Reflective functioning is the capacity to be aware of, find meaning in, and flexibly adapt in response to both internal and external life experiences while maintaining a coherent continuous perspective (a sense of self) (Ordway et al. 2015). Although reflective functioning may seem to be primarily a cognitive activity, it is grounded in emotion regulation and together with emotion regulation is a prerequisite for the development of secure attachment bonds in parent-child relationships (Morel and Papouchis 2015). Traumatic stress reactions are characterized by survival-based hypervigilance—a preconscious scanning for even the smallest sign of impending danger that is fundamentally incompatible with reflective functioning (Ford 2009). TARGET assists traumatized mothers in recognizing the adaptive purpose of hypervigilance in order to enable them to become consciously aware of when and how they are becoming hypervigilant. Rather than encouraging clients to attempt to cease or reduce hypervigilance, TARGET enables the therapist to guide the client in making a conscious choice about when and how to be alert to potential threats and how to also be aware of the choice to focus her attention on feelings, thoughts, goals, and actions that reflect her core values and sense of purpose in life. This is done by teaching clients to intentionally deploy a mental focusing skill that is described with a mnemonic, “SOS”: slow down/sweep your mind clear; orient yourself by concentrating your attention on one thought that is a reminder of who you are as a person and what you most value in life; and self-check how much stress and how much personal control you feel at this moment.

TARGET makes it clear that focusing with the SOS is not intended to erase fear or anxiety nor to compromise alertness to potential danger. It also is not a rote exercise. Instead, focusing with the SOS provides an alternative to hypervigilance that makes it possible to be alert and to think clearly without being preoccupied with threats or feeling overwhelmed with distress or shut down mentally and emotionally. Focusing opens up the possibility of conscious choice about when and how to be alert to danger. Focusing thus gives a person greater control over their own feelings, thoughts, and destiny (and ultimately safety) than habitual hypervigilance. The goal of focusing is to increase the client’s confidence in her ability to choose options for deploying her perceptual and mental capacities purposefully rather than automatically. This allows her to choose when and how to allocate her attention to her core values and goals, to responsibly anticipate and be prepared to recognize (rather than being blindsided by) danger and distress, and to effectively respond (rather than avoid or react) to opportunities as well as to adversities.

Focusing thus provides a practical approach for trauma survivors to responsibly protect themselves and their loved ones based on what they have learned from traumatic experiences while also remaining aware of and honoring their core values and goals (i.e., reflective functioning). This is of particular importance for traumatized parents because it enables them to protect and guide their child[ren] with due regard for the reality of the traumatic dangers and harm that they have had to survive and overcome while also serving as a role model of emotion regulation (i.e., balancing distress and excitement with calm confidence) and drawing on reflective functioning to responsively provide their child[ren] with consistent empathic understanding, encouragement, and love (i.e., good enough caregiving to establish and sustain a secure attachment bond). Thus, when TARGET helps traumatized mothers to recognize and choose to utilize their capacity to focus, this provides them with a foundation and scaffolding for emotion regulation and reflective functioning while they cope with traumatic stress reactions.

Reflective functioning does not come easily or naturally for everyone, especially when posttraumatic hypervigilance dominates a person’s mental and emotional life. Those who are inclined by temperament or social learning toward anxiety or dysphoria tend to be more limited in this capacity—not necessarily due to any inherent deficit, but as a result of automatically allocating finite psychological resources that are needed for reflective functioning instead to hypervigilance. Rather than simply instructing and encouraging mothers who struggle to achieve reflective functioning to attempt to apply the SOS as a rote coping tactic, TARGET emphasizes recognizing and building on positive exceptions. Those exceptions are the times when a mother is able to maintain (or regain) a focus on her core values and goals and to be with her child[ren] in a calm, confident, empathic, and reflective manner despite feeling stressed, distressed, or shut down. By highlighting exceptions, TARGET builds a scaffold to support gains in focusing.

TARGET also promotes reflective functioning as a counterbalance to hypervigilance by helping clients to identify triggers that elicit “alarm reactions” (i.e., feeling distressed or shut down emotionally, reacting without forethought). Triggers in parenting often are obvious (e.g., time or money pressures; fussy, defiant, or “noncompliant” children) but equally often are subtle and unique to each mother. For example, a family holiday or child’s birthday celebration may seem on the surface to be entirely positive. Such “highlight” events also involve many obvious but often overlooked stressors for the parent (e.g., responsibility to orchestrate a successful event for a large number of participants who are in conflict with one another or have competing agendas). In addition, there may be nonobvious triggers related to the parent’s past traumas (e.g., reminders of similar past events that involved or were followed by abusive interactions or that involved key people who were subsequently killed or died prematurely). Paying attention to such triggers and their legitimate emotional significance not only provides a preparation for future occurrences but also is in itself a form of autobiographical reflective functioning that can lead incrementally to a sense of resolution. In both respects, the identification and validation of triggers represent a shift from hypervigilance to proactive preparation for future stress reactions.

TARGET helps clients to identify both internal (e.g., body and emotion states) and external (e.g., physical circumstances, the presence and behavior of other persons) triggers. This can be important in enabling a traumatized mother to shift from an exclusive externalized perspective (e.g., worrying about or blaming her child[ren] or herself) to paying attention and becoming better attuned to her own internal states. Attunement to one’s own inner states and, with this as a scaffold, to those of others such as one’s child[ren] is an essential feature of both emotion regulation and secure attachment bonding. Trauma experiences often teach survivors unfortunate lessons: that inner states are a distraction that can interfere with rapid emergency responding, that being aware of internal states is an act of selfishness that causes harm, and that inner states send a signal of vulnerability to perpetrators which leads to escalating violence or maltreatment. For these reasons, instead of having clients simply make superficial lists of “things that make you feel distressed,” TARGET engages clients in a discussion of how their life experiences have led them to adaptively and protectively develop alarm reactivity to key internal states or external cues or events. With this awareness and reflection, triggers can be seen as an opportunity for mothers to develop attunement and empathy as a counterbalance to hypervigilance while preserving their ability to be alert and prepared for signs of potential threat.

TARGET also enables mothers to distinguish between trauma-related hypervigilance and extreme stress reactions to triggers related to ordinary stressors. In the absence of a traumatic threat, these intense alarm reactions seem (and often to the client herself) to be “irrational overreactions.” Such posttraumatic stress reactions are viewed in TARGET as having meaning in that they signal to the client that it is necessary to take two steps to reset her brain’s inner alarm. The first step is verifying that there is no severe threat for which the client is unprepared, which requires a careful examination of life circumstances. If she is not sure that she is prepared to handle major threats, then planning ways to handle such circumstances is important to maintain a genuine sense of self-trust and self-efficacy. Secondly, the alarm reaction is a call to refocus on core values and goals that may have slipped off the radar screen in the ongoing press of daily life and parenting. Rather than signaling a problem, a preoccupation with potential danger is reframed in TARGET as a combination of fear based on past traumas and legitimate caution. Mothers are helped to transform hypervigilance into confident protectiveness by reflecting on how doing so can change what was a “symptom” into an adaptive way to honor core values and life goals in relation to key people (especially, but not limited to, child[ren]).

Parenting involves a wide range of emotions that can either enhance or interfere with mothers’ emotional availability. Emotion regulation involves awareness and use of emotions as a guide to decisions and actions and the ability to feel emotions in an optimal window of intensity (i.e., neither overwhelmingly strong nor numbed and dissociated). In TARGET, posttraumatic alarm reactions triggered by the non-traumatic stressors involved in parenting and life are viewed as expectable destabilizers of the capacity for emotion regulation. This destigmatizing trauma-informed perspective enables traumatized mothers to become aware of posttraumatic emotion dysregulation without shame.