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Daniel D. Rutimann / Kevin B. Meehan 60/3

Validity of a Brief Interview for

Assessing Reflective Function

The Reflective Function Scale was developed by Fonagy and colleagues

(1998) to empirically measure the capacity to mentalize thoughts, inten-
tions, feelings, and beliefs about oneself and others. Reflective Function
(RF) has been reliably measured by the Adult Attachment Interview
(AAI; Main and Goldwyn 1998), but its length (45–90 minutes) and the
labor required to administer, transcribe, and code for RF may be pro-
hibitive for many research studies. The present study measured the
reliability and validity of the Brief Reflective Function Interview (BRFI;
Rudden, Milrod, and Target 2005) by administering it to 27 undergradu-
ate participants previously assessed using the AAI in another research
study (Morrison 2010). The BRFI was coded reliably by two independent
raters (ICC = .79) and yielded a highly significant positive correlation
(r = .71) between RF scores obtained by BRFI and by AAI. The average
administration time of the BRFI (M = 24.15 minutes) was significantly
shorter than that of the AAI (M = 44.65 minutes). These findings suggest
that the BRFI may offer a reliable, valid, and streamlined alternative to
the AAI as a measure for coding RF.

M entalization, the process by which we make sense of interper-

sonal behavior in terms of underlying mental states, has been
operationalized for research as Reflective Function (RF; Fonagy et al.
1998). Although several theorists have put forth similar notions (Bion
1962; Dennett 1978; Winnicott 1971), Fonagy and his colleagues have

Daniel D. Rutimann, doctoral student, Clinical Psychology Doctoral Program,

Long Island University, Brooklyn Campus. Kevin B. Meehan, Assistant Professor,
Department of Psychology, Clinical Psychology Doctoral Program, Long Island
University, Brooklyn Campus.
This research was supported in part by a grant from the International
Psychoanalytical Association to Matthew Morrison and Kevin B. Meehan. The
authors thank Matthew Morrison and Adam Frankel for invaluable assistance with
data collection, and John Markowitz, Barbara Milrod, Chris Nelson, and Marie
Rudden for comments and guidance on this work. Submitted for publication August
15, 2011.

DOI: 10.1177/0003065112445616 577

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Daniel D. Rutimann / Kevin B. Meehan

extended these ideas by proposing a central role for their construct in

determining individual patterns of self-organization, affect regulation,
and interpersonal attachment (Fonagy et al. 2002).
Reflective Function has had significant implications for understand-
ing the relationship between parental attachment security and infant
attachment patterns in the Strange Situation (Ainsworth et al. 1978). The
London Parent-Child Project, which investigated determinants of parent-
child attachment patterns (Fonagy, Steele, and Steele 1991; Fonagy et al.
1991), found that mothers who were classified as secure on the AAI and
who had high RF when discussing their own attachment history were
likely to have infants who showed more secure base behaviors in the
Strange Situation. In other words, the mother’s capacity to understand her
childhood relationship to her own parents in terms of states of mind (RF)
proved a better predictor of infant attachment security than parental
attachment security alone (Fonagy, Steele, and Steele 1991).
Consistent with these findings, Slade and colleagues (Slade et al.
2005; Grienenberger, Kelly, and Slade 2005) found that mothers who
exhibited high RF in discussing their relationship with their infant on the
Parent Development Interview (PDI; Aber et al. 1985) were more likely
to have infants categorized as secure in the Strange Situation. Moreover,
mothers’ RF mediated the relationship between atypical behaviors asso-
ciated with maternal trauma (fearful/disorganized behaviors, role or
boundary confusion, intrusiveness, withdrawal) and attachment security
in their infants.
RF has also become important as a clinical concept for understanding
personality pathology (Choi-Kain and Gunderson 2008; Fonagy et al.
2002; Holmes 2001; Levy et al. 2006). Using a cross-sectional design,
Fonagy and colleagues (Fonagy1996; Fonagy et al. 1996) found an inter-
action between RF and early experiences of abuse in the later development
of a personality disorder in a sample of 82 nonpsychotic inpatients; abused
patients with low RF (below the median of 3) were more likely to be diag-
nosed with borderline personality disorder (BPD) than patients who were
abused but had high RF (above 3). The finding of low RF (level 3) in
patients with BPD was confirmed in two subsequent studies. In a sample
of outpatients with BPD (n = 90), Levy and colleagues (2006) found that
patients with BPD had an average RF rating of 2.9. Similarly, in a sample
of outpatients with BPD (n = 92), Fischer-Kern and colleagues (2010)
found that patients with BPD had an average RF rating of 2.7. Further,
they found a positive relationship between RF and level of personality

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Validity of Brief Reflective Function Interview

organization as assessed by the Structured Interview for Personality

Organization (STIPO; Clarkin et al. 2004). Studying a forensic sample
(n = 44), Levinson and Fonagy (2004) found that prisoners had lower RF
(2.1) than patient populations (3.8), and that violent offenders showed the
greatest RF deficits (1.4).
There is current interest in investigating RF as a possible mechanism
of change in psychotherapy, particularly for psychodynamic psycho-
therapy. Levy and colleagues (2006) found that outpatients with BPD
(n = 90) treated for one year in Kernberg’s transference-focused psycho-
therapy (TFP) evinced significant changes in RF (from 2.86 to 4.11),
whereas the RF of patients treated with dialectical behavior therapy
(DBT) (from 3.31 to 3.38) or supportive psychotherapy (from 2.80 to
2.86) did not change. Using an interview that focused specifically on the
capacity to reflect on panic symptoms, Rudden and colleagues (2005)
found greater changes in RF in patients treated with panic-focused psy-
chodynamic psychotherapy than in those treated with behavioral applied
relaxation treatment. Other clinical trials designed to evaluate RF as a
mediator of clinical change in Axis I disorders are currently under way
(Rudden et al. 2009).
However, limitations in the current scale have hampered research
efforts that require focal evaluations of RF. The RF scale has traditionally
been applied to transcripts of the Adult Attachment Interview (AAI), a
semistructured clinical interview assessing early attachment relationships
(George, Kaplan, and Main 1985). Although the AAI provides a wealth
of clinical data, the interview is long and laborious to administer, tran-
scribe, and code (Levy and Kelly 2009; Choi-Kain and Gunderson 2008).
A sixty-minute interview, for example, may take up to six hours to tran-
scribe and an additional hour or two to code. The burden of such a
lengthy and elaborate interview may preclude its use in many randomized
clinical trials, during which patients will already undergo hours of evalu-
ation. Given the need in some instances for a more focal interview, a
brief, reliable, and well-validated alternative to the AAI from which RF
can be scored would facilitate research in this area.
Although several studies have applied the RF scale to AAI interviews
that have been modified in length and focus (e.g., Slade et al. 2005;
Rudden et al. 2005), none have reported comparisons of the RF scores
obtained from modified interviews with those obtained from the original
AAI. The validity of the scores from modified interviews thus remains
uncertain. One study that did compare RF scored on the Object Relations

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Daniel D. Rutimann / Kevin B. Meehan

Inventory (ORI), which asks for brief spontaneous descriptions of self

and others, to scores obtained on the AAI in a sample (n = 14) of border-
line personality disorder patients revealed only a moderate correlation
(r = .32; Loewyck et al. 2009).
In the present study we assessed the reliability and validity of the
Brief Reflective Function Interview (BRFI; Rudden, Milrod, and Target
2005). This interview, based on the AAI, was designed for use with the
RF scale and is intended to reduce administration time by focusing on
questions that specifically prompt for reflection about attachment rela-
tionships and focusing less on episodic memories than does the AAI.
However, it should be noted that both interviews contain questions that
prompt participants to demonstrate their capacity for RF and that this
prompting is considered a valid assessment technique. The BRFI was
administered to 27 undergraduate participants who had previously been
assessed for RF using the AAI for another research study (Morrison
2010). The two sets of independently administered and coded RF scores
were then compared. We predicted that the BRFI would show strong
internal consistency (a > .8) and that RF scores obtained using the brief
measure would be significantly and positively related (r > .5–.7) to those
obtained using the AAI. In addition, the administration time of the BRFI
was expected to be significantly shorter than that of the AAI (M < 30
minutes).

Method

Participants
Twenty-seven undergraduate students at a northeastern university,
who had been administered the AAI in a separate research project, were
contacted by phone or e-mail and recruited for the present study. Participants
in the earlier study had been recruited from a research participation pool of
introductory psychology students (n = 25) and from students responding
to flyers posted on campus bulletin boards who were paid for their time
(n = 37). That study had found no differences in RF between participants
as a function of recruitment strategy (Morrison 2010).
For the present study, those participants were recontacted after a mini-
mum of two months had elapsed since AAI administration; elapsed time
between interviews ranged from 2.5 to 10.6 months (M = 6.4, SD = 2.7).
Participants were recruited by phone or e-mail and were paid fifteen dollars

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Validity of Brief Reflective Function Interview

for their time. Of the 62 participants in the original research project, 27

(43%) were successfully recruited for the present study, 23 were unreach-
able, and 13 were contacted but refused to participate. The current sample
consisted of 15 men (53.6%) and 12 women (44.4%). Ages ranged from 18
to 47 years (M = 26.08, SD = 6.27). Twenty of the participants in the cur-
rent sample had been recruited for the original research project through
flyers, and seven were introductory psychology students.

Measures
Adult Attachment Interview (AAI; George, Kaplan, and Main 1985).
The Adult Attachment Interview is a semistructured clinical interview
designed to elicit thoughts, feelings, and memories about early attachment
experiences and to assess the individual’s state of mind or internal
working models concerning early attachment relationships. The interview
consists of twenty questions asking individuals to describe their childhood
relationships with their parents. For each parent or attachment figure,
participants are asked to spontaneously generate a list of five adjectives
to describe the relationship and to support these descriptors with specific
memories. Participants are also asked about attachment-related events,
such as how their parents responded when they were upset, injured, or
sick as children. Interviewers ask about memories of separations, loss,
experiences of rejection, and times when they might have felt threatened,
including, but not limited to, physical and sexual abuse. The interview
requires that participants reflect on their parents’ styles of parenting, and
that they consider how their childhood experiences with their parents
have influenced their lives. The administration time of this interview
across many studies ranges from 45 to 90 minutes. The interviews were
administered, audiotaped, and transcribed in accordance with a procedure
developed by Main and colleagues.
Brief Reflective Function Interview (BRFI; Rudden, Milrod, and
Target 2005). The BRFI is a brief semistructured interview that, unlike the
AAI, asks participants to reflect on their relationship with only one parent
(or other attachment figure), of their own choosing, and to consider how
their childhood experiences with this parent have influenced their lives. Its
eleven questions ask participants to reflect on their childhood relationship
with the parent. The interview questions specifically prompt for reflection
about attachment relationships, with less focus than the AAI on eliciting
attachment-related episodic memories. Interviewers also ask participants
to describe someone important in their current life in order to capture their

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Daniel D. Rutimann / Kevin B. Meehan

understanding of a nonparental attachment relationship. Taken together,

the participant’s responses are thought to reflect a general capacity for RF
in relationships, rather than being specific to a particular attachment
figure. Administration time runs from 15 to 30 minutes. The interviews
were also audiotaped and transcribed in accordance with the procedure
developed by Main and colleagues.
Reflective Function (RF; Fonagy et al. 1998). The Reflective Function
Scale is an 11-point scale that evaluates the quality of mentalization in
the context of attachment relationships. Transcribed interview passages
are rated on a scale of −1 (negative RF, concrete, totally barren of
mentalization, or grossly distorting of the mental states of others) to 9,
(exceptional RF, complex, elaborate, or original reasoning about mental
states), and these scores are then aggregated to provide an overall score.
There is no formula for arriving at a global RF rating. However, the
manual includes general guidelines, which raters use in combination with
their impression of the entire interview and their experience of other
narratives to which they have assigned ratings to derive a final RF score.
The AAI and BRFI were each scored with the Reflective Function
Scale. The two interviews were administered a minimum of two months
apart by independent interviewers and were scored by independent
coding groups. For each coding group, raters were doctoral-level psy-
chology students trained to reliability in coding RF and blind to all
identifying characteristics of the participants. AAI coding group reli-
ability was established on a subset of 15 randomly chosen interviews
(ICC; Absolute Agreement, average = .89). BRFI coding group reliabil-
ity was established on a subset of 21 interviews (ICC; Absolute
Agreement, average = .79). Discrepancies in scores were reconciled to
reach consensus by the coders in each group.

R e s u lt s

To demonstrate that the participants in the current study were adequately

representative of the larger sample from which they were recruited, we
compared them to the eligible nonparticipants (n = 36) on age, gender,
and AAI RF score. An independent samples t test revealed no significant
difference (t = .409, ns) between the mean age of participants (M = 26.08,
SD = 6.27) and nonparticipants (M = 25.44, SD = 5.98). Mean AAI RF
score for current study participants (4.04, SD = 1.87) did not significantly
differ from that of nonparticipants (3.90, SD = 1.14, t = .32, ns).

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Validity of Brief Reflective Function Interview

A chi-square analysis of independence revealed a significant group

difference between gender and participant status, χ2 (1, 63) = 4.97,
p < .05, with the ratio of females to males higher in the nonparticipant
group. However, independent samples t tests indicated no significant
gender differences in RF score on either the AAI (t = −.401, ns) or
the BRFI (t = −1.11, ns) among current study participants. Mean
RF scores were comparable for male (3.87, SD = 1.99) and female (4.27,
SD = 1.73) current study participants as well as male (3.86, SD = 1.07)
and female (3.92, SD = 1.18) nonparticipants. Thus, the present sample
was deemed adequately representative of the larger sample from which
participants were recruited.
Regarding our main hypotheses, RF scores obtained using the BRFI
were significantly positively correlated with those obtained using the
AAI (see Figure 1; r = .71, p < .01). Both sets of RF scores were nor-
mally distributed (see Figure 2), and a paired samples t test revealed no
significant difference (t = 1.19, ns) between the mean RF scores on the
AAI (4.00, SD = 1.84) and the BRFI (4.30, SD = 1.20). Because visual
inspection of the data suggested the presence of possible influential data
points, regression diagnostics were run to assess for such leverage.
Consistent with Fox (1991), we considered cases with a Cook’s D
greater than 1 potentially influential; no influential data points were
detected using these criteria. The BRFI also showed strong internal con-
sistency (α = .97), indicating that its eleven items are cohesive and likely
measure the same underlying construct (RF). The BRFI had a signifi-
cantly shorter administration time (M = 24.15, SD = 9.65) than the AAI
(M = 44.65, SD = 16.94; t (27) = 6.69, p < .01).

Discussion

The high correlation between RF scores obtained on the two interviews

supports the main hypothesis of the study and suggests that the BRFI and
the AAI evaluate the same construct (RF). This finding is impressive
considering that each participant was administered the two interviews on
average six months apart by independent interviewers and scored by
independent coding groups.
On average, the administration time of the BRFI was twenty minutes
shorter than that of the full-length AAI. This is a conservative estimate of
the BRFI’s overall benefit, since shorter administration times translate
directly to faster transcription and coding of the interviews. The BRFI

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Daniel D. Rutimann / Kevin B. Meehan

Figure 1. Correlation between AAI and BRFI RF scores

RF Scores- BRFIxAAI
9

5
BRFI

0
0 1 2 3 4 5 6 7 8 9
AAI

Figure 2. Distribution of RF scores on the AAI

and the BRFI

showed acceptable reliability on a more conservative test of absolute

agreement between coders. This suggests that the BRFI, while more
quickly administered than the AAI, still yields sufficient material for
reliable coding of RF. Its high internal consistency indicates that its
individual items all measure a single construct (RF).

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Validity of Brief Reflective Function Interview

The overall results of this study indicate that the BRFI may present
a valid, reliable, and streamlined alternative to the AAI as a measure for
coding RF, an alternative that would confer advantages in a variety of
research designs. The BRFI is not only more quickly administered, but
more quickly transcribed and coded as well. By substituting the BRFI for
the AAI, researchers may avoid the bottlenecking that tends to occur at
the transcription and coding phases. The briefer interview would also
reduce the cost of transcribing and coding and ultimately would allow
researchers to produce results more efficiently and cost-effectively. This
is particularly true for research designs geared toward measuring change
in RF with treatment and mediator analyses, which require multiple
assessments of each participant.

L i m i tat i o n s a n d F u t u r e D i r e c t i o n s

Participants in this study were found to be representative of the larger

sample from which they were recruited in age and RF score obtained by
AAI. Although participants and nonparticipants did differ significantly
in gender distribution, no gender differences were found for RF scores
obtained using either measure. Thus it is unlikely that gender distribu-
tion across the two groups represents a significant confound. Although
RF scores were largely consistent across the two interviews, there were
more discrepancies on the low end of the scale (scores of 1 and 2; see
Figure 2). Further research should clarify whether this results from
scoring errors or insufficient sensitivity of the BRFI to the lower end of
the RF scale.
Because all study participants had previously completed the AAI in
a separate research study, counterbalancing of the two interviews was
not possible. Whether a practice effect may have contributed to scoring
discrepancies across the two interviews is not known. Though RF is
thought to be fairly stable over a period such as six months, future
research should include counterbalancing procedures to control for this
potential confound.
The BRFI asks participants to choose one parent to reflect on, rather
than both parents, as in the AAI. This is consistent with the use of the
RF scale on the AAI, which treats RF as a general capacity rather than
as caregiver-specific, the total RF score representing a mean capacity
across attachment figures. The creators of the BRFI measure tried to
address the possibility that it may be difficult to mentalize about a parent

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Daniel D. Rutimann / Kevin B. Meehan

who looms especially large in the participant’s mind by also asking

about a significant nonparental figure in order to get a broader feel for
the person’s reflective capacities. However, future research should
evaluate possible discrepancies in RF for different attachment figures on
both the AAI and the BRFI.
While past research involving both original and modified versions of
the AAI has focused on clinical samples, the current study was based on
a nonclinical sample. In addition, many participants were originally
recruited as undergraduates seeking course credit (and possibly the
approval of their professor), raising the issue of the generalizability of the
results. Replication of the present study in a clinical sample would further
validate the brief measure.
Finally, future research should include a more rigorous test of the
validity of RF scores obtained from the BRFI by replicating past validity
studies that have used the AAI. As we have noted, high maternal RF as
measured by the AAI has been shown to predict secure base behaviors in
the Strange Situation (Fonagy, Steele, and Steele 1991; Fonagy et al.
1991). Further, while parental RF as measured by the AAI has a modest
correlation to verbal IQ, when further evaluated in hierarchical linear
regression models, RF was found to predict infant-parent attachment,
while verbal IQ was found to be no longer significant (Steele and Steele
2008), suggesting that attachment outcomes were not a function of paren-
tal intelligence. Thus, a more rigorous future evaluation of the validity of
the BRFI would be to demonstrate the predictive value of its RF scores
in terms of infant-parent attachment, and to demonstrate that this predic-
tive value is not better accounted for by verbal IQ.1
Similarly, research has demonstrated the validity of RF as measured
by the AAI as an outcome measure of patient improvement in treatment
(Levy et al. 2006). Thus, a more rigorous future evaluation of the validity
of the BRFI would be to demonstrate that its RF scores are related to treat-
ment outcome. As we have said, such treatment studies using the BRFI are
currently under way (Rudden et al. 2009). Taken together, such studies
would rule out the possibility that the BRFI measures some generic reflec-
tive capacity that correlates to RF scores obtained on the AAI but does not
hold the same predictive value for attachment and treatment outcomes.
Nonetheless, the overall results of this study indicate that the BRFI may
represent a comprehensive yet streamlined alternative to the AAI as a
measure for coding RF.
1
We thank Howard Steele for this astute observation.

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Validity of Brief Reflective Function Interview

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Kevin B. Meehan
Department of Psychology
Long Island University
1 University Plaza
Brooklyn, NY 11201
E-mail: kevin.meehan@liu.edu

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