Silvia Salcuni

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.

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.

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.

Rorschach Comprehensive System Data for a Sample of 249 Adult Nonpatients From Italy

This project provides information on how Italian adult nonpatients perform on the Rorschach test administered and scored following Rorschach Comprehensive System (CS) guidelines (Exner, 1995). Lis, Zennaro, Calvo, and Salcuni (2001) reported previously initial data for 101 of the nonpatients who were administered this instrument between July 1998 and February 2001 by graduate and postgraduate students in a 2-year research course at the Psychotherapy School of the University of Padua. The current study extends that previous work and includes information on an additional 148 participants gathered between April 2001 and March 2004, for a total of 249 individuals. Exclusion criteria are described and interrater reliability statistics at the response level for scoring segments are reported using both percent of agreement and iota. Comprehensive System findings are presented.

“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.