Clinical psychological work with children in mental health settings has increasingly been concerned with experience of attachment issues, as the value of attachment theory has been recognized. No relevant techniques have been developed specifically for clinical use. However, over decades of clinical practice, several techniques which have potential relevance to the specific understanding of security of attachment have been developed, for assessment of a child’s attitudes to self and
others and interpersonal relationships. Table 4, on page 37 below, provides a summary of such techniques that have been available for use in clinical practice.
Table 2.
Clinical Assessment Techniques that Elicit Attachment Related Information
Name of Test Age Description of Test Reliability/Validity Recorded
The Test of Family Attitudes (FTA)
Jackson (1950) ) cited in Semeonoff (1976)
6-12 yrs. Uses a series of 7 slightly larger than postcard-sized pictures, which were spiral bound.
Administration is much the same as TAT. Sketchy pictures depict common family situations. In general the child figures are androgynous with only one card having a boy and a girl version. The faces all have features but there are no obvious emotional expressions. Stories obtained were analyzed to give 68 types of response or themes. No details of coding are available
• Norms were given for normal, neurotic and delinquent children. • No information on reliability or
validity available.
The Object Relations Technique (ORT) and the Children’s Object Relations Technique
Phillipson (1955) cited in Semeonoff (1976)
4yrs-adult Used 15 pictures in 3 series (A, B,C). Administration is almost identical to the TAT, however the style and content of the pictures is noticeably different, as they are very ambiguous, vague and misty. Some pictures have color in them. Scoring of the child’s stories resembles the content analysis of the Rorschach technique rather than the TAT.
• No information available.
The Family Relations Test (FRT)
Bene & Anthony (1957)
3-7yrs A self-report Q-Sort. The child is engaged in the task of assembling a group of cardboard people, with attached boxes, to represent people in his or her family. As statements on cards are read, the child must put each card into the box of the person who fits with that statement. Cards that do not fit with family members are put in the ‘Nobody’ box. A score sheet that sorts the statements is used to reveal the child’s level and intensity of involvement with various family members.
• No norms for this measure but gives indication of patterns of response that indicate pathology. • No information about reliability
or validity available. The House Tree Person
Projective Drawing Technique (HTP)
Buck (1992)
8yrs-adult HTP materials include a Drawing Form and an Interpretation Booklet, which are used in the inquiry phase. Several Diagnostic manuals are available for this test. The child is seated at a table and provided with the Drawing Form, pencils and crayons. The test has 4 steps: The invitation to draw a house, a tree, and a person in pencil; The inquiring phase; The child is asked to draw another house, tree and person using colored crayons; and finally the interviewer asks a series of questions. Analysis of the drawings includes a consideration of general observations, proportion, perspective, detailing and use of color.
• No norms given. • Research on validity and
reliability has been mixed.
TAT, CAT (Animal & Human)
Bellak & Abrams (1997).
3yrs-adult The Thematic Apperception Test and its derivatives are projective tests. The CAT is specifically designed for children. It consists of 10 pencil drawings of humans or animals in various social situations. Cards are presented in a sequential order and children are invited to participate in a storytelling game, telling a story for each picture. Responses are scored in 10 different categories including concept of world, relationship to others and significant conflicts.
• No norms included. • Research on reliability and
The Test of Family Attitudes (Jackson, 1950) and the Object Relations Technique (Phillipson, 1955) are both out of print and this would make it very difficult for a clinician to be able to obtain them.
The Family Relations Test (Bene & Anthony, 1957) was developed to assess a child’s emotional attitudes in relation to their family. This technique is a self-report Q-Sort technique, engaging the child in sorting statements that he or she associates with particular family members. It gives an indication of the quality and intensity of the child’s emotional involvement with these others, and yields information about the child’s view of self (self-love vs. self-hate). This technique mainly taps a child’s conscious thoughts and feelings, and depends on a limited number of responses, which can be problematic for a child with a large family network. The FRT does not deal specifically with attachment-sensitive issues, and would demand considerable interpretation to be used to assess IWMs of attachment.
The House, Tree, Person Projective Drawing Technique (Buck, 1992) is a projective technique that involves drawing a house, a tree, and a person, with each drawing being followed by an inquiry phase. It aims to facilitate the “projection of personality elements and the area of conflict into the therapeutic setting, allowing them to be identified for the purpose of assessment and shared for the purpose of establishing effective therapeutic communication” (Buck, p.1). The child can project feelings, needs, goals, and attitudes related to their drawings, including those related to the family. Again, while attachment issues may well be elicited by this technique, House Tree Person responses would require considerable interpretation to be used to assess IWMs of attachment.
The Children’s Apperception Test (Bellak & Abrams, 1997) was designed to assess personality from a classically psychoanalytic theoretical orientation. It has been
found useful for eliciting responses to feeding problems, oral problems, sibling rivalry and the child’s relationship to his or her parents as a couple (Bellak & Abrams). Responses provide information about ego and superego strength and the child’s conflicts and defenses. The Children’s Apperception Test stimuli (human and animal versions) depict social situations, but only a couple of these scenes portray situations likely to stimulate representations highlighting attachment in a clear way. Therefore, while attachment issues may arise, the CAT is also unlikely to be an adequate tool for assessing attachment IWMs. On the positive side, the CAT is a projective tool thought to reveal unconsciously held information (Semeonoff, 1976). It has been shown to produce rich descriptive data and it gives respondents a great deal of freedom in choosing the content and manner of their responses.
2.6 Critique of research and clinical techniques for assessing aspect of