Indications of attachment security in a drawing task

The Arts in Psychotherapy, Vol. 23, No. 4, pp. 333-340, 1996 Copyright 0 1996 Elsevier Science Ltd Printed in the USA. All rights reserved 0197.4556/96 $15.00 + .@I

Pergamon

PI1 SO197-4556(96)00003-Z

INDICATIONS

OF ATTACHMENT

SECURITY

DONNA H. KAISER,

Drawing tasks for diagnosis and screening can prove to be valuable instruments for art therapists. From its inception, the profession of art therapy has devised assessment and treatment interventions based on a client’s spontaneous visual expressions projected in their imagery (Naumberg, 1958). Neale and Rosal (1993) emphasized the importance of developing and researching innovative projective drawing techniques to address various problems of the populations treated by art therapists. The artistic manifestations of a client’s developmental level, use of various defense mechanisms, underlying emotional issues and perception of the self in relation to others have supplied a rich source of therapeutic material yielding diagnostic information useful in developing treatment goals. This material often emerges more clearly in imagery than in verbalization, and the concrete form of the art expression provides material open to exploration and development of insight. It also provides a mode of symbolic communication that facilitates the development of rapport between client and therapist. Art therapy was originally used by those with a psychoanalytic orientation and has served therapists with varied theoretical orientations since the early days of the profession. Drawing on attachment theory, this therapist proposed that the depiction of a bird’s nest would have the potential to elicit graphic indicators of secure or insecure attachment style in women. Furthermore, it was anticipated that the Bird’s Nest Drawing (BND) would prove beneficial in providing more emotional distance than the family drawing. In the experience of this therapist, it has also proved useful in tapping underlying emotional issues especially as they involve internalizations of a person’s

*Donna Kaiser is an art therapist who works as a Family Advocate

IN A DRAWING TASK

MS*

expectations of how to relate to family members and intimate partners. The depiction of a bird’s nest, initially perceived as an innocuous task by most people, often yields rich associations about the contents of the nest, the physical nature of the nest form, the absence or presence of nurturing figures and the fate of the eggs or baby birds drawn or omitted. Attachment theory has provided a foundation for valuable research and the development of assessment measures of an individual’s attachment system. The theoretical concept of an unconscious internal working model of secure or insecure attachment lends itself to the modality of art therapy where it may be manifested symbolically in imagery. The resulting expression can then provide a framework for the therapist and client to explore past experiences as they impact current attachment patterns. In this process, additional art therapy interventions can be used to assist the client to acknowledge, explore, understand and ultimately rework insecure attachment patterns. Attachment

Theory

Attachment theory provides a useful perspective for understanding both healthy and disturbed relationship patterns. Bowlby (1979) observed the detrimental effects attending the separation of young children from their mothers and delineated the concepts of secure and insecure attachment organization. He concluded that a child’s strong or secure attachment provided the basis for healthy emotional and social development during later childhood and even into adulthood. Working from a psychoanalytic frame of reference, he incorporated an evolutionary-etho-

with Lutheran 333

Family Services in Newport News, Virginia

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DONNA H. KAISER

logical approach to explain human infant behavior and the development of subsequent relationship patterns. Bowlby’s ethological approach viewed the development of attachment behavioral systems and their corresponding internal working models as necessary for the survival of a species via the proximity and protection of the primary caretaker. Bowlby formulated attachment theory and published the first volume of his trilogy, Attachment and Loss, in 1969. Subsequently, research incorporating attachment was launched when Mary Ainsworth devised the Strange Situation to assess attachment in young children (Ainsworth, Blehar, Waters & Wall, 1978). Research in child development indicates that attachment organization determines behavior and is significant for a number of reasons. Attachment patterns formed in early life persist and determine an individual’s subsequent relationship patterns with peers, with significant others and with one’s own children (Bowlby, 1979). Insecure attachment has been associated with a wide range of difficulties in a child’s development (Sroufe, 1988; Weber, Meloy & Gacone, 1992). Recent findings on adult attachment styles also suggest that an internal organization of insecure attachment leads to interpersonal problems of varying kinds (Hazan & Shaver, 1987). Sroufe (1988) stated that insecurity of attachment does not cause later social problems, but probably makes it more likely that a developmental context is created for the emergence of unfavorable outcomes. A rich body of research assessing attachment in children has evolved over the past two decades. This research has expanded to include assessment of attachment patterns and organization in older children, adolescents and adults, and provides a conceptual framework contributing to the understanding of optimal development throughout the lifespan. In addition, attachment relationships are being studied as they relate to other relationships through life and to the development of risk for psychopathology. Family therapists are beginning to examine attachment styles in couples counseling. Shaver and Hazan (1988) conceptualized the love relationship as the intense emotional attachment that adults experience in the intimate bond. Pistole (1994) utilized attachment theory with couples engaged in closeness-distance struggles as “. the starting point of the couples’ relational system and the foundation for other processes or patterns such as communication and intimacy” (p. 156). The Association for Treatment and Training in the Attachment of Children (ATTACh) describes attach-

ment disorders in terms of an individual’s difficulty with establishing loving, lasting, intimate relationships. Those who are attachment disordered may experience difficulty giving and receiving affection, be unable to trust and, in extreme cases, may fail to develop a conscience. This organization advocates public education and awareness of attachment issues as they impact children, families and society. Art therapists have not used the paradigm of attachment in their assessments although one clinical report discussed the use of art therapy to facilitate attachment in pregnant women who have had previous miscarriages (Swan-Foster, 1989). Family drawings have been used by art therapists to assess family dynamics and the individual’s perception of the family constellation and interpersonal conflict for many years (Kwiatkowska, 1978). It has been observed that the family drawing is one of the most anxietyprovoking of art therapy assessment tasks and often evokes a more defensive response than tasks which provide greater emotional distance (Kwiatkowska, 1978). This study proposed that an individual’s depiction of a bird’s nest may tap unconscious psychic representations of early caregiving experiences that contribute to secure or insecure attachment patterns. As a symbol, the nest has both affective and cognitive dimensions. Edinger (1972) discussed the nest as a symbol of the maternal and the protective in its containing function and womblike form. Naumann (1955) also noted the symbolic nature of the nest in its protecting and containing aspects. In addition, a nest is generally supported in a protective manner, usually in the crook of a tree’s limb. The tree is often viewed as a maternal symbol of nurturance (Matthews, 1986) and, if included in the Bird’s Nest Drawing, another dimension of caregiving is represented. Naumann (1955) noted that the New Year’s festival in Egypt is called the “day of the child in the nest” (p. 245). Often young children spontaneously draw a bird’s nest and, in this author’s experience, it is generally viewed as an innocent and non-threatening directive. For the purpose of this investigation, the BND was conceived as a directive that has potential to visually portray an individual’s unconscious internalized representation of attachment. Method Nature of Sample The subjects in this study were 41 women, aged 21-38, from a university day care center. Attachment

ATTACHMENT

SECURITY

research has shown that secure attachment organization is generally found in 60% of the population and that the remaining 40% would be insecurely attached, either insecure-avoidant or insecure-ambivalent (Campos, Barrett, Lamb, Goldsmith & Sternberg, 1983). Therefore, it was considered likely that there would be enough subjects in each attachment category to obtain correlation, Assessment

Procedures

The subjects were seen individually at the day care center. Each subject was provided a sheet of 8i/2” x 11” white paper, a #2 pencil with eraser, a pack of 8 colored thin-line markers and was asked to “draw a bird’s nest.” After completing the drawing, the subject completed a 25item self-inventory, the Attachment to Mother (ATM) scale of the Inventory of Parent and Peer Attachment (Armsden & Greenberg, 1987). (The Inventory of Parent and Peer Attachment includes three scales, Attachment to Mother, Attachment to Father and Attachment to Peers.) The subjects were then asked to complete a second questionnaire giving basic demographic data, including age, marital status, number of children, educational level, income level and religious preference. The ATM scale has established high reliability and validity in previous studies. Reliability for the ATM in a three-week test-retest for a sample of college students was .93 (Armsden & Greenberg, 1987). Validity for the Parent Attachment scale (Mother and Father scales) has been established by a correlation with several other scales including the Family and Social Self scores from the Tennessee Self-Concept Scale (Armsden & Greenberg, 1987), the FACES (including degree of positive family coping) (Lewis, Woods & Ellison, 1987) with non-delinquency (Redondo, Martin, Fernandez & Lopez, 1986) and with adolescents’ self-reports of less conflict between parents and less experience of loneliness (Armsden, 1986). The Attachment to Mother scale contains 25 items designed to measure communication, trust and alienation, presumed components of an individual’s attachment system. In this inventory, subjects indicate the degree to which each of the statements is true. An overall score is computed with high scores indicating more secure attachment and low scores indicating less secure attachment. In a study using the IPPA, Swinth (199 1) reported that type of attachment as determined by the ATM scale was closely related to other attachment measures. There was not as strong an associa-

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tion with Attachment to Father. This suggests that Bretherton’s (1985) belief that an individual’s internalized representation of attachment is based on experiences with one primary caregiver may be valid. The instrument developed to rate the drawings collected for this study was the Attachment Rating Scale (ARS). This checklist provided the raters with a list of specific characteristics to identify in each drawing. A total of nine hypothesized indicators of attachment were included in the original ARS. The first four items relate to the containing function of the nest: whether the nest has contents, whether the nest is supported by a tree, whether the nest has a bottom and whether the nest is untilted so that any contents would not fall out. The remaining five items relate to the use of space, color, line quality, placement and size of the nest, formal elements that have been associated with mental health or pathology (Jolles, 1964). According to the scores on the ATM scale, subjects were placed into one of two categories, either a more securely attached or less securely attached category. The two groups were split down the middle utilizing the median split technique; subjects with higher scores (High ATM Group) were rated as more securely attached and subjects with lower scores (Low ATM Group) were rated as less securely attached. Three raters, blind to the nature of the study, were trained to use the ARS. After training, the raters were given the drawings in random order. After ratings were completed, data from the ratings and from the self-inventory were subjected to statistical analysis. Results Eight of the nine indicators of the ARS had sufficiently high Kappas (above .7) to be considered reliable; therefore the inter-rater reliability was considered high for all but this one indicator. This item, whether the nest is depicted with anxious line quality, should be excluded from any replications of this study. Scores on the ATM scale ranged from 50 to 121 with a mean of 94.9 and a median of 89. Using the median split technique, the subjects were divided into two groups, the High ATM Group and one less securely attached (Low ATM Group). To rule out ATM scores being associated with items on the demographic questionnaire, correlations were run between the subject’s score and her age, marital status, number of children, educational level, income level and religious preference. All these correlations proved to be small and not significant and, thus, not statistically related.

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Chi-square analyses were used to test for differences in frequencies of occurrence of the hypothesized attachment indicators in each attachment group. These were conducted for all the indicators of the ARS with the ATM scores. Results indicated that statistical significance was not obtained between the nine indicators used and subject scores on the ATM scale. Pearson product-moment correlation coefficients were run on all ARS indicators, and two indicators (“Does the nest have a bottom?” and “Does it appear that the contents would not fall out of the nest, whether or not the nest contains anything?“) approached significance (r = .27, p = .08 and r = .26, p = .07 respectively) (see Table 1). If a larger sample size had been used (n 2 60), these items may have been found to be significant. An unexpected result seen in the subjects’ drawings was the inclusion of parent and/or baby birds. In a pilot study, only art therapy students had included birds, and this was assumed to have been a result of drawing ability. No birds were drawn by other subjects in the pilot study, therefore this was not a consideration in the design of the ARS rating instrument. Based on this observation, an additional series of unplanned analyses were added to this study. A revised ARS, with five additional indicators, was used to take the inclusion of birds into account. Three new volunteer raters, who were unaware of the nature of the study, rated the drawings with the revised ARS. High inter-rater reliability was attained on all five indicators of the revised ARS, with the first three indicators having 100% agreement among the three raters and the last two indicators each having .95 correlations of agreement. Chi-square analyses were calculated on the five additional items (inclusion of baby birds, inclusion of Table 1 Pearson Product-Moment Scores on ATM and ARS

Correlation

Coefficients

parent birds, inclusion of either parent or baby birds, inclusion of two parent birds and depiction of a nest containing only eggs) with ATM scores again divided by a median split into the High and Low ATM Groups. Significance was obtained for two of the five indicators, with two other indicators approaching the 0.5 level of significance (see Table 2). The highest level of significance was seen between the inclusion of either parent and baby birds and a subject’s score on the Attachment to Mother scale, x2 (1, N = 4 1) = 7.04, p < .Ol. The presence of baby birds was significant at x2 (1, N = 41) = 3.89, p < .05. The resence of parent birds approached significance at x ! (1, N = 41) = 3.45, p = .06. The depiction of a nest with eggs and no birds by less securely attached subjects approached significance at x2 (1, N = 41) = 3.48, p = .06. Discussion The results of this study demonstrate support for the association between secure attachment patterns and a subject’s inclusion of birds in the BND. Lower attachment security may correlate with a subject’s depiction of a nest without a bottom (often appearing as wreath-shaped) and with a subject’s depiction of a nest that appears unable to hold its contents, (i.e., tilted so that any contents would probably fall out). Replication of the study with a larger sample size might yield significant results regarding these indicators, which approached significance in this study. Non-significant trends were noted in the remaining indicators on the ARS. Figures 1, 2 and 3 show drawings done by women Table 2 Chi-square Analyses: ATM by ARS Indicators

for 10. Baby Birds

Indicator

r-Value 11. Parent Birds

1. 2. 3. 4. 5. 6. 7. 8. 9.

Contents Tree Bottom Able to contain %7or more of page Less than % blank 3-5 colors Line quality Centered image

0.21 0.18 0.27 0.26 0.22 -0.07 -0.08 0.01 -0.02

12. Either Baby or Parent Birds 13. Two Parent Birds 14. Contents Other Than Only Eggs *p < .05.

**p < .Ol.

Yes No Yes No Yes No Yes No Yes No

High Group

Low Group

n=l ?I= 13 ?I=8 n= 12 n= 14 n=6 it=5 II = 1.5 n = 16 n=4

n=2 il= ,* = rr= n=6 n= n=2 n= n= II =

Chi-Square 3.88*

19 3 18

3.45 7.04**

15 1.I3 19 11 10

3.48

ATTACHMENT

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TASK

Figure 1

in the more securely attached group (High Group) and show depictions of the various combinations of birds that appear in the drawings of these subjects. These are useful in a comparison with drawings from the

less securely attached group (Low Group). The results of this study are consistent with the view that less securely attached women may be unconsciously expressing felt lack of support from significant others ? ‘4..

DONNA H. KAISER

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Figure 3.

when they leave out parent and/or baby birds. Figure 4 shows a drawing done by the subject with the lowest score on the ATM. This drawing is typical of nest drawings seen in clinical settings by this investigator in that the nest is empty, little color is used and the image appears isolated and without a surrounding or supporting environment. This may be an unconscious representation of subjective experiences in early life with attachment figures as well as revealing lack of felt security from important affective relationships in the present. Figure 5 shows another drawing from the Low Group that is similar to patient drawings of a nest holding eggs. The absence of parent birds to warm,

Figure 4.

protect and hatch the eggs may demonstrate the subject’s intrapsychic experience of early life with an emotionally detached or uninvolved caretaker. Figure 6 shows a nest that contains eggs that appear as though they will fall out. The nest also has no bottom and is wreath-shaped. These two qualities are among the two original ARS indicators that approached the 0.5 level of significance. They are also frequently seen by this researcher in nest drawings in patient populations.

Figure 5.

ATTACHMENT

SECURITY

IN A DRAWING

TASK

Figure 6.

Revision of the ARS rating instrument to include the five additional indicators and using new raters yielded significant results in two areas. Near significant results were attained previously in two other areas. These results suggest that more securely attached subjects tend to include either parent or baby birds in their nest drawing (p = .008). More securely attached subjects also tended to include baby birds in the BND (p = 0.49). Depiction of a nest with parent birds by more securely attached subjects approached the @ =

.06) level of significance. Depiction of a nest with only eggs by less securely attached subjects also approached the (p = .06) level of significance. With fine tuning of the ARS and replications of this study, the BND has potential value as a clinical instrument useful in art therapy assessment and treatment. It would be interesting to repeat the study with adult men, with adolescents and with elementary school age children to determine whether age or gender affect depictions of the BND. Clinical experience

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with administering this test to a population of men who are in treatment for addiction raises the question of whether men express different aspects of relational patterns in their drawings. Future exploration of this is needed before results of this study can be generalized. With revision of the ARS to include the indicators that have been shown here to be associated with attachment security, and with replication of the present study, a necessary step toward integrating attachment theory with the field of art therapy will potentially result. Conclusion The attachment paradigm provides a rich theoretical framework that explains behavior from an evolutionary viewpoint that considers important cognitive, affective and behavioral components. The use of this projective has potential to benefit art therapists and other mental health professionals in clinical settings to assess and treat what Bowlby (1979) called “attachment pathologies.” The use of the BND as a projective and as a model for developing therapeutic interventions is of particular relevance for art therapists in the development of intervention strategies designed to enable patients to reconstruct or repair an internalized insecure working model of attachment. This therapist includes the BND in all individual and family art evaluations to enhance therapeutic understanding of existing attachment patterns. Therapeutic interventions based on nest symbology are then developed and utilized in individual, family, couples and group art therapy to introduce attachment concepts. Client understanding of relationship and intimacy issues, when introduced through the BND, often elicits responses of recognition and insight that promotes the healing of disturbed attachments and the building or strengthening of a mutual connectedness with others. There is potential for art therapy to utilize the attachment model in a variety of ways to optimize healthy development in clients who seek treatment. Neale and Rosa1 (1993) called for the development of idiosyncratic projective drawings that are developed for use in studying particular problems. The BND fits this category and can possibly contribute to “. . . the creation of diagnostic instruments unique to the field of art therapy” (p. 47). References Ainsworth, M. D. S., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Basic Books. Armsden, G. (1986). Coping strategies and quality of parent and

peer attachment in late adolescence. Paper presented at the first biennial meeting of the Society for Research on Adolescence, Madison, WI. Armsden, G., & Greenberg, M. (1987). The inventory of parent and peer attachment: Individual differences and their relationship to psychological well-being in adolescence. Journal of Yourh and Adolescence, 16(5), 427453. Bowlby, J. (1969). Attachment and loss: Vol. I. Attachment. New York: Basic Books. Bowlby, J. (1979). The making and breaking of affectional bonds. London: Tavistock. Bretherton, I. (1985). Attachment theory: Retrospect and prospect. In I. Bretherton & E. Waters (Eds.), Growing points of attachment theory and research. Monographs of the Society for Research in Child Development. 50 (Serial No. 209) 3-35. Campos, J. J., Barrett, K. C., Lamb, M. E., Goldsmith, H. H., & Sternberg, C. (1983). Socioemotional development. In M. M. Haith & J. J. Campos (Eds.), Handbook ofchildpsychology: Vol. 2 Ifhncy and Psychobiology (pp. 783-915). New York Wiley. Edinger, E. F. (1972). Ego and archevpe. Harrisonburg, VA: R. R. Donnelly & Sons. Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Persona1it.y and Social Psychology, 52(3), 5 1 l-524. Jolles, I. (1964). A catalog of the qualitative interpretation of the house-tree person. Los Angeles, CA: Western Psychological Services. Kwiatkowska, H. Y. (1978). Family therapy and evaluation through art Springfield, IL: Charles C Thomas. Lewis, F. M., Woods, N. F., & Ellison, E. (1987). Family impact study. Unpublished report, University of Washington. RolNUOlOOO, Division of Nursing, Public Health Service. Matthews, B. (Trans.). (1986). The Herder symbol dictionary. Wilmette, IL: Chiron Publications. Naumann, E. (1955). The great mother. Princeton, NJ: Princeton University Press. Naumberg, M. (1958). Art therapy: Its scope and function. In E. F. Hammer (Ed.), The clinical application of projective drawings. Springfield, IL: Charles C Thomas. Neale, E. L., & Rosal, M. L. (1993). What can art therapists learn from the research on projective drawing techniques for children? A review of the literature. The Arts in Psychotherapy, 20, 37-49. Pistole, M. C. (1994). Adult attachment styles: Some thoughts on closeness-distance struggles. Family Process, 33, 147-159. Redondo, L. M., Martin, A. L., Femandez. J. S., & Lopez, J. M. (1986). An examination of the relationship between family environment and juvenile delinquency. Unpublished manuscript, University of Santiago, Chile. Shaver, P. R., & Hazan, C. (1988). A biased overview of the study of love. Journal of Social and Personal Relationships, 5, 473-501. Sroufe, L. A. (1988). The role of infant-caregiver attachment in development. In J. Belsky & T. Nezworski (Eds.), Clinical implications of attachment (pp. 18-38). Hillsdale, NJ: Erlbaum. Swan-Foster, N. (1989). Images of pregnant women: Art therapy as a tool for transformation. The Arts in Psychotherapy, 16, 283-292. Swinth, M. (1991). The relationship between systemic thinking and capacity for human relatedness. Unpublished doctoral dissertation. Eastern Virginia Medical School, Norfolk, Virginia. Weber, C. A., Meloy, J. R., & Gacono, C. B. (1992). A Rorschach study of attachment and anxiety in inpatient conduct-disordered and dysthymic adolescents. Journal of Personality Assessment, 58(l), 16-26.