The Meaning of the Child Interview: A new procedure for assessing and understanding parent–child relationships of ‘at-risk’ families

Abstract

Reder and Duncan’s well-known studies of the 1990s on fatal child abuse drew attention to how parental scripts regarding their children could dangerously distort relationships in ways that were sometimes fatal to children. This article reports on a new system for assessing the ‘meaning of the child to the parent’, called the Meaning of the Child Interview (MotC). Parents are interviewed using the established Parent Development Interview, or equivalent, and the transcript of the interview is then analysed according to parental sensitivity and likely risk to the child. The MotC constructs were developed from those used in observed parent–child interaction (specifically, the CARE-Index) and the form of discourse analysis used in the Dynamic Maturational Model – Adult Attachment Interview, allowing a more systemic and inter-subjective understanding of parenting representations than often put forward. This article discusses the theoretical background to the MotC, gives a brief review of similar measures and then introduces the coding system and patterns of caregiving. The validity of the MotC is addressed elsewhere.

Keywords

Attachment parent–child relationships Meaning of the Child Interview parental sensitivity family risk assessment reflective functioning inter-subjectivity

Introduction

In their classic studies of child death enquiries, Reder et al. drew attention to the ways in which the meaning parents gave to a particular child could become so distorted that, in extreme cases, it led to fatal abuse (Reder & Duncan, 1999; Reder, Duncan, & Gray, 1993). While all children hold a psychological meaning to their parents, in these situations, the children’s own identity had become submerged in their parent’s blueprint for the relationship; they became ‘actors in someone else’s play’ (Reder & Duncan, 1999, p. 71). While the meaning children have to their parents can be seen as a core dimension of all parenting (Farnfield, 2008), it is of particular relevance to situations of child abuse and neglect. This article describes a new system for analysing the meaning of the child to the parent, which can be used by child protection and other health and social care professionals.

What is the meaning of the child?

The meaning an adult invests in his or her child and the way in which it shapes the parent–child relationship have a long history going back at least to psychoanalytic models of the development of identity in infant development (Winnicott, 1967). In Miller’s (1979) paraphrasing of Winnicott,

The mother gazes at the baby in her arms, and the baby gazes at his mother’s face and finds himself therein . . . provided that the mother is really looking at the unique, small, helpless being and not projecting her own expectations, fears, and plans for the child. In that case, the child would find not himself in his mother’s face, but rather the mother’s own projections. This child would remain without a mirror, and for the rest of his life would be seeking this mirror in vain. (pp. 61–62)

In a literature-based theoretical model of the assessment of parenting, the meaning of the child is seen as a core dimension of parenting (Farnfield, 2008). The task for assessment is whether the parental script or dominant story about a child can be made visible in a way that supports informed intervention in that relationship. The Meaning of the Child Interview (MotC) offers a means of doing this.

The ‘meaning of the child’ in attachment theory: the self-protective transformation of meaning

Put rather crudely, the assessment of parenting can be reduced to observing what parents do with their children and asking them questions about their child and parenting to elicit how they think about what they do. In theoretical terms, these are parental sensitivity and the parent’s representations of a particular child or the meaning the child holds for the parent (Farnfield, 2014). Risk increases when parents act in self-protective rather than child protective ways (Crittenden, 2008) leading to chronic withdrawal (neglect) or hostile control (physical abuse).

In the attachment field, pioneering work on adult representation of attachment was begun by the Main and Goldwyn system of discourse analysis (patterns of speech; Main & Goldwyn, 1994) for analysing the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1985). The basic premise of the AAI is that coherence of speech about early experience is a direct window onto coherence of mind regarding the same topics, a coherence that has found to be related to security in wider relationships and in parenting (Hesse, 2008). For example, a ground-breaking study found that security of adults on the AAI before their baby was born actually predicted attachment security of the infant at 11 months old (Fonagy, Steele, & Steele, 1991).

The mechanisms by which attachment security is passed on from parent to child are imperfectly understood, leading Van IJzendoorn (1995) to point out a ‘transmission gap’. In particular, parental sensitivity (what parents do) is only weakly linked to attachment security in their child (Madigan et al., 2006), suggesting a strong mediating factor is how parents think about the child and how they process information concerning comfort and danger (Crittenden, 2008; Grienenberger, Kelly, & Slade, 2005; Slade, 2005). Other confounding influences may be gene expression (Fearon, Shmueli-Goetz, Viding, Fonagy, & Plomin, 2014) and the impact of the wider family system (Crittenden, Dallos, Landini, & Kozlowska, 2014).

To understand this further, interviews were developed that specifically elicited parental representation of their child, rather than of their childhood relationships (the focus of the AAI). An early attempt simply to apply AAI discourse analysis to a parenting interview found, perhaps not unsurprisingly, that AAI patterns of attachment could be identified in a parenting interview, but not as clearly as in the AAI itself (Crittenden, Partridge, & Claussen, 1991), suggesting that further thought needed to be done in relation to understanding the differences between the mental representations parents hold of their children compared with those of their own childhood.

Aber, Slade, Berger, Bresgi, and Kaplan (1985) developed the Parent Development Interview (PDI) for such a purpose. Their breakthrough came when Slade et al. adapted the Reflective Functioning (RF) scale, originally developed for the AAI by Fonagy et al., to code the PDI (Fonagy, Target, Steele, & Steele, 1998; Slade, Bernbach, Grienenberger, Levy, & Locker, 2005). Shifting the focus away from attachment patterns to looking at the capacity of a mother to represent her child as having thoughts and feelings and intentions, and ability to make use of this in understanding her own relationship with her child (also called mentalising) opened a rich vein of research (e.g. Slade, Grienenberger, Bernbach, Levy, & Locker, 2005; Suchman, DeCoste, Leigh, & Borelli, 2010). Other approaches assessed essentially the same concept in a different way, for example, Meins et al. (2003) examined the ‘mind-mindedness’ of parents through analysing their mentalising speech in free-play interactions with their child. Oppenheim and Koren-Karie used an interview to examine a mother’s ‘insight’ into the mental states of both herself and her child on watching a video of free-play interaction between them (Insightfulness Interview: Oppenheim & Koren-Karie, 2009).

The weakness of these measures is they do not adequately identify the differences that exist between particular parent–child relationships, especially those thought to be ‘at risk’. By measuring the capacity of the parent to mentalise, the RF scale in the PDI has been useful in identifying where parents may struggle to parent through lack of mentalising, but is less useful in identifying and understanding differences between parents with a low mentalising capacity or the difference in relationships with different children that a parent who struggles to mentalise might have. For example, while low RF in the parent was found to be predictive of insecure attachment in the child generally, child disorganised attachment (the most ‘at-risk’ pattern) and avoidant attachment (where children inhibit attachment responses) were found hard to identify (Slade, Grienenberger, et al., 2005).

Other researchers, perhaps mindful of this, took a different tack in trying to preserve a link in their understanding of parenting representations with the attachment classifications and patterns. Solomon and George, for example, adapted the PDI into their Caregiving Interview, and with it developed four patterns of caregiving theoretically (and in their research, empirically) linked to the four basic attachment patterns identified in Main and Goldwyn’s system of classifying the AAI (George & Solomon, 2008; Solomon & George, 2011). However, by virtue of focusing on overall patterns of caregiving linked to or identified with adult patterns of attachment, their coding system is equally unable to shed light on differences in the relationships a parent might have with different children. In addition, by having only one ‘at-risk’ category (‘helpless’ parents, who abdicate parental responsibility, linked to attachment disorganisation), George and Solomon’s constructs similarly cannot be used to systematically distinguish different kinds of ‘at-risk’ relationships.

These difficulties raise the wider question of whether constructs used to understand parenting representations that are linked either to adult attachment directly or to a capacity of the parent (such as their reflective capacity) can sufficiently capture the dynamic and developing way a parent and child interact. The parent is simultaneously responding to outside danger and her own maturing child, and the child is responding to her parent with continually new possibilities opened up by her own development. For example, pregnancy, and maternity itself, has been seen to have the potential to lead to reorganisation and change (Slade, Cohen, Sadler, & Miller, 2009). In other words, the parent’s current relationship with the child and the meaning she (or he) derives from it stands at the fulcrum of a two-way process. Not only does a parent’s past experience influence interaction with the child, but also that same interaction is capable of changing the parent’s representation of the past: ‘The past is fixed, but its meaning is re-written every time it is recalled’ (Crittenden, 2003, p. 357).

The point is now well known and acknowledged by the researchers discussed above, but does not yet appear to be fully integrated into a system of classifying parenting interviews. Even the Working Model of the Child Interview (WMCI; Benoit, Zeanah, Parker, Nicholson, & Coolbear, 1997; Zeanah, Benoit, Hirshberg, & Barton, 1986), which makes explicit use of the idea in its basic understanding of parent–child relationships, does not quite capture this dynamic and dyadic quality in its coding system and also encounters some of the problems already outlined in both delineating risky relationships and differentiating between them. Some of the most fruitful work with the WMCI has been in clinical studies (Zeanah, 2007) that do not make explicit use of the coding system, perhaps suggesting that there is more to be ‘captured’ from this interview than the existing coding system identifies.

The MotC system of classifying parenting interviews

The Meaning of the Child is an attempt to take this same dyadic focus and make it central to its understanding of the parent–child relationship. It combines constructs drawn from an assessment of face-to-face parent–child interaction (the CARE-Index; Crittenden, 2010; Crittenden & Bonvillian, 1984), with the method of discourse analysis used to classify the AAI (Crittenden & Landini, 2011). To understand how parental representations of their child and their own parenting actually translate into behaviour and relationship with the child, a system is needed that is dyadic and relational in focus, concentrating on aspects that connect with what is specific to a particular parent and child, rather than what is shared by all children in the same family. The patterns of Crittenden’s CARE-Index (classified from short videos of free-play interaction) are derived from how the parent is assumed to experience the particular child (and vice versa) – how the one connects to the other. Using the same patterns, the MotC is able to understand a parent’s representations of their child in a way that directly reflects this connection (see also below).

At the same time, the integration of discourse analysis derived from the AAI preserves the link between coherence of speech and coherence of mind that was the premise upon which the AAI’s success in predicting infant security was built. In particular, the MotC coding system makes use of Crittenden’s approach to the AAI offered by her Dynamic Maturational Model of Attachment (DMM; Crittenden, 2008; Crittenden & Landini, 2011). Crittenden’s DMM expands Ainsworth’s original patterns of attachment (Ainsworth, Blehar, Waters, & Wall, 1978) to include modifications of the basic patterns of avoidance (Type A) and ambivalence (Type C) under conditions of extreme threat. In doing so, the DMM avoids reliance upon the Cannot Classify or Disorganised category (Type D) used by the more commonly used, and more extensively researched, Main and Goldwyn system of classifying the AAI. There is nonetheless a developing body of research surrounding the DMM-AAI, as well as a history of clinical use (Farnfield, Hautamäki, Nørbech, & Sahhar, 2010; Sahhar, 2014).

While the MotC makes use of the DMM-AAI in its methodology, it does not seek to replicate Crittenden’s (or any other) patterns of adult attachment (see also the discussion of Figure 1). It is Crittenden’s understanding of conscious and unconscious defensive information processing under conditions of threat and her integration of this with Memory Systems theory (Schacter & Tulving, 1994) that the MotC makes particular use of. The differentiation of different ‘Memory Systems’ or pathways by which the brain ‘re-presents’ (reinterprets) experience and the elucidation of how these processes may be transformed in conditions of danger described by Crittenden’s theory have opened up potential to understand parent–child discourse in ways that had not previously received attention. In many ways, the work in developing the MotC coding system echoed Solomon and George’s use of Bowlby’s understanding of defensive information processing in their work on caregiving (George & Solomon, 2008; Solomon & George, 2011), but with an explicit effort to achieve a more dyadic focus, as well as make use of the developments offered by Crittenden’s thinking on the AAI.

Figure 1.

The Meaning of the Child – dyadic patterns of caregiving.

More recent work on RF (e.g. Luyten & Fonagy, 2014) has extended the concept to include ‘dimensions of mentalising’, namely, ‘automatic/controlled’ mentalising (loosely translated as conscious/unconscious reflection), ‘self versus other’ (the subject of mentalising), ‘internal versus external’ (derived from internal knowledge of own mental states or inferred from external behaviour) and ‘cognitive/affective’ (understood or felt). These dimensions are not, however, made use of in the parental RF scale itself, but aspects of them, if not all, are integral to Crittenden’s method of analysing discourse by memory systems. In particular, the method enables conscious and unconscious processes to be differentiated and examines how affect and cognition are transformed in the way parents speak. Making use of these theoretical developments has offered a practical methodology for developing a system of classifying the meaning a parent gives to their child and the parenting relationship. At the same time, these have been related to constructs derived from a procedure used to understand observed parent–child interaction in order to more easily ‘capture’ the interrelated nature of the parent–child relationship.

While it has been called the ‘Meaning of the Child Interview’, so as to make clear the means used to assess parent–child relationships, the MotC is a system of analysing parenting interviews rather than the interview procedure itself. For the most part, the MotC has employed a modified version of the PDI, but the system of analysis has been used clinically with other interviews as it has no theoretical or practical reliance on any particular interview protocol. Similarly, while the focus of the MotC’s validation study (Grey, 2014a, 2014b; Grey & Farnfield, 2016) was parents (mothers and fathers) of children aged 0–3 years, because of the method’s original link with the CARE-Index, the interview has been used with parents of children of all ages, including grandparents in relation to both their adult children and their grandchildren. While further work around validity of these other uses is needed, in individual clinical cases where there is support from established procedures, the use of the interview has proved fruitful.

The MotC patterns of caregiving

The heart of the MotC has been to see the development of child attachment in a more dynamic way, one that recognises that the child is an active participant in the relationship (even if the parent has significantly more power), and to make this insight central to a system of classifying parent–child interviews. The meanings that both the child and the parent have in relation to each other are both derived from the nature of the interactions between them, which at the same time shape that interaction. While all the parent and child ‘see’ of each other is the other’s behaviour, this behaviour is the outworking of an internal process, where both parent and child are constantly giving meaning to each other’s actions. Hence, the ‘meeting’ of parent and child can be seen as a collaborative (or non-collaborative) dialogue, a series of conversations between parent and child (Lyons-Ruth, 1999) in which the meaning that each has of the other is constructed, what Beebe et al. call the ‘inter-subjective’ space (Beebe, Lachmann, Markese, & Bahrick, 2012; Beebe, Lachmann, Markese, Buck, et al., 2012).

Of course, this picture does not acknowledge the developmental differences between parent and child. The parent gives meaning to the child prior to birth (and from a wider social context that the child is not immediately aware of). As the child gets older, she or he becomes a more active, intentional participant in the dialogue. Attachment, therefore, is better seen as ‘co-constructed’ rather than ‘transmitted’ from parent to child (Beebe, Lachmann, Markese, & Bahrick, 2012; Beebe, Lachmann, Markese, Buck, et al., 2012).

With this in mind, the MotC patterns are based upon a continuum between distanced, psychologically unavailable caregiving on one side (called Unresponsive) and intrusive, overly close, psychologically enmeshed caregiving on the other (called Controlling), with Sensitive caregiving being a cooperative, mutual dialogue that occupies the balance between these two extremes. These patterns have been derived from Crittenden’s CARE-Index, but have been given a meaning here that links more closely to how parents think about their child (see also Figure 1).

Sensitive caregiving

The ‘Sensitive’ parent enables the development, protection and nurture of the child through facilitating a collaborative ‘inter-subjectivity’ between them. Such parents wait for the child’s responses and invest positive and appropriate meanings to the child’s initiatives. As in any collaborative conversation, each party offers something of themselves while listening and eagerly attending to both the responses and initiatives of the other. Such ‘dialogues’ are a pleasure to listen to as there is ebb and flow, more than one perspective, and a full range of moderate (non-coercive) emotional expression. This is true of all collaborative relationships, not just parent–child ones, but the parent facilitates this with their child by acting in the child’s Zone of Proximal Development (ZPD; Vygotsky, 1967). This can only be done if the parent truly knows their child; generalised knowledge of child development is not enough as it may obscure or mislead the intentions and understanding of the specific child. However, the child’s involvement in the conversation is not feared by the parent, so the parent feels free to let the child contribute to the inter-subjective dialogue while also being present herself.

Sensitive parents are able to use the parenting interview to explore openly and honestly their relationship with their child. The overall tone of such interviews is likely to be affectionate and positive, but the parent is also open to discussing and thinking about frustrations and problems. These interviews are personal and lively – they contain incidents and images that are personal to the relationship and could not be borrowed from TV, social clichés or professional prescriptions of how things ‘ought’ to be. The parent is able to convey their knowledge of the child. Their account of the child and their own parenting is credible, and the expression of affect is appropriate to what is being discussed. In this way, Sensitive interviews tell a story that is built together by parent and child cooperatively, rather than imposed by one on the other, and without being something of a fantasy to avoid looking at what is really going on.

Controlling caregiving

For parenting classified as ‘Controlling’, the inter-subjective space in the ‘dialogue’ between parent and child can be re-envisaged as parental dominance of the meaning-making process. The child is required to take on a meaning to the dialogue that echoes the parent’s own. The intrusive parent perceives the child’s autonomy and ability to make meaning of the relationship as a threat and so ‘moves into’ the space that is otherwise jointly constructed in healthy relationships. The controlling parent responds to the threat they perceive from the child by attempting to make the relationship what they want or need it to be, rather than feeling secure enough to allow the relationship to develop in a way that respects the child’s subjectivity and personality. The parent needs to control the dialogue (have the ‘first and the last word’) because to let the child shape it is too threatening as the child will in effect be shaping them also. The parent constructs the meaning of the child in such a way as to necessitate directing the child onto a different path from which he or she might choose on his or her own.

The controlling parent (mis)perceives the child’s ZPD such as to necessitate the parent’s constant intervention. In the mind of the parent, problems in the relationship are the result of the child’s attempts to contribute something different and potentially damaging to the dialogue (which is why controlling parents commonly perceive their children as controlling). The parent’s fear of the child controlling them leads them to try and control the child.

Some of these interviews show a pattern of covert or overt hostility (see Figure 1 for all patterns highlighted): the child presents a problem or difficulty for the parent, and the child is to blame for the negative experiences of the parent (and themselves). Sometimes some positive semantic (generalised) conclusions about the child or the parent’s relationship with the child are given. However, these are undermined or made vacuous by negative images of the child (or the child’s feelings) and by relating episodes that emphasise the difficulties involved in parenting this child. The language used about the child and their relationship often evokes negative feelings about the child in the listener, and so engendering sympathy towards the parent. Often there is a subtle undercurrent of hostility, expressed in humour that trivialises the child or his or her needs, belittles them or exaggerates their anger and aggression. In extreme cases, the hostility may be overt in actively derogatory statements and language, although this is rare. What is more commonly seen are descriptions of the child’s mentalising (thinking, feeling, believing and so on) that make the child out to be more hostile or rejecting than is either likely or developmentally credible. The interview justifies aggressive thinking, feeling and sometimes even actions towards the child (and exonerates the parent’s negative behaviour towards the child).

Enmeshed interviews mistake the child’s perspective for the parent’s. They are more positive in tone than the more hostile interviews, but the parent’s needs and desires are read into the child. They are often mistakenly perceived as sensitive because they are generally positive and highly imaged. However, unlike sensitive interviews, these interviews have a highly aroused tone throughout, to the point of desperation. Ultimately, the parent is describing their own needs, and the child remains unseen (and unvalued) as a person in her (or his) own right. The transcripts are therefore characterised by a confusion of the parent’s perspective with that of the child. At the same time, there remains an unacknowledged undercurrent of hostility in these interviews, reflecting the parent’s anger at (or fear of) the child making a meaningful contribution to the relationship and the fact that ultimately the child cannot live up to the burden of expectation placed upon him or her.

In less serious cases (such as those characterised as Frustrated or Needy), controlling thinking serves to highlight and draw attention to problems in the relationship and to elicit support for the parent in resolving them. Ultimately, the parent still recognises their parental role and is searching for a solution. Also, keeping the problem alive may function to keep others involved in supporting the parent and enable the parent to feel better about their role despite the difficulties.

Unresponsive caregiving

The defence of parents classified as ‘Unresponsive’ to the perceived threat of the child’s ability to shape them is to withdraw from the dialogue. The unresponsive parent constructs a meaning of the child that justifies their own lack of genuine participation in the conversation. Usually, the child is idealised, the parent understanding the child’s ZPD in such a way that underestimates the involvement the child needs and facilitates parental absence. In the case of depressed parents, their own involvement is pathologised and seen as ineffective or unhelpful, so exonerating psychological and often physical withdrawal. However, assuming that the unresponsiveness stops short of actual physical abandonment, the child is still physically there, and so there is, by necessity, some kind of dialogue. The child must fill the vacuum for his or her own survival and become the driving force in the ‘conversation’. The fear of the unresponsive and withdrawing parent appears to be not so much what the child will do if given autonomy in the relationship, but what the parent will feel if fully ‘present’. What is particularly striking in these interviews is the emotional absence of the parents, as much as their lack of knowledge of the child.

The idealisation of interviews classified as Unresponsive is seen in the parent’s inability to describe genuine experience that might give their statements personal relevance. There is an absence of images, descriptions of mentalising and ‘fresh’ lively discourse. Such Absent parents struggle to give meaning to the child’s signals and behaviour, so they are unable to represent it in an interview in a meaningful way. This also characterises what are here termed Depressed parents, not as a proxy diagnosis, but rather to identify parents who have in some way given up on the relationship and perceive it implicitly or explicitly as ‘lost’ or hopeless.

Some psychologically distancing parents appear to be doing more, but what they do is largely unrelated to the child in front of them. These parents are more likely to describe a fantasy child and a fantasised relationship. Often the child is idolised – placed on a pedestal to be admired, rather than parented. Such children are presented as ‘more than’ children, which by extension means that they require something ‘less than’ parenting from their caregiver. The parent speaks as if they are something of a spectator (as if they were in awe of the child) rather than actively involved in relating to them. Lacking a genuine connection to the child, in extreme cases this is imagined; an almost magical communication is described, or the child is attributed with mentalising that he or she is developmentally incapable of.

In less threatened relationships, the parent may overlook the child’s less critical needs, through a mildly idealised account of their experiences (which minimise the child’s need for comfort and reassurance when not seriously threatened). Similarly, somewhat business-like parents tend to focus on the tasks involved in parenting, at the expense of fully being ‘present’ to their child as a person – their efficiency and undoubted dedication making up for a lack of joy in the relationship.

Unresponsive and controlling caregiving

Some parents both intrude on the child and distance themselves at different times and in relation to different dangers or level of threat. This is easiest to understand in relation to the different forms it takes. It is most classically seen in Role-reversed relationships: these, unlike purely Unresponsive or purely Controlling patterns are reciprocal (in some way mutual), but unlike Sensitive relationships function to protect and even nurture the parent, rather than the child. The depiction therefore mirrors that of the Sensitive parent, but the nature of the cooperation involved does not support the child’s development.

The unresponsiveness comes from the way in which role-reversing transcripts idealise the child in order to facilitate withdrawal from the parental role. Such a distortion, therefore, functions to support the parent’s leaning upon the child, whose ‘childlikeness’ is ignored or minimised to emphasise the child as a source of support to them. However, most role-reversing relationships also have a strong controlling element to them. This is likely the result of the burden of expectation upon the child to become what the parent needs them to be. The role-reversed parent cannot afford to truly ‘see’ the child’s neediness and vulnerability, which is often dismissed, feared or pathologised. There is only room for the parent to be the needy one in the relationship. Both rejection and idealisation are, therefore, present in the transcript, but not integrated or reflected upon.

Some, more truly unresponsive parents (in the sense of wanting distance from the child) find that the child’s negative affect threatens their equilibrium and the fantasised or idealised ‘safe’ world they seek to inhabit psychologically. The child’s negative affect in these relationships threatens the fantasy, and so the parent must suppress it or dismiss it intrusively. These transcripts are seen as Unresponsive-Rejecting, as the parent’s physically intrusive behaviour and occasional elements of rejecting thought ultimately serve to maintain the distance in the relationship rather than keep the child close. Often these transcripts combine a strongly idealised view of the parent–child relationship and the child herself or himself, with an undercurrent of fear of the child’s negative affect (and the parent’s own ability to manage it). Anger, fear or sadness can take on the quality of ‘the elephant in the room’.

On the other hand, in some seemingly Controlling relationships, hostility towards the child functions to exonerate the parent withdrawing from the child, abdicating the parenting role (because the child is perceived as impossible to help or care for in some way). This category is labelled Controlling-Withdrawal, as in these cases the parent is attempting to intrude and change the child, but their disappointment and frustration at their inability to do so are so great that they have to some degree ‘give up’ on the child. Their behaviour may be neglecting rather overtly punitive towards the child, but an intense struggle with the child is still going in the parent’s mind.

These different patterns can be visualised as a circle, with the horizontal axis depicting the reciprocity and mutuality of the relationship: the absent parent on the left (Unresponsive), and the dominating parent on the right (Controlling). In the middle are the mutually negotiated relationships (Sensitive and Role-reversed): these are differentiated vertically according to the degree in which the parent is able to act as the protective and nurturing one in the relationship (the ‘psychological parent’). The conceptualisation of the Meaning of the Child patterns in the form of a circle owes much to Crittenden’s presentation of her DMM patterns of attachment in adulthood (Crittenden & Landini, 2011), but the MotC patterns do not correspond with Crittenden’s, which are arranged in respect to information processing axes of cognition/affect and falsity of information, rather than the dyadic ones of intrusion/absence and parent/child role depicted here. This reflects the Meaning of the Child’s conceptualisation as inter-subjective and ultimately more systemic way of looking at attachment relationships (in the sense that the patterns are organised by the ‘position’ and ‘role’ that the participants in a relationship take to each other).

Leanne and John: case studies

The discourse of Leanne (mother of Lizzie, who is aged 22 months), a mother whose Meaning of the Child Interview was classified sensitive, is full of warm and affectionate images and rich discourse about her child’s experience that show the positive impact she has upon her mother. Lizzie was very much ‘there’ in the interaction described; her personality and likes and dislikes were vividly described. Leanne was being assessed as part of court proceedings following the removal of her daughter over a year previously. Leanne came from a socially and materially well-off family and married a man with a well-respected job, who was well regarded by her family. Some months after they were married and their (only) child was born, Leanne had agreed to return to work after her maternity leave, but on an early visit to her workplace, Lizzie was thrown by her father who was looking after her, and seriously injured. Leanne initially supported her husband and covered for him, which resulted in her separation from Lizzie. However, by the time of the assessment, Leanne had separated from Lizzie’s father and was doing all she could to have her daughter returned to her care.

Leanne’s separation from Lizzie is intensely felt, but this is not exaggerated or coercive of the interviewer; it is her genuine experience:

What do you like most about Lizzie?

Um . . . that’s quite a difficult question to answer (soft laugh).

It is a difficult question, have a go, have a shot.

(7–8 seconds of silence, thinking)

Well it’s difficult to put my finger on one thing, there’s a couple of things that I really love about Lizzie . . . um (pause) one of them is um (pause) I really love her smile, she’s got, she smiles at everybody but she’s got a particular smile that she turns around and grins for you, for somebody special in her life umm (pause) she’s got a very infectious laugh, she loves to laugh umm (pause), really like that about her umm (pause) Sorry it’s very strange, the way she smells cos she’s my child and it’s a funny parent thing I know, maybe only I’ve got but there’s the smell of Lizzie and I can still go into her room and even though she’s not been there for a very, very long time, it smells like Lizzie in that room (pause) it’s a very strange thing.

It’s not a strange thing.

And even though she’s been with her foster mother, she still smells like Lizzie (pause) um so that’s quite important to me um (pause) and um (pause) but when she calls mummy even if she’s upset or she’s (pause) um happy or you know when she calls for me that really melts my heart even if it’s, even if she’s annoyed with me (laughs) . . .

This is a powerfully emotive passage, but it is so because of the sadness of the situation, not because the listener is coerced through distorted information or one-sided presentation. It is Leanne’s intimate and personal knowledge of and connection with her daughter that make the passage so affecting. Smell is among the most intimate of senses, and its appearance in interviews tends to evidence either the most positive or the most negative (often traumatised) affective responses. It is clear that Lizzie as a person has had as powerful effect upon Leanne as her mother has upon her, but the influence is mutually pleasurable and affirming (even if it also entails loss, given the reality of their situation).

In Sensitive interviews, the ‘co-constructed’ inter-subjectivity is shown in the interview itself as well as the parent’s relationship with their child. Without losing awareness of her own feelings and point of view, Leanne also took the interviewer’s perspective and was open and cooperative in her discussion of her daughter. At times, she moderated the intensity of her feelings by distancing language, but far from distancing herself from the child, or being overly intense, she was in fact regulating herself (and protecting the interviewer) in the face of her very strong emotions. The interviewer has access to Leanne’s feelings about her child and her loss, but they are not pushed upon her.

This ability to allow the listener to form her own conclusions, to make the interview a joint process where both participants are active in deriving meaning from it, was absent in the interviews of more endangered parents. These either retreated from the interview process, contributing just enough to ‘get through’, or sought to control the interview, desperate to ensure that the one and only meaning acceptable to the parent is allowed to dominate. For John, a father trying to reform himself after a period in prison, his 15-month-old son Tommy was presented as the sole motivation and source of John’s reformation from his violent past and his reason for living:

If [Tommy is not returned to my care], I dread to think what I’m going to do, honestly, I think, I think I’m gonna get – ‘bout 15 years jail or something stupid honestly if I don’t get my boy, I dread to think cos – like I said to you, that’s my life – in that little boy’s hands. He holds the key to my heart.

The problem is what John sees in Tommy, and himself as a parent, is largely what he needs to see. Tommy was cast into the role of ‘saviour’, which both placed an unfair burden on a 1-year-old child and necessarily distorted John’s discussion of their relationship. John could not afford to trust Tommy to contribute freely in his own right to the inter-subjective space between them because this would have risked him giving a different meaning to the relationship than the one that John so desperately needs to believe in.

Therefore, John’s descriptions of their relationship were extremely exaggerated and intense. Many of his images were simply not credible. John regularly confused himself with his child, and their perspective was enmeshed and not distinguished. It was clear that whether Tommy’s behaviour is affectionate or distancing, John gives a meaning to it that fits his predetermined script:

The love, the uniqueness of my son and our relationship, cos it’s one of a kind, you won’t get one like me and my son has got, I don’t care who you got, whatever they think . . .

. . . can you tell me about just a particular moment, describe a time with him where, where, that has showed the love there is between you.

Every time I open that door to walk in, to see him, every time, you can just feel the love in the room. Its, I don’t know if that sounds strange but, you just can, I walk in and as soon as his arms come up, and he just wraps himself and squeezes so tight that, that just shows me he loves me and that I do the same back, I show him I love him, but when I put him in the car, he won’t kiss me, he won’t wave goodbye – nothing, it hurts, but I think I know why, cos he’s having to go back, which he doesn’t want to do, you can see it, he doesn’t wanna do it, but that’s my opinion, other people might have their own outlook on that when they see it, and see how he is, but that’s my personal opinion as his father.

There appears nothing that Tommy can do to influence the meaning that John constructs around their relationship, and John’s need to insist on this in the face of what he perceives as hostile attempts by others so see things differently, is both palpable and desperate.

Conclusion: the particular contribution of the meaning of the child

It is the more systemic, inter-subjective approach to classifying parenting representations that represents the most significant contribution of the MotC. This approach allows the Meaning of the Child to be alive to the way in which outside relationships, such as couple, family and wider social relationships, help shape the meaning of the relationship for both parent and child, in addition to the influence of the parent’s childhood attachment experiences. It also enables the MotC to explain differences in children who share the same carer, giving attention to the way in which meaning is ‘co-constructed’ in a specific relationship. Finally, the MotC avoids lumping all ‘at-risk’ relationships within a ‘catch-all’ category (usually relating in some way to ‘disorganised’ attachment) or simply scoring the level of risk, and so can make meaningful distinctions between differently functioning struggling relationships. This extends its clinical and forensic potential through its ability to identify dyads and families whose relationships work very differently from each other, resulting in differing developmental pathways for the child. We hope that by differentiating different patterns of thinking associated with problematic and at times dangerous caregiving, the MotC can make a fruitful contribution to both practice and future research.

Footnotes

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

Author biographies

Ben Grey is a Co-Director and Founder of Cambridge Centre for Attachment, which aims to integrate attachment theory, research, and assessment methods into work with endangered parents and children. He is a social worker, and visiting lecturer at the University of Roehampton. He is the author of the Meaning of the Child Interview (MotC), and trains professionals nationally on this procedure, and other aspects of child and adult attachment, caregiving, and endangered relationships.

Steve Farnfield is a Senior Lecturer and Convenor of the MSc in Attachment Studies at the University of Roehampton. He is a Social Worker and Play Therapist and licensed trainer for various DMM attachment assessment procedures including the AAI. Steve is author of the Child Attachment and Play Assessment, a new method of analysing children’s story stems for attachment strategy and unresolved trauma. His interests include child an adult attachment in the context of family stress, child maltreatment, fostering and adoption. With Paul Holmes he is co-editor of the three volume Routledge Handbooks of Attachment.

References

Aber

Slade

Berger

Bresgi

Kaplan

(1985). The Parent Development Interview: Interview protocol. Unpublished manuscript, Barnard College, Columbia University, New York, NY.

Ainsworth

M. D. S.

Blehar

M. C.

Waters

Wall

(1978). Patterns of attachment: A psychological study of the Strange Situation. Hillsdale, NJ: Lawrence Erlbaum.

Beebe

Lachmann

F. M.

Markese

Bahrick

(2012). On the origins of disorganized attachment and internal working models: Paper I. A dyadic systems approach. Psychoanalytic Dialogues, 22, 253–272.

Beebe

Lachmann

F. M.

Markese

Buck

K. A.

Bahrick

L. E.

Chen

. . . Jaffe

(2012). On the origins of disorganized attachment and internal working models: Paper II. An empirical microanalysis of 4-month mother–infant interaction. Psychoanalytic Dialogues, 22, 352–374.

Benoit

Zeanah

C. H.

Parker

K. C.

Nicholson

Coolbear

(1997). ‘Working model of the child interview’: Infant clinical status related to maternal perceptions. Infant Mental Health Journal, 18, 107–121.

Crittenden

P. M.

(2003). A dynamic maturational approach to continuity and change in patterns of attachment (Chapter 18). In Crittenden

P. M.

Claussen

(Eds.), The organisation of attachment relationships: Maturation, culture, and context (pp. 343–357). New York, NY: Cambridge University Press.

Crittenden

P. M.

(2008). Raising parents. Devon, UK: Willan.

Crittenden

P. M.

(2010). CARE-Index: Infants. Coding manual (Unpublished manuscript). Family Relationships Institute, Miami, FL.

Crittenden

P. M.

Bonvillian

J. D.

(1984). ‘The effect of maternal risk status on maternal sensitivity to infant cues’. American Journal of Orthopsychiatry, 54, 250–262.

10.

Crittenden

P. M.

Dallos

Landini

Kozlowska

(2014). Attachment and systemic family therapy. Maidenhead, UK: McGraw-Hill.

11.

Crittenden

P. M.

Landini

(2011). Assessing adult attachment: A dynamic-maturational approach to discourse analysis. New York, NY: W.W. Norton.

12.

Crittenden

P. M.

Partridge

M. F.

Claussen

A. H.

(1991). Family patterns of relationship in normative and dysfunctional families. Development and Psychopathology, 3, 491–512.

13.

Farnfield

(2008). A theoretical model for the comprehensive assessment of parenting. British Journal of Social Work, 38, 1076–1099.

14.

Farnfield

(2014). The assessment of attachment and parenting. In Farnfield

Holmes

(Eds.), The Routledge handbook of attachment: Assessment (pp. 17–36). London, England: Routledge.

15.

Farnfield

Hautamäki

Nørbech

Sahhar

(2010). DMM assessments of attachment and adaptation: Procedures, validity and utility. Clinical Child Psychology and Psychiatry, 15, 313–328.

16.

Fearon

Shmueli-Goetz

Viding

Fonagy

Plomin

(2014). Genetic and environmental influences on adolescent attachment. Journal of Child Psychology and Psychiatry, 55, 1033–1041.

17.

Fonagy

Steele

(1991). Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age. Child Development, 62, 891–905.

18.

Fonagy

Target

Steele

(1998). Reflective-functioning manual, version 5.0, for application to Adult Attachment Interviews. Unpublished manuscript, University College London, England.

19.

George

Kaplan

Main

(1985). The Berkeley Adult Attachment Interview (Interview protocol). Berkeley: Department of Psychology, University of California–Berkeley.

20.

George

Solomon

(2008). The caregiving system: A behavioral systems approach to parenting. In Cassidy

Shaver

(Eds.), Handbook of attachment: Theory, research, and clinical applications (Vol. 2, pp. 833–856). New York, NY: Guilford Press.

21.

Grey

(2014a, June). The meaning of the child to the parent: An inter-subjective approach to assessing representations of caregiving. Poster presented at the WAIMH Conference, Edinburgh, UK.

22.

Grey

(2014b). The meaning of the child to the parent: The development and validation of a new method of classifying parenting interviews for the nature of the parent-child relationship (PhD thesis). University of Roehampton, London, England.

23.

Grey

Farnfield

(2016). The Meaning of The Child Interview (MotC) – The preliminary validation of a new procedure for assessing and understanding the parent-child relationships of ‘at risk’ families. DOI: https://doi.org/10.1177/1359104516633495.

24.

Grienenberger

Kelly

Slade

(2005). Maternal RF, mother–infant affective communication, and infant attachment: Exploring the link between mental states and observed caregiving behavior in the intergenerational transmission of attachment. Attachment & Human Development, 7, 299–311.

25.

Hesse

(2008). The Adult Attachment Interview: Protocol, method of analysis, and empirical studies. In Cassidy

Shaver

(Eds.), Handbook of attachment: Theory, research, and clinical applications (Vol. 2, pp. 552–598). New York, NY: Guilford Press.

26.

Luyten

Fonagy

(2014). Assessing mentalizing in attachment contexts. In Farnfield

Holmes

(Eds.), The Routledge handbook of attachment: Assessment (pp. 210–216). London, England: Routledge.

27.

Lyons-Ruth

(1999). The two-person unconscious: Intersubjective dialogue, enactive relational representation, and the emergence of new forms of relational organization. Psychoanalytic Inquiry, 19, 576–617.

28.

Madigan

Bakermans-Kranenburg

Van IJzendoorn

Moran

Pederson

Benoit

(2006). Unresolved states of mind, anomalous parental behaviour, and disorganised attachment: A review and meta-analysis of a transmission gap. Attachment & Human Development, 8, 89–111.

29.

Main

Goldwyn

(1994). Adult Attachment Interview scoring and classification manual. Unpublished manuscript, University of California–Berkeley.

30.

Meins

Fernyhough

Wainwright

Clark-Carter

Das Gupta

Fradley

Tuckey

(2003). Pathways to understanding mind: Construct validity and predictive validity of maternal mind-mindedness. Child Development, 74, 1194–1211.

31.

Miller

(1979). Depression and grandiosity as related forms of narcissistic disturbances. International Review of Psycho-Analysis, 6, 61–76.

32.

Oppenheim

Koren-Karie

(2009). Parents’ insightfulness regarding their children’s internal worlds: Assessment, research, and clinical implications. In Zeanah

C. H.

(Ed.), Handbook of infant mental health (Vol. 3, pp. 266–280). New York, NY: Guilford Press.

33.

Reder

Duncan

(1999). Lost innocents: A follow-up study of fatal child abuse. London, England: Routledge.

34.

Reder

Duncan

Gray

(1993). Beyond blame: Child abuse tragedies revisited. London, England: Routledge.

35.

Sahhar

(2014). An expanded approach to the Adult Attachment Interview. In Farnfield

Holmes

(Eds.), The Routledge handbook of attachment: Assessment (pp. 156–177). London, England: Routledge.

36.

Schacter

D. L.

Tulving

(1994). What are the memory systems of 1994? In Schacter

D. L.

Tulving

(Eds.), Memory systems (pp. 1–38). Cambridge, MA: Bradford.

37.

Slade

(2005). Parental reflective functioning: An introduction. Attachment & Human Development, 7, 269–281.

38.

Slade

Bernbach

Grienenberger

Levy

Locker

(2005). Addendum to reflective functioning scoring manual. Unpublished manuscript, The Psychological Center, The City College of New York, New York.

39.

Slade

Cohen

L. J.

Sadler

L. S.

Miller

(2009). The psychology and psychopathology of pregnancy. In Zeanah

C. H.

(Ed.), Handbook of infant mental health (Vol. 2, pp. 22–39). New York, NY: Guilford Press.

40.

Slade

Grienenberger

Bernbach

Levy

Locker

(2005). Maternal reflective functioning, attachment, and the transmission gap: A preliminary study. Attachment & Human Development, 7, 283–298.

41.

Solomon

George

(2011). The disorganized attachment-caregiving system. In Solomon

George

(Eds.), Disorganized attachment and caregiving (Vol. 1, pp. 3–24). New York, NY: Guilford Press.

42.

Suchman

N. E.

DeCoste

Leigh

Borelli

(2010). Reflective functioning in mothers with drug use disorders: Implications for dyadic interactions with infants and toddlers. Attachment & Human Development, 12, 567–585.

43.

Van IJzendoorn

(1995). Adult attachment representations, parental responsiveness, and infant attachment: A meta-analysis on the predictive validity of the Adult Attachment Interview. Psychological Bulletin, 117, 387–403.

44.

Vygotsky

L. S.

(1967). Play and its role in the mental development of the child. Journal of Russian and East European Psychology, 5, 6–18.

45.

Winnicott

(1967). The Mirror-role of the mother and family in child development. In Logan

(Ed.), The Predicament of the Family: A Psycho-Analytical Symposium (Vol. 1, pp. 26–33). London, England: Hogarth Press.

46.

Zeanah

(2007). Constructing a relationship formulation for mother and child: Clinical application of the working model of the child interview. In Oppenheim

Dolev

Koren-Karie

Sher-Censor

(Eds.), Attachment theory in clinical work with children: Bridging the gap between research and practice (pp. 3–30). New York, NY: Guilford Press.

47.

Zeanah

Benoit

Hirshberg

Barton

(1986). Working model of the child interview: Rating scales and classifications. Unpublished manuscript, School of Medicine, Louisiana State University, New Orleans.