Daniela Di Riso

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.

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.

Parenting quality in drug-addicted mothers in a therapeutic mother–child community: the contribution of attachment and personality assessment

Growing evidence shows that attachment is a key risk factor for the diagnosis and treatment of clinical diseases in Axis I, such as drug addiction. Recent literature regarding attachment, psychiatric pathology, and drug addiction demonstrates that there is a clear prevalence of insecure attachment patterns in clinical and drug addicted subjects. Specifically, some authors emphasize that the anxious-insecure attachment pattern is prevalent among drug-addicted women with double diagnosis (Fonagy et al., 1996). The construct of attachment as a risk factor in clinical samples of drug-addicted mothers needs to be studied more in depth though. The present explorative study focused on the evaluation of parenting quality in a therapeutic mother–child community using attachment and personality assessment tools able to outline drug-addicted mothers’ profiles. This study involved 30 drug addicted mothers, inpatients of a therapeutic community (TC). Attachment representations were assessed via the Adult Attachment Interview; personality diagnosis and symptomatic profiles were performed using the Structured Clinical Interview of the DSM-IV (SCID-II) and the Symptom Check List-90-R (SCL-90-R), respectively. Both instruments were administered during the first six months of residence in a TC. Results confirmed the prevalence of insecure attachment representations (90%), with a high presence of U patterns, prevalently scored for dangerous and/or not protective experiences in infanthood. Very high values (>5) were found for some experience scales (i.e., neglect and rejection scales). Data also showed very low values (1–3) in metacognitive monitoring, coherence of transcript and coherence of mind scales. Patients’ different profiles (U vs. E vs. Ds) were linked to SCID-II diagnosis, providing insightful indications both for treatment planning and intervention on parenting functions and for deciding if to start foster care or adoption proceedings for children.

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.

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.

“A child’s nightmare. Mum comes and comforts her child.” Attachment evaluation as a guide in the assessment and treatment in a clinical case study

There is a gap between proposed theoretical attachment theory frameworks, measures of attachment in the assessment phase and their relationship with changes in outcome after a psychodynamic oriented psychotherapy. Based on a clinical case study of a young woman with Panic Attack Disorder, this paper examined psychotherapy outcome findings comparing initial and post-treatment assessments, according to the mental functioning in S and M-axis of the psychodynamic diagnostic manual. Treatment planning and post-treatment changes were described with the main aim to illustrate from a clinical point of view why a psycho-dynamic approach, with specific attention to an “attachment theory stance,” was considered the treatment of choice for this patient. The Symptom Check List 90 Revised (SCL-90-R) and the Shedler–Westen Assessment Procedure (SWAP–200) were administered to detect patient’s symptomatic perception and clinician’s diagnostic points of view, respectively; the Adult Attachment Interview and the Adult Attachment Projective Picture System (AAP) were also administered as to pay attention to patient’s unconscious internal organization and changes in defense processes. A qualitative description of how the treatment unfolded was included. Findings highlight the important contribution of attachment theory in a 22-month psychodynamic psychotherapy framework, promoting resolution of patient’s symptoms and adjustment.

The Fear Survey Schedule for Children-Revised: normative developmental data in Italy.

The aim of the study was to explore childrens fear content. Using the Italian Fear Survey Schedule for Children, an Italian-language version of Ollendicks Fear Survey Schedule for Children–Revised (1983), the study assessed the reliability of the survey and reported intensity, prevalence, and content of fears in children aged six to 10 years, using this questionnaire. 1,845 school children (931 girls, 914 boys; M age = 8.3 yr., SD = 1.4) were asked to complete the survey, indicating what they thought were their fears, and the intensity of those fears. Sex and age differences were also examined. Girls endorsed significantly higher fearfulness than did boys. Few age differences were found, with seven-year-olds appearing more fearful than 10- to 11-year-old children. Results were interpreted in relation to developmental changes. Cross-national comparisons were discussed.

The role of co-parenting alliance as a mediator between trait anxiety, family system maladjustment, and parenting stress in a sample of non-clinical Italian parents

This study investigated the role of co-parenting alliance in mediating the influence of parents’ trait anxiety on family system maladjustment and parenting stress. A sample of 1606 Italian parents (803 mothers and 803 fathers) of children aged one to 13 years completed measures of trait anxiety (State Trait Anxiety Inventory—Y), co-parenting alliance (Parenting Alliance Measure), family system maladjustment (Family Assessment Measure—III), and parenting stress (Parenting Stress Inventory—Short Form). These variables were investigated together comparing two structural equations model-fitting including both partners. A model for both mothers and fathers was empirically devised as a series of associations between parent trait anxiety (independent variable), family system maladjustment and parenting stress (dependent variables), mediated by co-parenting alliance, with the insertion of cross predictions between mothers and fathers and correlations between dependent variables for both parents. Results indicated that the relation between mothers and fathers’ trait anxiety, family system maladjustment and parenting stress was mediated by the level of co-parenting alliance. Understanding the role of couples’ co-parenting alliance could be useful during the family assessment and/or treatment, since it is an efficient and effective tool to improve the family system maladjustment and stress.