 02

  Otherwise, you will feel constantly under threat. But once you emerge out of that relationship, you're an adult, and it's your turn to become a parent. If you are still kept in that representation of yourself as being the one to blame, as your parents as having done the best they can in that situation, that may be problematic. And that's when we see that intergenerational cycles of trauma, that if she still had that representation, probably she will repeat it the same way.

• 42:47David Puder?

  And I think that what's interesting is that you guys found that it's specifically with trauma reflective function, right? And it's because I think also when the, it's these heightened moments that lead to the mismentalization sometime. It's like that, a lot of times, parents can be completely, you know, normal, you wouldn't be able to see the dysfunction, but then when a big stressor happens, it's like then they may regress into kind of earlier reflective function gaps.

• 43:27Speaker 02

  Yeah, absolutely. If I can open the parentheses here. And we did document that through our research that when we evaluate different types of affective functioning, so attachment-based affective functioning, parental affective functioning, and trauma-specific affective functioning, we see that these different types of IRF are correlated, but not that much. They are not assessing the same construct exactly. They are at some point independent from one another. And our data are especially surprising since they suggest that it's trauma-specific affective functioning that most strongly predict parenting

• 44:11Speaker 02

  and the parent-child relationship, even more so than parental affective functioning and attachment-based affective functioning. So it seems that how people mentalize in these emotionally hot moment when their past trauma come to mind seems that it's especially predictive of how they will behave as parent in emotionally hot moment as well.

• 44:37David Puder?

  Okay, so that's the third profile. Maybe we'll jump to the, well, let's jump to the fifth one and then we'll go back to the fourth one. So this is global failures and mentalization of trauma. And so you're seeing a lot of the different things all at once. Is that correct? You're seeing identification with the victim, identification with the perpetrator, disorganization of thoughts, grandiosity, avoidance, absorption, and trauma, justification of trauma. Tell me about this one. Julia, do you want to try?

• 45:15Speaker 01

  I can. And so our questionnaire has, just for context, seven scales. And we see all seven scales here in this profile. So all seven disruptions that can be assessed using our questionnaires are being represented in this profile.

• 45:33Speaker 01

  And this profile includes, can include a mix of all the things that we've just looked at, basically. And so maybe some grandiosity, maybe some lapses and some absorption, maybe some disorganized narratives too. So lacking coherence and not really walking us through thoughts and feelings and emotions. Contradictions, we can see contradictions as well in either one specific answer or throughout the interview, right? Things that don't really add up. And

• 46:11David Puder?

  Talk about the contradiction, because I think that's a very, that's a very important thing for us as clinicians to catch. We haven't mentioned that one yet.

• 46:20Speaker 01

  Yeah, I don't think we have an example about that. But we do see those, and even in adult attachment interviews, we can see those as well, where people, for example, will at some point kind of deny implications of trauma, right? Say that it doesn't impact them at all. But there might be lapses here and there where, oh, but maybe it does in the end. And so I think that's where interviews are really helpful to catch those brief moments that might not even be fully conscious. Yeah. I don't know, Nik, if you want to add something to that.

• 46:55Speaker 02

  I totally agree. I think that that group is different from the others, since we see much more severe mentalizing impairments. And most of the time, it shows through narrative that we cannot make sense of. So it's almost psychotic way of thinking about trauma. There are elements that do not fit together. So contrary to the other subgroups we've been discussing, seems like these participants don't have a consistent and current strategy to deal with with past trauma. And it shows through very disorganized narratives most of the time.

• 47:38David Puder?

  Yeah, so let me, uh, let me read one of these to kind of bring it to life. So he did not, he did not hit. It never went physical. Okay, so that's the first statement. And then, so there's five minutes of interview and going on. And then the person says, it happened once that he hit me. It was with a belt and it was quite bad. I had to go to the doctor. And then later in the interview, the person once again says, other moments were when he came home drunk. Really, my dad was not a violent person. And so you could see some inconsistencies in that narrative. Part of me wonders of, um,

• 48:23David Puder?

  sometimes what I'll see is when the person is new to me, their shame might be so high or they might be dissociated away from memories. And then as, as the, uh, the connection increases, as the shame decreases, they might have a better ability to remember things. But I think that, that what you're seeing in this narrative is that there's an inconsistency. Like, oh, it happened once that he hit me. But then late, even later in the interview, it's, oh, really? There are other moments when he came home drunk, you know? So there's like more, more there. And there's this kind of like

• 49:07David Puder?

  lack of memory, lack of consistency in the narrative.

• 49:12Speaker 02

  Uh huh, yeah. I, I understand what you said, David. I think the example you've been, uh, giving that when we see someone for the first time and there's not that alliance, uh, so far that, that, uh, person don't feel secure enough. There was, person may be, uh, reserved or not fully expressed, uh, difficult, uh, life experiences. And I think these are good instances of higher order, uh, defense mechanism, like repression, that kind of thing. Uh, but with, with these narrative, what, what we see with people who have global failures in mentalizing trauma in that after one hour,

• 49:55Speaker 02

  Take your head and just say, what the hell? What did happen with that person? You cannot understand what she's been saying. She's been saying one thing and definitely the opposite. Like here, we see in a few words that she said, my dad never went physical. But a few minutes after, she described an instance when she was hit so bad with a bell that she had to go to the doctor. And later, she starts discussing a situation when the father came home drunk and something happened, but she doesn't go into that direction. And she ended up saying, really, my dad was not a violent person. So it definitely do not makes any sense. It go into all direction.

• 50:37Speaker 02

  And most of the time, you end up that interview and you have the feeling that you don't know that person. You have no clue about her history, what really happened. It was highly confusing. And that's the type of situation, since you've been discussing that as profile as being probably reflecting of people with depressive personality or avoidant personality and the other profiles with sadisms or narcissistic personality. Here, that's the type of discourse we see with some people with severe borderline personality disorder or complex trauma, that kind of fragmented discourse about their life history

• 51:20Speaker 02

  that's highly difficult to make sense and that we have to pause and reflect on these experiences.

• 51:27David Puder?

  Yeah, yeah. It's the like a borderline level of functioning in the psychodynamic theory of where you can idealize one moment and then devalue the next or like it's almost like the in that idealizing of the father that they can have moments of in one in the same interview that they have moments where they can disclose stuff. So that's one thing I'm thinking about. The other thing I'm thinking about is

• 51:56David Puder?

  It's like the with the dissociation, right? If the if the person you're interviewing is highly dissociative and your countertransference is confusion because you're feeling some of that dissociation as well. So when I'm working with clients like this, I will feel sometimes confused and I'll have to kind of ground myself because the confusion I'm feeling is actually the dissociation. The dissociation, it kind of puts a haze in the room. It puts a haze in the the conversation. And this is a very unprocessed trauma when someone is dissociating like that. So it's like as we kind of go back to it again and again,

• 52:40David Puder?

  I don't feel that same dissociativeness. The narrative coherence is there. There, you know, narrative coherence, one thing leads to another, leads to another, leads to another. There isn't like this kind of like incongruencies.

• 52:53Speaker 02

  Yeah, yeah, totally. So the dissociation is there. I think what adds with with that particular profile is that it's not only dissociation. There is that, but there's definitely something at the level of self and other representation. So these are some group and it's a minority of people. I don't remember the percentage. I will look at it, but I think it's something like six or something, six percent or something like that. So a minority of people who have experienced trauma that seems like the trauma has been embedded within self and other representation and in a very consistent fashion. So it interferes generally broadly

• 53:38Speaker 02

  with the way they think about themselves and others. Whereas people who only dissociate, even though that's quite painful, it's it doesn't come to confusion all the time through the all the narrative.

• 53:51David Puder?

  Right, okay. So maybe I would maybe I would say what you're describing sounds like identity diffusion, identity, you know, this kind of like a. What Kernberg talks about with the borderline level of functioning and the you have the idealization, the devaluation, the projective identification, the identity diffusion. This kind of like big, you know, overlapping thing. You could have different personality styles. You could have a dependent person. You could have a depressive, masochistic. You could have various different types of styles of personalities, the way that I understand it. But then it's like you have this fracturing of the self, right? This, this, yeah, really, really, really difficult. Takes a lot longer to do the therapy.

• 54:35Speaker 02

  Yeah, absolutely. And just a confirmation of that, in that particular study, we administered an instrument. She says the self and interpersonal functioning scale, which is based on a criterion A of the alternative model for personality disorder of the DSM five. And we, we evaluate self and interpersonal functioning. And we, we did observe severe impairments on both domains in people from that profile to the point that more than half of people in that profile definitely respond to the criteria for personality disorder. So, yeah, I totally agree that, and that's one element that we did assess with that instrument,

• 55:19Speaker 02

  the identity diffusion of Kernberg. Definition of identity diffusion and totally, this was strongly present in people of that profile. Which was not the case for people in the, the previous profile we were talking about that were absorbing trauma, didn't, didn't have the same level of identity diffusion. It was more the level of interpersonal problem that was present in the previous profile.

• 55:48David Puder?

  Okay, so you also said here, the participants express unintegrated, bizarre, or inappropriate representations of self and other, and a clear misunderstanding of psychological functioning. And I'll read an example that, maybe if she would have loved me, I wouldn't have been good to my children. So it's like a statement that doesn't quite make sense, right?

• 56:15David Puder?

  Another one, this was talking about sexual abuse during childhood. This person said, "He was a man who really, really loved women. So whenever he was in my company, well..." So it's like, okay, I could see it's a bizarre representation that this person loved women and then sexually assaulted her because of that love, right? Is that...

• 56:44Speaker 02

  Yeah, absolutely. If she has that representation that a man who loves women is normal, that he's interested in children as well.

• 56:55Speaker 02

  I don't know what will happen in her current relationship with her partner, but it's a highly risky situation. And we might expect what we often see, a repetition of sexual abuse of our generation. And we can't understand why when we see that kind of representation about others here.

• 57:20David Puder?

  Okay, and then maybe we'll... So that's profile five. Let's go to profile four, which is no failure in mentalizing trauma. So this is the... You want to talk about this one?

• 57:33Speaker 02

  Go ahead, Ziya.

• 57:34Speaker 01

  I can start. These people were low across the board on all the failures of mentalizing trauma that we experienced, we measured, sorry, and then also experienced fewer symptoms and personality dysfunctions. And so we could think of them as potentially, at least by these correlations that we see, resilient women. And so they are... We don't know that from the questionnaire, but with the illustration, we can see that they perhaps have processed the experience of trauma. They're able to understand mental states in that context and to make sense, to tie

• 58:14Speaker 01

  those to behaviors, to really understand, maybe develop mental features and the nature of mental states. And so people who are showing a reflective process, like we would expect to see for higher scores.

• 58:36David Puder?

  So these people were not having identification with the victim, identification with perpetrator. They were not having disorganization of thoughts. They were not having grandiosity, where they were not being avoidant of their emotional world. They were not having absorption in the trauma or justification of the trauma.

• 58:58Speaker 01

  They might, just to note, like, these are not dichotomous variable. They're continuous, but they presented the lowest levels of all of these. Doesn't mean that their functioning or their reflective functioning was like perfect and was, if we think about a negative one to nine scale was a nine all the time. That wouldn't be the case, but their levels of those elements were the lowest.

• 59:21Speaker 02

  Yeah, and most of the time when they present that type of disruption, they are able to note that and comment on that. So there may be instances where they get quite absorbing trauma, but they will say in the course of the interview, I can see that I'm still much more affected by these experiences than I thought I was. Just talking about that, it makes me very emotional. So they are able to comment on these processes, on these differences we've been talking about during this hour. They see that that's happening. They are conscious about that. They are trying to act upon that. And we think it's very, very interesting. And which I find amazing is that it's the majority of people.

• 1:00:06Speaker 02

  It's quite surprising. And for me, I'm glad to see that, that when the majority of people talk about very severe experiences they have during their childhood, they are quite reflective and they are saying very interesting thing. And it's very optimistic for us to see that. And since we may expect that they'll be quite good parents, even though they have experienced quite severe experiences. What we note or whatever is that it's not because you're reflective on your past trauma, that it always protects you from suffering at some point. You may be quite reflective, see the impact it has on yourself,

• 1:00:50Speaker 02

  being able to reflect on that, but still experience pain, experience grief and feel depressed or anxious, yeah.

• 1:01:02David Puder?

  Yeah, let me, let me read one of these and we'll talk about it.

• 1:01:07David Puder?

  Well, I thought it was just by seeing how I react to these memories. I thought I had forgotten about it. Not forgotten because some things leave a mark forever. But I don't define my life by that experience, you know? I always try to do better. I know I had a troubled childhood. I don't want to replicate it over again. Nor with my children, nor with my husband. But still, when I talk about it, I can see I am still sensitive about it. Like, it's still there, you know? Because I never really had the chance to sit down and talk about it with someone.

• 1:01:54Speaker 02

  That's a good example of what we've been seeing. There's still an issue there. She, she, she has the kind of instinct to be like the people we label functionally grandiose. Say, it's in the past, it doesn't affect me anymore. But she's not doing the same. She's able to see that going unfolding and to reflect on that.

• 1:02:19Speaker 02

  So as Julia said, being reflective doesn't mean being, I don't know, free of any types of defense and free of any types of suffering. But it's being able to connect with that, reflect on that.

• 1:02:34David Puder?

  Right.

• 1:02:34Speaker 02

  And be curious.

• 1:02:36David Puder?

  What would you score this out of the? What would this little passage be scored, do you think?

• 1:02:42Speaker 02

  It's not an impressive passage neither. She's just identifying mental states in the course of the interview. There are some elements that are quite rational here. Probably we will be at the lowest side of the good mentalization scoring. So I don't know. Somewhere between five and six. What do you think, Julia?

• 1:03:07Speaker 01

  Yeah, I was thinking you're on a five too. I think we're meeting the threshold of reflective functioning, but we're not seeing a lot of sophisticated, like, for example, developmental stance or freshness elements.

• 1:03:24Speaker 02

  Yep.

• 1:03:26David Puder?

  Yeah, I was thinking five. So I'm glad we're in. We're in agreement here, negative one to nine, uh, which Miriam said she she's almost never given a nine. Like a nine is like, like totally un- so she's usually five plus. It's like there's some passages that are five, that are some that are more than five.

• 1:03:48Speaker 02

  Yeah, I I will comment on that if you permit me, David. That that's an issue we have sometime with the I R F scale. Since this, as you said, this is a scale ranging between minus one and and nine, so a 10 point scale. And most in many studies, what we see is that our our scores are between three and six or three and seven. This there is not a lot of variability. But what is very interesting when we look at trauma specific reflective functioning using an interview such as one we use, trauma making interview, is that we do see a lot of variability and we generally use most of the sky, the scale from minus one to eight.

• 1:04:33Speaker 02

  You're right, I think we never go to nine. It's the something that most people rarely do. But uh, it's it's a scale that permits to capture the variability in mentalizing process. That's a very interesting.

• 1:04:48David Puder?

  That's good. Of course, when you do my score, it'll come back at a nine.

• 1:04:53Speaker 01

  Of course.

• 1:04:53David Puder?

  Of course. So. Of course, that's grandiosity. So that'll that'll that'll bring me down a little bit right there.

• 1:05:02David Puder?

  But that interpersonal, that interpersonal knowledge might increase me a little bit.

• 1:05:09David Puder?

  But then knowing that I'm doing this to make you laugh, maybe that increases me as well, right?

• 1:05:13Speaker 01

  Good.

• 1:05:14David Puder?

  Okay, so being playful with it there. Okay, so here we go. Number, so here's another passage. I worry too much about what people, particularly my parents, think.

• 1:05:26David Puder?

  And I think it's related to the abuse. I just, I'm not as free as I would like to be. I mean, I'm going to be thirty nine next week. And I sort of like, in the back of my mind, I'm still thinking, oh, would dad be okay with this? Okay. Yeah, you could see in this passage, it's the, um, it's, it's different when the person is just unaware of their idealization of their father, maybe? When they are like, they don't have the insight, right?

• 1:06:07David Puder?

  There's a little bit of insight here into how the early childhood abuse maybe plays out in the present. Is that what you're thinking?

• 1:06:18Speaker 02

  Yeah, absolutely. I see three elements in that very short passage that I find very interesting. The first one, when called reflective functioning, you know, we have to get a sense that the person is aware of the nature of mental states. And here we, we do see that, that she's recognizing the persistence of certain trauma-related mental states despite the willingness to change. She would like to feel different, but that's the way she, she feels. And even though she, she works on it, she, she sees, she still have that, that emotion, that underlying feeling that is there. And that's, I think that's a good understanding of the world of, of mental states that we, we may change,

• 1:06:58Speaker 02

  but it's, it's difficult and some, some things are lasting over time. The other thing I think is freshness. She, she's describing things as they are happening in the moment. I'm not sure if she's saying things that she reflected a lot prior to the interview, something unfolding here. And the, the last one is the, uh, what we often see when we evaluate reflective functioning, the explicit effort to tease out mental states, underlying behaviors. Here she's describing the impact of trauma on, on herself, on their mental states, on their thought processes. So that's, that's very interesting. And that's not something at the I N of the scale.

• 1:07:41Speaker 02

  It's probably around, around a six, uh, but, uh, I think it's totally interesting.

• 1:07:48David Puder?

  Yeah, that's good.

• 1:07:51David Puder?

  Okay, let me read another one of these. So you said, there are little instances of denial, minimization, or self-blame. When this happens, these speakers are able to identify that it represents an attempt to keep a distance to difficult emotions. Okay, so one of them is, I laugh, but it's not funny. So it's like, they laugh, they recognize that it's not funny. It's like they're recognizing the defense of laughter. Laughter's a, humor's a higher order defense. Another one says, I said at the beginning that my dad was not violent, but I realize that he was, in fact, quite violent.

• 1:08:35David Puder?

  I think it's difficult for me to acknowledge that. No one likes to say or admit that one of your parents is violent, you know? My father was really violent verbally.

• 1:08:50Speaker 02

  Yeah, I think we try there to give example that reflect more subtle indicators of reflective functioning. Since people on the high end of the scale, people are highly reflective, it's quite easy to observe. Most of the time, we are like, wow, that's, that's amazing what you said. I don't think I could have said that myself. Probably you could, David, since you're nine on the scale, but being a five or a six.

• 1:09:19David Puder?

  I'm not, I'm not.

• 1:09:21Speaker 02

  I'm not, no. Just kidding, but yeah, so these are example that are most, more subtle. We see people sit on the go, some suffering about trauma. They are still dealing with it, but they can see themselves go. And they can look at themselves from the outside, see these processes. And I think that's, that's what will eventually protect them to repeat these experiences within the relationship where they are child, even though trauma is not totally resolved.

• 1:09:57David Puder?

  Hmm. Yeah, I could, I could see here, so it starts out, I said at the beginning that my dad was not violent, but I realized he was, in fact, quite violent. So it shows a progression, even in the midst of talking about something. They're aware that they.

• 1:10:17David Puder?

  Are changing their sort of like wordage.

• 1:10:22Speaker 01

  I think it's a good alternative to the one we looked at for the prior profile where there was a lot of contradiction, right, about hitting or ending with really my dad was not violent. And here we see a reflective process that kind of shows that we're reaching maybe a novel interpretation during the process of the interview or realizing the implication of abuse on her functioning. And I think it's a nice like alternative to something that can be quite similar.

• 1:10:58David Puder?

  Or even the, when this person says, I think it's, I think that it's difficult for me to acknowledge that. There's an awareness of the difficulty to say that her dad is violent. So it's like, there's a maybe a propensity to want to imagine her father not as violent. There's an awareness of the difficulty of that, right? And then the no one, she says, no one likes to say or admit that your parent is violent, you know? So there's like this kind of like knowledge of the idealization of not wanting to sugarcoat the abuse, to want to not see the abuse. And then there's this acknowledgement, my father was really

• 1:11:42David Puder?

  violent verbally. So yeah, you could kind of, it's, it's, you can see this person working through and mentalizing in real time or changing or kind of adjusting, right?

• 1:11:58David Puder?

  Yeah. So what would you, what would you score this one?

• 1:12:02Speaker 02

  Uh, yeah, it's difficult since when we score, we have access to the whole response.

• 1:12:09David Puder?

  Big portion. This is just a small portion.

• 1:12:11Speaker 02

  Yeah, probably that person from what we see here is around six or more, since she's quite reflective. And if we would have access to the whole narrative, probably we'll, we'll see more complexity to that.

• 1:12:28David Puder?

  Okay, and then this last one. Oh, sometimes I would just be studying and she would have a tantrum for no reason. But now I understand, but now I can understand. She was in a frustrating situation with her husband because he was never there. He wasn't taking care of his children, so I was the one who paid the price for it. That's how I see it today. It's like she took her frustration out on me. So um. It's kind of like there's an acknowledgement of the mother's displacement,

• 1:13:09David Puder?

  of the mother's anger from the, from the husband onto her. It seems a little bit overly justifying the mother's bad behavior. So I could see why this is a more subtle example, right? Tell me about this one.

• 1:13:27Speaker 02

  Yes, I think she's doing what's the most difficult to do when you're mentalizing trauma is to try to tease out the perpetrator's mental state. So it's much more easier to reflect on your own mental states than reflecting on the perpetrator's mental states. Here, we took that example again to uh make the difference between when you're justifying past abuse, saying it was deserved, a good way to to react. Here, she don't take the blame for the abuse. She says she acknowledged that this was inappropriate, but she she can see that the mother was undergoing a conflictual situation. It was not easy for her in that, as you said, she, it was a lot of displacement,

• 1:14:12Speaker 02

  displacement of the mother on on her. She acknowledged that developmental perspective. She can say, that's now I see it today, implying that when she was younger, she didn't see it this way. So there, there's something interesting again here. I think only that passage is, it will probably be around the five. It's not, there's something missing, but that's, that's some interesting. Yeah, interesting response.

• 1:14:45David Puder?

  Very good.

• 1:14:48David Puder?

  So tell me, maybe, you know, I think we're gonna probably have to do a follow up, getting more into the detail of like the different scorings and stuff as you get further along. I know you guys are developing kind of a manual for that, specifically for trauma. I think that there's some, you know, you've shared an early version of this and I know you're working on finalizing it, which I'm excited for you guys to get that out there and start doing trainings and such. And more people hopefully will do research. I have people email me quite often and they're like, you know, I'm undergrad, I want to do a PhD in this, you know, what do you recommend? And I've started to point them towards, you know, like labs that are doing this kind of work because I think it's so important.

• 1:15:32David Puder?

  It's really good and we need a lot of youthful energy to do these because it's very time intensive, right? To do the scorings.

• 1:15:40Speaker 01

  Yes.

• 1:15:42Speaker 01

  Have a lot of youthful energy, a little bit less now, but.

• 1:15:46David Puder?

  Oh, yeah. It's like, um, there's a reason why there's only so many score, um, studies on reflective function. And it's because it's very time intensive to do an adult attachment interview and then to score it for reflective function, right?

• 1:16:06David Puder?

  It's costly. So hopefully at some point I can do like some like, uh, fundraising for this type of research. So we'll have to, uh, hope that I can raise some money for further studies like this. Where do you think that the, like, when you think about like where the studies are today? What you would like to see in the future? What are you hoping, Julia, maybe like you're young, you know, you're, you're in your postdoc at Vanderbilt. What are you hoping someday to, to have as part of your lab and, and to see accomplished?

• 1:16:44Speaker 01

  Yeah, that's a good question. I think what both of us are hoping to move forward to is really complementary. And for me, I think really trying to better understand what's happening in those moments of either lapses or good reflective functioning. So we have a study right now in Quebec that Nicholas is leading, that he can talk more about, about really processing and using multimodal information to really better understand the reflective processes. And for me, I'm really interested in how that relates to functioning for like individual level mental health, for example, but also how that relates to the parent-child relationship and really in those moments. And so trying to really

• 1:17:28Speaker 01

  have more of a microscopic view of those processes. I think a lot of the theory around mentalizing is that it is somewhat a co-regulatory process, right? When you're in relationship with others, especially with kids who are highly dependent on their parents. And so trying to better understand how that co-regulatory power of reflective functioning occurs in these moments.

• 1:17:55David Puder?

  Interesting, yeah. I'm thinking there was this moment where I took my daughter to this really hard basketball practice. She was young. She was probably fourth grade, yeah, fourth grade, end of fourth grade. And it was so hard. There were a couple balls that hit her in the head, passed too quickly, you know, they were older girls. She's crying. It was like she got in the car and she's like, I never want to do this again. And it was like, it was really hard to watch the practice. It was like painful. Like it was like, I was like suffering watching the practice, you know? And, you know, like

• 1:18:39David Puder?

  the way that I remember talking about it was, yeah, it makes sense. It's really hard. It was a really hard practice. That was the hardest practice you've ever been through. But you, I'm so impressed that you got through the whole practice, like despite it being as hard as it was. And and then we did like some meaning making about how like doing hard things is is good because you know it's like how we grow and if you want to I said like look like if you want to continue to do this it's up to you I think it's going to help you be a better basketball player eventually like it's going to take a lot of work you know it's going to take a lot of lot of these things it could have been it could have been almost a traumatic

• 1:19:23David Puder?

  experience but I think that the post discussion and she was completely regulated afterwards we had ice cream we went home she was in a great mood you know

• 1:19:34Speaker 01

  Yeah.

• 1:19:35David Puder?

  What do you think about that in terms of like is is that an example of like putting words to is that kind of what you were talking about like how we put words to things how we connect with someone in the midst of distress?

• 1:19:48Speaker 01

  Definitely and I think I think that's a great example of doing it I think unfortunately in labs and in research we tend to sometimes miss those moments so I think it's about finding ways to to measure moments that might be ecologically valid for families or that might in lab kind of lead to negative affect or frustration in kids and and how we can then look at how parents adjust so I think those moments are are harder to see in a laboratory and so that's kind of where I see my I want to see them in the lab but that's kind of

• 1:20:30Speaker 01

  where I see a lot of work being needed and especially if they think about I tend to study younger kiddos for whom the language of meaning making like the direct path of how this process that you're you're illustrating with this experience with your daughter might be less direct right if if we're thinking about doing this with an eight month old kid then then what what is it that makes it make sense I think we still have a lot of work to do there and I'm sure it I'm sure it is important but I think we still have a lot of of ways that we could better understand kind of the active ingredients almost of this.

• 1:21:13David Puder?

  Yeah, I think about in the psychoanalytic tradition, you often do these like home observations. They find these families that are okay with you just basically standing in the home observing mother infant interactions. You're not talking, you're just kind of observing. And you're actually just like a fly on the wall, right? And you might be there for 10 hours, just kind of like watching a day of this person's life, you know?

• 1:21:42Speaker 01

  Yeah.

• 1:21:43David Puder?

  And then I'm thinking about like the patients that I have that have had issues with bonding and have the kids and it's not every day that they're going to have issues, right? It's like, maybe they're sleep, extra sleep deprived, maybe they're having an argument with their spouse and they're more dysregulated. And it's in those moments that they're not feeling as connected, or they're having these very, very strong, intense emotions. How do you start to capture that in a lab if you're not in that sort of situation where you would get that evocative day, you know?

• 1:22:19Speaker 01

  Yeah. Well, I don't want to get us too far from the topic of the podcast, but I think now with technology advancements too, we have a lot more ways to have cameras that are a lot less invasive. I know of people who use kind of like the baby monitors that people put on top of cribs and then they can have access to the recordings at pretty much any time that someone's in the baby's rooms. And so I think we can, we can try to be, to use these technologies in research as well to, so maybe it's not happening in the lab, it's happening in the home, but I think we can have better ways of capturing it now.

• 1:23:01David Puder?

  Love that. Yeah, that's, that's, that's good.

• 1:23:04Speaker 02

  Yeah. And I think the example you gave with your mother is really evocative, that of the things we're trying to, to capture. And we think that trauma IRF is a good proxy of how parents will respond in such, such situations because. I think your example is highly evocative. How complex it is to be to be a parent and how complex it is, especially in situation where in emotionally odd situation. And it's so difficult because as you said, when you look your your child in pain, you you feel the pain as well. So and you have to to accept experiencing that,

• 1:23:49Speaker 02

  tolerate that emotion, contain that, reflect on that, and then intervene with your child. And that that's why we think trauma I R F is is so important because people who have experienced I R F have underwent intense pain, intense stress during their life. So when they see their child in pain, it may be much more difficult than other parents. And even in other parents who did not experience trauma, that's a very difficult situation to to manage. And I I think trauma I R F helps us to understand that some parents will have kind of very inappropriate reaction under these circumstances, will will laugh at the pain of their child

• 1:24:34Speaker 02

  or will jump on the field and yell at the coach. But we can understand that from what they they went through. And what to respond your your initial question, what we want to do next was the future. I think that knowing that, what we can try to do is try to prepare parents as much as as we can. And the way we would do it, Juri and I and our team, is to intervene from pregnancy based on these principles of trauma-specific reflective functioning and mentalizing. So we did develop an intervention which called the the STEP program, supporting the transition to an engagement and parenthood program, which is one of the very first intervention, especially designed for survivors of trauma,

• 1:25:19Speaker 02

  where we have nine sessions trying to to mentalize about different elements, but especially about themselves as people, as parents, and their experience of trauma for them to be more comfortable when situation as the one you described will eventually arise and the child will be will be there.

• 1:25:40David Puder?

  Hmm. And how is this? Do you have a result of this yet? Has this the STEP program been?

• 1:25:49Speaker 02

  Yeah, well, we have several results. First, we took the time to develop that program. It's kind of tricky discussing trauma during pregnancy, which is a very sensitive life period. So we have good data supporting the acceptability of the program, both from the point of view of experts and from the point of view of parents. And then we evaluated the program with, I think, we reached about eighty participants so far, parent women who have experienced trauma who participate in the program. And when we look how they evolved during the program, when contrasting with people who had under one trauma but did not receive the program, we see a decrease in depression,

• 1:26:33Speaker 02

  a decrease in anxiety, an increase in emotional regulation, a decrease in unresolved trauma as well. So it seems like it's highly beneficial. And now we're following these families over time and trying to see how the relationship with their child unfolds. That's where Julia's expertise will be quite important for the future to look at the parent-child relationship.

• 1:26:58David Puder?

  How much did the RF scores change pre and post?

• 1:27:03Speaker 02

  We're coding.

• 1:27:05Speaker 01

  We don't know that yet. So yeah, we're coding right now.

• 1:27:09David Puder?

  Okay.

• 1:27:10Speaker 01

  Yeah, so hopefully, hopefully they did change. We think it's at least a mechanism of change, but it'd be fantastic to see it as an outcome too.

• 1:27:21David Puder?

  Because I know the change is, it takes time, right? So nine sessions would be, would be surprising almost to me at this point, but I would be happy to see that. And transference focused therapy, you know, we know that twice a week therapy over the course of like a year can improve a train or change in reflective function. So we do know that there are studies that show there can be an increase.

• 1:27:47Speaker 02

  Yeah.

• 1:27:48David Puder?

  Um. So I run cohorts and we're potentially going to be doing some research to see if, you know, eventually, I've been doing the cohorts, but eventually we'll be maybe looking at pre and post reflective function as well. And I would like to see if providers reflective function can increase a little bit over the course of a year. I think they do from what I read of their responses to questions. We have weekly reflective questions. But this is great. This was a great conversation. I'm excited to connect with you guys. I'm looking forward to maybe having some further episodes down the line as new papers

• 1:28:32David Puder?

  get published, as you get further along in your journey. And if you're incredibly wealthy and you're listening to this, I'm sure they could use some funding so you could find them and provide them for their research teams. All right, yeah. Any other final thoughts or any other final things going through your mind? I'll have links to your articles on my website. People can find you guys, links to your bios. And yeah, it was wonderful having some primary research on here and getting into the details. So thank you.

• 1:29:09Speaker 02

  Thank you very much, David, for the invitation. It was a very nice discussion. It was a pleasure.

• 1:29:14Speaker 01

  Yeah, thanks so much for having us. It was great.

• 1:29:17David Puder?

  Nice. Okay. So we'll leave it there for today.