THE CHILD ATTACHMENT Q-SORT: DEVELOPMENT, TRAINING, AND VALIDATION ATHENA TSIOKRIS Thesis submitted for the degree of Doctor of Philosophy University College London September 2015 1 I, Athena Tsiokris, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. 1 September 2015 2 Acknowledgements Completing a PhD is a difficult task, applying to one enormous pressure both to self and to the immediate environment. It is probably one of the most stressful experiences that the self encounters in working life. For this reason, the task cannot be completed unless one has absolute and full determination to it and is a recipient of maximum support from one’s immediate environment. With this in mind, I would like to extend my warmest appreciation and gratitude to all those people who supported and helped me throughout. First and foremost, I would like to extend my gratitude to my supervisor Professor Mary Target for her patience and support over the years. Mary proved to be a stable supporting force when all other elements were constantly shifting. Her politeness by nature and gentle and kind demeanor coupled with fierceness when circumstances required provided an impetus for me to complete the task. I would also like to express my gratitude to my secondary supervisor, Professor Peter Fonagy for being patient and understanding and teaching me to work beyond limitations and think outside of the box. His ability to meet moments of anxiety with perfectly timed humor helped me put things in the right perspective. Special thanks are extended to my colleague Ana Calderon; discussions with Ana were valuable in analyzing in greater depth the findings of my research. Also, I would like to thank the coders who participated in this research. Last, but not least, I would like to express my deepest gratitude to my family for supporting me both morally and financially throughout this long endeavor, that at times seemed impossible. Throughout the entire PhD process, I’ve come to learn that attachment does matter in life; when stressed, this kept me going to complete my research. 3 Abstract The present thesis describes the development of the Child Attachment Q-sort (CAQ), an alternative approach to assessing quality of attachment in middle childhood, currently offered by the Child Attachment Interview (CAI). Although, the same semi-structured interview is used to activate the attachment system of the child and elicit the information necessary for coding, the CAQ departs in the method used for coding and classification. It differs in that raters are required to use Q-sorting to assess the attachment classification of each child based on direct and specific observations making it more behaviorally based rather than inferential. Further, the training system of the CAQ was designed with the intention of requiring limited formal training and attachment knowledge, thereby increasing its usability and application in both research and potential clinical settings. Furthermore, this method provides the opportunity to develop a standard language for attachment classification in middle childhood, whereas the language used in the CAI coding system is at an advanced conceptual level. Overall the CAQ attempted to simplify the process and retain classification at the observational level, offering an alternative approach to assessing attachment and contributing to a new way of thinking about it, while also making it available to a wider range of professionals. The psychometric properties of the CAQ were assessed by examining the reliability across various coders and samples and the main findings are reported. All major aspects of validity of the CAQ were assessed and the findings are presented. Overall the findings support the notion that the CAQ could be used as a reliable and valid instrument for measuring attachment in middle childhood. 4 TABLE OF CONTENTS Table of Contents Acknowledgements ............................................................................................... 3 Abstract ................................................................................................................. 4 Table of Contents ................................................................................................. 5 List of Tables ...................................................................................................... 13 List of Figures ..................................................................................................... 17 Chapter 1: Attachment Theory and Attachment Measures .......................... 18 1.1. The Origins of Attachment Theory – A Brief Overview ................................. 18 1.1.1. The work of John Bowlby. ............................................................................ 18 1.1.2. The attachment behavioral system. ............................................................... 20 1.1.3. Development of attachment in early childhood. ........................................... 21 1.1.3.1. Phase I: Pre-attachment (birth). ....................................................................... 21 1.1.3.2. Phase II: Attachment-in-the-making (6-12 weeks old +). .............................. 22 1.1.3.3. Phase III: Clear-cut attachment (7 months old +). .......................................... 22 1.1.3.4. Phase IV: Goal-corrected partnership (4 years old). ...................................... 23 1.1.4. Patterns of attachment. .................................................................................. 23 1.1.5. Internal Working Models (IWM). ................................................................. 23 1.2. Assessment of Attachment across the Lifespan ............................................... 24 1.2.1. Infancy – Strange Situation Procedure (SSP). ............................................... 25 1.2.1.1. Procedure. ........................................................................................................ 25 1.2.1.2. Coding and classification. ............................................................................... 25 1.2.1.3. Interrater reliability. ......................................................................................... 26 1.2.1.4. Test-retest reliability. ....................................................................................... 26 1.2.2. Preschool years. ............................................................................................. 26 1.2.2.1. Attachment Q-Sort (AQS). .............................................................................. 26 1.2.2.2. Sixth year reunion procedure. ......................................................................... 27 1.2.2.3. Cassidy-Marvin system. .................................................................................. 27 1.2.2.4. Preschool Assessment of Attachment (PAA). ................................................ 28 1.2.3. Adolescence. ................................................................................................. 29 1.2.3.1. Discussion. ....................................................................................................... 31 1.2.4. Adulthood – Adult Attachment Interview (AAI). ......................................... 31 1.2.4.1. Procedure. ........................................................................................................ 31 1.2.4.2. Coding and classification. ............................................................................... 32 1.2.4.3. Stability and interrater agreement. .................................................................. 32 1.2.4.4. Discriminant validity. ...................................................................................... 33 1.2.4.5. Predictive validity. ........................................................................................... 33 1.2.4.6. Discussion. ....................................................................................................... 34 5 TABLE OF CONTENTS 1.3. Assessment of Attachment in Early and Middle Childhood ........................... 34 1.3.1. Interview Measures. ...................................................................................... 35 1.3.1.1. Child Attachment Interview (CAI). ................................................................ 35 1.3.1.2. Friend and Family Interview (FFI). ................................................................ 40 1.3.2. Family drawings. ........................................................................................... 43 1.3.3. Narrative approach. ....................................................................................... 43 1.3.3.1. Separation Anxiety Test (SAT). ...................................................................... 44 1.3.3.2. Family photos. ................................................................................................. 47 1.3.3.3. Doll play, story stem procedures, and the MCAST. ....................................... 47 1.3.4. Self-report measures. ..................................................................................... 53 1.3.4.1. Security Scale. ................................................................................................. 53 1.3.4.2. Coping Strategies Questionnaire. .................................................................... 55 1.3.5. Future directions and conclusions. ...............................................................