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The Arts in Psychotherapy 41 (2014) 391399

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The Arts in Psychotherapy

Revisit : Tapproa

Limor GoGraduate Scho lege o

a r t i c l

Article history:Received 1 FebReceived in reAccepted 16 JuAvailable onlin

Keywords:Attachment seBird Nest DrawFamily drawinProjective art based technique

er, 19ity. Inlationthe atachmings

Codingy, 3sing s

point to associations between the childrens self-reported security score, and the BND indicators andglobal scales. Similarly, scores on both the specic indicators and global scales in family drawings werecorrelated with the BND global scales. Levels of BND scales varied as a function of the childrens attach-ment orientations derived from their family drawings. Associationswere also found between attachmentorientations basedon family andBNDdrawings. Resultswere interpreted as supporting theuse of a globalapproach of rating in addition to a sign-based approach.

Introductio

The Birdtechnique gattachmentreviews Atfrom previovalidate theindicators i

Attachment

Attachmtinuing thrand capacitprevious retional supp& Munholactual expe

E-mail add

http://dx.doi.o0197-4556/ 2014 Elsevier Ltd. All rights reserved.

n

s Nest Drawing (Kaiser, 1996; BND) is an art-basedrounded in Attachment Theory which is used to assessrepresentations models. The current study briey

tachment Theory, delineates the signicant ndingsus studies, and reports on the results of an attempt toBND in elementary school-age children using specic

n addition to a global perspective of rating.

theory

ent Theory posits that beginning in infancy, and con-oughout the lifespan, an individuals mental healthy to form close relationships are intimately linked tolationships with attachment gures that provide emo-ort and protection (Belsky & Cassidy, 1994; Brethertonland, 2008). According to this theory, childrensriences shape their representational models, which

ress: [email protected]

subsequently serve to guide their behavior in novel circumstances(Bowlby, 1980). Children experiencing sensitive and responsivecare will develop trust in others, comfort with closeness and adap-tive ways of dealing with stress (secure attachment); avoidantattachment is associated with discomfort with closeness and aninclination for self-reliance, whereas anxious (ambivalent) attach-ment is associatedwith an intensedesire for closeness and constantconcern about parental availability (Mikulincer & Shaver, 2006).Children with disorganized attachment are characterized by anapparent lack, or collapse, of a consistent organized strategy fordealing with stress. The particular forms and mixtures of disor-ganized behaviors tend to be idiosyncratic from child to child,but include anxious, helpless, or depressed behaviors, unexpecteductuations of approach and avoidance toward the attachment g-ure, and other conicted and unpredictable behaviors (see Main &Solomon, 1990).

As children get older, the attachment system develops towardincreased self-reliance on the part of the child in that older childrenare better at copingwith stress situations andare less dependent onparents (Marvin & Britner, 1999). Moreover, theremay be a changein the goal of the attachment system, with availability rather thanproximity of the attachment gure becoming the aim of the orga-nization (Bowlby, 1987, cited in Ainsworth, 1990; Kerns, Tomich,

rg/10.1016/j.aip.2014.06.0032014 Elsevier Ltd. All rights reserved.ing the Birds Nest Drawing assessmentch

ldnerol of Creative Art Therapies, University of Haifa, Israel Faculty of Education, Oranim Col

e i n f o

ruary 2014vised form 24 May 2014ne 2014e 25 June 2014

curityingsgs

a b s t r a c t

The Birds Nest Drawing (BND) (Kaistechnique to assess attachment securthe BND mainly in adult clinical popuchildren, the current study examinedassessment techniques evaluating atclassication of childrens family drawversity of California) Family Drawinget al., 1996. Developmental Psycholo(n=81) in Israel. BNDs were scored uoward a global

f Education, Haifa, Israel

96. The Arts in Psychotherapy, 23, 333340) is an art-basedthe past 15 years, several studies have tested the validity ofs. In an attempt to strengthen the validity of the measure inssociations between the BND and two other frequently usedent security: Kaplan and Mains (1986. Instructions for thein terms of representation of attachment. Berkeley, CA: Uni-g System and the Attachment Security Questionnaire (Kerns2, 457466) on a sample of elementary-school age childrenpecic indicators as well as global rating scales. The ndings

392 L. Goldner / The Arts in Psychotherapy 41 (2014) 391399

Aspelmeier, & Contreras, 2000; Lieberman, Doyle, & Markiewicz,1999). Nevertheless, despite these changes, children continue toneed and rely on parents as attachment gures (Bowlby, 1979),and individual differences in attachment security, expressed inemotional rfor personaSroufe, Ege

In generand servesinsecure atinstance, suchildren wicompetencThey havetion of emo& Morgan,Mayseless,social com2006; Kernpeer accepCole, 1996)childrens loless depresIn additionattachmentdisruptivequent condSpeltz, Dek

Projective a

Given thtoms experto better uchildren in1988). Divefessionals aself-reportavoidant anPerry, 1996the cooperaor her negapotential decult to dete

Given ththirty yearsoped to eva(1986) FamNest Drawithat drawinbefore childthey expreand concernplausible threvealed iningmodelscaregivers w

Classicatiodrawings

Kaplan alyzing childclassies chsecurity. Thchildren as

attachment categories and developed a classication system forcoding a sample of childrens family drawings that matched, with76% accuracy, their Strange Situation classications (Ainsworth,Blehar, Waters, & Wall, 1978).

resumentandalikimped aserabiat doanded asand dy p, drae straor aplaed o(199famconspridemonessougto hrieselanfamimentnterain atedncyg forns eredit al.childnaloundwingogy w< .05entlycodimentildresoci

ed chdrawheirthanaid,ed ch2) wconder &revions arity s, as wg pregulation and exploration, have important implicationslity development as well as for adjustment (Weineld,land, & Carlson, 2008).al, attachment security facilitates resilient functioningas a buffer when coping with adversities, whereastachment might hamper childrens adjustment. Forbstantial evidence indicates that elementary school ageth secure attachment develop better social-emotionale (Granot & Mayseless, 2001; Ranson & Urichuk, 2008).more constructive coping mechanisms, better regula-tion in the classroom (Kerns, Abraham, Schlegelmilch,2007), and better behavioral adjustment (Granot &2001). Attachment security is also associated withpetence (NICHD Early Child Care Research Network,s, Tomich, & Kim, 2006), and with social support andtance (Granot & Mayseless, 2001; Kerns, Kelpac, &. Security of attachment was negatively associated withneliness (Kerns & Stevens, 1995; Kerns et al., 1996) andsive symptomatology (Graham & Easterbrooks, 2000)., a strong association was found between insecureand early behavioral problems, anti-social behavior,

hyperactive behavior (Lyons-Ruth, 1996), and subse-uct disorder (Greenberg & Speltz, 1988; Greenberg,lyen, & Endriga, 1991).

rt based techniques to evaluate attachment security

e severity of psychological and social-behavioral symp-ienced by insecurely attached children, it seems crucialnderstand the representations of insecurely attachedtheir elementary school years (Cicchetti, Toth, & Bush,rse instruments are available to help healthcare pro-ssess attachment orientation in these children usingmeasures of attachment security (Kerns et al., 1996) ord preoccupied coping strategies (Finnegan, Hodges, &).However, completionof thesequestionnaires requirestion of the child, who often attempts to conceal histive experience with his/her caregivers. In these cases,terioration into a clinical situation may be more dif-ct.e shortcomings of self-report questionnaires, in the lasttwo art-based projective assessments have been devel-luate childrens attachment security: Kaplan andMainsily Drawing Coding system and Kaisers (1996) Birdng. These approaches are grounded on the assumptiong is a natural mode of expression for children. Longren verbalize their feelings and thoughts into words,

ss both conscious and unconscious attitudes, wishes,s in symbolic methods such as drawing. It thus seemsat representations of attachment experienceswould bedrawings, and, specically, that the childs innerwork-(Bowlby, 1973) of the self, caregivers, and the self withould be manifested (Fury, Carelson, & Sraufe, 1997).

n of attachment representations through family

nd Mains (1986) sign-based coding system for ana-rens family drawings contains a set of indicators thatildrens family drawings according their attachmente researchers studied family drawings by kindergartenpredictors of assignment to the secure or insecure

Theattachtered,exactlyand anclassiinvulnway thguresclassismall,Soft boFinallyincludobjectsness (K

Baset al.drensscalesfamilybility,bizarre

Althshowncategoand Egdrensattachvious iand agcorrelain infatrollinchildreto thep(Fury e2003),emotiowere fily drapatholtory (p

Rec(1986)attachand chin theattachwhosewith tpetentLongmattach(n=22fewer(Goldn

A pchildreinsecumarksnalizinlts showed that drawings by children reecting secureare realistic; gures are complete, grounded and cen-

individuated (gures seem unique and are not drawne). There is a natural proximity among family membersression of happiness in the family. Drawings by childrenavoidant try to convey a positive picture, emphasizinglity and happiness. Arms may be absent or drawn in aes not allowholding, there is lack of individuation of thelack of movement in the picture. Drawings by childrenambivalent include gures that are extremely large orgures that either overlap or are separated by barriers.

arts and facial features are exaggerated in the drawings.wings assigned to the disorganized classication oftenngemarks, threatening and fantasy themes, unnishedgures, and sometimes excessive and irrational sweet-n & Main, 1986).n Kaplan and Mains (1986) coding system, Fury7) developed a global approach for coding chil-ily drawings using eight global rating scales. Theseist of two positive dimensions (vitality/creativity ande/happiness) and six negative dimensions (vulnera-tional distance/isolation, tension/anger, role reversal,/dissociation, and global pathology).h difcult and time-consuming, this system has beenave reliability and validity for determining attachment(Kaiser & Deaver, 2009). For instance, Carlson, Sroufe,d (2004) conducted a longitudinal study in which chil-ly drawings at age 8 were found to correlate with theirclassications according to data gathered from pre-

views with the children when they were in preschoolt age 12 (p< .001). The global rating scales were alsowith childrens attachment classications as assessed(p< .001). The analysis showed that even after con-IQ, current life stress, and emotional functioning, thearly attachment historymade a signicant contributionctionof negative dimensions in their drawings (p< .001), 1997). In another study (Madigan, Ladd, & Goldberg,ren whose family drawings depicted higher levels of

distance, vulnerability, and parentchild role reversalto have an insecure attachment history, whereas fam-s that scored higher on family pride and lower in globalere drawn by children with a secure attachment his-.01)., researchers have started using Kaplan and Mainsng system to assess the associations between childrensclassications as manifested in their family drawingsns adjustment. The ndings suggest better adjustmental, academic and behavioral realms among securelyildren. For example, kindergarten children (n=200)ingswere judged as securewere rated asmore sociablepeers, more task-oriented and more socially com-insecurely ambivalent children (p< .05.01) (Pianta,

& Ferguson, 1999). The superior functioning of securelyildren was also evidenced in 912 year old Israelisho exhibited higher levels of pro-social behavior anduct problems than their counterparts (p< .05.01)Scharf, 2011).us study (Goldner & Scharf, 2012) designed to detectdjustment found that indicators reecting attachmentuch as omitting and adding gure parts, adding bizarreell as a lack of femininity were correlated with inter-

oblems among Israeli elementary school age children

L. Goldner / The Arts in Psychotherapy 41 (2014) 391399 393

(n=222, p< .05.001). Role reversal in childrens family drawingsin American children (n=44, mean age=8.14) with an incarcer-ated or estranged parent was associated with more phone, mail,and physical contact with this parent. Greater overall insecurity inchildrens fagiver behavin drawingsing stress in& Wilson, 2

Birds nest d

Inspireddevelopedless threatedrawing, thtions of thealong with&Deaver, 2the absencebirds), a treuse of mostand centereexpanded tspective onin prole, titree, depictactivity, theying birds

The clasattachmentKaisers oriBNDs werethe Attachmand Peer Atpants weresecurely attheir drawiwhereas thbirds. A maance of thedraw nestscontain themore securthat particidescribed a

Francisstance abusgroup from(n=27). ParBartholomeParticipantsattachmentpants in theof participamore likelybirds drawnas tilted orentire sampmore birds,drew the necolor. Conteily, nature aenvironmen

Recentlydren and ad

Sheller (2007) used the BND and a Birds Nest Sculpture (BNS) as ametaphoric process to examine childrens internal attachment rep-resentations using a phenomenological approach. The study wasconducted on four school age children identied by the research

as bue tok revlity. Myedbure,um,ce-by usiowetudieere batiores.n sigapprof inverced toentatationxpliconnawinge Situaleslso bf BNcrimd geors (is hychmd scay aseir s

d

ants

ty-oecruin Isr% werangfamirage

ure

r reomplnnatedbcon

res

ily dite petedmily drawings was associated with more hostile care-iorwhereas increased global pathology and bizarrenesswere associated with stressful life events and parent-an American sample (p< .05.001) (Dallaire, Ciccone,

012).

rawing (BND)

by the research on family drawings, Kaiser (1996)the Birds Nest Drawing (BND). In an attempt to use aning and anxiety-provoking assessment than a familye researcher identied personal internal representa-self and others by eliciting experiences of attachmentmetaphorical concepts of safety and protection (Kaiser009; Sheller, 2007). BNDswere rated for the presence orof numerous indicators such as content (eggs or baby

e, the bottom of the nest able to contain [birds or eggs],of the page, using more than two colors, line quality,d image. Later on, Francis, Kaiser, and Deaver (2003)his list by adding several indicators such as the per-the nest (the nest as seen from above, the nest drawnlted nest), the features of the tree (drawing of a wholeions of a dead or a dying tree), the existence of feedingpresence of an entire family of birds, the existence ofand a general faint quality of the drawing.sication of BND drawings with existing measures ofsecurity revealed several associations. For instance, inginal study of the Birds Nest Drawing (Kaiser, 1996),collected from a sample of mothers (n=41). Usingent to Mother (ATM) scale of the Inventory of Parent

tachment (IPPA) (Armsden & Greenberg, 1987) partici-divided into a more securely attached group and a lesstached group. The high-ATM group included birds inngs signicantly more often than the low-ATM groupe low-ATM group often depicted a tilted nest withoutrginally signicant trend was found for the appear-nest. Participants from the low-ATM group tended towithout bottoms or tilted nests that were unable toir contents. Kaiser also noticed that the BNDs of theely attached group had a whimsical, happy quality andpants composed titles for their drawings that could bes engaging or gently humorous.et al. (2003) compared the BNDs of adults with sub-e (SA) disorders (n=43) to patients in a comparisona medical clinic who had no substance abuse disordersticipants completed a BND, a story about their BND, andw and Horowitzs (1991) Relationship Questionnaire.in the SA group were more likely to have an insecurestyle and to use fewer colors in their BNDs than partici-control group. The control group, comprised primarilynts with a secure attachment style, was signicantlyto feature green as the predominant color and includein the nest. The SA groupmost often depicted the nestviewed from above. Analysis of the drawings for thele indicated that securely attached participants drewdrew an entire bird family, used four or more colors,st in prole (not tilted) and used green as the dominantnt analysis of the stories revealed themes such as fam-nd renewal of life, food or hunger, abandonment, andts of personal signicance (Francis et al., 2003)., studies also examined the use of the BND in chil-olescents (see Kaiser and Deaver, 2009). For example,

facilityvices dartwornerabiportrabird g

In sevidensecuritsion. HMost sand wexaminmeasubasis o(1986)groups

To odesignrepresAssociboth eQuestiily draStrangeral schave agates onot disings anindicatlar, itof attators ansecuritfrom th

Metho

Particip

Eighwere rhoodsand 59years (parentan ave

Proced

Aftedren cquestioconducof the

Measu

Famon whcompleing in the early stage of requiring therapeutic ser-insecure attachment. The childrens stories about theirealed themes of danger, lack of protection, and vul-oreover, the insecure attachment pattern was further

y the absence of themother bird, distortion of the fatherand placing the nest on thin and brittle branches.studies have indicated that the BND may be used as anased tool for the assessment of individuals attachmentng both separate indicators aswell as an overall impres-ver, these methods also have several shortcomings.s have focused on clinical or maladaptive populationsased on relatively small sample sizes. Moreover, then of the validation was based mostly on self-reportFinally, attachment classications were made on then-based approach, as described in Kaplan and Mainsoach, rather than using general impressions alongwithdicators.ome someof these shortcomings, the current studywasexpand validation of the BND to assess attachment

ions in non-clinical elementary school-aged children.s have been examined between the BND indicators andit (Kerns et al.s, 1996 Attachment Security self-reportire) and implicit measures (Kaplan &Mains, 1986 Fam-coding system). As in other attachment measures (e.g.,ation, Adult Attachment Interview), and the use of gen-by Fury and her Colleagues (1997) validation attemptseen made using integrative scales composed of aggre-D indicators. It is possible that individual signs mightinate early attachment history, and that integrative rat-neral impressions may have more power than discreteFury et al., 1997; Kaiser & Deaver, 2009). In particu-pothesized here that indicators and scales indicativeent security in the BND should correlate with indica-les in childrens Family drawings assessing attachmentwell as with their attachment security score derivedelf-report questionnaire.

ne (81) children participated in the study. The childrenited from elementary schools in middle-SES neighbor-ael. Forty-one percent of the childrenwere boys (n=33)re girls (n=48). Themean age of the childrenwas 10.26e 812; SD=1.26); 69% of the children were from two-lies and 31% were from divorced families. Children hadof 2.38 siblings (range 111; SD=1.56).

ceiving consent from children and their parents, chil-eted the Family drawing, the BND, and the attachmentire during home visits, in their natural surroundings,y trained researchassistants. Participantswere assureddentiality of their responses.

rawing: Children were asked to draw their families,aper, using eight colored felt-tipped pens. After theythe drawings, the research assistants wrote the identity

394 L. Goldner / The Arts in Psychotherapy 41 (2014) 391399

of each gure and any additional information the child provided.Two coders coded all drawings using Kaplan & Mains (1986)attachment classications that focus on the location of the gures(gures are grounded and centered), natural proximity amongfamily memsmall), empeyes and noindividualizarms or armgerated swbizarre, ineelements frDrawings wpresented, 3and Mainsdiminish amincluding rsample. Theintra-class cdrawings) rwere resolv

Moreove(1997) eighlevel) for themotional idrawing; (bfamily groufamily memof gures awhich refeexpressed ia lack of ptension/angby carelessindicated bgures; (g)in unusualwhich referexpressionreliability focients (ICC)to .95. Disag

In additattachmentambivalentbetween th24 cases, wDisagreeme

The Birdthe list in Kincluded tha groundedbird, an ext(incubationusing of moEach drawithese indica(.70 to 1.00drawings);high. Disagrresolved by

In addition KaisersThree scaleconstructeddimension

drawing,whereas the fourth scale (optimism)was constructed on a10-point Likert scale (1 = low level to 10=high level) evaluating theoverall feeling of the drawing. Specically, Vitality refers to emo-tional investment in drawing and creativitymanifested in richness,

lnestheegy re ofholloe), tpropsencwines, ovefersf opted siunprsm ise exincubandaptetraiatioe intwingen thally,inse

wereay rmater (Cags wgh leesemof eainimambilityer, 2lassi; kaesolvldrenaluaThehern a 4ids.ids akedand tm ored acg fronshipct anres hsuppmopro

etestangeeierbers, genuine smile, size of gures (realistic, large orhasis of soft body and facial parts (belly, lower body,strils) missing father or mother, degree of movement,ed characteristics, completeness of gures, missings drawn in a way that does not allow holding, exag-

eetness or overly bright drawings, addition of strange,xplicable or unnished objects, omission of unexpectedom the drawing, scratched out gures and restarts.ere coded on a Likert scale ranging from 13 (1notfully presented). A detailedmanual, based on Kaplanwork, was adapted, delineating specic examples tobiguity. The training and adaptation of the manual,

eliability examination, was initially based on anotherintra-class reliability between the two coders using anorrelation coefcient (ICC) for 24 drawings (30% of theanged from .70 to 1.00. Disagreements between codersed by consensus.r, each drawing was also coded using Furys et al.st global scales ranging from 1 (low level) to 7 (highe following dimensions: (a) vitality, which refers tonvestment, creativity, and the richness of detail in the) pride, which refers to expressions of happiness in thep and the degree of connectedness depicted amongbers; (c) vulnerability, as expressed in the placementnd distortions in the size of body parts; (d) isolation,rs to a sense of emotional distance and lonelinessn neutral or negative affects, and is also depicted asroximity between the mother and child gures; (e)er, referring to a restriction of the gures expressedappearance, lack of colors, etc.; (f) role reversal, asy disproportionate size and/or roles depicted in thebizarreness, which indicates disorganization, reectedsigns and fantasy themes; and (h) global pathology,s to negativity, incompleteness of the gures, and poorin the drawing, details, and background. The inter-raterr the global scales using intra-class correlation coef-for 24 drawings (30% of the drawings) ranged from .80reements between coderswere resolved by consensus.ion, the drawings were classied into one of fourcategories (Kaplan & Main, 1986): secure, avoidant,and disorganized, as described above. The agreemente coders on the four main classications, based onas 84% {2 (9) =48.51, p< .001; kappa= .83, p< .001}.nts between coders were resolved by consensus.Nest Drawing: A list of distinct indicators based onaiser (1996) and Kaiser et al. (2003) was obtained ande depiction of: content in the nest, a tree, a dry tree,tree, a baby bird, a parent bird, an extremely large

remely tiny bird, eggs, an adequate caregiving behavior, feeding, protection), a protected nest, a spiky nest,re than 20% of the page and more than three colors.

ng was coded based on the presence or the absence oftors. All of the 14markers had sufciently high Kappas) to be considered reliable for 24 drawings (30% of thetherefore, the inter-rater reliability was consideredeements between coders regarding the drawings wereconsensus.on, as done in Fury et al. (1997) four global scales based(1996), Francis et al. (2003) lists were constructed.s (Vitality, General pathology, and Bizarreness) wereon a 7-point Likert scale (1 = low level of the specic

to 7=high level) assessing specic dimension in the

colorfuence topatholoin sens(e.g. aor looslack ofthe prethe draerasurmism rlevel odistortbirds,optimition, thing orfulnesswas adity. Theexaminple. Th24 drabetwe

FinversusBNDsthat mto intimannedrawinand himay rvalueand mmirroravailab& Shavmain cp< .001were r

Chiwas ev1996).in motrated oother kother krst asthem,for thesummranginrelatioconduthe scotionalas withness toTestrtency rAspelms, decorativeness, adding details to the drawings, refer-nvironment, and interactionbetween thebirds.Generalefers to a general impression of negativity manifestedemptiness, loneliness and spikiness, unprotected nestw nest, a tilted or a nest that is falling apart, spread outhreat to birds, lack of stability, overlap between birds,ortion, and size distortion of birds. Bizarreness refers toe of irrelevant and irrational elements, lack of logic ing, strange form of the nest, omitting unexpected parts,er-sweetness, and inadequate caregiving. Finally, Opti-to an overall positive impression of the drawing. A lowimism is expressed by loneliness, emptiness, spikiness,ze of the nest or the birds, strangeness, a threat to theotected nest, and a broken line quality. A high level ofmanifested in a sense of fullness, stability and protec-

istence of adequate caregiving behavior (i.e. gaze, feed-ation), a spontaneous and a owing line quality, color-proportion between objects. Again, a detailed manuald, delineating specic examples to diminish ambigu-ning and adaptation of the manual, including reliabilityn, was initially constructed based on another sam-ra-class reliability between the two coders regardings (30%) ranged from .74 to .86 (for intercorrelationse sub scales controlling for gender see Appendix 1).two classications of attachment security (securecure) were drawn from the general scales. Securecharacterized by high levels of vitality and optimismeect the prominent place secure individual allocaterelationships and their ability to cope in a exiblessidy, 2001; Collins & Sroufe, 1999), while Insecureere represented by low levels of vitality and optimismvels of pathology and bizarreness. This kind of pictureble avoidant individuals tendency to minimize therly attachment relationships as well as to deactivateize emotional expression (Dozier & Kobak, 1992) orivalent individuals constant concern about caregiversas well as their intense wish for closeness (Mikulincer006). The agreement between the coders on the fourcations, based on 24 cases, was 87.5% {2 (9) =50.74,ppa= .83, p< .001}. Disagreements between codersed by consensus.s attachment security: Childrens attachment securityted using the Attachment Security Scale (Kerns et al.,inventory assesses childrens perceptions of securitychild relationships. It is composed of 15 items that are-point scale usingHarters (1985) format: Somekids. . .. . (e.g., Some kids nd it easy to trust their mom BUTre not sure if they can trust their mom.) Childrenwereto choose which statement was more characteristic ofhen to indicate whether the statement was really truesort of true for them. Ratings (on a 4-point scale) wereross the 15 items to form an attachment security scorem 15 to 60, with higher scores indicating a more secure. This scale has been associated with general, social,

d academic competence (Kerns et al., 1996). Moreover,ave been shown to correlate with the degree of emo-ort received from mother, father and friends, as wellthers reports regarding their acceptance and willing-vide a secure base to their child (Kerns et al., 1996).reliability has been reported at .75 and internal consis-s from .72 to .84 (Bauminger&Kimhi-Kind, 2008;Kerns,, Gentzler, & Grabill, 2001; Granot & Mayseless, 2001).

L. Goldner / The Arts in Psychotherapy 41 (2014) 391399 395

As implemented in Kerns et al. (1996), a score of 45 was usedas a categorical cut-off point to distinguish secure childmotherattachment (more than 45 points) from insecure childmotherattachment (fewer than 45 points). This categorical cut-off pointhas been umiddle chilMayseless,study .77.

Results

Preliminary

Forprelirevealed thand the BNgirls scoreddf=78, p< .scored highdrens BNDfor vitalitydf=77, p< .df=77, p< .0regarding tBNDs.

The twoet al.s quesThe four-wtion based oavoidant (1two-way seyielded 27 s

The associatindicators a

To examscores as wQuestionna2 Chi-Squarthe two attattachmentoff point anindicators w2 (1,n=79Secure childdren tended

To examdrens attacscales, afterlations betwscores on thchildrens swith optim

Finally,classicatioattachmentrun, howev

The associatglobal scales

To examchildrens faeral scales,between th

Table 1Associations between Attachment Security scale, distinct family drawings signs,family drawing global scales and BND global scales, controlling for gender.

Vitality Pathology Bizarreness Optimism

ty sca

ct signnded

tered pletedtting ugurgerathasizuine sviduatder diinines do nral clance fance femenstranrre anr-sweeures

scalelityeerabitionssreverrrenesology

< .10,

e BND, levecorreredn the familydrawingswerepositively correlatedwithvitalitytimism and negatively with pathology in the BNDs. Levels ofes in the family drawings were positively correlated withogy and bizarreness and negatively with optimism in BNDs.ng unexpected parts, exaggerated gures, and distance fromin the familydrawingswaspositively correlatedwithpathol-the BNDs. Emphasized parts and add strange signs wereely correlatedwith bizarreness, while natural closeness wasely correlated.xamine the associations between the general scales of thens family drawings (Fury et al., 1997) and the BND gen-ales, a series of partial Pearson correlations was conductedn scores on the general scales of the family drawing and theales, controlling for gender. As can be seen in Table 1, vitalityide in family drawings were positively correlated with vital-optimism and negatively with pathology and bizarreness inDs. Stress and pathology in family drawings were negativelyted with vitality and optimism and positively with pathol-d bizarreness in the BNDs. Vulnerability in family drawingssitively correlated with pathology in the BNDs. Role rever-amily drawings was positively correlated with bizarrenesss.xamine the associations between the distinctmarkers of therawings and attachment classication as was derived fromildrens family drawings, a series of 2X 2 Chi-Square testsxamined. Due to the small number of participants in thenized and the avoidant groups, the three insecure classi-were combined into one insecure group. As can be seen in, differences in BND indicatorswere found for six indicators:sed in previous studies in the eld of attachment indhood (e.g. Bauminger & Kimhi-Kind, 2008; Granot &2001; Kerns et al., 1996). Alpha Cronbach in the current

analyses

minary analyses, a series of independent-sampleT-testsat childs gender was signicantly related to the FuryD global scales. Regarding childrens family drawings,signicantly higher than boys for vitality (t=3.16,

01) and pride (t=3.13, df=78, p< .01), whereas boyser for stress (t=2.86, df=78, p< .01). Regarding the chil-global scales, girls scored signicantly higher than boys(t=2.78, df=76, p< .001), and optimism (t=2.95,01) whereas boys scored higher in pathology (t=2.33,1). No differences between boys and girls were found

he distinct indicators in childrens family drawings or

-way, secure/insecure distribution based on Kernstionnaire was 61 secure (75%) and 20 (25%) insecure.ay secure/avoidant/ambivalent/disorganized distribu-n the childrens family drawingswas 31 secure (38%), 80%), 30 ambivalent (37%) and12disorganized (15%). Thecure/insecure distribution based on childrens BNDsecure (34%), 52 insecure (66%).

ion between attachment security score and the BNDnd global scales

ine the associations between attachment securityas obtained from the childrens Attachment Securityire and the distinct markers in the BND, a series of 2Xe tests for the entire sample was conducted betweenachment groups (secure/insecure) as derived from thesecurity questionnaire using Kern et al.s (1996) cut-d the distinct indicators of the BND. Differences in BNDere found for two indicators: depiction of a baby bird

) =4.66,p< .05anda tinybird2 (1,n=56) =5.97,p< .05.ren tended to draw a baby bird, whereas insecure chil-to draw a tiny bird.

ine the relations between the continuous scale of chil-hment security (Kerns et al., 1996) and the BND generalcontrolling for gender, a series of partial Pearson corre-een scores on the continuous security scale andgenerale BND scales was conducted. As can be seen in Table 1ecurity score correlatedwith vitality (r= .29, p< .05) andism (r= .23, p< .05).to examine the associations between attachmentns (secure versus insecure) according to childrenssecurity scale and the BNDs a 2X 2 Chi-Square test waser no correlationwas found between the classications.

ions between childrens family drawings and the BND

ine the relations between the distinct indicators of themily drawings (Kaplan&Main, 1986) and the BNDgen-a series of partial Pearson correlations was computede scores on the distinct indicators of the family drawing

Securi

DistinGrouCenComOmiTinyExagEmpGenIndiGenFemArmNatuDistDistMovAddBizaOveEras

GlobalVitaPridVulnIsolaStreRoleBizaPath

Note: # p

and thTable 1ativelyof centment iand operasurpatholOmittifatherogy inpositivnegativ

To echildreeral scbetweeBND scand prity andthe BNcorrelaogy anwas posal in fin BND

To eBND dthe chwere edisorgacationsTable 2le .29* .10 .06 .23*s in family drawingsgure .02 .22* .26* .20#gures .26* .31** .20# .35**gures .13 .21# .17 .13nexpected parts .16 .23* .10 .17

es .07 .04 .09 .01ed gures .07 .24* .11 .10ed parts .03 .21# .37** .15mile .23* .31** .11 .28*ed gures .40*** .36** .12 .39***fferences .10 .23# .24# .16signs .09 .17 .22 .12ot able to hold .13 .05 .00 .12oseness .03 .20# .34* .16rom mother .03 .04 .11 .05rom Father .17 .27* .21 .21t .30** .29** .07 .35*ge signs .05 .14 .23* .10d phantasy themes .09 .03 .19 .09tness .12 .19 .22# .14

.11 .27* .35*** .29*s in family drawings

.62*** .59*** .35** .65***

.38** .44*** .28* .48***lity .12 .27* .16 .18

.07 .21# .07 .18.48*** .55*** .38** .59***

sal .03 .06 .33* .13s .05 .04 .14 .00

.43*** .54*** .33** .51***p< .05, ** p< .01, ***p< .001.

global scales, controlling for gender. As can be seen inls of groundedgures in the family drawingswere neg-elated with pathology and bizarreness in BNDs. Levelsgures, genuine smile, individuated gures, andmove-

396 L. Goldner / The Arts in Psychotherapy 41 (2014) 391399

Table 2Chi-Square analyses: Attachment security according to childrens family drawingsby BND indicators.

Indicator Secure Insecure Chi-Squaren=31 n=48

Content No 4 36 1.71Yes 27 12

Depiction of a tree No 7 19 2.47yes 24 29

Grounded tree No 3 15 5.71*Yes 24 25

Protected nest No 11 34 9.60**Yes 20 14

Use of more than 20percent of the format

No 1 11 5.67*Yes 30 37

Depiction of young birds No 21 37 .84Yes 10 11

Depiction of

Depiction of

Depiction of

Depiction of

Depiction of

Depiction of

Caregiving

Note: # p< .10,

depiction otion of a drbird 2 (1,mat 2 (1, nn=79) =9.62 (1, n=79group tendegiving behagroup tendeout trees anand girls seof these indprotected nto use morto draw mop< .01. Onbirds in the

Table 4Chi-Square analyses: Association between attachment classications for the entiresample and for boys and girls separately.

BND classication

Family Secure Insecure Total Chi-Square KappaDrawings

classicationsSecure 25 6 31 48.97*** .78***Insecure 2 46 48

Total 27 52

BoysDrawings

classicationsSecure 8 2 10 20.11*** .78***Insecure 1 22 23

Total 9 24 33

GirlsDrawings

classicationsSecure 17 4 21 28.35*** .78***Insecure 1 24 25

Total 18 28 46

Note: ***p< .001.

examlobaled fror genindedepeffect. Ases forleven comentred td ch

levelly at

Table 3Differences in

Vitality

Pathology

Bizarreness

Optimism

Note: ** p< .01a parent bird No 8 20 2.28Yes 23 27

eggs No 15 27 .47Yes 16 21

a spiky nest No 24 27 3.69#

Yes 7 21

a tiny bird No 20 20 1.63Yes 5 11

a large bird No 25 23 4.38*Yes 1 7

a dry tree No 21 17 4.77*yes 4 13

No 12 31 5.08*Yes 19 17

* p< .05.

2

ToBND gobtainling foas theas themain egenderferenchigherchildreattachcompadren anlowersecuref a grounded tree (1, n=67) =5.71, p< .05, depic-y tree 2 (1, n=55) =4. 77, p< .05, depiction of a largen=56) =4.38, p< .05, use of more than 20% of the for-=79) =5.67, p< .05, depiction of a protected nest 2 (1,0, p< .01, and depiction of adequate caregiving behavior) = 5.08, p< .05. Children from the insecure attachmentd to draw less protected nests and less adequate care-vior. By contrast, children from the secure attachmentd to use more than 20% of the page, to draw less driedd large birds. Examination of these associations for boysparately showed gender differences regarding the useicators. Specically, insecure boys tended to draw lessests 2 (1, n=33) =14.06, p< .001. Secure girls tendede than 20% of the page 2 (1, n=46) =4.71, p< .05 andre adequate caregiving behavior 2 (1, n=46) =6.88,

the other hand, insecure girls tended to include largeir drawings 2 (1, n=34) =4.53, p< .05.

compared tment securpathology t(see Table 3

Finally,sicationsfamily drawand reveale2 (1, n=7As can beboys 2 (1separatelytended to pinsecure drfamily andsecure class(Figs. 16).

BND global scales across attachment groups according to family drawings, controlling fo

Secure Avoidant Ambivalent Disorgann=30 n=7 n=29 n=12

4.85 2.43 4.05 3.701.25 1.17 .99 .65

2.15 3.57 2.85 3.37.73 .53 .72 .80

1.73 2.50 2.24 2.75.69 .96 76 1.30

6.01 3.07 4.87 3.871.59 1.13 .90 .80

, ***p< .001.ine the differences between children scores on theirscales according to their attachment groups as werem their family drawings, aMANCOVA analysis control-der was conducted with attachment patterns servingpendent variable and the BND general scales servingndent variable. The MANCOVA revealed a signicantfor groups F(4,71) =7.99, p< .001, 2 = .31 but not for

can be seen in Table 3 the Anova analyses showed dif-all four variables. Post-hoc Duncan tests demonstratedls of vitality and optimism among securely attachedmpared to children with disorganized and ambivalentsecurity. These in turn had a higher level of vitality

o avoidant children. In addition, securely attached chil-ildrenwith ambivalent attachment security exhibited aof bizarreness compared to their counterparts. Finally,tached children exhibited a lower level of pathologyo children with ambivalent and disorganized attach-ity orientations. These in turn exhibited a lower level ofhan childrenwith an avoidant attachment classication).to examine the associations between attachment clas-(secure versus insecure) according to the childrensings and the BNDs a 2X 2 Chi-Square test was rund a signicant association between the classications9) =48.97, p< .001, Kappa=78, p< .001 (see Table 4).seen in Table 4, a similar picture was obtained for, n=33) =20.11, p< .001, Kappa=78, p< .001, and girls2 (1, n=44) =25.56, p< .01, Kappa=78, p< .001. Girlsroduce secure drawings while boys tended to makeawings. Pictures 1 to 6 illustrate pairs of drawings (i.e.bird nest) by the same child. Pictures 1 to 2 show aication. Pictures 3 to 6 show an insecure classicationr gender.

ized F 2 Contrast

8.47*** .26 2

L. Goldner / The Arts in Psychotherapy 41 (2014) 391399 397

Fig. 1. An example for a secure family drawing.

Fig. 2. An example of a secure BND.

Fig. 3. An example for an insecure family drawing.

Fig. 4. An example of an insecure BND.

Discussion

The resuthe BND astary schoolvalidation oparent birdthere shouhighlights tsole reliancand a globaclassicatio(1997) regarole of orgameasures (chiey onpattern of rcontains asbetweenbirThis patternin human dsupport andepiction mmodels regtrustworthycreate in a r

This stuily drawingglobal scaleand the birdative scalesis consistenAmericangures, especias Japaneseels of vitalitHowever, timpact of gand fourthence betweusing colorFig. 5. An example for an insecure family drawing.

Fig. 6. An example of an insecure BND.

lts of the current study lend additional weight to usinga way to tap attachment representations in elemen-age children. The current study provides an additionalf certain distinct indicators such as the depiction of aor a tree among secure children. Moreover, it suggestsld be a broader approach to classifying drawings andhe need for a more integrative perspective rather thane on individual signs. The use of aggregations of signsl rating scale as a powerful tool to identity attachmentn is consistent with the ndings reported in Fury et al.rding childrens family drawings, and emphasizes thenization of the drawings similar to other attachmente.g., the AAI or the Strange Situation) which are basedcoherence (Main, 1996). Specically, the most robustesults was obtained using the optimism scale, whichpects of caregiving behaviors, and positive interactionsds and the childs emotional investment in thedrawing.may signify the centrality of caregiving relationshipsevelopment (Bowlby, 1969, 1973) that afford emotionald protection (Belsky & Cassidy, 1994). This optimisticay also indicate childrens positive internal working

arding their social network as available, benevolent andas well as their exploratory competence and ability toelatively exible manner.dy also revealed gender differences in childrens fam-s and BNDs. Girls exhibited high scores in the positives indicative of attachment security both in their familynest drawings, whereas boys scored higher in the neg-indicative of attachment insecurity. The data for girlst with ndings in previous studies that demonstratedirls superiority compared toboys indrawinghumang-ally female gures (Koppitz, 1968; Scott, 1981), as well(Behrens & Kaplan, 2011) and Israeli girls higher lev-y and pride in family drawings (Goldner & Levi, 2014).hey contradict Deavers ndings (2009) regarding theender on Human Figure Drawings (HFD) among secondAmerican graders, which showed a signicant differ-en boys and girls only with regard to color t with girlsmore realistically than boys.

398 L. Goldner / The Arts in Psychotherapy 41 (2014) 391399

These differences may reect girls more extensive drawingexperience, their extra attention to detail and richness in theirdrawings, aswell as their tendency toorganizedrawings in a frontalway. In contrast, the lower levels of maturity and investment indrawing amand their teto use a perthe negativMilne & Gre

Finally,research rerity, the saparticipantsin line within Europeatern of croclassicatioeties such& Larson, 12005; vanWalraven,this uniqueare often asinvolvemenet al., 1997;

Clinical im

The BNDfor therapiattachmenttheir distrerole of attacadjustmenttive conseqdevelopmeself-esteemtence (Kim1998; Miku

Furthermchotherapychildren andyadic relaical role inthis perspeessential fefunctioningingful persosimilar to eondary attato be wiserin times ofsive to need(Bowlby, 19Therefore,tation maydevelop anment (Byng

Limitation

Several lthe attachmhave been bof insecurit

indicators and scales and type of attachment. Second, the samplesize was relatively small; therefore generalizing from this studyrequires future corroboration. Moreover due to the small size noclassication into the four types of attachment security was made

basit stuatheres vof ative eer ans chningtaktionl conamilicatos seeifferetaskto otgs ws an

dix 1

rcor

ylogyenessism

, ***p

nces

th, Mssmenti, & Eago, ILth,M.dale,n, G. Ct: Indolescer, N

chmenf Learmew,st of a244., K., &tachmJ., & Cay (Edrd: BlJ. (20ssmenciatioon, I.,ionsharch aJ. (196s.J. (19, NY:J. (197ll, J. (2escentJ. (198BasicJ. (19ent. Loong boys, their avoidance of detail in their drawings,ndency to include fantasy and imaginary themes andspective from abovemay explain their higher scores one global scales (Lijima, Arisaka, Minamoto, & Arai, 2001;enway, 1999; Richards & Ross, 1967; Turgeon, 2008).counter to the prevalent assumption in attachmentgarding the standard distribution of attachment secu-mple in the current study revealed many ambivalent, according to their family drawings. This nding isprevious studies, mostly conducted elsewhere than

n and North American countries, suggesting a pat-ss-cultural differences, in which the C (ambivalent)n is relatively more frequent in collectivistic soci-as Israel (Leyendecker, Lamb, Fracasso, Schoelmerich,997; Takahashi, 1990; Tomlinson, Cooper, & Murray,IJzendoorn & Kroonenberg, 1988; Zevalkink, Riksen-& Van Lieshout 1999). Researchers have attributeddistribution to interdependent societal values, whichsociated with more maternal intrusiveness and over-t, resulting in resistant infant behaviors (LeyendeckerZevalkink et al., 1999).

plications

holds promise for providing valuable informationsts involved in assessing and treating children withproblems to improve their adjustment and alleviatess. This is especially important given the prominenthment security in promoting or hampering childrens(Weineld et al., 2008), and in buffering the nega-uences of adverse experiences due to decits in thent of childrens self-system processes that include highand a sense of agency, optimism and perceived compe-& Cicchetti, 2006; Masten, 2001; Masten & Coatsworth,lincer & Shaver, 2007).ore, a growing body of evidence in the eld of psy-suggests that the quality of attachment bonds betweend their attachment gures may be generalized to othertionships such as psychotherapy and may play a crit-psychotherapy processes and outcomes. According toctive, the therapeutic relationship is believed to mirroratures of an attachment relationship, with the therapistas the secure base from which clients explore mean-nal material (Mikulincer & Shaver, 2007). In addition,arly attachment gures, therapists may serve as sec-chment gures as they are perceived by their patientsand stronger, to provide help and emotional regulationdistress, and to be dependably available and respon-s, and thus functioning as a secure base for exploration88; Dozier & Tyrrell, 1998; Mikulincer & Shaver, 2007).combined with other clinical data, attachment orien-shed light on how the therapeutic relationship mightd how best to establish a secure relationship in treat--Hall, 2001; Slade, 1999).

s and future directions

imitations of this study should be acknowledged. First,ent inventory examined security in general, and mayiased toward positive presentation. Specifying the typey might help clarify the associations between the BND

on thecurrenwere rmeasunitudenormato largsuch afunctioshouldassociaculturaclose fthe inddren afrom dbe theapplydrawinnding

Appen

Inte

VitalitPathoBizarrOptim

** p< .01

Refere

AinsworassechetChic

AinsworHills

Armsdemenin ad

Baumingattanal o

BartholoA te221

Behrensto at

Belsky,D. HOxfo

Betts, D.asseAsso

Brethertrelatrese

Bowlby,Book

Bowlby,York

Bowlby,Byng-Ha

AdolBowlby,

NY:Bowlby,

opms of the childrens BNDs. Third, the correlations in thedy were relatively moderate; hence the effects sizesr small. The different assessment methods (projectiveersus self-questionnaire) might account for the mag-ssociations. Furthermore, the sample includes ratherlementary school children. A clinical samplemight leaddmore clear-cut effect sizes. Additionally, other aspectsildrens temperament, cognitive abilities and generalmay moderate these associations. Future research

e these characteristics in account when testing thes. Furthermore, the study was conducted in the Israelitext, which is characterized by high family values and

y ties (Lavee & Katz, 2003). The relationships betweenrs and especially the large number of ambivalent chil-n in the family drawings may be different in childrennt cultures. Thus, as suggested by Betts (2013), it mightof future studies to explore whether these ndings alsoher cultures and contexts. Finally, most of the secureere made by girls. Future studies should reexamine thed classications to enable further generalizations.

.

relations between BND scales, controlling for gender

Vitality Pathology Bizarreness Optimism

1.00 .66*** .30** .88***1.00 .52*** .79***

1.00 .45***1.00

< .001.

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Revisiting the Birds Nest Drawing assessment: Toward a global approachIntroductionAttachment theoryProjective art based techniques to evaluate attachment securityClassification of attachment representations through family drawingsBirds nest drawing (BND)

MethodParticipantsProcedureMeasures

ResultsPreliminary analysesThe association between attachment security score and the BND indicators and global scalesThe associations between childrens family drawings and the BND global scales

DiscussionClinical implicationsLimitations and future directionsAppendix 1References