Adriana Lis

Attachment, Assessment, and Psychological Intervention: A Case Study of Anorexia

Attachment patterns and personality dimensions have always been considered important to the development and adaptation of the individual. The first aim of this article was to address some basic questions about the place of attachment in a multimethod assessment when compiling a complete picture of the patients personality functioning. The second aim was to present the Adult Attachment Projective Picture System (AAP; George & West, 2001) as a valid and productive assessment measure. Based on a single case study of an anorexic young woman, the article demonstrates how the AAP is integrated with the Rorschach Comprehensive System (Exner, 1991, 1993) and other assessment tools in both the assessment and in developing a treatment plan.

Rorschach Comprehensive System Data for a Sample of 116 Preadolescent and 117 Adolescent Nonpatients From Italy

This project provides information on how preadolescent and adolescent nonpatients perform on the Rorschach test, administered and scored following Exners guidelines (2003). Lis, Salcuni, Parolin, and Superchi (2001) reported previously initial data for 51 adolescent nonpatients living in Italy who were administered this instrument by graduate and postgraduate students in a 2-year research course at the Psychotherapy School of the University of Padua, between July 1998 and February 2001. The current study is an extension of that work and includes information on additional adolescent nonpatients and preadolescent nonpatients, gathered between April 2001 and December 2006. The study thus includes information on 233 participants, 116 preadolescents (aged 12–14) and 117 adolescents (aged 15–18). Individuals were excluded if they had a major medical illness in the past 6 months, any psychiatric hospitalization, psychological treatment within the past 2 years, any felony conviction, or psychological testing within the past year. Interrater reliability statistics at the response level for scoring segments are reported both with percentage of agreement and iota. Rorschach Comprehensive System (CS) findings are presented.

Child and Adolescent Empirical Psychotherapy Research

This paper reviews child and adolescent psychotherapy research, with a focus on two major theoretical classes of psychotherapies: cognitive-behavior and psychoanalytic psychotherapies. Our interest is particularly drawn to different issues: definition of psychotherapy and research on outcome and process. Specific attention is given developmental issues. We identify the major results and problems and propose methodological strategies for improving psychotherapeutic treatment research for child and adolescent disorders. Some areas that need to be addressed in the future are also discussed, such as the effects of specific techniques, the intensity and duration of treatment outcome and process, the effect of comorbidity, and the relationship between research and clinical practice.

Anorexia and attachment: dysregulated defense and pathological mourning

The role of defensive exclusion (Deactivation and Segregated Systems) in the development of early relationships and related to subsequent manifestations of symptoms of eating disorders was assessed using the Adult Attachment Projective Picture System (AAP). Fifty-one DSM-IV diagnosed women with anorexia participated in the study. Anorexic patients were primarily classified as dismissing or unresolved. Quantitative and qualitative analyses of defensive exclusion were carried out. Results showed potential benefits of using the AAP defense exclusion coding system, in addition to the main attachment classifications, in order to better understand the developmental issues involved in anorexia. Discussion concerned the processes, such as pathological mourning, that may underlie the associations between dismissing and unresolved attachment and anorexia. Implications for developmental research and clinical nosology are discussed.

The APS and APS-P: A Methodological Comparison between Italian Preschool and School-Aged Children

Pretend play is a natural mode of expression for children. The Affect in Play Scale (APS) (Russ, 1993, 2004) is a standardized measure of affective expression in pretend play—using puppets—of children aged between 6 and 10 years, and many research studies support its usefulness. The development of the APS was guided by Russs (1993, 2004) conceptualization and the theoretical model encompassed what was currently known about how, and the extent to which, affect is an important part of the creative process. Based on their work with the APS, Russ, Niec, and Kaugars (2000) adapted it for use with children 4 and 5 years of age. They developed the Affect in Play Scale Preschool (APS-P)—using toys—to be sensitive to individual differences in childrens play at this younger age. The aim of this article is to compare the application of APS and APS-P in a balanced experimental design with 56 preschool and school-aged (4-10 years old) Italian children. Results show no significant differences between the two versions of the APS (Toys versus Puppets) except for Comfort. Children of all ages seem more comfortable playing with toys than with puppets. Gender and age-group differences were found.

The Affect in Play Scale: confirmatory factor analysis in elementary school children.

The aim of this paper was to study the construct validity of the Affect in Play Scale, an empirically based measure of pretend play, in a group of 519 Italian children ages 6 to 10 years. In confirmatory factor analysis, a correlated two-factor structure with a cognitive and an affective factor was identified. Possible differences in factor scores by sex and age were investigated but no significant differences were found.

Children's fears: a survey of Italian children ages 6 to 10 years.

The aim of this study was to explore childrens fears. The article reports on average factor scores of a study carried out in Italy using the Fear Survey Schedule for Children (here, the “Fear Survey”; Ollendick, 1983) with normal 6- to 10-yr.-old children (931 girls, 914 boys). Participants were 1,845 children, recruited in mainstream classrooms. Respondents were asked to complete the schedule indicating their fears and the intensity of such fears. A principal components analysis yielded a four-factor structure (1: Death and Danger, 2: Injury and Animals, 3: Failure and Criticism, 4: Fear of the Unknown). Average factor scores showed significant differences across the factors and according to sex and age. Girls reported significantly higher fearfulness than boys. Age differences were found on some factors.

The Impact of Administration and Inquiry on Rorschach Comprehensive System Protocols in a National Reference Sample

We investigated the impact of administration and inquiry skills on Rorschach Comprehensive System (CS; Exner, 1974, 1991, 1993) protocols collected for the Italian adult nonpatient reference sample. The same research team collected CS protocols on two occasions. The initial reference sample (N = 212; Lis, Rossi, & Priha, 1998) was collected under the supervision of experienced psychologists who carefully studied CS administration and scoring procedures (Exner, 1986, 1990, 1993). The second sample (N = 101; Lis, Zennaro, Calvo, & Salcuni, 2001) was collected after the team obtained additional and sustained CS training from Rorschach workshops certified instructors. Both samples were scored, reliably but they showed large differences on many codes, with protocols from the second sample being richer and more complex than the first. The results indicate that administration skills can have a dramatic impact on CS protocols and may contribute to variations in samples collected by different investigators. Training standards should be devised to insure uniform administration procedures are followed when collecting CS protocols.

Rorschach Comprehensive System Data for Two Samples of Nonpatient Children From Italy: 75 Aged 5–7 Years and 148 Aged 8–11 Years

This project provides information on how nonpatient children perform on the Rorschach test, administered and scored following Exners guidelines (1995). Lis, Parolin, Zennaro, and Mazzeschi (2001) previously reported initial data for 70 nonpatient children living in Italy who were administered this instrument by graduate and postgraduate students in a 2-year research course at the Psychotherapy School of the University of Padua between July 1998 and February 2001. The current study is an extension of that work and includes information on an additional 153 participants gathered between November 2002 and December 2006. The total number of participants includes 223 individuals, 75 5–7-year-old children in the first level of elementary school, and 148 8–11-year-old children in the second level of elementary school. Exclusion criteria are described, and interrater reliability statistics at the response level for scoring segments are reported using percent agreement and iota. Rorschach Comprehensive System (CS) findings are presented.

A Cross-Cultural Comparison of Pretend Play in U.S. and Italian Children

Pretend play reflects cognitive, representational, and affective expression abilities in children. Cross-cultural studies stress the importance of culture-specific practices involved in shaping the context for play. Differences in the cultural environment and the parental care-giving system could influence children’s pretend play activities. There is a need for cross-cultural comparisons of play that use the same standardized measure of play. The current study was a cross-cultural comparison of two samples of American and Italian children 6 to 8 years old. All children were administered the Affect in Play Scale. As hypothesized, Italian children had significantly more types of affect expression in play than children in the United States, showing a medium effect size. Children in the United States had more imagination in their play, although with a small effect size. Implications of these findings are discussed.