Berberi, Alexandra (2025) Exploring Therapeutic Factors: A Philosophical Inquiry into Art Therapy's Role in Healing Attachment Insecurity in an Adult Population. [Graduate Projects (Non-thesis)] (Unpublished)
Preview |
Text (application/pdf)
780kBBerberi_MA_F2025.pdf - Accepted Version Available under License Spectrum Terms of Access. |
Abstract
Attachment insecurity in adulthood has been linked to emotion dysregulation, maladaptive relational patterns, and vulnerability to psychopathology. While several attachment-informed therapeutic models exist, few are tailored to address attachment insecurity through nonverbal, sensory-based modalities. This thesis examines the therapeutic potential of art therapy for addressing attachment insecurity in adulthood, employing philosophical inquiry to synthesize theoretical and empirical literature. Drawing on attachment theory, neurobiology, and art therapy frameworks, three core therapeutic factors are examined: sensory and tactile engagement, imagery and concretization, and therapist attunement within the triangular relationship. Findings suggest that the multisensory, embodied, and relational nature of art therapy aligns closely with the mechanisms of attachment formation and regulation, offering an alternative pathway for clients who struggle with traditional talk therapies. These therapeutic factors support emotional regulation, promote reflective functioning, and provide corrective emotional experiences, particularly for individuals who are high in attachment avoidance or have limited verbal access to emotional material. This study highlights the relevance of art therapy as an attachment-informed modality, offering a Tripartite Mechanism Model for Attachment Repair in Art Therapy, and advocating for its further integration and empirical investigation within adult mental health treatment.
Divisions: | Concordia University > Faculty of Fine Arts > Creative Arts Therapies |
---|---|
Item Type: | Graduate Projects (Non-thesis) |
Authors: | Berberi, Alexandra |
Institution: | Concordia University |
Degree Name: | M.A. |
Program: | Creative Arts Therapies (Art Therapy Option) |
Date: | 15 August 2025 |
Keywords: | attachment, attachment insecurity, adult, art therapy, creative arts therapies, avoidant attachment, therapeutic factors, mechanisms of change |
ID Code: | 995880 |
Deposited By: | Alexandra Berberi |
Deposited On: | 21 Aug 2025 13:16 |
Last Modified: | 21 Aug 2025 13:16 |
References:
Abbing, A., Ponstein, A., van Hooren, S., de Sonneville, L., Swaab, H., & Baars, E. (2018). The effectiveness of art therapy for anxiety in adults: A systematic review of randomized and non-randomized controlled trials. PLOS ONE, 13(12), e0208716. https://doi.org/10.1371/journal.pone.0208716Adams, G. C., Wrath, A. J., & Meng, X. (2018). The relationship between adult attachment and mental health care utilization: A systematic review. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 63(10), 651–660. https://doi.org/10.1177/0706743718779933
Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Lawrence Erlbaum Associates.
Armstrong, V. G., & Ross, J. (2022). The experiences of parents and infants using a home-based art intervention aimed at improving wellbeing and connectedness in their relationship. Frontiers in Psychology, 13(732562), 1–21. doi: 10.3389/fpsyg.2022.732562
Azoulay, B., & Orkibi, H. (2015). The four-phase CBN psychodrama model: A manualized approach for practice and research. The Arts in Psychotherapy, 42(1), 10–18. https://doi.org/10.1016/j.aip.2014.12.012
Avrahami, D. (2005). Visual art therapy’s unique contribution in the treatment of posttraumatic stress disorders. Journal of Trauma & Dissociation, 6(4), 5–38.
Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61(2), 226–244. https://doi.org/10.1037/0022-3514.61.2.226
Basu, R. (2023). Risky inquiry: Developing an ethics for philosophical practice. Hypatia, 38(2), 275–293. doi:10.1017/hyp.2023.39
Bat Or, M. (2010). Clay sculpting of mother and child figures encourages mentalization. The Arts in Psychotherapy, 37(4), 319–327.
Bion, W. R. (1962). The psycho-analytic study of thinking. International Journal of Psycho-Analysis, 43, 306–310.
Bosgraaf, L., Spreen, M., Pattiselanno, K., and van Hooren, S. (2020). Art therapy for psychosocial problems in children and adolescents: A systematic narrative review on art therapeutic means and forms of expression, therapist behavior, and supposed mechanisms of change. Frontiers in Psychology. 11,584685. https://doi.org/10.3389/fpsyg.2020.584685
Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. New York, NY: Basic Books.
Briere, J. N., & Scott, C. (2014). Principles of trauma therapy: a guide to symptoms, evaluation, and treatment (DSM-5 Update) (2nd ed.). SAGE Publications.
Cassidy, J. & Shaver, P. (2016). Handbook of attachment: Theory, research, and clinical applications (3rd Ed). Guilford Press.
Cheche Hoover, R., & Jackson, J. B. (2021). Insecure attachment, emotion dysregulation, and psychological aggression in couples. Journal of Interpersonal Violence, 36(19-20). https://doi-org.proxy3.library.mcgill.ca/10.1177/0886260519877939
Cherland, E. (2012). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, self-regulation [Review of the book The polyvagal theory by S. W. Porges]. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 21(4), 313–314.
Cortés-García, L., Takkouche, B., Rodriguez-Cano, R., & Senra, C. (2020). Mediational mechanisms involved in the relation between attachment insecurity and depression: A meta-analysis. Journal of Affective Disorders, 277, 706–726. https://doi-org.lib-ezproxy.concordia.ca/10.1016/j.jad.2020.08.082
Czamanski-Cohen, J. & Weihs, K. (2016). The bodymind model: A platform for studying the mechanisms of change induced by art therapy. The Arts in Psychotherapy. 51, 63–71. https://doi.org/10.1016/j.aip.2016.08.006
Dalley, T. (1987). Images of art therapy. Tavistock.
de Witte, M., Orkibi, H., Zarate, R., Karkou, V., Sajnani, N., Malhotra, B., Kaimal, G., Baker, F. A., & Koch, S. C. (2021). From therapeutic factors to mechanisms of change in the creative arts therapies: A scoping review. Frontiers in Psychology. 12(678397). https://doi.org/10.3389/fpsyg.2021.678397
Diamond, G., Russon, J., & Levy, S. (2016). Attachment-based family therapy: A review of the empirical support. Family process, 55(3), 595–610. https://doi.org/10.1111/famp.12241
Einhorn, C. G., Shamri-Zeevi, L., & Honig, O. (2023). Case study of therapist-client co-creation for the treatment of relational trauma in children. The Arts in Psychotherapy, 82, 101993. https://doi.org/10.1016/j.aip.2022.101993
Eisanbach, N. A., Snir, S., & Regev, D. (2015). Identification and characterization of symbols emanating from the spontaneous artistic product of victims of childhood trauma. The Arts in Psychotherapy, 44, 45–56.
Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York, NY: Other Press.
Franklin, M. (2010). Affect regulation, mirror neurons, and the third hand: Formulating mindful empathic art interventions. Art Therapy: Journal of the American Art Therapy Association, 27(4), 160–167. https://doi.org/10.1080/07421656.2010.10129385
Geller, S. M., & Porges, S. W. (2014). Therapeutic presence: Neurophysiological mechanisms mediating feeling safe in therapeutic relationships. Journal of Psychotherapy Integration, 24(3), 178-192. https://doi.org/10.1037/a0037511
Girme, Y. U., Jones, R. E., Fleck, C., Simpson, J. A., & Overall, N. C. (2021). Infants’ attachment insecurity predicts attachment-relevant emotion regulation strategies in adulthood. Emotion, 21(2), 260–272. https://doi.org/10.1037/emo0000721
Goldner, L. (2014). Revisiting the Bird’s Nest Drawing assessment: Toward a global approach. The Arts in Psychotherapy, 41(4), 391–399. https://doi.org/10.1016/j.aip.2014.06.003
Haeyen, S., Heres, H., & Pol, S. (2024). Making meaning of one's own life story in words and images: A narrative case report of personal recovery from personality disorder through the interventions “An Empowering Story” and art therapy. Journal of Clinical Psychology, 80(8), 1736–1753. https://doi-org.lib-ezproxy.concordia.ca/10.1002/jclp.23690
Haeyen, S., van Hooren, S., & Hutschemaekers, G. (2015). Perceived effects of art therapy in the treatment of personality disorders, Cluster B/C: A qualitative study. The Arts in Psychotherapy, 45, 1–10.
Haeyen, S., Van Hooren, S., Van Der Veld, W., & Hutschemaekers, G. (2018a). Promoting mental health versus reducing mental illness in art therapy with patients with personality disorders: A quantitative study. The Arts in Psychotherapy, 58, 11–16. https://doi.org/10.1016/j.aip.2017.12.009
Hamilton, N. G. (1989). A critical review of object relations theory. The American Journal of Psychiatry, 146(12), 1552–1560. https://doi.org/10.1176/ajp.146.12.1552
Han, G., Wang, C. D. C., Jin, L., & Bismar, D. (2022). Insecure attachment, maladaptive perfectionism, self-esteem, depression, and bulimic behaviors for college women: A cross-cultural comparison. International Journal for the Advancement of Counselling, 44(2), 197–219. https://doi.org/10.1007/s10447-021-09462-w
Illing, V., Tasca, G. A., Balfour, L., & Bissada, H. (2010). Attachment insecurity predicts eating disorder symptoms and treatment outcomes in a clinical sample of women. Journal of Nervous and Mental Disease, 198(9), 653–659. https://doi.org/10.1097/NMD.0b013e3181ef34b2
Jacobsen, C. F., Falkenström, F., Castonguay, L., Nielsen, J., Lunn, S., Lauritzen, L., & Poulsen, S. (2024). The relationship between attachment needs, earned secure therapeutic attachment and outcome in adult psychotherapy. Journal of Consulting and Clinical Psychology, 92(7), 410–421. https://doi.org/10.1037/ccp0000900
Kaiser, D. H., & Deaver, S. (2009). Assessing attachment with the Bird's Nest Drawing: A review of the research. Art Therapy, 26(1), 26–33. https://doi.org/10.1080/07421656.2009.10129312
Keller, H. (2018). Universality claim of attachment theory: Children's socioemotional development across cultures. Proceedings of the National Academy of Sciences of the United States of America, 115(45), 11414–11419. https://doi.org/10.1073/pnas.1720325115
Knox, L., Karantzas, G., & Ferguson, E. (2024). The role of attachment, insecurity, and stress in partner maltreatment: A meta-analysis. Trauma, Violence, & Abuse, 25(1), 721–737. https://doi.org/10.1177/15248380231161012
Ko, C. H., Liang, Y. T., Liao, Y. C., & Chen, H. F. (2024). Exploring the Relationship Between Transitional Object Attachment and Emotion Regulation in College Students. Healthcare (Basel, Switzerland), 13(1), 39. https://doi.org/10.3390/healthcare13010039
Kramer, E. (1986). The art therapist’s third hand: Reflections on art, art therapy, and society at large. American Journal of Art Therapy, 24(3),71–86.
Laird, L., & Mulvihill, N. (2022). Assessing the extent to which art therapy can be used with victims of childhood sexual abuse: A thematic analysis of published studies. Journal of Child Sexual Abuse, 31(1), 105–126. https://doi.org/10.1080/10538712.2021.1918308
Lavey-Khan, S., & Reddick, D. (2020). Painting together: A parent-child dyadic art therapy group. The Arts in Psychotherapy, 70,101687. https://doi.org/10.1016/j.aip.2020.101687
Lee, A., & Hood, B. (2021). The origins and development of attachment object behaviour. Current Opinion in Psychology, 39, 72–75. https://doi.org/10.1016/j.copsyc.2020.07.023
Levy, K., Kivity, Y., Johnson, B., & Gooch, C. (2018). Adult attachment as a predictor and moderator of psychotherapy outcome: A meta-analysis. Journal of Clinical Psychology, 74(11), 1996–2003. https://doi.org/10.1002/jclp.22685
Lorenzini, N., & Fonagy, P. (2013). Attachment and Personality Disorders: A Short Review. Focus, 11(2), 155–166. https://doi.org/10.1176/appi.focus.11.2.155
Malhotra, B., Jones, L. C., Spooner, H., Levy, C., Kaimal, G., & Williamson, J. B. (2024). A conceptual framework for a neurophysiological basis of art therapy for PTSD. Frontiers in Human Neuroscience, 18, 1351757. https://doi.org/10.3389/fnhum.2024.1351757
Manzotti, A., Panisi, C., Pivotto, M., Vinciguerra, F., Benedet, M., Brazzoli, F., Zanni, S., Comassi, A., Caputo, S., Cerritelli, F., & Chiera, M. (2024). An in‐depth analysis of the polyvagal theory in light of current findings in neuroscience and clinical research. Developmental Psychobiology, 66(2), e22450. https://doi.org/10.1002/dev.22450
Mikulincer, M., & Shaver, P. R. (2016). Attachment in adulthood: Structure, dynamics, and change (2nd ed.). Guilford Press.
Murphy, K. M., & Wheeler, B. L. (2016). Music therapy research (3rd ed.). Barcelona Publishers.
Noppe, I. C. (2000). Beyond broken bonds and broken hearts: The bonding of theories of attachment and grief. Developmental Review 20(4), 514-538.
Overall, N. C., Fletcher, G. J. O., Simpson, J. A., & Fillo, J. (2015). Attachment insecurity, biased perceptions of romantic partners’ negative emotions, and hostile relationship behavior. Journal of Personality and Social Psychology, 108(5), 730–749. https://doi.org/10.1037/a0038987
Park, Y., Sanscartier, S., Impett, E. A., Algoe, S. B., Leonhardt, N. D., Schrage, K., Carmichael, C. L., Collins, N. L., Conte, F., De Rosa, O., Ficca, G., Fredrickson, B. L., Harris, P., Keltner, D., West, T. N., & MacDonald, G. (2022). Meta‐analytic evidence that attachment insecurity is associated with less frequent experiences of discrete positive emotions. Journal of Personality. Advance online publication. https://doi.org/10.1111/jopy.12796
Poole Heller, D. (2019). The Power of Attachment: How to Create Deep and Lasting Intimate Relationships. Sounds True.
Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.
Rees, C. (2007). Childhood attachment. The British Journal of General Practice, 57(544), 920–922. https://doi.org/10.3399/096016407782317955
Richardson, E., Beath, A., & Boag, S. (2022). Default defenses: The character defenses of attachment-anxiety and attachment-avoidance. Current Psychology. Advance online publication. https://doi.org/10.1007/s12144-022-03919-w
Rossi, E., Cassioli, E., Martelli, M., Melani, G., Hazzard, V. M., Crosby, R. D., Wonderlich, S. A., Ricca, V., & Castellini, G. (2022). Attachment insecurity predicts worse outcome in patients with eating disorders treated with enhanced cognitive behavior therapy: A one‐year follow‐up study. International Journal of Eating Disorders, 55(8), 1054–1065. https://doi.org/10.1002/eat.23762
Sandberg, D. A., & Refrea, V. (2022). Adult attachment as a mediator of the link between interpersonal trauma and International Classification of Diseases (ICD-11) complex posttraumatic stress disorder symptoms among college men and women. Journal of Interpersonal Violence, 37(23–24), Article 08862605211072168. https://doi.org/10.1177/08862605211072168
Schore, A. N. (2003). Affect dysregulation and disorders of the self. W.W. Norton & Company.
Schore, A. N. (2012). The science of the art of psychotherapy. W. W. Norton & Company.
Shaver, P. R., & Mikulincer, M. (2002). Attachment-related psychodynamics. Attachment & Human Development, 4(2), 133–161. https://doi.org/10.1080/14616730210154171
Shaverien, J. (1994). The transactional object: Art psychotherapy in the treatment of anorexia. British Journal of Psychotherapy, 11(1), 46–61.
Shaverien, J. (1999). Art within analysis: Scapegoat: Transference and transformation. Journal of Analytic Psychology, 44, 479–510.
Sholt, M., & Gavron, T. (2006). Therapeutic qualities of clay-work in art therapy and psychotherapy: A review. Art Therapy, 23(2), 66–72. https://doi.org/10.1080/07421656.2006.10129647
Siegel, D. J. (2012). The developing mind: How relationships and the brain interact to shape who we are (2nd ed.). Guilford Press.
Simpson, J. A., Kim, J. S., Fillo, J., Ickes, W., Rholes, W. S., Oriña, M. M., & Winterheld, H. A. (2011). Attachment and the management of empathic accuracy in relationship-threatening situations. Personality and Social Psychology Bulletin, 37(1), 242–254. https://doi.org/10.1177/0146167210394368
Simpson, J. A., & Rholes, W. S. (2017). Adult attachment, stress, and romantic relationships. Current Opinion in Psychology, 13, 19–24. https://doi.org/10.1016/j.copsyc.2016.04.006
Sood, M., Carnelley, K. B., & Newman‐Taylor, K. (2022). How does insecure attachment lead to paranoia? A systematic critical review of cognitive, affective, and behavioural mechanisms. British Journal of Clinical Psychology, 61(3), 781–815. https://doi.org/10.1111/bjc.12361
Snir, S., & Wiseman, H. (2010). Attachment in romantic couples and perceptions of a joint drawing session. The Family Journal, 18(2), 116–126. https://doi.org/10.1177/1066480710364318
Stovall-McClough, K. & Dozier, M. (2016). Attachment states of mind and psychopathology in adulthood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (3rd ed., pp. 715-732). Guilford Press
Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice (7th ed.). Wiley.
Tasca, G. A., Ritchie, K., Zachariades, F., Proulx, G., Trinneer, A., Balfour, L., Demidenko, N., Hayden, G., Wong, A., & Bissada, H. (2013). Attachment insecurity mediates the relationship between childhood trauma and eating disorder psychopathology in a clinical sample: A structural equation model. Child Abuse & Neglect, 37(11), 926–933. https://doi.org/10.1016/j.chiabu.2013.03.004
Taylor, P., Rietzschel, J., Danquah, A., & Berry, K. (2015). Changes in attachment representations during psychological therapy. Psychotherapy Research, 25(2), 222–238.
Wang, K. Y. H., Kealy, D., & Cox, D. W. (2022). A pathway to meaning in life: Early parental support, attachment, and the moderating role of alexithymia. Journal of Adult Development, 29(4), 306–317. https://doi.org/10.1007/s10804-022-09418-3
Xie, Z., Yan, Y., & Peng, K. (2023). Pragmatism or idealism: A systematic review and visual analysis of Winnicott's psychoanalytical treatment views. Frontiers in Psychiatry, 14, Article 1237005. https://doi.org/10.3389/fpsyt.2023.1237005
Repository Staff Only: item control page