Watson, Philippa; (2025) The role of parental mentalizing and epistemic trust in parenting interventions. Doctoral thesis (D.Psych), UCL (University College London).

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Abstract

This doctoral thesis examines parental mentalization and epistemic trust within parenting interventions. It opens with a narrative literature review that explores how mentalization is used in parenting interventions and its effectiveness in improving reflective function (RF). The review highlights the diverse formats and target groups for these interventions, which may be delivered in group, individual, or dyadic settings, and incorporate mentalization directly or indirectly. While not a systematic review, the paper consolidates research on parenting interventions for biological caregivers across all child age groups, showing general agreement that mentalization improves parental RF, particularly for those who struggle with mentalizing. This insight could inform policy, clinical practice, encouraging funding for mentalization-based interventions in healthcare. However, the thesis emphasizes the multidimentionality of the constructs involved in parenting, such as the role of parental hostility or sensitivity, which do not necessarily improve in tandem with RF. Despite the challenges of generalizing results due to the variability in interventions and research methodologies (including small sample sizes), the study calls for more refined tools to assess RF, particularly at the lower end of the scale, to better detect changes in high-risk parents' mentalization. The review also points to a need for further research into the distinction between self-focused and child-focused RF, as this could influence how mentalization interventions are delivered and assessed. The transition from the literature review to the empirical research centres on a deeper analysis of mentalization, illustrated by a case study of a parent who attended the Lighthouse mentalization-based parenting program. The case study underlines the need for a more sensitive RF assessment tool and demonstrates how prementalizing modes may be overlooked when scoring RF on the Parent Development Interview (PDI). The empirical research’s most significant contribution lies in its application of epistemic trust (ET) theory to empirical data. This research supports much of the existing theory while showing how epistemic mistrust and credulity can coexist in a parent's experience of a Mentalization-Based Therapy (MBT) intervention. The findings emphasize the importance of further research into different domains of ET and their impact on engagement and outcomes in parenting interventions. ET, epistemic mistrust (EM), and credulity may operate as distinct mechanisms, suggesting the need for more personalized interventions. Clinically, this understanding could improve parental mentalization by tailoring interventions to individual needs. The ETMCQ, a tool for assessing epistemic trust, could be used to screen parents and guide interventions. Despite the parent in the case study not showing measurable improvement in RF using existing screening methods, the research indicates that a significant increase in EM may signal that parental mentalization requires more time to develop. Initial improvements may occur in self-focused domains before extending to interpersonal mentalization, as highlighted in the literature.

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