Attachment, Anxiety, and Depression: A Study of Women in Residential Treatment with Their

240 Pages·2017·12.6 MB·English

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Gary Miles Forrest
Nova Southeastern University, [email protected]
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Gary Miles Forrest. 2015. Attachment, Anxiety, and Depression: A Study of Women in Residential
Treatment with Their Children at the Susan B. Anthony Recovery Center (SBARC) (1995-2010). Doctoral
dissertation. Nova Southeastern University. Retrieved from NSUWorks, Graduate School of Humanities
and Social Sciences. (2)
https://nsuworks.nova.edu/shss_dft_etd/2.
This Dissertation is brought to you by the CAHSS Theses, Dissertations, and Applied Clinical Projects at NSUWorks.
It has been accepted for inclusion in Department of Family Therapy Dissertations and Applied Clinical Projects by
an authorized administrator of NSUWorks. For more information, please contact [email protected].
Attachment, Anxiety, and Depression: A Study of Women in Residential Treatment
with their Children at the
Susan B. Anthony Recovery Center (SBARC) (1995–2010)

by

Gary Miles Forrest

A Dissertation Presented to the
Graduate School of Humanities and Social Sciences of Nova Southeastern University
in Partial Fulfillment of the Requirements for the Degree of
Doctor of Philosophy

Nova Southeastern University
2014
Copyright
by
Gary Miles Forrest
December 2014

Acknowledgment
Leading 20th century British social worker, Clare Winnicott, once wrote in a letter
to her husband, Donald Winnicott:
If one has a good experience once—it never ceases to exist, it is dynamic &
creative & enters so deeply into the fabric of the personality—that it is
independent of time & place—& simply cannot pass like any ordinary event. It is
not only made up of external reality. (Winnicott & Kanter, 2004, p. 276)
Until recently, I have not truly appreciated the simplicity, rightness, and
appropriateness of Winnicott’s sentiment. In some ways, the secure base provided by my
family of origin provided an abundance of good experiences such that I was largely
unaware of their positive effects. Because of this, perhaps I learned to expect good
experiences, while at the same time, becoming inured to them? My research at the Susan
B. Anthony Recovery Center (SBARC) provided stark and sad evidence that good
experiences are not a universal construct. It is most fortunate, therefore, that
organizations such as SBARC exist.
Although you will not find it listed anywhere in literature, or written in any of its
residents’ treatment plans, or even lettered on one of the many handcrafted inspirational
posters that adorn the walls of the group activity rooms, a key motivator for all of the
clinicians, administrators, workers, and volunteers at SBARC is a genuine desire to
provide the women and children at SBARC with a good experience. I know that I
certainly had one while working on this dissertation at SBARC.
I would like to acknowledge my sincere thanks and admiration for the SBARC
clients, staff, and volunteers who inspired this dissertation. I dedicate this research study
iv
to you. Finally, I want to thank Marcia Currant for her unswerving leadership of SBARC
and for her years of dedication to helping scores of women and their children recover
their lives.

v
Table of Contents
Pages
Acknowledgement ...........................................................................................................iv
List of Tables ................................................................................................................. xii
List of Figures ............................................................................................................... xiii
Abstract ..........................................................................................................................xiv
CHAPTER I: INTRODUCTION ..................................................................................... 1
SBARC Data Collection Project (SDCP) ............................................................. 1
Statement of the Problem ...................................................................................... 2
Purpose of the Study ............................................................................................. 2
Limitations and Assumptions of the Study ........................................................... 3
Significance of the Study ...................................................................................... 5
Research Summary ............................................................................................... 7
Research Questions ............................................................................................... 8
Organization of This Dissertation ......................................................................... 9
CHAPTER II: REVIEW OF THE LITERATURE ........................................................ 10
Organization of This Chapter.............................................................................. 10
Previous Studies at SBARC ................................................................................ 12
Co-occurring Disorder Treatment ....................................................................... 12
Victimization, Traumatization, and Substance Abuse ............................ 14
Incarceration ........................................................................................... 14
Addiction................................................................................................. 15

vi
Theoretical Framework: Attachment Theory...................................................... 17
John Bowlby (1907–1990) ...................................................................... 17
Mary Ainsworth (1913–1990) ................................................................ 21
Attachment Analogy in MRI: Different Branches, Common Roots ................... 23
Attachment Patterns of Behavior ........................................................................ 23
Attachment and Infants ........................................................................... 28
Attachment and Toddlers ........................................................................ 29
Attachment and Adolescents ................................................................... 29
Attachment and Gender Differences ....................................................... 30
Attachment-Based Family Therapy ........................................................ 31
Dyads and Attachment ............................................................................ 32
Parenting Programs and Attachment ...................................................... 37
Marriage and Family therapy and Attachment ................................................... 38
Anxiety, Depression, and Attachment ................................................................ 39
Overview of Assessments ................................................................................... 43
Functional Assessment Rating Scale (FARS) ......................................... 44
Dyadic Attachment Assessments ............................................................ 45
Q-sort assessment........................................................................ 45
Q-sort methodology .................................................................... 46
Attachment Q-set ........................................................................ 46
Mother-Infant/Child Interaction Scales .................................................. 48
Nonexperimental Quantitative Research ............................................................ 49

vii
Nonexperimental Research Categories ............................................................... 50
Research Objective Dimension ............................................................... 50
Time Dimension ...................................................................................... 51
CHAPTER III: METHODOLOGY ................................................................................ 53
Study Subjects ..................................................................................................... 54
Subject Inclusion Criteria ....................................................................... 55
Subject Exclusion Criteria ...................................................................... 56
Assessments ........................................................................................................ 57
Mother-Infant/Child Interaction Scales .................................................. 58
Functional Assessment Rating Scales (FARS) ....................................... 58
Data Collection ................................................................................................... 58
Nonexperimental Quantitative Research ............................................................ 59
Archival Data ...................................................................................................... 60
Research Design .................................................................................................. 61
Research Procedure ............................................................................................. 61
Pretest Source: SDCP Intake Evaluation Data ........................................ 62
Intervention: SBARC Residential Program Participation ....................... 63
Posttest Source: SDCP Discharge Evaluation Data ................................ 64
Internal Validity .................................................................................................. 65
External Validity ................................................................................................. 68
Statement of the Problem .................................................................................... 68
Research Questions ............................................................................................. 69
Hypotheses .......................................................................................................... 70
viii
Data Analysis ...................................................................................................... 70
Expected Findings ............................................................................................... 72
Confidentiality, Privacy, and Storage ................................................................. 73
Ethical Consideration .......................................................................................... 74
CHAPTER IV: DATA ANALYSIS AND RESEARCH FINDINGS ............................ 75
Description of Study Sample Subjects ................................................................ 76
Age at Intake ........................................................................................... 76
Race/Ethnicity ......................................................................................... 77
Marital Status at Intake ........................................................................... 78
Educational Level ................................................................................... 78
Violence, Abuse, and Suicide Ideations or Attempts ............................. 80
Arrests and Criminal Justice System Involvement ................................. 80
Mental Health Diagnosis at Intake .......................................................... 82
Status at Discharge .................................................................................. 83
Statistical Approach ............................................................................................ 84
Cases Excluded Based on z Values ..................................................................... 85
Assumption Testing (Skew and Kurtosis) .......................................................... 86
Correlations Among Variables ........................................................................... 88
Main Analysis ..................................................................................................... 89
Results of Study .................................................................................................. 91
Hypothesis 1: Difference in Dyadic Measures of Attachment ............... 92
Hypothesis 2: Difference in Maternal Anxiety ....................................... 92
Hypothesis 3: Difference in Maternal Depression .................................. 93
ix