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. Author manuscript; available in PMC: 2024 Mar 1.
Published in final edited form as: Infant Ment Health J. 2023 Mar 1;44(2):255–267. doi: 10.1002/imhj.22044

Self-Reported Reflective Functioning and Father-Child Interactions in a Sample of Fathers who have used Intimate Partner Violence

Carla S Stover 1, Angela Farren 1, Ryan Campbell 2, Michele J Day 3, Zoe Sernyak 1
PMCID: PMC10901457  NIHMSID: NIHMS1876203  PMID: 36860128

Abstract

Reflective functioning (RF) has been found to be associated with mother-child interactions, but less is known about the association of fathers’ self and child-focused RF and father-child relationships. Fathers who have histories of intimate partner violence (IPV) are known to have poor RF, which may impact their father-child interactions. The current study was designed to examine how types of RF are associated with father-child relationships. Pretreatment assessments and recorded, coded father-child play interactions were used to examine associations among fathers’ history of adverse childhood experiences (ACES), RF and coded father-child play interactions in a sample of 47 fathers with a history of IPV use in the last 6 months with their coparent. Fathers’ ACES and their child’s mental states (CM) were associated with father-child dyadic play interactions. Fathers with greater ACES and higher scores on CM had the most dyadic tension and constriction during play interactions. Those with high ACES but low CM had scores similar to those with low ACES and low CM. These results indicate that fathers who have used IPV and have a history of significant adversity may benefit from interventions to increase their child-focused RF and further improve their interactions with their children.

Keywords: Reflective Functioning, Fathers, Intimate Partner Violence, Father-Child Relationships

Reflective functioning (RF) has been defined as the capacity to understand and interpret one’s own and other’s behavior as an expression of mental states such as feelings, thoughts, fantasies, beliefs, and desires (Fonagy et al., 2018). The absence of RF is at the core of several kinds of psychopathology, including anxiety, depression, personality disorders and relational problems (Fonagy et al., 2002; Suchman et al., 2010) including aggression and intimate partner violence (IPV) (Bateman et al., 2016; Fonagy, 2003; Mohaupt & Zuckert, 2016). Several studies of men with co-occurring histories of IPV and substance use disorders, compared to control men without these issues, found that a history of IPV was associated with deficits in understanding the mental states of others (Romero-Martinez et al., 2013; Stover & Spink, 2013, Stover & Kiselica, 2014). These findings suggest that deficits in RF may contribute to relational difficulties of fathers with a history of IPV and substance misuse.

Suchman and colleagues (2010) identified two types of RF: self-focused RF and child-focused RF. Self-focused RF is the understanding of one’s own feelings and thoughts, whereas child-focused RF is the ability to think about the emotions, thoughts, and motivations of one’s children (Suchman et al., 2010). Child-focused RF entails parents’ ability to understand their children’s behaviors as the result of their emotional states and motivations, as well as parents’ self-focused internal reflections about their roles as parents (Slade, 2005). Parents’ self-reflection abilities can impact their attachment styles and concrete parenting behaviors, and therefore influence their child’s behavior (Slade, 2005). Poor child-focused RF is of particular interest because it has been shown to be associated with insecure mother-child attachment and more distressed mother-child interactions (Brennan et al., 1998; Camoirano, 2017; Slade et al., 2005).

No one understood these connections better than Dr. Nancy Suchman. She spent her career developing, testing, and disseminating RF-focused interventions for mothers who misused substances. She was one of the first to study RF-focused treatment for mothers of young children who were addicted to opioids. She found that changes in RF were associated with improved mother-child interactions (Suchman et al., 2017). Nancy’s work informed the research and intervention work of the many trainees and junior faculty she mentored. Her work with mothers in substance misuse treatment inspired work with fathers that have similar substance misuse and parenting difficulties. Moreover, her work influenced the development of an emerging treatment for fathers with co-occurring family violence (FV) and substance misuse called Fathers for Change. Fathers for Change focuses on RF and emotion regulation to reduce fathers’ use of family violence and substance misuse, while improving father-child interactions (Stover, 2015; Stover et al., 2019, 2020). Despite burgeoning work related to maternal RF and mother’s parenting, there has been a dearth of research for fathers in this area. Nancy encouraged this work and shared her knowledge and expertise to guide the work that continues in this area. The current study was designed to further understand how self and child-focused RF are associated with father-child interactions in a sample of fathers who have used IPV. This work extends the kind of examination Dr. Suchman pioneered considering both self and child-focused RF and how they may differentially impact parent-child relationships in parents who are considered high-risk for parenting difficulties.

Understanding the connection between self-focused and child-focused RF, IPV and parenting are vital because many fathers who use IPV continue to remain important in their children’s lives (Israel & Stover, 2009). Some fathers who have used IPV behaviors have positive relationships with their children; however, research has also shown that children who grew up with a father who used IPV behavior are more likely to use IPV as adult men or become victims of IPV as adult women (Whitfield et al., 2003). Understanding protective factors to the father-child relationship, like RF, has implications for assessment in families experiencing IPV because they allow for evaluation of strengths in families that mean better outcomes. Identification of such factors could also assist with father-child contact decisions and needed interventions to promote a healthy and safe father-child relationship. Similar to previous effective interventions with mothers, RF is an important area of intervention for fathers (Sadler et al., 2013; Suchman et al., 2013). In order to advance such interventions, a better understanding is needed in regard to the aspects of RF that contribute to father-child interactions in families with IPV.

Factors Associated with Poor RF

Development of RF skills are influenced by external factors, including adverse childhood experiences (ACES), like childhood abuse and neglect. Child-focused RF has been shown to be negatively associated with both mothers’ and fathers’ retrospective reports of their own histories of emotional abuse and neglect (Hakansson et al., 2018; Mohaupt & Zukert, 2016). However, the relationship is complex and may not be linear. A study by Ensink and colleagues (2014) found that childhood trauma did not, by itself, necessitate poor RF, but parents who had trauma histories and were unable to mentalize about abusive experiences were more likely to have poor RF. Several studies in women found neither the severity of past maternal trauma nor PTSD to predict RF (Huth-Bocks et al., 2014; Schechter et al., 2005; Stacks et al., 2014). This has led to the conclusion that the ability to mentalize about one’s experiences of abuse and neglect are most helpful to developing resilience to poor relationship outcomes (see Allen, 2013 for a review). Although ACES, like child maltreatment, are considered a risk factor for developing poor RF (Cicchetti et al., 2003), a study of parents with a history of childhood abuse and neglect who had strong RF, had secure attachments with their children (Arnott & Meins, 2007). This suggests strong RF may be protective for parents who have experienced childhood abuse and neglect in regard to their own parenting. These findings have led to the development of RF-focused interventions for mothers, with the hope of intervening in the intergenerational transmission of child maltreatment (Camoirano, 2017). Less has been understood how ACES impact fathers’ RF and how these may be associated with father-child interactions or fathers’ parenting. Fathers who have used IPV behaviors have significantly higher likelihood of having experienced child maltreatment or ACES and these have been correlated with poor RF (Stover & Spink, 2012; Mohaupt & Zuckert, 2016) indicating a need to further understand the unique contributions of ACES and paternal RF to father-child interactions, especially with fathers who have used IPV behaviors.

Paternal Parenting, RF and Father-Child Relationships

Despite burgeoning work related to mothering, maternal RF and mother’s parenting, there is a dearth of research on paternal parenting by comparison. According to the U.S. Census Bureau (2018), 19.5 million children, more than 1 in 4, live without a father in the home. Early research on fathers was focused on their involvement and primarily revealed a host of adverse effects of fathers’ absence on children’s wellbeing (Balcom, 1998; Cabrera et al., 2000). Most of these early studies examined father involvement in terms of presence vs. absence, equating involvement with residency in most studies rather than any measure of father-child relationship quality (Cabrera, 2019). Focus on fathers as present, sensitive, and nurturing caregivers and the possible benefits to their children has received much less attention in the literature (Cabrera et al., 2000; 2018). However, growing research has shown that fathers can be just as nurturing as mothers (Cabrera et al., 2007; Mills-Koonce et al., 2015) and that warmth and affection in the father-child relationship are associated with the most positive child outcomes related to fathers’ involvement with their children (Cabrera et al., 2000). Further research has shown that fathers also play an outsized role in helping children develop prosocial behaviors while regulating negative emotions and anger (Shewark & Brandon, 2014). These studies highlight the importance of not only time fathers spend with their children, but the quality of the relationships that are formed (Teufl & Ahnert, 2022). How RF may be associated with father-child relationship quality is much less understood.

A few studies of paternal RF and child development have highlighted differences in mothers’ and fathers’ RF skills and the unique contributions of paternal RF. Pazzagli and colleagues (2017) explored the differences between mother’s and father’s scores on the Parental Reflective Functioning Questionnaire (PRFQ; Luyten et al., 2017). Results found that mothers reported higher interest in the child’s thoughts and feelings, as well as greater curiosity about children’s states of mind that motivate their behaviors than fathers. This significant difference in child-focused RF in mothers compared to fathers is consistent with previous studies that examined RF in samples of fathers (Arnott & Meins 2007; Esbjørn et al., 2013; Madsen et al., 2007; Stover and Kiselica 2014). Fathers may generally show less emphasis on their children’s emotional states and focus more on stimulating and exploratory play interactions with their children (Pazzagli et al., 2018). Arnott and Meins (2007) found that fathers made more inappropriate comments than mothers about their 6-month-old infants’ internal states during a free-play laboratory session, which may be associated to the fathers’ rating in their certainty about their child’s mental states. The certainty of mental states (CM) is their ability to recognize that their children’s mental states may not be readily apparent (Luyten et al., 2017). This child-focused RF scale is associated with fathers’ reports of their secure attachment style (Pazzagli et al., 2018).

Several studies have examined RF of fathers of toddlers and preschoolers. Buttitta and colleagues (2019) coded RF from narrative accounts of parenting by 77 fathers of toddlers. Results showed that higher levels of RF were associated with more social emotional supporting behaviors of fathers during interactions. These behaviors were associated with reduced child distress. Two prior studies examined RF in samples of fathers with IPV behaviors (Stover & Coates, 2015; Stover & Kiselica, 2014). In a small sample of 24 father-child dyads in which all fathers had co-occurring IPV and substance misuse, results revealed paternal RF as measured by the Parent Development Interview (PDI; Slade, 2005) was not significantly associated with observed parent-child behaviors during interactions. However, substance misuse severity and IPV severity were associated with child avoidant behavior, dyadic tension, and dyadic constriction (Stover & Coates, 2015). This study had a very small sample and did not examine the fathers’ trauma histories or distinguish self and child-focused RF. In a sample of 79 fathers of preschool children, half with histories of IPV and substance misuse, RF was not significantly associated with fathers’ self-reported parenting behaviors when IPV behaviors and substance misuse were included in regression models (Stover & Kiselica, 2014). This study included all self-report measures with no direct observations of fathers’ behaviors. The lack of association of RF and parenting or father-child interactions in these studies was surprising but may be due to the limited range of RF displayed by fathers in the samples with a mean of around 3 (low RF) in each study. The range of scores in the Stover and Kiselica (2014) sample was two to five on a nine-point scale. Further examination of how RF is associated with father-child interactions is needed to understand these prior unexpected findings.

Current Study

The current study was designed to examine the association between fathers’ self-focused and child-focused RF and father-child interactions in a sample of fathers who have used IPV with a co-parent in the last six months. We hypothesized better self- and child-focused RF in fathers would contribute unique variance in dyadic interactions with their children. Examining the role of RF in father-child interactions in the context of IPV will expand understanding of the extent to which RF is related to parenting behaviors and dyadic interactions in this population of fathers. Since RF has been increased through targeted interventions with mothers to improve maternal sensitivity and parent-child interactions, data can inform interventions for fathers who have caused harm to improve their parenting and parent-child interactions.

Given previous research has associated childhood experiences of adversity, family violence, and abuse with the development of poor RF, and RF has been associated with quality of parent-child interactions, we will test the following specific hypotheses: 1) Greater experiences of adverse childhood experiences (ACES), greater certainty of the child’s mental states (CM), and uncertainty in self-focused RF will be uniquely associated with poorer father-child interactions; and 2) child focused-RF will moderate the association between fathers’ ACES history and their interactions with their children.

Methods

Participants

The sample consisted of 47 fathers who were referred for intervention for use of IPV at an outpatient parenting clinic. All participants had histories of using IPV based on a report to child protective services or the police and a biological child under the age of 12 years. Ages ranged from 20 to 53 years for fathers (Mage = 33.19, SD = 8.27) and 6 to 120 months (10 years) for the children (Mage = 50.81, SD = 38.13). Fathers in the sample were 55% Black, 19% White, 13% Other race, 9% Mixed race, and 4% did not report race; 29.8% of the fathers in the sample reported their ethnicity as Hispanic or Latino. The majority (66%) of fathers reported never being married, while 23% of fathers were married, 9% were divorced, and 2% were separated from their spouses. Most fathers (38%) lived with at least one of their children, 32% saw their children daily or almost daily, 23% saw their children 2 to 5 times a week, 2% saw their children once a week, 2% saw their children several days per month, and 2% saw their children once a month.

Procedure

Participants were recruited to the Fathers for Change Study through the Parent and Family Development Program at the Yale Child Study Center after being referred for services by family relations or child protective services in the New Haven, CT area. All participants were in a randomized treatment study of two IPV interventions for fathers. Data from the current study were drawn from baseline assessments prior to treatment for participants who met the following inclusion criteria: (a) fathers had used IPV against the coparent of the target child (based on referral from Child Protection or the Criminal Court, (b) they had a biological child under 12 with the coparent who participated in father-child interactional assessment, and (c) they had contact with their child on at least a monthly basis. Fathers were excluded if (a) they had an untreated bipolar or psychotic disorder, were currently suicidal or homicidal (based on fathers’ reports of symptoms on the Brief Symptom Inventory), (b) had a full no-contact protective order pertaining to their child, or (c) had threatened their coparent with a weapon or caused injuries requiring hospitalization (based on collateral reports from coparents, police or DCF records).

Fathers were screened for eligibility and then met with trained research assistants (RAs) over Zoom to complete informed consent and baseline study measures, which were read aloud and displayed visually through Zoom’s screen share feature. Participants were asked to keep their cameras on for the duration of the interview as RAs went over the study measures to ensure minimal distractions. Fathers then attended a video recorded play assessment with their youngest biological child in person, after which they were paid $50, and their child was given a small toy. All study procedures were approved by the Yale University Institutional Review Board and confidentiality of participants is protected by an NIH certificate of confidentiality.

Measures

Self-focused RF.

The Reflective Functioning Questionnaire (RFQ-8; Fonagy et al., 2016) measures one’s ability to mentalize, or understand the feelings, intentions, and attitudes underpinning behaviors (e.g., “People’s thoughts are a mystery to me”). Responses to 8 statements are scored on a 7-point Likert-type scale (1 = strongly disagree to 7 = strongly agree). The RFQ contains two scales to assess certainty (RFQc) and uncertainty (RFQu) of one’s mental states. Due to concerns over the scoring and validity of the RFQc scale (Müller et al., 2020), we used the RFQu scale in our study. Scores were calculated as outlined by the measure developers in Fonagy et al. (2016). High scores indicate hypo mentalizing, or difficulty analyzing one’s own mental states. Conversely, low scores on this scale reflect a more realistic, moderate understanding of one’s mental states. Internal consistency reliability for the current sample for the RFQu scale was acceptable at α = .71.

Child-focused RF.

The Parental Reflective Functioning Questionnaire (PRFQ; Luyten et al., 2017) assesses the capability of parents to gauge their own mental states as well as those of their children (e.g. I can completely read my child’s mind; I can sometimes misunderstand the reactions of my child). Responses based on agreement with the 18 items are scored on a 7-point Likert-type scale. The measure includes three scales: Pre-Mentalizing (PM) which captures a non-mentalizing stance, malevolent attributions, and an inability to enter the subjective world of the child in particular (e.g., “My child cries around strangers to embarrass me”). The second scale, Certainty about Mental States (CM), measures parents’ tendencies to be overly certain about the mental states of their children (i.e., to not recognize the opacity of mental states), reflecting intrusive mentalizing or hyper mentalizing. The third scale captures Interest and Curiosity (IC) in mental states (e.g., “I like to think about the reasons behind the way my child behaves and feels”). Low levels reflect an absence of interest in one’s child’s mental states. Internal consistency for the PRFQ scales in this sample were (CM = .72; PM = .72; and IC = .60). This study focused on the CM scale given previous studies indicating CM may be associated with father-child interactions (Arnott & Meins, 2007; Pazzagli et al., 2018).

ACES.

Thirty-one questions from the Adverse Childhood Experiences International Questionnaire (ACE-IQ; WHO, 2018) were used to document common childhood stressors such as abuse, neglect, IPV between parents, bullying, death or incarceration of a parent, guardian, or relative, and community violence such as civil unrest, gang violence, police brutality, or war. Previous studies have linked adverse childhood experiences, especially experiences of abuse and neglect to RF in mothers (Håkansson et al., 2018; Kolomeyer et al., 2016). The current study utilized the ACES-total severity score which is a sum of all types of adversities experienced with weighting for more frequent experiences (e.g., witnessing “many times”).

Father-Child Contact.

The amount of contact fathers had with the target child who participated in the play assessment over the past 12 months was reported by fathers on a 7-point scale as follows: (1) less than once per month, (2) once a month (10 to 14 days of the year), (3) several times a month (14 to 40 days of the year), (4) once a week, (5) several times (between 2 and 5 days) per week, (6) daily or almost daily, or (7) if they lived with their children full-time.

CIB.

The Child Interactive Behavior Coding (CIB; Feldman, 1998) was used to assess quality of father-child interactions during a 15-minute play observation that was recorded and later coded by a trained reliable CIB coder on scale of 1 to 5. Training consisted of didactic training with the measure developer and coding practice tapes until reaching reliability >.80 with the developer. Play sessions consisted of 15 minutes of free father-child play and 5 minutes of clean-up. For the purposes of this study, we used the following CIB codes that were appropriate across the age ranges of children in our sample and had a range of scores within our sample to allow for statistical analysis: 1) dyadic reciprocity and fluency; and 2) dyadic constriction and tension. Infant, preschool, or child coding guidelines for the CIB were used depending on the age of the child. Dyadic reciprocity is characterized by mutually positive interactions and dyadic fluency is a natural, cohesive pattern or flow observed in the interactions between the father and child. These two scales were combined for a sum score ranging from 2 to 10. Dyadic constriction reflects a rigid, inhibited father-child interaction and dyadic tension is a strained, antagonistic interaction. These were also combined for a sum score of 2 to 10. These scales were combined to reduce individual outcomes given their high association with one another and consistency of constructs.

Analytic approach

First, descriptive statistics and variable distributions were examined, followed by performed data transformations to adjust for skew. RFQ-Uncertainty was log transformed. Next bivariate correlations were examined for all study variables. Next, two linear regression models were computed to examine the associations among fathers’ ACES, RFQ-uncertainty and PRFQ-Certainty of Mental States (CM) and the father-child interaction outcomes of: dyadic reciprocity/fluency and dyadic tension/constriction. Last, moderation analyses were conducted to examine whether CM moderated the association between ACES and father-child interactions on two dyadic interaction scales.

Results

Means and standard deviations and Pearson product-moment correlations of all variables of interest can be seen in Table 1. Interestingly, the PRFQ scales were not significantly correlated with the RFQ uncertainty scale. The ACES also was not significantly correlated with any of the RF scales on the PRFQ or the RFQu. There were significant correlations among the father-child interaction variables and several of our proposed independent variables. Dyadic reciprocity/fluency was negatively correlated with fathers’ certainty of their child’s mental states (CM) and ACES scores. Dyadic tension/constriction showed positively significant correlations with ACES. Dyadic tension/constriction also showed a positively significant correlation to CM. Father-child contact and child age were examined to determine associations with study variables. Father-child contact was not significantly associated with any study variables so was not included in subsequent models. There was a significant association between child age and father-child play interaction variables and this variable was retained in our regression models.

Table 1.

Means, standard deviations and Pearson correlations among all predictors and outcomes.

Variable M SD Min Max 1 2 3 4 5 6 7 8 9 10 11
1. Dyadic Reciprocity 3.76 0.93 1.50 5.00 –
2. Dyadic Fluency 3.77 0.97 1.50 5.00 .794** –
3. Dyadic Tension 1.26 0.66 1.00 4.00 −.622** −.567** –
4. Dyadic Constriction 1.38 0.74 1.00 4.00 −.745** −.660** .890** –
5. DY _FLUa 7.52 1.80 3.00 10.00 .945** .949** −.628** −.741** –
6. TEN_CONb 2.64 1.36 2.00 8.00 −.707** −.634** .969** .975** −.707** –
7. RFQuc −0.07 0.24 −0.78 0.40 0.051 −0.091 −0.036 −0.071 −0.022 −0.056 –
8. Certainty of mental statesd 4.60 1.23 1.33 6.50 −.334* −.297* 0.251 .365* −.332* .320* −0.077 –
9. Interest in curiosityd 5.97 0.94 3.33 7.00 −0.176 −0.141 0.147 0.068 −0.167 0.108 −0.176 .306* –
10. Total ACEse 4.66 2.99 0.00 11.00 −.342* −.360* .376** .370* −.371* .383** −0.002 −0.079 0.078 –
11. Father-child contact 5.96 1.12 2.00 7.00 −0.135 −0.139 −0.014 0.007 −0.145 −0.003 −0.030 0.032 0.150 −0.076 –
12. Child age (months) 50.81 38.13 6.00 120.00 .424** .331* −0.245 −0.250 .398** −0.255 0.150 0.038 0.064 −0.184 −0.282
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a

Sum of Dyadic Reciprocity and Dyadic Fluency Scores

b

Sum of Dyadic Tension and Dyadic Constriction scores

c

Reflective Functioning Questionnaire, uncertainty

d

Subcatergories of the PRFQ, the Parental Reflective Functioning Questionnaire

e

Total score of ACESs, Adverse Childhood Experiences

**

p < 0.01.

*

p < 0.05.

Associations of ACES, self-focused and child-focused RF and father-child interactions

Represented in table 2, two linear regressions were computed to examine the association of child age, fathers’ ACES, CM, and uncertainty about their own mental states (RFQu) with the following father-child interaction variables (dyadic reciprocity/fluency and dyadic tension/ constriction). The model for dyadic reciprocity/fluency was significant accounting for 34.2% of the variance. Child age, ACES and CM were all significant individual predictors. ACES and CM were negatively associated with dyadic reciprocity. The regression model for dyadic tension/constriction was also significant with the set of predictors accounting for 24.3% of the variance. Similarly, to the previous model ACES and CM were significant individual variables each with positive associations with dyadic tension and constriction.

Table 2.

ANOVA Summary and Regression Coefficients for All Outcomes.

ANOVA Regression Coefficients
Unstandardized 95% CI
Outcome Model Adjusted R2 Sum of Squares df Mean Square F Predictor b SE p lower upper
Fluency/Reciprocity Regression 0.342 59.624 4 14.906 6.967** (Constant) 10.091 0.987 0.000 8.217 11.819
Residual 89.855 42 2.139 RFQua −0.201 0.073 0.009 −2.366 0.983
Total 149.479 46 Total ACESb −0.790 0.894 0.382 −0.348 −0.040
CMc −0.559 0.177 0.003 −0.894 −0.216
Child age 0.017 0.006 0.005 0.005 0.031
Tension/ Constriction Regression 0.243 26.223 4 6.556 4.69** (Constant) 0.389 0.797 0.628 −1.083 1.726
Residual 58.628 42 1.396 RFQua 0.170 0.059 0.006 −1.378 1.215
Total 84.851 46 Total ACESb 0.013 0.722 0.986 0.039 0.314
CMc 0.395 0.143 0.008 0.099 0.737
Child age −0.007 0.005 0.138 −0.017 0.001
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a

Reflective Functioning Questionnaire, uncertainty

b

Total score of ACES, Adverse Childhood Experiences

c

Subcategory of the Parental Reflective Functioning Questionnaire, Father’s Certainty of M ental States

**

p < 0.01.

*

p < 0.05.

Moderating role of child-focused RF on the association between ACES and father-child interactions

As seen in Table 3, the regression model for dyadic reciprocity/fluency was significant with the set of predictors accounting for 22.1% of the variance. Both CM and ACES were significant individual predictors, however the interaction of fathers’ ACES with CM was not significant. For dyadic constriction/ tension, the overall regression model was significant accounting for 36.1% of the variance. CM, ACES and the interaction of ACES and CM were significant. Fathers with high ACES and high CM had more tension and constriction in their father-child interactions as depicted in Figure 1.

Table 3.

Moderator Analysis Using Hierarchical Multiple Regression

ANOVA Regression Coefficients
Unstandardized 95% CI
Outcome Model Adjusted R2 Sum of Squares df Mean Square F Predictor b SE p lower upper
Fluency/Reciprocity Regression 0.229 41.796 3 13.932 5.563** (Constant) 7.503 0.232 <.001 7.035 7.971
Residual 107.682 43 2.504 Zscore(Total ACES)c −0.68 0.24 0.007 −1.164 −0.197
Total 149.479 46 Zscore(CM)d −0.661 0.234 0.007 −1.134 −0.189
Total ACESxCM −0.238 0.303 0.437 −0.849 0.373
Tension/Constriction Regression 0.361 34.13 3 11.377 9.645** (Constant) 2.688 0.159 <.001 2.367 3.009
Residual 50.721 43 1.18 ZscoreTotal ACES 0.45 0.164 0.009 0.118 0.781
Total 84.851 46 Zscore CM 0.494 0.161 0.004 0.17 0.818
Total ACESxCM 0.64 0.208 0.004 0.221 1.059
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Note: ACES= Adverse Childhood Experience Sum Score; CM = Certainty of Mental States from PRFQ

Figure 1. Moderation of the effect of Fathers’ Certainty of Child’s Mental States on Tension/Constriction during Father-Child Interaction at high and low values of the moderator ACES Score.

Figure 1

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a Subcatergory of the Parental Reflective Functioning Questionnaire, Father’s Certainty of Mental States

b Total score of ACES, Adverse Childhood Experiences

Discussion

Following the legacy of Nancy Suchman’s work, this study explored relationships among paternal self-focused and child-focused RF and father-child interactions. The goal was to explore how self-focused and child-focused RF uniquely contribute to father-child interactions to inform intervention development for at-risk fathers and their children. Results of this study indicated that both fathers’ history of adverse childhood experiences and his certainty of the mental states of his children were significantly associated with less positive interactions assessed by dyadic reciprocity/fluency and more negative interactions measured by dyadic constriction/tension in a sample of fathers with a history of IPV.

Contrary to some prior studies (Hakansson et al., 2018; Mohaupt & Duckert, 2016), RF was not associated with fathers’ self-reported ACES. This may be due to differences in the measurement of RF in this study, with all reports of RF by self-report scales rather than the language-based coding of measures like the PDI. Prior studies have reported differences in findings between the PRFQ and the PDI (Carlone et al., 2022). It may also be, as suggested by several studies in mothers, history of trauma alone does not predict RF, but instead the ability to mentalize about past trauma is associated with RF (Schechter et al., 2005; Huth-Bocks et al., 2014; Stacks et al., 2014). Future studies with fathers that further explore RF specific to past trauma, self-RF and child-focused RF would help further understand these dynamics in fathers. Importantly, though, some researchers have indicated that language-based coding may be biased, especially in samples of parents who are from high-risk clinical samples (Camoirano, 2017; Shai & Belsky, 2011). Therefore, thoughtful consideration to measurement will be important in future work on RF in fathers with childhood histories of trauma.

This is one of the few studies to use the PRFQ (Luyten et al., 2017) with fathers of young children and the only to study the use of this measure in a sample of fathers referred for treatment of IPV. It was fathers’ high certainty about their child’s mental states along with greater histories of ACES that appeared to result in the most constricted and tense interactions. These findings are consistent with Luyten and colleagues’ theory (2012; 2017) in the development of the PRFQ that this form of hyper mentalizing can be experienced as intrusive and further lead to misreading of the child’s mental state by the parent. This data suggests that improving fathers’ understanding of the opacity of mental states may improve father-child interactions especially for fathers who have high rates of ACES.

An RF focused intervention delivered to fathers who have used IPV and misuse substances demonstrated improvements in father-child interactions following the intervention (Stover, 2015). However, the sample was too small to further test if the intervention improved RF and whether that served as the mechanism through which the intervention improved father-child interactions. Future intervention studies could examine this important research question. Examining whether direct coaching of fathers about their children’s mental states strategies improve child-focused RF and in turn father-child interactions could have significant benefit for treatment development and application of existing parent-child treatments like Child Parent Psychotherapy (Lieberman, Ippen & Van Horn, 2015) with fathers.

More broadly, this study has significant implications for the growing research on fathers and their importance in their children’s lives. Many parenting interventions overlook the importance of fathers, what constitutes involvement in their children’s lives, and how that may differ from maternal parenting (Cowan et al., 2008; 2009). This study used dyadic codes from recorded play sessions to assess the quality of the father-child relationship in accordance with previous findings that suggest that play and stimulating social activities may be an ideal indicator of a father’s engagement with his children (Cabrera et al., 2000; Pazzagli et al., 2017). The association between reports of ACES and high certainty of the child’s mental states with dyadic tension and constriction in father-child interactions are important to fathering research broadly, not just for fathers who have a history of IPV behaviors. Fathers’ ACES and certainty of their child’s mental states should be further studied in large community samples, since favorable wellbeing for children is associated with warm, supportive relationships with their fathers (Cabrera et al., 2000; Webster et al., 2013). These associations can inform father-child relationships broadly, as well as prevention and intervention beyond fathers who have used IPV. Prevention efforts could identify fathers at risk through screening for ACES and child-focused RF for expectant or new fathers. These screenings and subsequent educational or therapeutic interventions could help fathers develop a stance of interest and curiosity for their children and an openness to understanding their children’s mental states, emotions and behaviors. Ultimately, this may improve their relationships with their young children and promote RF development for their children as well.

Limitations and Future Directions

This study is one of the first investigations to examine associations among ACES, self-focused and child-focused RF, and coded father-child interactions in a sample of fathers with a recent episode of IPV with their coparents. There were several notable limitations that must be considered. First, causality cannot be determined from cross sectional studies, and it is possible that bidirectional, dynamic relations may underlie these associations. The small sample prevented inclusion of more variables in regression models. The sample included all fathers who had used IPV referred for intervention, therefore limiting generalizability to other non-IPV or non-treatment referred samples of fathers. Fathers may also have been motivated to present their best selves and to minimize difficulties. Therefore, measures may not fully represent the extent of their histories of ACES and/or reflective skills. Future studies should be prospective with larger samples and multiple informants and methods of measurement of constructs. It is also likely that self-report measures of RF yield different results from coded interviews like the PDI as found in other studies (Carlone et al., 2022, Schechter et al., 2016). Future studies should include both self-report and coded measures of RF to examine how these may yield different or similar findings related to father-child interactions. Examination of child-focused RF in treatment studies with fathers is a needed next step in intervention development to improve father-child relationships.

Conclusions

This study adds to the extant literature on the use of the self-report measures of self and child-focused RF in high-risk samples of fathers and their associations with father-child interactions. Fathers’ lack of understanding of the opacity of their child’s mental states was a significant predictor of poorer father-child interactions, this was particularly true for those with severe ACES scores. This indicates that fathers who have significant histories of adversity and are prone to misinterpreting their child’s emotions and intentions may most benefit from RF focused intervention in order to improve their father-child relationships. This suggests self-reported child-focused paternal RF may be an important indicator of positive father-child interactions. Further research is needed in larger samples to better elucidate the relationships among these constructs to guide intervention with this population.

Statement of Relevance.

Fathers with a recent history of IPV may have histories of adverse childhood experiences and poor reflective functioning skills that result in a lack of understanding the opacity of mental states of their children. The paired difficulties can result in tense and constricted father-child interactions. Identification and intervention with fathers who have severe histories of ACES and poor child-focused RF can improve outcomes for infants and young children.

Key Findings.

  • Fathers who have a recent history of IPV use who had greater certainty of their children’s mental states and more severe ACES had more tense and constricted father-child play interactions.

  • Fathers ACES and certainty of their children’s mental states were significantly associated with father-child dyadic reciprocity and fluency during play.

  • Fathers ACES were not associated with their self-reported self or child-focused RF.

Acknowledgement:

This work was developed, and funding achieved through the strong mentorship of Dr. Nancy Suchman in the professional development of Dr. Carla Stover.

Funding Sources:

This work was supported through funding from NICHD (Stover). The views presented in this manuscript are those of the authors and do not necessarily reflect those of the funding agencies.

Footnotes

Conflict of Interest: The authors have no potential conflicts of interest to disclose.

Data Sharing and Data Availability Statement:

Research data are not available to be shared.

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