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Applications of Attachment Theory in American Art Therapy Practice Illustrated through the Bird’s Nest Drawing and Story

12 October 2016

We asked Dr Donna Betts, ATR-BC to introduce us to the subject of her keynote speech for the 2016 Attachment and the Arts conference...

“In recent years, a convergence has developed between research and theory in the areas of attachment, infant development, neurobiology, psychopathology, and psychotherapy that is revolutionizing the way we think about and interact with the clients who seek our services” (Finn, 2012, p. 440).

Attachment theories have impacted art therapy in the United States and inspired unique approaches to practice. This presentation details one such example – the Bird’s Nest Drawing and story (BND; Kaiser, 1996), an art therapy assessment of attachment security. As is described in Yoon, Betts, Harmon-Walker and Kaiser (2016), attachment theory is one of the most empirically grounded frameworks in the field of human development (Cassidy & Shaver, 2008).

Rooted in the theoretical work of John Bowlby (1969) and the experimental procedures of Mary Ainsworth (Ainsworth & Wittig, 1969), modern attachment theory provides a model for understanding the cognitive and behavioral aspects of early internalized childhood experiences. Attachment security in infancy has been correlated with numerous challenges through the lifespan, impacting emotional health, academic achievement, suicide risk, and quality of life (Betts, 2003; Cassidy & Shaver, 2008). For instance, studies on children with insecure attachment have demonstrated that early attachment styles elicit certain behaviors from an individual such as impaired social, psychological, and neurobiological functioning over time (Schore, 2001).

Schore’s work is foundational to art therapist Linda Chapman’s (2014) neurobiologically-informed trauma therapy for children and adolescents, the “neuro-developmental model of art therapy” (NDAT). Designed to treat chronic trauma, the NDAT facilitates activation of the right hemisphere of the brain “to create a nonverbal narrative of the patient’s experience through drawings that can be translated into a verbal narrative of the event” (p. 23). Indeed, attachment theory is integral to the treatment of trauma.

“This paradigm shift from behavior, to cognition, to bodily based emotion has acted as an integrating force for forging stronger connections between the disciplines of psychology, social neuroscience, and psychiatry, all of which are now focusing on affective phenomena” (Schore, 2012, p. 4).

In the art therapy literature, Hass-Cohen and Findlay (2015) described several approaches as essential to the understanding of human relationships, including cognitive behavioral, social ecological, psychodynamic, and systemic, and as rooted in the integrative framework known as “mentalizing.”

The foundation of successful mentalizing is the ability to understand and respond to others (Fonagy & Target, 1997), and supports healthy Inner Working Models (IWM; Bowlby, 1969) and secure attachment. The authors further emphasized the relational role of the art making process in art therapy. Malchiodi (2014) cited advancements in neurodevelopment and neuroplasticity and tenets from object relations theory as foundational to this work.

The experiential nature of art therapy is conducive to mutual attunement in sessions with families and is a central concept in effective attachment work. Attachment theory is further connected to successful models of treatment for couples in Metzl (2017).

Family drawings have historically been used to provide information about family dynamics and functioning (Kwiatkowska, 1978). However, for some, drawing one’s family can provoke anxiety and avoidance. The BND (Kaiser, 1996) measure of attachment security was developed to provide a less threatening projective. As a process-based, constructive assessment that involves drawing a bird’s nest and writing a story about it, the task allows for expression of attachment visually, while often representing concepts of safety, nurturance, protection, and security using metaphor. The advantages of process- and performance-based testing are well established in the psychological assessment literature (Bornstein, 2011; Finn, 2012).

Further, “performance-based personality tests are very useful in part because they tap right-hemisphere and subcortical brain functioning and provide information that clients cannot directly report” (Finn, 2012, p. 440). Presenting problems can appear more clearly in drawings than by verbal description alone, and can aid in building rapport between client and therapist (Kaiser, 1996).

As is described in this presentation, a team of art therapy researchers (Yoon et al., 2016) established a systematic method for coding the BND stories (N = 136). A content analysis yielded five thematic categories, and the coding system was then examined in conjunction with the corresponding BND drawings, as well as data derived from: Kaiser’s scale (Kaiser, 2012a), the BND Two Category Checklist and Four Category Overall Impression Scale (BND-TCC and BND-OIF; Kaiser, 2012b), the Inventory of Parent and Peer Attachment (IPPA), and the Experiences in Close Relationships Questionnaire (ECR).

The results provide support for bolstering art therapy assessment data (quantitative global ratings) with clients’ verbalizations/stories, toward establishment of assessment validity and to promote a more humanistic evaluation process for the client. As is elucidated in this presentation, information from the BND can be used to inform treatment planning and relevant art therapy interventions to address insecure attachment.

 

Dr Donna Betts is Board President of the American Art Therapy Association (AATA) and Associate Professor in the Graduate Art Therapy Program at the George Washington University, Washington, DC.

We hope you can join us in welcoming Dr Betts to the 2016 Attachment and the Arts conference on 2nd December.

For more information and booking please click here

You can also see highlights of last year's conference, get the latest on this year's conference, and share relevant articles throughout the year by joining the Attachment & the Arts Conference Facebook Group here

You can also join in with the Attachment & the Arts conference on Twitter using #AttachmentArts @baat_org

 

Images: Reproduced with the required permissions.

 

References

Ainsworth, M. D. S., & Wittig, B. A. (1969). Attachment and exploratory behavior of one year-
olds in a strange situation. In B. M.  Foss (Ed.), Determinants of infant behaviour IV, (pp. 111-136). London, UK: Methuen, 1969.

Betts, D. (Ed.). (2003). Creative arts therapies approaches in adoption and foster care:
Contemporary strategies for working with individuals and families. Springfield, IL: Charles C Thomas. 

Bornstein, R. F. (2011). Toward a process-focused model of test score validity: Improving
psychological assessment in science and practice. Psychological Assessment, 23(2), 532–544.
Bowlby, J. (1969/1980). Attachment and loss: Attachment (Vol. 1). New York, NY: Basic
Books.

Cassidy, J., & Shaver, P. R. (2008). Handbook of attachment: Theory, research, and clinical
applications. New York, NY: Guilford Press.

Chapman, L. (2014). Neurobiologically informed trauma therapy with children and adolescents:
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Finn, S. E. (2012). Implications of recent research in neurobiology for psychological assessment.
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Fonagy, P. & Target, M. (1997). Attachment and reflexive function: Their role in self-predictors
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Hass-Cohen, N. & Findlay, J. C. (2015). Art therapy and neuroscience of relationships,
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Kaiser, D. H. (1996). Indications of attachment security in a drawing task. The Arts in
Psychotherapy, 23(4), pp. 333-340.

Kaiser, D. H. (2012a). Kaiser’s Bird’s Nest Drawing and Story Rating Scale. Unpublished
manuscript. Creative Arts Therapies Department, Drexel University, Philadelphia, PA.

Kaiser, D. H. (2012b). Kaiser’s Bird’s Nest Drawing Two Category Checklist and Four
Category Overall Impression Manual. Unpublished manuscript. Creative Arts Therapies Department, Drexel University, Philadelphia, PA.

Kwiatkowska, H. Y. (1978). Family therapy and evaluation through art. Springfield, IL: Charles
C Thomas.

Malchiodi, C. A. (2014). Art therapy, attachment, and parent-child dyads. In C. A. Malchiodi &
D. A. Crenshaw, Eds. (52-66). Creative arts and play therapy for attachment problems. New York, NY: Guilford Press.

Metzl, E. S. (2017). When art therapy meets sex therapy: Creative explorations of sex, gender,
and relationships. New York, NY: Routledge.

Schore, A. N. (2001). Effects of a secure attachment relationship on right brain development,
affect regulation, and infant mental health. Infant Mental Health Journal, 22(1–2), 7–66.

Yoon, J. Y., Betts, D. J., Harmon-Walker, G., & Kasier, D. (2016). A coding system for Bird’s
Nest Drawing stories to measure attachment security. Manuscript submitted for publication.