Parental Reflective functioning (PRF) is a psychodynamic construct defined traditionally within the field of infant mental health as the caregiver’s capacity to mentalize the infant’s internal state and present needs (Slade, 2005; Fonagy, Steele, Steele, Moran, & Higgitt, 1991). What emerges with caregiver reflection is the infrastructural layout of the attachment trajectory which encompasses the infant’s capacity to regulate, connect, and communicate with the surrounding world. Research suggests that PRF is multifaceted as it encompasses reflection, attunement, curiosity, and the interpretation of the infant’s cues (Luyten, Mayes, Nijssens, & Fonagy, 2017).
The PRF journey for parents is quite complex and possibly mediated by a myriad of socio-cultural factors. Despite the dearth of research on the impact of culture, religion, and the broader context on PRF, a few studies have illustrated the importance of considering macro level factors in terms of emerging PRF trends and patterns. Lee, Meins, & Larkin (2024) for instance, suggested that Korean and British mothers may vary in the content of their mentalization; whereas the former tend to focus on cognitions and emotions, the latter may lean into the desires and preferences of their infants. Researchers continue to advocate for a widened lens to keep the culture “in mind.” In a systematic review by Aivel-Naveh, Rothschild-Yakar, & Kurman (2019), the authors postulated that mentalizing “profiles” diverged between individualistic and collectivistic cultures.
While Western models of PRF and mentalization have made significant contributions to the literature of infant mental health research and interventions, limitations in terms of the applicability and generalizability have been postulated. PRF tools, for example, commonly assume the primacy of the mother-infant dyad, parental introspection, and self-reports. Such assumptions may overlook alternative cultural modes of introspective embodiment, and differences in perceiving mental states and definitions of caregiving/parenting (Berg, 2016). Classic reflective models tend to focus on tangible and verbal expression, leaving non-verbal and culturally-specific forms of mentalization underexamined (Camoirano, 2017).
As Hisako Watanabe eloquently states in Reflective Practice from Around the World (2025), “Reflective practice takes us back to the basics of life and the enigma of encounters and relationships.” This perspective encourages redefining PRF through non-Western lenses such as that of the Gulf culture, where infant mental health is a rapidly developing field, particularly in countries like the United Arab Emirates. Despite this growth, literature on PRF and infant mental health in the Gulf remains non-existent. By examining these concepts with regard to the Gulf region, this paper seeks to highlight both the universality and the cultural nuances of PRF, and how caregiving can be shaped and enriched by collective, spiritual, and intergenerational systems.
Caregiving in the Gulf: Religious and Cultural Foundations
Caregiving in the Gulf region is diverse, including countries such as the United Arab Emirates, Saudi Arabia, Qatar, Kuwait, Bahrain, and Oman, and shaped by Islamic values, cultural traditions, extended family systems, and a collective sense of responsibility (Amin, Cochrane, & Al-Kaabi, 2025; Daher-Nashif, Hammad, Kane, & Al-Wattary, 2020). This caregiving ecology contrasts with Western models that emphasize verbal and individualized interaction (Fonagy, Campbell, Constantinou, Higgitt, Allison, & Luyten, 2021). Caregivers in the Gulf often express attunement through embodied practices centered on physical touch, such as rocking, co-sleeping, rhythmic soothing, or massage with traditional oils (Saffer, Hariri, Alhuseini, Aljanoubi, Bah, & Rais, 2024). This is consistent with developmental research showing that touch promotes attachment and reduces stress in early caregiving, and physical proximity not only soothes the infant but also helps regulation and emotional security (Carozza & Leong, 2021; Norholt, 2020). These embodied practices, or “embodied attunement,” promote connection and demonstrate culturally coherent sensitivity, even in the absence of explicit verbal mentalization (Markman, 2020).
The theological concept of amanah (trust) is central in Islam, where children are viewed as a trust from God, and parents are held morally and spiritually responsible for their well-being (Bensaid, 2021; Raffar, Hamjah, Hasan, & Dahlan, 2021). This idea fosters an attachment style based on embodied presence, sukun (calm), and rahma (mercy) (Hani, 2024). Attachment is further conveyed through co-regulatory spiritual practices such as Qur’anic recitation, and whispered invocations and protective prayers especially at bedtime (Allana, Tennant, & Petrucka, 2017; Jafari‐Mianaei, Alimohammadi, Banki‐pooPRFard, & Hasanpour, 2017). These rituals can both regulate the infant and reinforce the caregiver’s role as moral guide, with an awareness of children’s emotional and spiritual needs (Allana et al., 2017; Devi & Rustina, 2019; Jafari‐Mianaei et al., 2017).
Within this framework reflective functioning emphasizes the caregivers mindful awareness of the child’s emotional and moral state which is often expressed nonverbally and spiritually. Caregiving in the Gulf, however, often extends beyond parents to include grandparents and aunts, creating a communal attachment network where emotional resonance and spiritual care are co-constructed across generations (Amin et al., 2025; Daher-Nashif et al., 2020). Expanding traditional models of attachment and PRF to include embodied rituals, spiritual language, and intergenerational caregiving may be highly relevant globally and clinically.
Regional Evidence and Cross-Cultural Insights
Research on reflective functioning in the Gulf remains scarce, albeit cross-cultural studies provide useful parallels. Zreik, Oppenheim, & Sagi‐Schwartz (2016) found that Jewish and Christian mothers in Israel conveyed attunement through rituals and nonverbal cues, showing that reflective functioning does not depend on explicit verbalization. Similarly, Gulf caregiving practices, which include shared rituals, physical closeness, and collective caregiving, reflect culturally and spiritually informed attunement (Luyten et al., 2017).
Regional literature highlights embodied connection, spirituality, and moral caregiving as intentional forms of attunement (Amin et al., 2025; Raffar et al., 2021). Assessments that focus narrowly on verbalization risk misinterpreting Gulf caregiving as deficient, when in fact such practices demonstrate rich, culturally grounded sensitivity (Bodak, 2018; Lister, Seibert, Chance, Huelett, Wilson, & Wilson, 2019). Reflective functioning is a universal phenomenon, but its expression may be culturally and diversely shaped in the Gulf region.
Future Directions in the Gulf Region
In order to advance the path of infant mental health in the Gulf region, it is critical to adapt the pre-existing models of PRF and mentalization to embrace culturally and spiritually diverse practices. An expanded approach that integrates embodied, collective, intergenerational, and spiritual lived experiences, and emerging research from the Gulf region will be a critical first step to framing adaptive PRF centered interventions. The Gulf region embodies a heterogenous culture with varying perceptions of the infant and the surrounding caregiving. “Gulf caregiving” and implications for PRF theories and assessment tools require further narrative and empirical exploration. The Gulf region has taken significant strides in early care and intervention, and shares the global vision for voicing the unique narrative of each infant and caregiver, and the impactful cultural wisdoms and traditions that envelop each.
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Authors
Abu Ali, Azhar, PhD
Infant Mental Health Committee Chair, Emirates Society for Child and Adolescent Mental Health, WAIMH Affiliate; Pediatric Mental Health Consultation Liaison & Research Lead, Al Jalila Children’s Specialty Hospital,
United Arab Emirates
Mohammed, Fatumo, MA
Infant Mental Health Committee Member, Emirates Society for Child and Adolescent Mental Health, WAIMH Affiliate; Psychologist, Al Jalila Children’s Specialty Hospital,
United Arab Emirates
