Dr Arnon Bentovim Good evening. I’m Arnon  Bentovim, and I’m Chair of the ACEs Special   Interest Group, and it’s an enormous pleasure  for me to welcome you all and our speaker this   evening, Dr Sheila Redfern, who’s the Head of  Family Trauma, Clinical Department and Consultant   Clinical Psychologist at the Anna Freud  Clinic. She’s going to be speaking about   the theme of reflective parents, with parents,  young children and particularly with adolescents. And this is such an important theme. I  was just – I’m not sure how many of our   participants here follow the newsletter which we  compile every month, but in the next newsletter,   which is coming out at the end of July,  there’ll be a paper on the extraordinary   power and relevance of child-centredness as  a way of countering the adversity which so   many children and young people are subject  to. And this is such an important theme,   because in recent years, although our Special  Interest Group is focused on adversity,   adverse childhood experiences, the reality  is that in recent years, people have become   extremely interested in benevolent experiences,  positive experiences and child-centredness,   and demonstrating that this can mitigate and  counter the impact of significant adversity. So, the theme we’re going to be exploring  this evening, that Sheila’s going to explore,   on Reflective Parenting, is very much in-line  with this approach, and, of course, Reflective   Parenting associated with mentalizing, has been  present over some years, and it’s interesting to   see that, at this juncture, the whole issue  of positive parenting, supportive parenting,   is beginning to come through as such a  key element for children and young people,   particularly given the tremendous range of  concerns that we all have about significant   mental health of children and young people.  Which is increasing at such a striking   rate and where there’s such stress on all  our services, trying to meet their needs. Probably should say that Sheila has worked in  a number of contexts. She’s worked in CAMHS   services, Head of Clinical Services at the Anna  Freud, she’s worked at Guy’s. She’s written a   number of books, including the book which has been  advertised and she’s going to I’m sure refer to,   “How Do You Hug a Cactus? Reflective Parenting  with Teenagers in Mind.” Such a powerful theme,   so important. And she’s written, also, books  on Reflective Parenting and understanding   what’s going on in children’s minds and  feelings and thoughts. So, I think this   evening is going to be a very special one,  of very significant and great relevance. Can I remind people, will they  please – because this is a webinar,   unfortunately we can’t have direct contact with  participants, but please use the chat to comment.   And we’ve invited you to tell us something  about yourselves in the chat, and the Qs and As,   questions and answers, for specific issues that  you’d like to have discussed. We’re going to   have a presentation for around about an hour,  then discussion in – for the last half hour,   and Sheila is going to ask participants, maybe,  to make some comments about some of the material   she’s going to show and share with us. So,  hopefully, this will be a dynamic and interactive   and a context where we can all really gain a great  deal of understanding about this important theme,   which, as I’ve indicated, is coming through as  being even more relevant today in the context. There’s an interesting paper, another paper which  I’ve reviewed, which has commented about the   tremendous amount of adversity which children in  many parts of the world are facing today, and yet,   they don’t necessarily have such a dire impact  on mental health, and it may well be that even   in context of highly significant adversity,  having a parent who’s struggling in caring,   trying to respond, trying to understand  feelings, and is child-centred in their approach,   it could make – has – maybe makes a huge  difference. So, Sheila, please, would you like   to present this evening? And we’ll look forward  to having a discussion with you in due course. Dr Sheila Redfern Thank you so much,  Arnon, and although I can’t see faces,   I can see there’s a lot of people out  there. As Arnon just said so kindly,   please do put any questions or comments into  the chat. And I am going to ask some questions   somewhat rhetorically, but I’m inviting you,  as we go through the material this evening,   I’m inviting you to put your own mentalizing  hats on, and I suppose tune in a little bit to   your own responses to some of the things that I  present you with this evening. And that’s not to   alarm you too much, but I’m sure there are lots  of, as well as professionals, like me and Arnon,   parents out there who, you know, for some of you  this material may resonate, it may bring up strong   feelings, and those are all really important  to attend to, as I’ll explain with the model. So, without any further ado, I’m going to share my  screen and I’ll take us through the presentation,   which I do need to, sort of, go back a little  bit on, because I was practising earlier. And I’m   going to wind back, so you’ll get a little preview  of all the things you were going to – you’re going   to see, which might terrify or excite  you, hopefully excite you. Here we go. Okay, so starting off with a slightly  shameless plug, these are the two books   that Arnon referred to earlier, and for people  who are interested, I’d just like to explain a   little bit of the context of these books,  and I guess something of the impetus for   actually writing them. They are books for parents,  primarily, despite being published by Routledge,   who people will know are an academic publisher.  I know lots of professionals find these books   really helpful and I’m really pleased  about that, and they’re there very much   as a guide for par – professionals working  with parents, like I’m sure many of you are. But I did write them primarily for parents to  read, and I think the second one, which is the   one on the right, “How Do You Hug a Cactus?” which  is for parents of teenagers and young adults,   and I’ll come onto that a bit later, I’ve really  tried to present this in a way that I guide the   reader through the steps of Reflective Parenting.  Hopefully, a little bit like a Therapist might   guide a parent through a session. Because I guess  if there’s anything that is common to parenting,   it’s, you know, the feeling that it is extremely  tough at times, it can be extremely lonely. And   what I’m trying to promote in these books is  some, kind of, connection with another mind.   And we’ll come onto how you connect with your  child and – or teenager’s mind later on, but,   in the first instance, what the model really  looks at is how to help parents tune into   their own state of mind, and we’ll talk about  that quite a bit as I go through this evening.  But just to say a little bit about why I  wrote the books and developed the model. So,   I used to work in – and excuse my voice  this evening, by the way, I’ve had a cold,   so I might be a little bit hoarse. But I used to  work for a long time in Children and Adolescents   Mental Health Services, so CAMHS as they’re  known in the UK. And I really noticed there   that parents would bring their children,  or teenagers, into the clinic, and often,   they would drop them in the waiting room and  then sometimes give a little cheery wave of,   “See you later then.” You know, “What – how long’s  the appointment for?” And I used to say, “Oh no,   no, no, you need to come in too. You know, this  is about your relationship.” And it was often   quite a surprise to parents that it wasn’t a bit  like taking your child to the Doctor to be fixed,   but actually that they were an  important part of the process. Now, I’m going back quite a long time,  and I’m sure things are quite different   now. I started in CAMHS services in the,  sort of, mid-90s. But certainly then,   there was very much an idea, perhaps a somewhat  medical model, that children might have these   mental health problems or disorders and we,  Psychologists or Psychiatrists or Counsellors,   Social Workers, were there to fix the  child. The parent was, sort of, somewhat,   kind of, you know, like, an escort, if you  like, sort of, bringing this child along. Now, this model is the antithesis of that, and  it’s very much about not saying that parents   are necessarily just responsible for change,  but they’re an im – most important person in   their child’s life, and therefore, not a  replacement for – you know, a Therapist,   rather, isn’t a replacement for a parent. But how  can we work, as Clinicians – excuse me – to help   parents have a sense of agency, to put them in  the centre of their child’s wellbeing? But also,   I wanted to develop something that didn’t blame  parents and leave them feeling somehow, “I’ve   failed,” because there’s nothing that probably  makes a parent’s heart sink more than being sent   on a parenting course. You know, the implication  is in parenting there’s something wrong. And so, I wanted to try and get away from all of  that, but I also wanted to bring to the forefront   the theory that could be put into practice. I’m  going to talk a little bit about the theory,   because the theory that underpins the  Reflective Parenting model is mentalizing,   or mentalization-based treatment. And I imagine  a lot of people here this evening, maybe most   of you, will know what mentalizing is, so I’m  not going to give a, kind of, huge description   of that. But just to, sort of, summarise that so  that you – put this into our minds at the start of   the presentation, to think a little bit about how  this might relate to parenting. Because the model   of mentalizing, somewhat surprisingly, actually  started when Peter Fonagy and Anthony Bateman   developed it, with parent – with adults, sorry,  with adults with borderline personality disorders.   But actually, the origins of mentalizing are in  infancy and in the parent-infant relationship. So, I remember when I wrote the first book,  Peter, who is my boss at the moment at the   Anna Freud Centre, Peter Fonagy said, “I  can’t believe – why didn’t I write that   book? It’s so obvious.” And I had a bit of a  chuckle to myself, thinking, well, you know,   if it was so obvious, how come you didn’t?  And he had been looking at how an absence   of good mentalizing manifested itself in  an adult population. For me – which is,   of course, tremendously interesting. For me, I  was really interested in thinking about, well,   mentalizing develops in the first few weeks,  1,001 days of a child’s life, so why don’t   we go back to where it started and think about  the parent, who is really the most important,   powerful person that can promote good mentalizing  in infancy, and therefore, perhaps prevent these,   kind of, adult quite high level mental health  problems, such as BPD, from even occurring?   Because if we can promote good mentalizing in the  early years, then our understanding is that that   promotes secure attachment, and we all know, I  think, the benefits of that to later outcomes. But just to really summarise what mentalizing  looks like, then. So, there’s this acknowledgement   that minds are opaque. I don’t know what’s in your  mind. I can maybe guess. I’m looking at Arnon,   he’s got his pen, and I’m thinking he’s probably,  maybe, making a few notes about things that might   be useful to discuss later, but I could be  wrong. He might be writing a little note to   his wife saying, “Please, I don’t want my dinner  until 7 o’clock.” I have no idea. I’m sure,   if I know him well enough, he’s making  a few notes about this seminar. But I   have to acknowledge that I can’t get into his  mind any more than I can get into anybody’s. And of course, this is a challenge in parenting,  because, as parents, we’re told we’re the people   who know our children best. So, if we don’t know  what’s going on in their minds, then there’s a   sense of, somehow, maybe I’m not such a good  parent if I don’t understand my child. But   it’s actually – the first step of this work is to  help parents acknowledge this is really difficult.   No-one actually can mind read, but what we can do  is be curious, to show interest and curiosity, to   not assume the worst. So, it’s, kind of, paranoid  thinking of, oh, I’m sure Arnon’s thinking I hope   she finishes this quickly, ‘cause it’s really  boring. That wouldn’t be good mentalizing. But when we’re not mentalizing, we can  slip into those, kind of, thoughts,   which usually come out of a strong emotion,  often high level of anxiety, or it could be   out of a feeling of depression. But when we’re  mentalizing well, those thoughts are far,   far in the background, and instead,  we have this, kind of, contemplative,   reflective stance, which allows us to start  being curious about what’s going on in other   people’s minds and start thinking about how other  people hold a very different perspective from us. So, how is this relevant, and how does this  link a bit to the theory, and to, also to the   model of Reflective Parenting? Well, I imagine  that most of you have heard about ‘parental   reflective functioning’, which is something that  Arietta Slade developed a tool to measure with her   Parent Development Interview. When we talk about  parents who are high in reflective functioning,   or RF as it’s often known, we’re looking at  two components there. And this is the really   important part for my model of Reflective  Parenting, because it’s both self and other. And in Arnon’s introduction, he talked about  how models are moving perhaps more towards   child-focused. I might take that a little bit  further and – because in my model of Reflective   Parenting, it’s actually not just about a parent  being focused on their child’s mind, and trying to   understand their experience, but it’s also about  them being curious about their own mind. Where   does my reaction come from? Why am I feeling so  strongly about my child’s sleep? What does that   really relate to? Is it my worry that they’re  not going to develop properly? Is it my worry   that I’m not going to get enough time to myself  in the evening if they don’t go to sleep? Is it   my anxiety that I won’t be able to do my job the  next day because I’ll be slo – so sleep deprived?   Is it a worry that I don’t want to separate from  my child? There’s many, many things it could be. But the components of reflective functioning,  which is really about holding mental states   in mind, so that’s thoughts and feelings,  categorises these two different aspects of   reflective functioning in a way that mentalizing  has really captured. So, it’s that self-other. And   there is some evidence, and it’s worth looking  at the papers of Suchman and her colleagues,   there’s a series of papers starting in 2010. They  go up to – I think the latest one is possibly just   last year. But what Suchman looked at, mostly  with substance misusing mothers, was the quality   of interaction between the mother and the toddler.  And what they found in their group, using the PDI   as one of the measures, and some video footage, as  well, looking at the quality of the interaction,   that actually, what predicted good quality  interaction between mother and child was more   about how the mothers mentalized themselves than  it was about how they mentalized their child. And   that was an interesting finding for me, because  it gave a little bit more traction to my model,   which was – is really focused on how do you  start with mentalizing yourself as a parent? So, Reflective Parenting is the approach  where I’ve really put together the – a link,   if you like, between the mentalizing theory  and this concept of reflective functioning.   Then I – tonight I’ll go just a little bit  into mentalizing theory, but not too much,   as I said, ‘cause I want to really focus  on the practical application. And I’ve   developed this in a number of ways.  One is just a self-help book, really,   or a guide for professionals to use with  parents, but the other way I’ve developed   it is a group programme. So, it’s an eight-week  psychoeducation group programme, and I can maybe   talk about that a little bit later or answer  questions on that, if anybody’s interested. But I’ve also extended Reflective Parenting to  work with foster carers, and we’ve currently   – we’ve just finished a three-year randomised  controlled trial with over 500 foster carers,   looking at how this model can help them to improve  outcomes for the children in their care, and also,   to stabilise placements between foster carers and  children. But that’s probably for another day,   that talk, but just to let you know that the  way that I’ve adapted the programme is to   go beyond just birth parents, and it’s also  been extended to adoptive parents, as well. So, what the Reflective Parenting Programme  essentially does is help both the parents,   the adults, to mentalize themselves  and to mentalize their child,   and to keep their child’s mind in mind is the  key thing. And why, why is that important? Well,   just a few, sort of, fun facts. We know that  parents who are high in reflective functioning   have more secure attachment histories and more  securely attached children, and that promotes   lots and lots of positive outcomes. The title of  this talk is about emotion regulation, and I know   lots of people here will be interested in that  theme. And Reflective Parenting teaches a child   about their emotions, about how to recognise them  and then, really, how to control or regulate them. And that’s something that’s promoted in the model  to parents right from the get-go. Because going   back to that little story I told about in  CAMHS, where parents bring their child into   the clinic, of course, children coming to our  services, they’re brought by their parents,   ‘cause their parents feel a bit desperate,  often. They feel they’ve lost control. They   don’t know how to manage behaviour. Perhaps their  child’s emotions are hard to understand. And what   I do with this model is first and foremost,  teach that actually, emotion regulation and   behaviour management are directly linked, and  that mentalizing is potentially the mechanism of   change. The mechanism by which a child can learn  to regulate their emotions, and then the parent   will see the kind of behavioural outcomes that  they brought them there for in the first place. And we have some preliminary data on this from a  study I did in South America, where we have just   a small sample from some parenting groups, 45  parents. And we’ve – in the outcomes, after the   eight weeks of group, we found both a reduction  in parental stress on the Parenting Stress Index,   and a reduction in behaviour problems on the  Strengths and Difficulties Questionnaire. And   this important bit to, sort of, emphasise is that  this is without ever seeing the children. So,   one of the things that maybe is a  bit surprising about this as a model,   in terms of its focus being on good outcomes  for children, is that we don’t actually   meet the children at any point during this  intervention. It’s all through the parents,   and we’re still seeing good outcomes for the  children. And that may be – you know, is an   interesting point to debate later on this evening  about how much children should be, or need to be,   directly involved in mental health services and  how much we can work through parents and carers. But the other positive outcome for children  of this Reflective Parenting model is that by   having the parent as the teacher in emotion  regulation and the teacher of what is going   on in the child’s mind, that maybe has  been a bit confusing up to that point,   because perhaps a non-mentalizing parent  hasn’t taught their child in those early   few months and years what they’re feel – what  they’re experiencing and what that emotion is,   how to understand it, how to really process  it. But Reflective Parenting not only helps   the parent to teach the child that, but  in doing that, it helps a young child   to understand other people’s minds and other  perspectives, and to interact with the world. So, the model extends beyond the child-parent  relationship, into the peer – world of peers.   And we know, particularly since COVID, that  there’s been a huge rise in social anxiety,   particularly, and particularly, I think it was  in one of the slides, I’m sure I saw it in the   presentation while we were waiting to start,  that this rise in anxiety and school-related   anxiety since COVID is a huge problem today. And  Reflective Parenting helps children to really,   kind of, be able to process those emotions and  to understand other people’s perspectives and   relationships, both in the home and in the social  world of school. So, it extends beyond the family. So, as I said earlier, mentalizing starts in  the parent-infant relationship, and in order to   develop securely, a child needs to experience  a parent or carer that has his or her mind in   mind. One that can reflect on their intentions  accurately, that doesn’t overwhelm him or her.   I think you will probably – all of you here  have watched, through your work, at some point,   the Still Face Experiment, Tronick’s famous  experiment where the mother is mirroring her   baby and then, she suddenly turns her face off,  and she goes completely still. And what we see   in that switch from a very reflective mind in  the mother, that’s giving her baby a sense of,   “Ooh, you’re interested in that. I  can see you pointing over there. Oh,   that makes you happy,” to then not reflect  on the baby’s intentions and to give nothing,   we watch this little girl in the Still Face  Experiment, sort of, lose control of her own   body and ultimately, lose her sense of herself.  You might even say that she doesn’t feel real   anymore, because there’s no mirror there to  reflect back to her what her sensations are. So, a person who can show a representation of the  baby’s feelings on their face, this contingent   marked mirroring, is someone who’s promoting  mentalizing in the infant. They’re saying,   “I see you, I have a mind that can read yours a  little bit, or I can guess what’s going on there,   and I can reflect back to you something of what  I imagine you’re feeling.” And by doing that,   this little baby gradually learns, oh, this  feeling is discomfort, this feeling is boredom,   this feeling is, ooh, I want to get out of  this chair. And all of that vocabulary and that   mirroring that’s going on between mother and child  is really teaching the child he or she has a mind.   A mind that’s of interest to the parent, a mind  that can think, a mind that can feel and another   perspective that can reflect back to him or her  what’s going on in their mind. And all of that is   incredibly helpful for not just the parent-infant  relationship, but later relationships, too. So, just a little bit more about mentalizing. So,  when we talk about mentalizing, we talk about a   spectrum, and along that spectrum, as well as  there being self and other, which I mentioned   earlier, there’s emotions and thoughts. So,  mentalizing isn’t just about what you’re   feeling. It’s also about what you’re thinking.  What’s the cognitive process that’s going on? So,   Sharp and Fonagy define this as something like,  “The capacity to regulate and experience one’s   own and others’ emotions in a non-defensive way,  without becoming overwhelmed or shutdown.” And   that’s, I think, what we see when that – in  that Still Face Experiment, when the mother’s   mirroring her little baby. There’s something  both cognitive and emotional that’s going on,   that has a regulatory impact on the infant’s  capacity to just enjoy the interaction. Oops, little bit. And the self-other part of  the mentalizing spectrum is that – and let’s   think about how parents might do this, that  there’s a balance that is being, sort of,   played out there between introspection – so,  in Reflective Parenting, I’m asking a parent   to think about what’s going on in their mind,  but also, a bit of hypothesising. So, sort of,   thinking a bit about their child. Now, a  natural defence, I think, in parenting,   is to put all the focus onto the child. What’s  wrong with them? Why are they behaving this way?   Why don’t they listen when I ask them to do this?  Why are they crying so much? Why is my little baby   not settling? And mentalizing it promotes not  just that, it is an important part of the model,   but also, it promotes this introspection  of, and how do I feel about that? And even   more important than that, where do my  feelings about that come from? And I’ll   show you a little bit later about how we help  parents to come to some understanding of that. So, another part of the mentalizing spectrum is  this balance between automatic and controlled   mentalizing. Just move you a little bit there. So,  automatic mentalizing is, kind of, unconscious,   sort of, fast processing of information. An  example might be, you know, I might – if I   was walking home from the train station at night  and I had to go through a, sort of, dark alleyway,   and I saw someone coming towards me,  I might immediately reach in my bag   for a key. I’m not thinking, hmmm, I wonder  what’s – what these people are doing here,   I wonder if they might be a threat. I have a,  kind of, automatic bit of mentalizing that says,   you know, defence, and that’s something  that’s happening at an unconscious level. But then there’s more conscious mentalizing  that ref – requires us to, kind of – oops,   sorry, going too fast – to, sort of,  consciously think through something.   And that’s something that I’m trying to promote  a little bit more in parenting, because that   automatic mentalizing sometimes means we, kind  of, leap to action rather than reflection. And   I think I’ve already said a little bit about  the, sort of, internal/externally focused,   but really, that the understanding one’s own  mind and that of others is through, kind of,   very much a focus on what’s going on on the  inside. And a lot of parenting programmes,   and a lot of, kind of, parenting advice is very  much focused on what’s going on, on the outside. And this is a little bit of a gear shift for  a lot of parents, and it’s nothing to do with   intelligence, but it’s to do with the focus  that they’ve been used to having on, I guess,   fixing behaviours and changing behaviours. That  we’re saying in this work, “Let’s think about   what’s the backstory to that behaviour?” And even  that can be thought about in a diagnostic way. The   parents determine that they want a diagnosis  of ADHD for their child. That might still be   important for the school, it might be important  for the child, but we also need to understand   about, why is this child not able to pay  attention in the classroom? What is that about?  I was supervising a group this morning who are  part of a clinical trial for an MBTC intervention,   and they were saying that – one  of them was presenting a case,   and it’s a little seven-year-old boy who had what  the supervisee labelled as ‘school-specific ADHD’,   which I thought was really interesting as a  concept. And she was worried that she couldn’t use   the mentalizing intervention with this parent and  child because what the parent wants is a focus on   ADHD. My approach to that is, absolutely, a really  helpful model for thinking about why does a child   who maybe has ADHD not pay attention at school,  or find at school he’s very fidgety, but he’s   very different at home? So, I’m sure all of you  do these, kind of, things very, very naturally. I’m just going to say something very, very  quickly, because this is a very busy slide,   but obviously, you can keep your – I think you’re  all getting a recording of this presentation,   if I’m right, so you might want to  take later to read the, sort of,   detail of this. But I guess what this slide  is helpful for understanding is that there   are modes of non-mentalizing which originate  from the, sort of, very early years of infancy,   when an infant’s in the, kind of, pre-mentalizing  mode. So, a classic example, so the pretend mode,   which is something that happens when you’re  talking to adults and they go into this   non-mentalizing mode of, kind of, often,  sort of, storytelling, with little affect   attached to it. Seems a bit detached from  internal experiences. This is a, kind of,   mode that very, very young children can get into,  and of course, children get into pretend play. Psychic equivalence is a mode where  the, sort of, outer reality is,   kind of, how things are. So, say, a very  depressed person might say, you know,   “The world’s just a terrible place,” because  they feel terrible. So, this becomes a, kind of,   non-mentalizing way of operating. In a very young  child, it might be, kind of, peek-a-boo. You know,   “I can’t see you, so, therefore, you can’t  see me.” These are, kind of, pre-mentalizing   modes that don’t really take account of  the fact that there’s another reality,   there’s a different mind out there that might  see the world differently. So, very young   children get into this mode where they, sort of,  think, how I feel and how I see it is how it is. Teleological mode is another one of these  non-mentalizing, or pre-mentalizing,   modes. You see this a lot in teenagers, who  we’re going to talk about later this evening,   a classic one being, “He doesn’t love me because  he didn’t put a kiss on the text he sent me this   morning.” That’s a teleological mode. Now, we  all might prefer to have a kiss on a text from   somebody that we’re close to, but non-mentalizing  means that you become utterly convinced that’s the   evidence you need that somebody cares about you.  And of course, adults and children can both get   into these modes, but very young children, before  they learn to mentalize, they have different,   kind of – in different situations they will  demonstrate all of these pre-mentalizing modes. But here’s the little bit that’s important to  remember, that all of us are only mentalizing   effectively probably about 30% of the  time. So, it’s not normal to be going   around all the time reflecting on our  thoughts and feelings. We don’t do that,   we’d never get anything done. So, that’s not  – a bit like Arietta Slade says with the PDI,   which is a, sort of, scale of reflective  functioning, it goes from nought to nine.   She’s not looking for a nine to be a good  reflective parent. She’s looking for, like,   about a five. Reminds me a bit of Winnicott’s,  you know, ‘Good Enough Parenting’. So,   effective mentalizing would only be about 30% of  the time that we’re consciously thinking about,   oh, well, I wonder what that means to him that he  didn’t get invited to that. Or, hmmm, he’s, sort   of, gone very quiet tonight, what’s that about?  We’re only doing that a small amount of the time. But what we’re trying to do within  that model is to promote that,   because promoting mentalizing means promoting  a sense in the child, or teenager, or adult,   of feeling understood, and it feels  really good when we feel understood.   We feel [audio cuts out – 3339] other people.  And when we don’t mentalize, it’s often because   our emotions are, you know, not under our  control, perhaps. We’re not in the right,   kind of, space, and I’ll explain to you  how I help parents get into that space. So, what I’ve done in the Reflective Parenting  model is to really develop a set of tools. I   suppose I’m a classic Clinical Psychologist in  that sense, because I love a tool and a good   measure, but I also want to make things accessible  and practical for parents. And if you read the,   sort of, handbook of mentalizing, which I have got  a chapter in, it’s so thick and dense. You know,   you’d be hard pushed if you were a parent  to get through even a tenth of that with a   busy life with young children or with  teenagers. So, what I’ve done in the   model is I’ve tried to operationalise the  theory of mentalizing and of MBT into tools   that parents can use in their everyday life.  Starting with the emotional thermometer. So,   I’ll just show you how that looks. This is – I  mean, this is actually slightly old-fashioned,   I realise now, because when I talk to my  – who – my youngest child, who’s now 15,   about a thermometer, he imagined something  that goes in your ear that’s digital. So,   this is the old-school thermometer, but most  people have an idea of what a thermometer is. And this is a very visual tool that we  give to parents in the groups, we give it   to foster carers, sometimes children use it for  themselves. And really, what it just explains is   that our emotions, which, kind of, do run the,  sort of, gamut from being very switched off,   detached, maybe even depressed, bored, the, kind  of like, the low arousal level of the thermometer,   which I talk about the ‘blue zone’, right  through to the, kind of, boiling up, raging,   angry, really, really excited, sort of, the  really, sort of, high affect, high level of   emotional arousal. I talk about that being in  the, kind of, ‘hot end’ of the thermometer. What we’re trying to do with parents,  and with ourselves, as Clinicians,   is to get into this middle range, where we  are in a, kind of, warm zone. Where we feel,   you know, not too, kind of, over-aroused  emotionally. We’re not too switched off,   but our emotions are, kind of, relatively  under our control, and we’re relatively calm,   and those are the times when it’s  possible to be reflective. Those   are the times when it’s easier to be curious  about what’s going on in someone else’s mind. You know, maybe you imagine your  partner comes home and he’s, kind of,   had a really bad day at work but he’s  forgotten the milk. And you asked him to   get the milk and you’re in the middle of making  a lasagne, and you’ve got no milk for the sauce,   and that’s going – and you’re a bit cross  about the lack of milk but he’s, kind of,   had a bad day. That’s not a good time to start  mentalizing, because everyone’s arousal levels   and emotions are too high, and that’s what leads  to arguments. You know, “Why didn’t you get the   milk?” “Oh, oh, why don’t you understand  I’ve got – had a hard day at work?” “Oh,   I can’t feed you.” And nobody’s able to reflect  on anybody else’s backstory in that situation.  So, you have to, through the model, teach  parents that regulating your emotional arousal   and mentalizing are, kind of, intricately  linked. You can’t do one without the other.   It’s impossible to mentalize if you’re angry  with the Teacher because they gave your child   a detention because their shirt was hanging  out of their trousers on their school uniform.   You’ve got to, kind of, regulate that first  in order to mentalize why did that happen? Another tool that I use in the Reflective  Parenting model I call the ‘parent map’.   This is a tool to help a parent mentalize  themselves. So, remember I said a bit earlier   that self-mentalizing is just as important, if  not slightly more, than mentalizing the child,   because it needs to come first. You know,  it’s the classic oxygen mask on before you   put your child’s on, because if you’re not  regulated enough in your own state of mind,   if you don’t really understand your own  reactions and own response and they’re   just really strong, or lower down the scale  of the thermometer and you’re really cut off,   it’s really hard to get into a, kind of,  connected interaction with your child. This is quite a big piece of work. It’s not  something you could do just, sort of, one-off.   We go back to this over and over again in the  group, and I encourage parents, when I’m working   with them individually, to start to plot out a  little bit a map for themselves. You know, what   kind of things influence their parenting? What  – you know, maybe they had a really difficult   childhood themselves, or maybe they were really  loved and they’ve got a large family. Now they’ve   got a really small family, and that feels somewhat  strange. What are the current influences going on   in the parent’s life? You know, maybe they’re  living in poor quality housing and they’ve just   been made redundant. How do you mentalize in  that, kind of, context? And that, of course,   influences current state of mind. If you find  yourself preoccupied with the basics of life,   it’s really hard to get to the point of  mentalizing yourself or anybody else. But this is a starting point, and we do something  in the groups which we call a ‘mind check’,   where every session, at the beginning  and the end, we ask parents just for   two minutes in pairs to say, “What’s in your  mind right now?” And it’s actually really hard,   especially the feelings bit, because we’re just  not used to doing it, but we do this two-minute   exercise at the beginning and the end of each  group to help parents to, kind of, practice this. So, these are just some questions that we  give to parents to really help them start   to build their map, to think about  how do they want to be as parents,   and what is it that’s influencing them? And it is  a very non-judgmental, non-blaming model, because   I don’t believe it is possible to mentalize  very easily if your current circumstances,   or your current relationship, is causing  you so much stress and worry, that that,   you know, that’s – that preoccupies 90% of  your mind. But helping parents understand   that that’s an influence might just actually  help them to tune into that a little bit next   time their child comes in from school and says,  you know, “I’m starving,” and the parent snaps. The parent who reflects on their own mind  a little bit understands a bit of where   that snappiness comes from. It’s not the child’s  demand, necessarily. It’s their own feeling of,   am I not a good enough parent? I don’t  have food in the cupboards. I can’t give   my child what they need. And it’s a way to –  doesn’t sort the problem of the finances out,   but it sorts out the empathy  from the child to the parent,   and, also, allows the parent to have  some empathy for themselves, as well. This is just a little example, I won’t read  it out loud, but we have some worksheets in   the group sometimes, that we’ll give to parents  to practice at home. And this is one where we   ask a parent to focus on a few difficult  times they had recently with their child,   and it might be anything. It could be a,  sort of, argument before school. It might be,   you know, a teenager that’s not speaking to  them, they’ve had a big row about leaving all   the dishes in the sink. It doesn’t matter,  anything. And we ask them to try and unpick   that event and think a little bit about what  influences they recognise that were going on   in their mind that had an impact on their reaction  in that situation. So, a bit like the mind check,   it’s a way of getting a parent to really learn  how to tune into their own state of mind. Now, depending on how old the child is,  they – there will also be influences   of that on the parent map. So, parenting an  adolescent compared to parenting an infant,   clearly, those parents are at different stage,  the child’s at a different developmental stage and   the things that go onto their parent map might be  very, very different. So, parenting an adolescent,   that might provoke some, kind of, issues  from their parent’s own adolescence. Probably   likely to provoke issues linked to separation and  individuation, which is a big part of adolescence.   Parenting an infant, there might be all sorts  of different cultural expectations of what   a baby needs, the influence of the stories  about themselves as babies. You know, “Well,   he was a good feeder.” “He didn’t – he never  slept.” These might also be on the parent map. Okay. Now, I’m going to shift gear a  tiny bit, and I’m just conscious of time,   because I’ve got a couple of little video  clips I want to show. It’s not that different   in terms of the tools to the model when it  comes to Reflective Parenting with teenagers,   but there is something specific about  parenting a teenager. And I was, sort of,   slightly joking with Arnon about this at the  beginning of this evening, about the, kind of,   strong things that teenagers can say, and how that  can really provoke a parent’s strong reaction,   as well, in a way that sometimes, you  know, a younger child might not do. So, the whole, sort of, balance between  mentalizing yourself and regulating your own   emotions, and trying to understand the  meaning of your teenager’s behaviour,   not just trying to change the behaviour itself,  it can be a little bit trickier in adolescents.   Not least because teenagers don’t tend to  like a parent trying to guess that’s going   on in their mind. For a younger child, this can  feel really lovely when a parent’s curious about,   “Oh, why didn’t you like that? What is it you’re  thinking about?” But a teenager whose parent,   you know, expresses curiosity about  what’s going on in their mind,   that could cause a massive shutdown. And  so, we’re going to think next, in the next,   sort of, 15/20 minutes, about what’s different  in using Reflective Parenting with teenagers? Well, one important thing that’s different  is that the brain is changing. There’s a   critical period of brain development going  on. From around the age of 12-years-old,   to – young people start to be more impulsive.  The prefrontal cortex is still developing,   and I gave a presentation a bit similar to  this recently with a good friend of mine,   Sophie Scott. Some of you might know her from TV  and radio. She’s a, kind of, famous Neuroscientist   now. But she has some brilliant slides that,  sort of, show areas of the brain that are,   kind of, fully developed and those areas flashing  that are still developing. And in teenagers,   what we see is this prefrontal cortex, which is  responsible for rational – excuse me – thinking   and decision-making, it’s still developing.  I’ll just take a little sip of water [pause]. But the impulsive behaviour isn’t just about  brain changes. It’s also about this normal   drive towards having new experiences. Oh,  I am sorry. I think what I’m going to do,   ‘cause I’m having a bit of a coughing  fit, is I’m going to show a quick video. [Video commences] Speaker 1 Teens and risk-taking. What  did you think of when I said that? Speaker 2 Most people think of  house parties and binge drinking,   smoking weed under the bleachers,  unsafe sex, or fighting and violence. Speaker 1 In other words, a bunch of  bad things. But really growing up is   nothing but a series of risks that we take,  from our first steps and our first words,   to learning to ride a bike or asking someone  out on a date. Each time we try something new,   we’re taking a risk, and we need  support to navigate these risks well. Speaker 2 For parents, Teachers, Counsellors  and the other adults who work with young people,   every day presents a new opportunity  for us to support healthy risk-taking. Speaker 1 That means being there to  answer questions without stigma or shame,   supporting us when we try  out new values or identities,   letting us make mistakes so we can learn from  them, celebrating when we succeed. Most of   all, adults who are the best at encouraging  healthy risk-taking and growth, they listen. Speaker 2 And listening is key, because  young people know their day-to-day world   better than anyone else. Trusting them to make  their own choices is critical for building   their confidence and life skills. Without  taking risks, teens have trouble developing   into capable adults. It’s everyone’s job  to make sure that they’re supported and   safe so they can grow up to be healthy, not just  physically, but emotionally, socially and more. Speaker 1 Given that society  thinks of risk-taking so negatively,   it makes sense that adults want to limit  or even get rid of risks altogether,   but that’s not what we need. Yes, there are  unhealthy risks that all of us need to avoid,   drug and alcohol use, unsafe sex and violence,  but healthy risks, good risks, the kind that   challenge us to expand our horizons, those  are so important for our learning, for growth. Speaker 2 Learn more about promoting  positive adolescent health be… [Video ends] Dr Sheila Redfern [Pause]   Sorry, I was on mute. It’s interesting  this video now, even in the last few years,   is slightly out of date, because I talk  a lot about risk-taking adolescents with   parents and the importance of letting  young people take normal risks. In fact,   what research shows is that today’s adolescents  are the least risky of any in the last 150 years.   The biggest risk at the moment to adolescents  is their mental health, and that’s why parenting   models and thinking about relationships with  adolescents and parents is so important. So, you know, just a few, kind of, statistics. So,  teenage pregnancy is at the lowest it’s been in a   long, long time. I’m not sure, kind of, how long.  Young people have sex much later than they used   to. They get married much later than they used  to. They leave home much later than they used to.   They go out to parties much less than they used  to. So, actually, the, kind of – thinking about   risks is really important, but it’s these normal  risks that we want to encourage teenagers to take,   like going to a party or going for a job and  having an interview in person, not online,   without ChatGPT to help you. You know, they’re  – sort of, the risk of exploring the world,   which used to be the biggest fear of  parents of adolescents, is now a, kind of,   bigger risk. So, I talk about that quite  a bit with parents, about healthy risks. I’m going to just move onto – sorry. [Video commences] Speaker 1 Behaviours and outcomes… Dr Sheila Redfern So, the, kind of, specific  things that Reflective Parenting is used for   to address is really the, kind of, conflict  that is commonly there between parents and   adolescents. Often the common thing, I mean, I  see a lot of teenagers in my clinical practice,   feeling understood, the, kind of, biggest one.  Lack of understanding different perspectives,   parents’ own preoccupations influencing  interactions, parents’ fears and anxieties   dominating. And then real difficulty regulating  closeness and distance. That’s a – such a massive   issue in parenting a teenager. So, this idea of,  like, “Go away, I don’t need you,” but, “Where   were you? Where were you when I messaged you?”  And I’m talking about the teenager here, now. So,   how close or how far a parent needs to be from  their teenager, the Reflective Parenting model   really helps parents to mentalize themselves,  as well as their teenager, in relation to that. Okay, I’m going to show you a little clip  from a TV series called the Gilmore Girls,   which some of you might know of, so it’s  an American TV series. And I’m just going   to ask a few questions at the end of it, but  probably, I’ll just leave them hanging, Arnon,   and then people can maybe come back to them  or they can pop messages in the chat if they   want to. ‘Cause what I’d like people to  do at this point is just think a little   bit about the mentalizing self-other. What is  and isn’t going on here in this interaction? So, I’ll just give a tiny bit of context to  the Gilmore Girls. So, there’s two characters,   Lorelai is the mother and Rory’s the daughter.  And Lorelai’s a single parent, and they’re very,   very close in their relationship. Probably you  might say, sort of, too close at times, a bit like   sisters. And Lorelai’s quite gossipy and quite  humorous, and there’s lots of things going on,   lots of characters in this local town. In  this scene, Lorelai’s come back from a,   sort of, event that was going on in the town,  and she’s come home to find her daughter,   Rory, with her ex-boyfriend, Dean.  So, let’s just have a little look. [Video commences] Lorelai Rory, oh my God, you’re missing  everything [runs upstairs]. Grab those CDs   and head back to the Inn, before you miss  the crossdressing midgets, ‘cause that’s   where the night is headed. Oh,  things are happening, big things,   wild things. I have so much to tell you.  Let me just open with this little titbit,   Kirk running naked through the  square [runs downstairs]. Of course,   with all of my careful planning and preparation,  I forgot to bring Band-Aids and a camera. I’ve   got to learn that always, without fail,  Kirk equals camera. Hey, what’s going on? Rory Dean came over to borrow something. Dean Yeah. Thanks. Rory You’re welcome. Dean So, I should go. Bye, Lorelai. Rory Bye, Dean. So, I’m almost  done getting the CDs together.   I picked a wide selection so we’d have choices,   and then I picked a bunch that probably only  you will like, but it’s good to have options. Lorelai So, what did he borrow? Rory I’m sorry I didn’t talk to you about it  first. I know I promised I would, but I swear,   I didn’t know that this was going to happen.  I mean, I didn’t know he was going to show   up tonight, and it just happened. It’s  awful for you to find out like this,   I know, but everything’s okay. I’m okay, and  we were, you know, safe, so all those Trojan   men jokes all these years really apparently  stuck. And I’m lucky, too, because Dean,   he’s – well, aren’t you glad that it happened  with someone who’s good and really loves me? Lorelai But he’s married. Rory You don’t understand the situation. Lorelai Is he still married? Rory Yes, but… Lorelai Then I understand the situation. Rory It’s not working out  between them. They’re not happy. Lorelai Oh, Rory. Rory Well, he tried the best he  could, but it didn’t work. It’s over. Lorelai He told you that? Rory Yes. Lorelai He told you he’s leaving her? Rory Well… Lorelai He told you he’s moving out,   they’re getting divorced, they’ve divided  up the Monster Truck season tickets? Rory We didn’t get around  to discussing everything.  Lorelai You didn’t get around  to discussing everything? Rory It was a crazy night. Lorelai You of all people, the girl who  thinks everything through, the list-maker,   you didn’t bother to discuss those things  before jumping into bed with a married guy? Rory He’s not a married guy. He’s Dean, my Dean. Lorelai He’s not your Dean, he’s  Lindsay’s Dean. You’re the other woman. Rory I told you, it’s over. Lorelai It’s not over until he’s  out of the house with the ring off. Rory He took the ring off. Lorelai Oh my Go – I don’t believe this. Rory He’s in love with me, not Lindsay. Lorelai Does Lindsay know that? Rory She’s not good for him, okay. She lets  him quit school and work himself to death and… Lorelai No, no, Rory, uh-uh,   you can’t be one of those girls who blames  the wife for forcing the husband to cheat. Rory He wasn’t cheating. Lorelai He was cheating, Rory. He was cheating,   and you were cheating with him.  There’s no other way to spin that, kid. Rory I’m not spinning it  and I’m not a kid, I’m 19. Lorelai This was your first time. It’s just  not the way your first time was supposed to be. Rory Oh, and how was my  first time supposed to be? Lorelai Well, first of all, it was  supposed to be in a retirement home,   and secondly, ideally, it was  supposed to be with someone single. Rory My first time was with  someone sweet and kind who loves me. Lorelai Well, I didn’t raise  you to be like this. I didn’t   raise you to be the kind of girl who  sleeps with someone else’s husband. Rory You slept with dad when he was with Sherry. Lorelai He wasn’t married to Sherry. Rory He was engaged and she was pregnant. Lorelai So, this is all my fault? I set one  crappy example for you and you have no choice   but to follow in my footsteps? Rory, what are  you going to do now, huh? Is there a plan? Rory I don’t want to talk about it anymore. Lorelai I just want what’s  best for you, that’s all. Rory I don’t want to talk about it. Lorelai I just don’t want you to get hurt,   Rory. What if he doesn’t leave her?  Now you’re all emotionally involved. Rory You’re just mad because  I didn’t come running to you   to discuss whether or not I was ready  for this step. I decided it on my own. Lorelai Well, obviously, you  weren’t ready for this step.   The very fact that you chose another  girl’s guy to sleep with proves that. Rory He was my boyfriend first. Lorelai But you dumped him, you  rejected him, you picked someone else. Rory Stop it. Lorelai Rory. Rory I hate you for ruining this for me  [pause] [dials number] [dialling tone]. Female on phone Hello? Hello? Hello [music]? [Video ends] Dr Sheila Redfern Okay, so, how might we apply  reflective parenting to Lorelai and Rory? Well, we   could probably do with another hour to really  unpick all of this. So, I’m just going to ask   a few questions, and maybe people can put a few  things in the chat, and we can discuss at the end   in the Q&A. I mean, what – the first thing that  we would do with this parent would be to try and   help her to notice her state of arousal. So, she’s  right at the top end of the emotional thermometer,   and she’s boiling hot. So, the first challenge  would be, how do we get Lorelai to bring down   her emotional arousal? And part of that would  be about using the mentalizing stance to be   curious about her feelings, to empathise  and to validate with her state of mind,   but just to try and get her a little  bit to bring that arousal level down. And then we would encourage her, using a Parent  MAP to think about where do these thoughts and   feelings come from? And only then, when she’s  got a better understanding of her own mind,   would we then use what is the, sort of, last  tool of the model, which is the Parent MAP,   to try and understand what Rory’s  actually thinking and feeling. So,   you know, we would ask some, kind of, questions  to her to help her to mentalize Rory, like,   what she’s feeling? What’s upsetting to  her in what her mum is saying? Why might   she have slept with her ex? What does  it mean to her to have slept with Dean? But you can imagine that all those questions  are not going to go down very well if we ask   them in the first five minutes of a session. What  Lorelai is going to need is for someone to really   help her to regulate herself first. She’s right  high up there, and Rory’s saying, “I’m not a kid,   I’m 19.” So, there’s a, sort of, severe challenge  there that says, “Don’t treat me like your child,”   and this is something, obviously, we see  over and over again in parenting teenagers. And equally, when we’re trying to mentalize  Lorelai, who’s got this strong narrative   herself of, “I didn’t raise you to be this  way,” so she’s making this very strong   personal statement about her own parenting, this  isn’t the kind of daughter I wanted. And yet,   in the clip, Lorelai comes in, and is  all chatty about the town and, “Oh,   I didn’t take a photo of the man who was running  naked through the town,” it’s all very, kind of,   girly to girly, then she’s coming in quite hard  and heavy about the safety and risk-taking of her   daughter. So, that’s potentially quite confusing  for Rory, and it feels a bit like she might be   quite unaware of her own parenting style in  that moment and of what’s influencing her. So, maybe just you could take a few minutes,  while I finish the next couple of slides off,   to think a little bit about, you know,  what is it that’s causing Lorelai to be   so dysregulated? And what’s the, kind of,  dominant feeling behind what she’s saying?   And all of these things aren’t just out  of nosy curiosity about Lorelai’s mind,   but they’re all to then help her to really  understand why did her reaction come out   as strongly as it did? And that’s not to say the  reaction was necessarily right or wrong, but just,   it led to this big rupture in her relationship  with her daughter that she’s normally very   close to. So, we need to think about how do we  repair that rupture using a mentalizing approach? Now, I just want to check in with Arnon.  I’ve got one more clip I’d like to show,   and it might mean that I run over by  about five minutes. How would that work? Dr Arnon Bentovim Yeah, yeah, I think that’s… Dr Sheila Redfern You’re on mute, Arnon. think that’s fine. I would show it. I think… Dr Sheila Redfern Okay. Dr Arnon Bentovim …it’s been so  interesting, and illuminating. Dr Sheila Redfern Okay. So, here’s a  bit of parent not listening to child   and child being – well, you’ll see  how this ends. This is from the film   ‘Lady Bird’ which many of  you might be familiar with. [Video commences] Narrator Her fingers moved gently in his  hair. She looked up and across the barn,   and her lips came together  and smiled mysteriously. Radio Presenter You’ve been listening to The  Grapes of Wrath, by John Steinbeck. If you… Mother [Cries]. Daughter Our college trip took 21 hours   and five minutes. Mother [Laughs]. Daughter [Laughs] Hey, why don’t we  – let’s just sit with what we heard. Daughter Are you serious? Mother We don’t have to constantly be  entertaining ourselves, do we [pause]? Daughter I wish I could live through something. Mother Aren’t you? Daughter Nope. The only exciting thing  about 2002 is that it’s a palindrome. Mother Okay, fine, well, yours is  the worst life of all, so you win. Daughter Oh, so now you’re mad… Mother No, it’s just… Daughter …because I wanted to listen to… Mother …you’re being ridiculous… Daughter …music? Mother …because you have a great life. Daughter I’m sorry I’m not perfect. Mother No-one’s asking you to be perfect,   just considerate would do. Daughter I don’t even want   to go to school in this state anyway. I hate  California. I want to go to the East Coast. Mother Your dad and I will barely  be able to afford in-state tuition. Daughter There are loans, scholarships. Mother Your brother, your really smart  brother, he can’t even find a job. Daughter He and Shelley work, they have jobs. Mother They bag at the grocery  store. That is not a career,   and they went to Berkeley. Your father’s  company is laying off people right and   left. Did you even know that? No, of  course you don’t, because you don’t   think about anybody but yourself. And  Immaculate Heart is already a luxury. Daughter Immaculate Fart.  You wanted that, not me. Mother Miguel saw someone knifed  in front of him at SAC High,   is that what you want? So you’re telling  me that you want to see somebody knifed… Daughter He barely… Mother …right in front of  you? Right in front of you. Daughter …saw that. I want  to go where culture is, like… Mother How in the world did I raise… Daughter …New York… Mother …such a snob? Daughter …or at least  Connecticut or New Hampshire… Mother No, well, you couldn’t… Daughter …where writers live in the woods. Mother …get into those schools, anyway. Daughter Mom. Mother You can’t even pass your driver’s test. Daughter Because you wouldn’t  let me practice enough. Mother The way that you work, or the  way that tuition works, Christine… Daughter My name is Lady Bird. Mother Well, actually, it’s  not, and it’s ridiculous… Daughter Call me Lady Bird… Mother …because your name is Christine. Daughter …like you said you would. Mother Just – you should go to city college,   you know, with your work ethic, just  go to city college and then to jail,   and then back to city college, and then  maybe you’d learn to pull yourself up   and not expect everybody to do everything… Daughter [Opens door] [falls out of car]. Mother [Screams]. Reverend [Music] The name of the Father,   the Son [music] and the Holy [“Fuck  you Mom” plaster cast shown] [music]… [Video ends] Dr Sheila Redfern A bit of a dramatic clip.  So, now, I mean, there’s a lot to think about   about that clip, but I guess some of the things  that I just want to pick out for us to, kind of,   pick up in the Q&A, perhaps, is that in this  clip this mum and her daughter who wants to   call herself Lady Bird, they were going to  college. And in – I think how we might help   the mum to mentalize herself is that she was  really enjoying this moment with her daughter,   listening to John Steinbeck’s Grape of Wraths  – Grapes of Wrath, and she wanted to stay in   it. You know, the daughter, sort of, wants  to immediately move onto having some music,   and the whole purpose of them travelling  is that she’s going to look at a college.   She’s going to separate. And mum’s saying, you  know, “I want to stay in this moment together.” And then that leads to this, kind of, big  explosion and a real criticism, really harsh   criticism, from the mother to the daughter, about,  kind of, you know, “You’re not really good enough   anyway for these other colleges. You should just  go to state college, and then you’ll go to jail,”   which is, sort of, really extreme. But what we  might try and understand using a mentalizing   framework, and particularly starting with this  mum, is, you know, winding right back to that   moment when things [inaudible – 6323], what was  going on just before that moment? And that’s a   technique that’s used an awful lot in MBT work and  used a lot in the groups for Reflective Parenting,   to take a difficult time, you know, a really  difficult time, in this situation. She jumps out   of the car and breaks her own arm, just to prove a  point to her mum, which is, sort of, half comical,   half extreme in the film. Because rewinding back  might take the mum back to – and the daughter,   eventually, back to the moment that things just  became really contentious between them, when mum   was probably just enjoying this really important  moment of closeness between her and her daughter. And then we might get into a much more mentalizing  conversation with the mum about how the, kind of,   thought of separation, the thought of her daughter  going away, the thought of the difference between   them and the identity that her daughter’s  forming, with her own new name and her own,   kind of, desire to go to a different college,  not in California, which she hates, is a, such   threat to the mum. And that was potentially the  trigger for all of these strong statements. So,   with the Parent MAP, we can help a parent to keep  the focus on what’s going on in their own mind and   to really unpick that a little bit. And then un  – through understanding of that, that then leads   them, hopefully, to be able to understand  what was going on in her daughter’s life. And just a final couple of things, ‘cause I know  we’re out of time, and I want to leave plenty   of space. But I think one of the things that  really comes up a lot in our group work and our   individual work, when we’re using this approach  with parents of teenagers, is this separation   and identity formation, and this indiv – need  for individuation. And so, some of the problem   behaviours that get highlighted are things like  teenagers lying, and we explore that a lot, like,   what is lying really about? Well, it’s partly  about keeping part of their life separate and   private, so they can forge their own identity,  but to a parent, that just feels dishonest and   “not the kind of way I brought you up to be,”  which is the Lorelai statement to her daughter. But it’s important for a parent to  try and mentalize that behaviour,   that why might a teenager not tell you where  they were going when they left the house,   or why might they lie about doing their  homework? You know, is it to manipulate,   or is it to say, “Actually, I need to have some  control over this part of my life, that I have to   ultimately separate from my parents, because  I’ve got to survive”? And more importantly,   they need to survive in the social  world of their peers. So, if they – if   their parent’s involved in every aspect of  their life and knows everything about them,   it becomes much harder to have a,  sort of, separate, private identity. So, in the model, we try and help parents  to mentalize that a little bit and then to   connect with their teenagers in ways that  are not critical and shaming, but are more   respectful and thoughtful, in order to promote  that, kind of, same response back. Because we   know that when teenagers are spoken to in that  way, you know, they feel valued and they’re   more likely to have a slightly more adult and  respectful conversation back with their parent. Okay, I think I can probably – well, I’ll just say  one last thing which I talk about in the teenage   book, which is that some of the things that we’ve  talked about this evening and that I’ve shown you,   sort of, as, kind of, issues that come up  between parents and teenagers particularly,   are, you know, cusping the, kind of,  high level of risk and anxiety. We got,   you know, a teenager there sleeping  with her boyfriend who’s married,   we’ve got a teenager who’s chucking herself out  of the car ‘cause she’s so angry at her mum,   that might be too much for a parent  just to deal with on their own. And so, we think a lot in the model, as well,  about finding a network, and I like to think of   it in these, kind of – this is ‘cause I’m probably  London based, I think of the zones of the London   underground. But we help parents and teenagers to  think a little bit about, well, who is best able   to mentalize them? You know, this teenager that  helped develop this diagram, you know, he put   his parents in the, kind of, zone two. They’re  not the most obvious people on this mind when   he wants to get help, and he’s got his friends  and his Football Coach and his dog in zone one. And that’s another important part of mentalizing  that parents have to do if they have adolescents   and young adults, is to not assume that I’m  the best placed person to try and understand   my teenager in this particular moment. You  know, maybe it’s somebody else that they feel   understands them a little bit better, and  that in itself is a challenge to parents,   because it can feel invalidating of  their role. But once a parent can,   kind of, mentalize themselves and their  teenager a little bit around that idea,   then they’re much more likely to reconnect with  their young person, who feels better understood. Okay, so, I’m going to stop there and  come out of the presentation. There’s   just a couple more slides, but you can read  those when you get them. Over to you, Arnon,   and over to any questions that people might have. Dr Arnon Bentovim Okay. Would you like to –  do you want to close down the slides, then? Dr Sheila Redfern Yeah, I’ll stop the share. Dr Arnon Bentovim Yeah, that’s –  oh, that’s great, that’s fine. Yes,   the – thank you very much. Very – those  clips are very challenging, aren’t they? Dr Sheila Redfern They are. Dr Arnon Bentovim They are, and it may be that  people need some time to absorb them. I mean, one   or two of the – one interesting question which I  think came up, from – I think it’s Shema. I’m not   sure where she’s from, ‘cause there were a number  of participants from abroad. And she asked whether   this approach might be relevant for professional  – for outreach teams, and she’s talking about   working with street children, talking about  working with shelters, in closed institutions. And I think it very much brings  in the whole theme of those in   parental authority, or those with a parental.  You were suggesting your work with foster carers,   and I mean, I think that work with foster carers  is so important and working with foster carers   with – we did it in our team, working with foster  carers of unaccompanied asylum seekers. I mean,   that – for them to understand their own responses  to these challenging and very, very distressed and   very, very much living in extreme trauma. So,   I wonder whether you’d like to comment on  the relationship of parenting young people,   but those who have the responsibility of parenting  when children are separated, foster, shelters… Dr Sheila Redfern Yeah. Dr Arnon Bentovim …street children, and so on? Dr Sheila Redfern Yeah, sure. Thank you for the  question, Shema. there’s a lot in that. I think… Dr Arnon Bentovim Well, she’s  telling us she comes from Turkey,   but living in Switzerland at the moment. Dr Sheila Redfern Oh, okay, all right. Dr Arnon Bentovim So, thank  you very much, guys, yes. Dr Sheila Redfern Okay, that’s a great question.  I mean, I – the first thing I would say is that   there are many different iterations of the  mentalizing model, really, or framework.   And one of them is the AMBIT model, which if Shema  doesn’t know about it, does work with teams around   risky young people, particularly, kind of, risk  – high risk, but not necessarily or exclusively   so. And I – that might be a model worth looking at  if you’re thinking about working with a whole team   of professionals around young people, rather than  working with individual carers. So, I would defer   a little bit to the AMBIT colleagues. So, Dickon  Bevington and Laura Tolbert and Liz Cracknell,   who mainly developed that model, and Peter  Fuggle. And that’s an excellent model of thinking   about how a network can, kind of, mentalize  themselves, each other and the young person. But in answer to the, sort of, second part and the  bit that you raised, Arnon, about foster carers,   and also non-birth parents, or separated parents,  I think what we’ve found, and we’ve worked a lot   with special guardians as well, who, you know,  are usually family members, supporting a child,   is that the bit that we get consistently the  most feedback on is the parent – or we call   it the carer in the foster care map part, that  that’s the bit that I was most worried about,   that would feel maybe a bit judgmental.  That these people would want to, kind of,   not reflect on their own minds, and they’d  want to just focus on the child. But we’ve   consistently had feedback that says that it’s  the self-mentalizing which feels so regulating,   so validating. Particularly, if you imagine  a special guardian might be looking after,   say, their son or daughter’s child, so they  might – you know, there’s another layer of,   maybe, some shame and guilt there about  how they’ve parented the neglectful parent. But in trying to understand the impact  on them of looking after a child who’s   maybe had these early adverse experiences,  which in itself, can be quite traumatising,   and to have some support for mentalizing  yourself in that relationship, that’s been   incredibly powerful and effective. And we  get a lot of feedback from foster carers,   who say they’ve been on all sort – ‘cause  foster carers go on lots of trainings.   You know, they’re really often sent to a  lot of mandatory training, you know, to   become carers and then, so – but the focus, they  say, is very rarely on their own states of mind. So, if you imagine a foster carer might have a  young person who’s been in several placements,   had early developmental trauma, comes to live with  them, really has very poor relational skills. And   then even your most secure mentalizing  foster carer will be challenged by that,   because they’re looking after a young person  who doesn’t have those relational skills. So,   it’s so important for that carer to feel  robust enough in their own mind to be able   to parent somebody who is struggling to  understand their intentions, you know,   as being supportive or even just benign,  because they’re often seen as threats. So, I think this model really supports the  resilience and the wellbeing of the parent   and carer and in turn, then, promotes  this more mentalizing and secure and   regulated relationship with the  child/young person. I’m happy… Dr Arnon Bentovim Thank you. Dr Sheila Redfern I’m just also  – so, the – I’m happy after this,   I could send them to you, Arnon, we’ve  got a number of papers that have come   out of the Reflective Fostering Study  about both its development and, sort of,   what we’ve done so far. So, perhaps they  could be linked afterwards if people… Dr Arnon Bentovim Yes. Dr Sheila Redfern …wanted to read more. Dr Arnon Bentovim Yes, we  – and, also, could you send   some references on – to the AMBIT model, as well? Dr Sheila Redfern Yeah, I will do. Dr Arnon Bentovim So, that – I think our  participants value having some papers,   references, and I think that would be… Dr Sheila Redfern Absolutely. Dr Arnon Bentovim …really very,  very valuable. And Natalie Clay,   yeah, so – talks about ‘therapeutic practice’,   which herself and the therapy team offer  “supporting secondary team attachments   through knowledge of developmental trauma,”  and I think that’s, that’s important, I think. Dr Sheila Redfern Hmmm, yeah,  very important. We have a whole   session – in the Reflective Fostering  group, we have a whole set – three-hour   session on living with a child who’s  experienced developmental trauma. Dr Arnon Bentovim Yes, I think that’s… Dr Sheila Redfern Not just to help them  understand what it means for the child,   but to help them understand  how that impacts on them. Dr Arnon Bentovim Yes, I think that’s very,   very important. Another very interesting  question, I thought, was from a colleague,   who asks, “What about parents with autistic  children?” You know, and that, I think,   is a very fascinating question, an issue. Dr Sheila Redfern Hmmm, yes. Dr Arnon Bentovim I’m pleased to say that  Georgia is giving a seminar next term,   so it may be that we’ll ask  her to speak a bit about that… Dr Sheila Redfern Yes. No, I’m happ… Dr Arnon Bentovim …you know, Pavlopoulou, but... Dr Sheila Redfern I’m happy to talk –  I’m happy to address that question. It’s   one of my particular areas of interest.  So, in both the first book and the book   “[audio cuts out – 7637] of Adolescents,” there’s  a specific chapter on parenting young children or   adolescents with ASD. And I was interested, ‘cause  while we were waiting to come on the call I saw   Tony Attwood’s presenting on parenting a child  with ASD, and that intersects so nicely with   my work. Because I talk about – and in China  they’ve actually just developed – they translated   the Reflective Parenting model, and they’ve  adapted it for parents of children with ASD.   I’m just waiting to see their work. Because the  Parent MAP bit become – and the self-regulation   becomes extremely important there, more so, I  think, than with parents of neurotypical children. Because the tendency to get into these ruptures  very, very quickly, when the child – you know,   there’s a, kind of, mismatch between the parent’s  ability to read the child’s intentions and vice   versa, because of the developmental difference of  having ASD means that that is naturally harder,   becomes all the more important for  a parent to try and stay regulated   around that. Because what you hear  time and time again, if you work,   as I have done, and I’m sure this person has  done too, with parents of children with ASD,   is there’s, like, multiple explosions, because  there’s so much emotion dysregulation. There’s   so many points of, kind of, not – of  misunderstanding in the relationship. So, the parent’s capacity to regulate  themselves around that and to use their   parent map to draw on what’s going on for them  and what – where their response comes from,   not to mention the grief and loss that  comes with often, having a child that   isn’t developing in the way that you had  anticipated. All of that has such a powerful   influence on a parent’s response to their child  or adolescent’s behaviour. And, also, you know,   I spoke about how one of the positive impacts is  that in promoting this parenting approach within   the family, it also teaches the child how to  mentalize and how to develop their relationships,   in a, kind of, way where they’re using  different perspective taking skills. That is also even more important  for a child on the spectrum,   because while you can’t completely change the  structure of someone’s brain, you can certainly   improve the perspective taking skills of a young  person on the spectrum. That’s not fixed. That’s   open to development and open to understanding. It  just has to be done in a slightly different way,   but I do that quite, sort of, structurally with  parents of children with ASD, about how you might   teach perspective taking skills. So, I think it  has very important application, both to the parent   and to the young person. I’m very interested  in how this model can help those families. Dr Arnon Bentovim Yes, and thank you  to our participant, who indicated that   he’s a Community – or they are, a Community  Paediatrician, with a nephew with autism. So,   it’s personal and professional. And I guess  the follow-up question to that, of course,   is I assume there are very similar issues with  children with disabilities, and with communication   problems and verbal or communication, or visual  impairment. And presumably, it’s a very similar   issue with children with ASD, when the – when  parenting children with a variety of disabilities. Dr Sheila Redfern Yeah. Yes, I think  there’s similar issues, and they’re   so – I don’t think that being a mentalizing  parent really has any restrictions on it in   terms of the type of developmental difference  or disabilities the child has. Or – and indeed,   we’ve had some parents in the group who’ve  had their own learning difficulties,   particularly a few parents with ASD, where  this has been a struggle for them, but really,   really helpful for them to learn a bit more how  to regulate themselves around their children when   they’re on the spectrum themselves. You know,  that’s also – emotion regulation, I – you know,   I really – I know I’m preaching to the converted  a bit here, but I feel so strongly that that’s   the key to this increased connection between  parents of all disabilities and their children. Dr Arnon Bentovim Yes, thank  you. Yes, very relevant,   indeed. And I think Shema has asked  about the text hold onto your kids,   that parent should be important for their  teens during adolescence and yet, it seems   that parents should be at the second circle.  And I think you’d probably say it’s not the   question of where parents would put themselves,  but where young people put them, because of the… Dr Sheila Redfern Yes. Dr Arnon Bentovim …issue of managing  their own individuation and separation,   and obviously a major issue for parents who’ve  had a rather enmeshed relationship, perhaps. Dr Sheila Redfern Yes, I mean, that  is a constant dance, that, sort of,   push-pull between closeness and distance between  parents and their teenager or young adult. So,   in my second book I talk about young people  up to the age of 25, because, of course,   you don’t suddenly become an adult at 18, even  though that’s what the law says. You know, the   brain isn’t fully developed and most young people  are still living at home and being parented. And yes, that, sort of, push-pull between  closeness and distance causes a huge amount of   tension. But I think where the mentalizing model  is particularly helpful is in helping parents to   be explicit about while they understand that  their teenager, say, may – I mean, you know,   any example might be, sort of, getting  the bus back late at night from a party,   you know, “While you can understand that’s  absolutely what you want to do, to be with   all your mates coming back on the bus rather  than having me pick you up, I’m still worried.” And it’s about that self-other, kind of,  holding both in mind at the same time   that’s so important, because otherwise,  we all default to, “You can’t do it,   it’s banned. I’m picking you up.” The  “I know best, this is what’s good for   you.” And it’s so hard to hold that, because  you have to hold onto a little bit of risk,   and risk obviously increases a parent’s anxiety,  and anxiety decreases mentalizing capacity.   And that’s what then leads to this, kind  of, either, sort of, escalation of arguing,   or a, kind of, the foot goes down, and  then it’s, like, “You’re not going.” So, you know, once a parent can see that, sort of,   dance between mentalizing and arousal on that  thermometer, I think they can really start,   then, to appreciate, I’ve got to try and  regulate myself, even though I’m holding onto   a lot of worry here. And that’s just so hard,  you know, there’s no question that it’s hard. Dr Arnon Bentovim Interesting points coming  up, obviously, as people are really absorbing   and thinking about what you’ve been saying.  Interesting point that Lynn Whiteman asks about   the relevance of “screen time, social media, on  relationships and reflective functioning.” And,   also, the – Rachel Watson, who asks  about the “impact on the whole family,   sibling relationships, helping, hindering.  Trying to be more reflective may be unfamiliar   to others in the family, might be acting to keep  things the same,” so family influences. I mean,   it’s – I have to say, it’s a fascinating issue  for somebody of my generation, who at the   four and a half was just left to get home from  school, sort of thing, so – and where somehow,   independence was just expected. And – so,  it’s a very interesting – the changes in… Dr Sheila Redfern Yeah. Dr Arnon Bentovim …how we are as  parents, and how this current generation… Dr Sheila Redfern Yeah. Dr Arnon Bentovim …the issues. Dr Sheila Redfern Absolutely. I mean, the social  media element is obviously a whole other seminar,   and I have written a chapter solely on that in the  teenage book. Because it’s mass – it is undeniably   everywhere and it’s a massive influence, not  just on, you know, attention regulation, which   is – I mean, this is going back a bit to, sort  of, men – establishing mentalizing. But at the,   kind of, bottom of the pyramid of developing  mentalizing skills is attention regulation,   and then it’s affect regulation, and then once  those are developed, it’s mentalizing capacity.   But if your attention isn’t regulated because  you’re – you only have attention for things   in six second, sort of, clips on TikTok, or  whatever platform you’re on, then, clearly,   you know, we’ve got a big problem. And you know,  there’s good books on this, like, Johann Hari’s   ‘Stolen Focus’ is brilliant on this, about how  our attention’s really significantly dipped. But I think what’s particularly problematic  about social media for, certainly for adolescents   and parents trying to parent them, is just  comparison. You know, I think comparison with   so many other people in – on the planet, really,  has just raised anxiety through the roof. Because,   you know, back in my day, I only had to compare  myself to another 20 people in my classroom and   when they went away on holiday, I had no idea what  was happening. But I can now compare myself to   almost everybody on the planet, and I’m always  going to fall short, because there’s going to   be a million other people having a better time.  And if you’re struggling with perspective taking   skills because of how your brain’s developing  in adolescence, and you’re a bit impulsive,   that’s quite a toxic mix when you’ve then  – when you’re being fed daily information   about what other people are doing. So, I think,  you know, there’s a lot to discuss about that. Dr Arnon Bentovim Yes, I think from our point of… Dr Sheila Redfern Self-regulation comes into  it. I mean, self-regulation does come into it,   again, and helping young people  to understand how it’s impacting   on them being on their phones that long.  And I think that’s where parents can help,   is, “What does it feel like when you  have a break? What does it feel like   when you don’t know what your friends  are doing?” and thinking that through. Dr Arnon Bentovim I think that – yes,  Natalie says, “The entire world and all   its dystopia and utopia at the end of  a finger,” quite; really challenging. Dr Sheila Redfern Very well put. Dr Arnon Bentovim One question – a couple   of questions, is – and I think  it would be very helpful, Sheila,   if you could provide information  about the courses so that people know… Dr Sheila Redfern Hmmm hmm. Dr Arnon Bentovim …where they can get training,  which I’m sure is through the Anna Freud Centre.   Training in this particular approach, because I  think evidently, extremely helpful and meaningful   from the way that people have responded. So  – and issues about self-regulation with ADHD,   so important managing that neurodiversity, in  managing a child with significant restlessness. Dr Sheila Redfern Hmmm. Dr Arnon Bentovim Final question which  came up is, “How do you repair the,   sort of, breakdowns that are indicated  in the film? How do you go from there,   what’s next?” And I think  that’s a very interesting issue. Dr Sheila Redfern Yeah, yeah. Dr Arnon Bentovim How do you repair  these ruptures and these sorts of   really significant breakdowns,  which may well be associated,   as in ‘Lady Bird’, with some  pretty harmful physical impacts? Dr Sheila Redfern Yeah. So, I mean, how I’d do  that through this model is by putting a heavy   emphasis on mentalizing the parent. So, I’d always  start – I mean, because we don’t see the young   people or children in this model, all the work is  with parents. But the first, sort of, step of the   model, I do go through it in a very structured  step-by-step way, is to really validate and help   them regulate their state of mind. So, in those  two clips, I would go quite heavy on how horrible   that felt for that first parent to come home and  find her daughter, you know, having just been in   bed with a married man and how disappointed  and sad she felt, and worried. And same with   the second parent, I would hugely empathise with  her going on this road trip to the university and   all the feelings that must have been going  on for her at that time, and then it all,   kind of, you know, gets trashed because she just  wants to listen to music and not talk anymore. So, I would really focus in on those moments  where the rupture started, until the parent   felt sufficiently validated, really, and  understood and mentalized themselves. So,   you know, once I think the parent feels, okay,  this person does understand how horrible this   feels and what a challenge it is, it would only  be after a few sessions like that that I would   then get into thinking, “And what about Rory? You  know, what do you think she was feeling, sort of,   having this rite of passage with this boy that  she’s really mad on?” and – you know. But you   can’t start with that, and that’s the mistake  that often, I think, we make as Clinicians. You know, really experienced Clinicians,  including myself, we always leap to   the, “Well, what was going on with Rory?” or,  “What was going on with Lady Bird? Why was she   doing that?” And it’s very hard to ask a parent  to answer that question in a mentalizing way,   until they feel that you’ve really  understood their perspective. So,   I do go through it in that sequence and inevit –  nearly all cases, once a parent has felt, okay,   you understand me a bit better, and I understand  me a bit better, then they can move onto starting   to mentalize the other, namely their child.  But they have to be regulated themselves first. Dr Arnon Bentovim Fantastic. I think that  summarises so well the stance and the approach,   and I’m sure that many of the people participating  will find that enormously value. So – and   certainly from the Association, tremendous  thank you to Sheila, to Dr Sheila Redfern,   for an inspiring presentation, which will really  resonate and which we’ll all be thinking about   and hopefully, continuing to learn. And  thank you for letting us know about your   books so that we can really read about it. And  the insight into the chapters you’ve given us,   and the area that you’re covering,  I think is so very valuable. So, we invite everybody to  feed – to give some feedback,   and we’ll share the presentation and the  slides, and hopefully, other information   about training and other literature that  might – people might find helpful. So,   thank you very much, indeed, and thank  you, everybody, for participating… Dr Sheila Redfern Thank you. Dr Arnon Bentovim …and the points  and questions you’ve raised. So,   thank you, and goodnight, everybody. Good evening. Dr Sheila Redfern Thanks so much, everyone.