Parental reflective functioning in attachment-based family therapy for LGBTQ+ young adults and their nonaccepting parents.

Parental rejection significantly impacts the mental health of sexual and gender minority young adults and can undermine parent-child relationships. Attachment-based family therapy for sexual and gender minorities aims to repair these ruptures by facilitating "corrective episodes," where parents listen to their young adult's experience of feeling rejected and respond with empathy and validation rather than defensiveness. Parental reflective functioning (PRF) is thought to be a necessary precursor to such productive enactments. This study examined whether PRF during individual preparatory sessions with parents predicted parents' observed behaviors toward their young adult during subsequent conjoint sessions. Participants included 45 parents of Israeli LGBTQ+ young adults who participated in an open clinical trial of attachment-based family therapy for sexual and gender minorities. PRF was observationally coded using a modification of the Reflective Functioning Scale. Parents' behaviors were coded using the Parent-Child Interaction Coding System. Consistent with our preregistered hypothesis, higher levels of PRF in individual sessions with parents predicted a greater frequency of constructive parent behaviors toward their young adult, including validating the young adult's experience and soliciting their emotional reactions, during subsequent conjoint sessions. Conversely, higher PRF predicted significantly lower frequencies of parents' patronizing and judgmental behaviors. Contrary to our hypothesis, parents' defensiveness was not associated with PRF. Notably, PRF in the final preparatory session with parents remained a significant predictor of their behaviors in subsequent conjoint sessions, even when controlling for initial parental reflective functioning, suggesting that fostering mentalization immediately prior to conjoint sessions is a crucial therapeutic task. (PsycInfo Database Record (c) 2026 APA, all rights reserved).