Reflective Parental Functioning and Reactive Attachment Disorder: Theoretical Considerations

The theory of reflective functioning (RF) which has gained notoriety in scientific literature these last fifteen years, offers a pertinent conceptual framework for the clinical work with children suffering from reactive attachment disorder (RAD) and their parents. Through a critical review of scientific literature on the subject, the relationships between RF and RAD are explored and linked to the clinical manifestations of the disorder. Two aspects of the primary care-giving relationships, constancy and contingency, are detailed as having a crucial impact on the development of a non-defensive reflective functioning in the child and a feeling of security in the parent-child attachment relationship. The persistence in the mother of a pre-mentalization mode of reflective functioning—equivalent or pretend mode— is thought to account for the emergence of some symptoms related to RAD in the child.