Theoretical Underpinnings

Mother playing with baby boy

The Minding the Baby® intervention is based on a strong theoretical core that unifies and drives the work of the program. The three main theories that guide MTB are attachment theory, social ecology theory, and self-efficacy theory. From the framework of these complementary theoretical perspectives, enhancing early attachment relationships must be accomplished at both the individual and contextual level, at the level of singular relationships and at the broad level of relationships to the family and community. Without attention to these diverse levels of influence throughout the work of the program, change is unlikely.

While attachment and social ecology models provide a broad perspective on thinking about how to effect change in these complex families, recent developments in attachment theory provide crucial windows to thinking about the mechanisms of change in such interventions, namely what aspects of maternal functioning really must be addressed in order to affect outcomes. Over the past ten years, Fonagy and his colleagues have developed the construct of reflective functioning (RF), which refers to the basic human capacity to understand behavior in light of underlying mental states and intentions, a capacity crucial to the development of intimate social relationships (see Fonagy & Target, 1997 and Slade, 2005 for a review).

Intrinsic to the MTB clinical model is the understanding that reflective functioning is key to maternal sensitivity. It allows the mother to regulate her baby’s states of arousal and affective experience, and is at the heart of a mother’s ability to insure her child’s physical health and safety, setting the stage for the development of secure, reciprocal, and flexible attachment relationships. A series of research investigations have provided empirical support for Fonagy and his colleagues’ notion that reflective functioning emerges out of the context of one’s primary attachment relationships, which are crucial to the capacity to think, feel, and ultimately integrate a variety of levels of self-experience.

In Minding the Baby®, it is the mother’s relationship with the home visitors that provides a variety of levels of presence and support that are crucial to mothers developing reflective capacities; the clinicians’ holding, containment, attunement, and acceptance are crucial to the emergence of coherent representations of self and other, personal autonomy, and a sense of a positively felt, authentic self.  Change in the mother’s (and family’s) sense of effectiveness and competence in relating to a variety of relationships and community systems emerge as a function of mutative relationships with a caring other. This is the therapeutic engine that drives the intervention, and that will hopefully promote maternal sensitivity and understanding across a range of domains.

Additional information and more detailed theoretical background is provided in the MTB Treatment Manual, which is available in conjunction with the Introductory Training Institute offered by MTB faculty and staff annually in the summer.