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Rosebush Q - sort : counsellor assessment of child abuse Bowden, Sara 1991

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ROSEBUSH Q - SORT: COUNSELLOR ASSESSMENT OF CHILD ABUSE by SARA BOWDEN B . A . , Simon Fraser U n i v e r s i t y , 1987 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OR ARTS i n THE FACULTY OF GRADUATE STUDIES Counse l l ing Psychology We accept t h i s thes is as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA A p r i l 1991 (c) Sara Bowden, 1991 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of The University of British Columbia Vancouver, Canada DE-6 (2/88) i i ABSTRACT The Rosebush V i s u a l i z a t i o n Technique (RVT) ( A l l a n & Crandal l ,1986) a p r o j e c t i v e a r t technique, and Q s o r t Methodology were combined i n an experiment to t e s t t h e i r usefulness i n assess ing sexual , p h y s i c a l and emotional abuse. Forty two c h i l d r e n between the ages of 8 and 13 i n c l u s i v e were s e l ec t ed from four groups; the s exua l ly abused wi th a mean age of 9 .5 , p h y s i c a l l y abused with a mean age of 10.75, emot ional ly neglected with a mean age of 9.0; and c h i l d r e n who had suf fered ne i ther abuse nor neg lec t with a mean age of 9 .7 . In accordance with the RVT, the subjects were i n s t r u c t e d to take a minute or two to imagine themselves as a rosebush. Each c h i l d then inspected 24 drawings of rosebushes s e l e c t e d from a previous study us ing the RVT and represent ing a range of trauma from no known trauma to severe trauma, from amongst the four groups. Each c h i l d then s e l ec t ed and ordered the 24 drawings in to those rosebushes that were most and l e a s t l i k e t h e i r own v i s u a l i z a t i o n s . Each c h i l d subsequently developed a Q-s o r t of the 24 drawings that was analyzed by both Q-sor t methodology and ana lys i s of var iance techniques. The r e s u l t s i n d i c a t e d that the Q-sor t analyses d i d not support the hypotheses that traumatized c h i l d r e n would s e l e c t drawings completed by s i m i l a r l y traumatized c h i l d r e n . However, a fo l low up repeated measures ana lys i s of var iance i n d i c a t e d a s i g n i f i c a n t j o i n t group x p i c t u r e e f f e c t at the .05 l e v e l of s i g n i f i c a n c e . A study of these j o i n t e f f ec t s i n d i c a t e d that the two d i f f e r e n t groups, traumatized and nontraumatized, d i d i n f a c t d i f f e r e n t i a l l y i d e n t i f y some of the p i c t u r e s , but not on the bas i s expected. Thi s f i n d i n g provides support for the hypothesis that c h i l d r e n ' s preference for a set of p i c t u r e s r e f l e c t s t h e i r own background o f abuse or non abuse. The i m p l i c a t i o n s of t h i s f i n d i n g for c l i n i c a l p r a c t i c e and research are d iscussed . i v TABLE OF CONTENTS Page APPROVAL i ABSTRACT i i TABLE OF CONTENTS i v LIST OF TABLES v i i LIST OF FIGURES v i i i ACKNOWLEDGEMENTS i X CHAPTERS I . INTRODUCTION ' 1 I I . LITERATURE REVIEW H i s t o r y of P r o j e c t i v e Techniques 4 Use of P r o j e c t i v e Techniques with C h i l d r e n 6 Symbolic and H o l i s t i c Approaches 8 Recent Research Using P r o j e c t i v e A r t Techniques 8 Common Methodologica l Problems 13 Inter Rater R e l i a b i l i t y 13 Test Re Test R e l i a b i l i t y 14 S t a t i s t i c a l S i g n i f i c a n c e 14 Rosebush V i s u a l i z a t i o n Technique 16 Normal C h i l d r e n 16 P h y s i c a l l y Abused C h i l d r e n 17 V Neglected C h i l d 17 Sexual ly Abused C h i l d r e n 17 Current Study 19 H o l i s t i c Versus Symbolic Approach 19 Inter r a t e r R e l i a b i l i t y 19 Test re t e s t R e l i a b i l i t y 20 Research Questions 20 Hypothesis 21 I I I . METHOD 22 Subjects 22 Sexual Abuse 23 P h y s i c a l Abuse 23 Emotional Neglect 24 Instrument 25 Procedures 25 Data A n a l y s i s of Q-sort 29 IV. RESULTS 30 Q-sor t Analyses 30 A n a l y s i s of var iance 31 D e s c r i p t i v e Results 32 A n a l y s i s of Variance Results 34 Resul ts of A n a l y s i s 36 Summary 40 v i V . DISCUSSION 41 Q-sor t A n a l y s i s 41 A n a l y s i s of Variance 42 Summary of Resul ts 44 D e s c r i p t i v e Resul ts 44 Subjects ' React ion to Task 45 C r i t e r i a for S o r t i n g 46 C h a r a c t e r i s t i c s of D i f f e r e n t i a t i n g P i c t u r e s 47 Comparison of Q - sor t drawings with the Subjects Drawings 48 Conceptual Issues of Research 48 Impl i ca t ions of Modi f i ed RVT for C l i n i c a l P r a c t i c e 50 Summary and Impl icat ions for Further Research 51 References 53 Appendix A 57 Appendix B 58 Appendix C 59 Appendix D 60 v i i LIST OF TABLES Table Page 1 Means and Standard Deviat ions for the two groups on 24 P ic tures 33 2 Schematic Repeated Measure Design 35 3 Anova Table 36 4 I n t e r a c t i o n E f f e c t s 38 V l l LIST OF FIGURES Schematic Q-sor t 28 i x ACKNOWLEDGEMENTS I would l i k e to express my thanks to my su p e r v i sor , Dr. John A l l a n , and to members of my committee, Dr. L . Cochran and Dr. Du Fay-Der . I would l i k e to extend p a r t i c u l a r thanks to Dr. A l l a n for h i s encouragement and support while I went through the thes i s process and to Dr. Walter Boldt for h i s guidance, pat ience and w i l l i n g n e s s to share h i s s t a t i s t i c a l knowledge with me. I would a l so l i k e to thank the c h i l d r e n who p a r t i c i p a t e d i n t h i s study and the counse l lors at The C h i l d r e n ' s Foundation and Surrey Mental Heal th who were invo lved i n t h i s re search . F i n a l l y , my deepest a p p r e c i a t i o n i s expressed to my husband, Conrad, f or h i s l o v i n g support and f a i t h i n my a b i l i t i e s and to my son, Max, who helped me to keep the thes i s process i n p e r s p e c t i v e . 1 CHAPTER 1 INTRODUCTION The assessment and treatment of p h y s i c a l , sexual and emotional trauma i n c h i l d r e n i s a major problem for mental h e a l t h p r o f e s s i o n a l s . The extent of the v i c t i m i z a t i o n of c h i l d r e n i s more apparent than was genera l ly thought. N a t i o n a l s t a t i s t i c s on sexual abuse by the Committee on Sexual Offenses Agains t C h i l d r e n and Youths (1984) i n d i c a t e that sometime dur ing t h e i r l i v e s , about one i n two females and one i n three males w i l l have been v i c t i m s of unwanted sexual a c t s . About four i n f i v e of these inc ident s occurred when the v i c t i m s were c h i l d r e n or youths. P r o v i n c i a l s t a t i s t i c s a l so r e f l e c t the wide spread prevalence of the d i f f e r e n t types of abuse. The Annual Report of the B r i t i s h Columbia M i n i s t r y of Human Resources (1987/88) c i t e s numbers of i n v e s t i g a t i o n s for the d i f f e r e n t types of abuse: 4,728 p h y s i c a l abuse, 5,257 sexual abuse, 7,298 neg lec t , 857 emotional and 2,985 m u l t i p l e abuse i n v e s t i g a t i o n s . Thus thousands upon thousands of c h i l d r e n each year are known or suspected to have been abused. The major problem i n the area of c h i l d abuse area i s how to decide whether c h i l d r e n have been abused and the type of abuse they have experienced. 2 A d u l t s ' abuse experiences can u s u a l l y be r e a d i l y assessed by us ing v e r b a l l y based measures. However, c h i l d r e n ' s abuse experiences are much less r e a d i l y assessed i n a v e r b a l format. Th i s i s so not only because of the developmental l e v e l o f t h e i r language, but because of the profound d e n i a l or d i s a s s o c i a t i o n to the traumatic events that some c h i l d r e n experience (Johnson, 1987) . C h i l d r e n a l so may be h e s i t a n t to d i s c l o s e because they f e e l ashamed o r , because they are f r ightened of what e f f e c t t h e i r d i s c l o s u r e w i l l have on the adul t or parent who has been respons ib le for the abuse ( F a l l e r , 1988). C h i l d r e n are comfortable with images and symbolic language and can arguably be assessed best through p r o j e c t i v e assessment techniques ( S g r o i , 1982). These p r o j e c t i v e techniques are u s e f u l i n h e l p i n g counse l lors understand the inner experiences o f c h i l d r e n (Burgess, McCausland,& Wolbert , 1981). C h i l d r e n may unconsc ious ly revea l aspects of themselves through p r o j e c t i v e techniques that they would never r e v e a l consc ious ly . Although the advantages of p r o j e c t i v e a r t assessment techniques with c h i l d r e n have long been acknowledged and u t i l i z e d , the advantages have been o f f s e t by r e c u r r i n g concerns about the r e l i a b i l i t y and v a l i d i t y of such techniques (Rabin, 1981). Recent research i n p a r t i c u l a r , has been methodolog ica l ly flawed by the i n a b i l i t y of researchers to obta in i n t e r - r a t e r agreement on the 3 assessment of abuse us ing p r o j e c t i v e a r t techniques . Th i s study attempts to demonstrate an improvement upon the t r a d i t i o n a l a d m i n i s t r a t i o n of a p r o j e c t i v e a r t technique wi th c h i l d r e n and overcomes some of i t s major methodological problems by combining i t with a Q-sor t s t a t i s t i c a l a n a l y s i s . In a Q-sor t c h i l d r e n rate the drawings themselves thus d i spens ing wi th the methodological problem of obta in ing i n t e r r a t e r agreement. I t was thought that a modif ied p r o j e c t i v e a r t technique combined wi th a s o p h i s t i c a t e d s t a t i s t i c a l a n a l y t i c technique would al low the usefulness of the a r t technique with c h i l d r e n to be r e t a i n e d wi th an increase i n s t a t i s t i c a l and methodological r i g o r . 4 CHAPTER 11 LITERATURE REVIEW In t h i s chapter , as background to t h i s study, four re l evant areas o f the l i t e r a t u r e are reviewed: a h i s t o r y of p r o j e c t i v e techniques; use of p r o j e c t i v e techniques with c h i l d r e n ; the recent research with groups us ing p r o j e c t i v e a r t techniques; and methodological problems us ing p r o j e c t i v e a r t techniques . Fo l lowing a review of these areas , the rosebush technique i s descr ibed and the previous research us ing the rosebush done by A l l a n and C r a n d a l l (1986) i s d i scussed . The chapter concludes by present ing the r a t i o n a l e for the present study and i t s hypothes i s . H i s t o r y of P r o j e c t i v e Techniques P r o j e c t i v e techniques are a 20th century phenomena and have been around s ince p s y c h o l o g i c a l t e s t i n g began (Rabin, 1981). The term p r o j e c t i o n o r i g i n a t e d with Freud who f i r s t used i t to descr ibe psychopathology but l a t e r a p p l i e d the term to normal human behaviour. The term p r o j e c t i o n descr ibes the a t t r i b u t i o n of one's c h a r a c t e r i s t i c s to the ex terna l world ra ther than look ing f o r them i n onese l f i n order to defend the ego from anxiety (Rabin, 1981). The p r o j e c t i v e hypothesis i s founded i n psychoana ly t i c theory which p o s i t s that a person's response to 5 ambiguous s t i m u l i w i l l r e f l e c t t h e i r c h a r a c t e r i s t i c s and repressed unconscious mental content ( K l e i n , 1986). One of the f i r s t p r o j e c t i v e t e s t s , the Rorschach Test (1942), was in f luenced by Freud's method of i n t e r p r e t a t i o n and Jung's a n a l y t i c a l psychology (Rabin, 1981). P r o j e c t i v e techniques burgeoned j u s t a f t e r the onset of World War II when there was a need for p s y c h o l o g i c a l t e s t s to be developed for personnel s e l e c t i o n , screening and c l i n i c a l assessments. In 1950 when Behavourisim was i n vogue p r o j e c t i v e techniques f e l l out of favour and were c r i t i c i z e d f i r s t because they d i d not f a c i l i t a t e the concept of behaviour m o d i f i c a t i o n and second because of the methodological problems with v a l i d i t y and r e l i a b i l i t y when us ing P r o j e c t i v e techniques for assessment. Despite the f a c t that methodological problems s t i l l e x i s t when us ing p r o j e c t i v e methods, many c l i n i c i a n s remain convinced of t h e i r usefulness i n understanding human p e r s o n a l i t y . In recent times mental h e a l t h pro fe s s iona l s no longer r e l y s o l e l y on b e h a v i o u r i a l observat ions and many c l i n i c i a n s use p r o j e c t i v e techniques as a support for subjec t ive c l i n i c a l judgement. As of 1982 f i v e p r o j e c t i v e methods (Rorschach (Rorschach, 1942), Thematic Appercept ion Test (Murray, 1943), Sentence Completion (Rotter & R a f f e r t y , 1950), House-Tree-Person (Buck, 1978) and Draw 6 A Person (Nag l i ere , 1988)) were among ten top most f requent ly used tes t s i n h o s p i t a l s and c l i n i c s (Rabin, 1986). Another c r i t i c i s m of p r o j e c t i v e techniques has been that of the r o l e of the expert that the mental h e a l t h p r o f e s s i o n a l t r a d i t i o n a l l y took when i n t e r p r e t i n g the r e s u l t s of p r o j e c t i v e t e s t s . When tak ing the r o l e of the expert the h e a l t h p r o f e s s i o n a l assessed and t rea ted a c l i e n t by us ing h i s \ h e r expert i se and excluded the c l i e n t from p a r t i c i p a t i n g i n t h i s process . Recent ly i n the f i e l d of Counse l l ing Psychology, t h i s problem has been overcome with the use of the Interview Method, by which the counse l lor inc ludes the c l i e n t i n the d e c i s i o n making process (Amundson, 1980). Use of P r o j e c t i v e Techniques With C h i l d r e n The o r i g i n a l s tudies with the major p r o j e c t i v e methods such as Rorschach and T . A . T . , invo lved adul t subjects but soon were adapted to the use of c h i l d r e n (Rabin, 1986). Other major p r o j e c t i v e techniques developed out of c l i n i c a l work wi th c h i l d r e n and were outcroppings of i n t e l l i g e n c e t e s t i n g . Goodenough (1926) devised an i n t e l l i g e n c e sca le based on the amount of d e t a i l s put in to a drawing of a person. She q u i c k l y became aware that the t e s t was tapping p e r s o n a l i t y fac tors as w e l l . Buck's H-T-P Test (1978) grew out of an i n t e l l i g e n c e sca le that he was working on at 7 the time. Buck found t h i s subtest to be a u s e f u l p e r s o n a l i t y assessment t o o l as c h i l d r e n found i t ea s i er to r e v e a l t h e i r problems through drawing than through v e r b a l i z i n g (Thompson & A l l a n , 1985). Machover's (1953) Figure Drawing technique grew from her experiences with the Goodenough t o o l for a p p r a i s i n g c h i l d r e n ' s i n t e l l i g e n c e (Rabin, 1981). Some more commonly used p r o j e c t i v e t es t s for c h i l d r e n are the Rorschach Test (Rorschach, 1942), C h i l d r e n ' s Appercept ion Test (CAT)(Be l lak , 1976), Blacky P ic tures (Blum, 1950), Bender-Gesta l t Test (Bender, 1952) and p r o j e c t i v e drawing techniques (Gi t te lman, 1986) . A r t p r o j e c t i v e techniques have been found to be p a r t i c u l a r l y u s e f u l for the assessment and treatment of traumatized c h i l d r e n who have been sexua l ly abused, p h y s i c a l l y abused or emot ional ly neglected (Johnson, 1987). The use of a r t can be a non threatening way for c h i l d r e n to d i s c l o s e or to work on t h e i r problems as of ten c h i l d r e n can draw an experience that they are unable to v e r b a l i z e (Burgess, McCausland,& Wolbert , 1981). In a d d i t i o n a r t p r o j e c t i v e techniques are a gentle way for a counse l l or to make enquir i e s of a c h i l d as the c o u n s e l l o r or the c h i l d can r e t r e a t to the imagery i f the m a t e r i a l i s too threatening to the c h i l d . 8 Symbolic and H o l i s t i c Approaches There are two approaches to p r o j e c t i v e a r t techniques: the symbolic and the h o l i s t i c . The symbolic approach looks at i n d i v i d u a l symbols and of ten c h e c k l i s t s are made to mark of the presence or absence of items. Most recent e m p i r i c a l s tudies use t h i s symbolic method. For instance s tudies us ing House-Tree-Person (H-T-P) i n the l a s t few years a l l use the check l i s t method although Buck (1978) i n s t r u c t s users of H-T-P to get a sense of the whole drawing before look ing at the i n d i v i d u a l symbols. The h o l i s t i c approach i s r a r e . Us ing t h i s approach the assessor looks at items i n r e l a t i o n to each other , what the f i r s t impress ion i s conveyed by the scene, how i t looks a f t e r var ious items have been i d e n t i f i e d and f i n a l l y whether the two percept ions c o i n c i d e . Di Leo (1983) points out that a symbol may be u n i v e r s a l but i t s meaning i s i n d i v i d u a l . I t may provide new i n s i g h t s or conf irm what i s known, but taken out of context , i t cou ld be mis l ead ing . The above s e c t i o n introduces the not ion that p r o j e c t i v e a r t techniques can be u s e f u l l y u t i l i z e d with c h i l d r e n . Below are reviewed some of the research s tudies that have s tud ied the e f f i c a c y wi th which d i f f e r e n t d iagnos t i c groups can be i d e n t i f i e d us ing p r o j e c t i v e a r t techniques. 9 Recent Research Using P r o j e c t i v e A r t Techniques Recent s tud ie s , us ing p r o j e c t i v e a r t techniques , have found s i g n i f i c a n t d i f f erences i n the imagery of known groups. These f ind ings support the use of p r o j e c t i v e techniques as an assessment t o o l f o r forming or support ing hypotheses about a c h i l d ' s experiences and behaviour. A l l a n and C r a n d a l l (1986) us ing the Rosebush p r o j e c t i v e drawing technique found that t r a i n e d r a t e r s could d i f f e r e n t i a t e 80% of the time between coping and non coping c h i l d r e n . They a d d i t i o n a l l y d i scovered d i f f erences between the drawings of s exua l ly abused, p h y s i c a l l y abused, emot ional ly neg lected and non traumatized c h i l d r e n . B l a i n , Bergner, Lewis and G o l d s t e i n (1981) us ing H - T - P drawings were able to d i f f e r e n t i a t e 32 p h y s i c a l l y abused c h i l d r e n , 32 non abused but d i s turbed c h i l d r e n and 45 apparent ly w e l l adjusted non abused c h i l d r e n by not ing the presence o f 15 o b j e c t i v e l y scorable items. F ive H-T-P Items taken i n d i v i d u a l l y d i s c r i m i n a t e d s t rong ly between the A b u s e d - C l i n i c a l group and the other two groups. These f i v e items were : Smoke present from the chimney of the house; the absence of windows from the ground f l o o r of the house; not i ceab le d i f f erences i n the s i ze of the legs or arms of the person; the absence of feet on the person; and d i s p r o p o r t i o n i n the s i z e of the head of the person ( s p e c i f i c a l l y 10 the head was 25 percent or more of the t o t a l s i z e of the f i g u r e ) . Items taken c o l l e c t i v e l y , s p e c i f i c a l l y a 6 item t e s t , d i s c r i m i n a t e d with reasonable p r o b a b i l i t y between abused and nonabused but d i s turbed c h i l d r e n . These 6 items were: Smoke present from chimney ; Absence of windows from ground f l o o r ; S ize of l imbs d i f f e r n o t i c e a b l y ; f i gure i s comprised of geometric f i g u r e s ; Absence of feet; head i s over 25 percent of the t o t a l s i z e of the f i g u r e . B l u e s t e i n (1978) Using Tree drawings found over a p e r i o d of ten years that ten c h i l d r e n who have l o s t a loved one through death l a b e l l e d a p o r t i o n of the tree as dead. Her data i s l i m i t e d but r a i s e s the quest ion to what extent do i n d i v i d u a l s i n the popu la t ion p r o j e c t the loss of a loved one onto the drawings of a Tree . Cohen and Phelps (1985) us ing three p r o j e c t i v e drawing techniques for each subjec t , H - T - P , K i n e t i c Family Drawing and a free drawing, d i f f e r e n t i a t e d s t a t i s t i c a l l y but not c l i n i c a l l y between 89 sexua l ly abused c h i l d r e n and 77 c h i l d r e n with emotional problems. The inces t and c o n t r o l groups were s i g n i f i c a n t l y d i f f e r e n t with respect to the t o t a l number of markers on the H - T - P drawings (F(1,162) = 8.46, p .004). The same p a t t e r n was apparent for the fami ly drawings with the s t a t i s t i c a l d i f f e r e n c e (F(1,162 = 6.00, p .015). On the Free drawing however the d i f f erences i n the 11 two groups was only marg ina l ly s i g n i f i c a n t (F( l ,162) = 3.73, p< .055). Flemming (1974) us ing a set of s i x p r o j e c t i v e drawings d i f f e r e n t i a t e d between h o s p i t a l i z e d school age c h i l d r e n and c h i l d r e n who had never been h o s p i t a l i z e d . Subjects were 136 c h i l d r e n aged 5 through 12 years . S i g n i f i c a n t d i f f e r e n c e s us ing ch i - square were found between the p h y s i c a l l y d i s a b l e d and the c o n t r o l group on focus . The p h y s i c a l l y d i s a b l e d group, more than any group, focused on things i n the two p i c t u r e s that had more "things". The c h r o n i c a l l y i l l group, l i k e the acute ly i l l , focused on things and people; while contro l s focused on people . The c h i -square d i f f erences between the p h y s i c a l l y d i s a b l e d and the c o n t r o l groups on focus were (x2 = 1 2 . 7 5 , df = 4, p < .02) and between the c h r o n i c a l l y i l l and the p h y s i c a l l y d i s a b l e d (x2 = 9 . 4 9 , df = 4, p < .05) . Howe, Burgess, and McCormack (1987) us ing Draw A Person p r o j e c t i v e technique found d i f f erences between p h y s i c a l l y abused c h i l d r e n , s exua l ly abused c h i l d r e n and c h i l d r e n who had experienced no abuse. The r e s u l t s of cross tabu lar a n a l y s i s suggested that runaways r e p o r t i n g no abuse (42%) were more l i k e l y to produce ambiguous gender drawings than youths r e p o r t i n g p h y s i c a l abuse (8%), sexual abuse (17%), or p h y s i c a l and sexual abuse (15%) (x2 = 9.43, p< .01). Females who were s exua l ly abused were more l i k e l y to draw a f i gure of the opposite sex than were females who were not s exua l ly abused (x2 = 4.44, p < .05) . Manning (1987) us ing A Favouri te Kind of Day p r o j e c t i v e drawing technique found that p h y s i c a l l y abused c h i l d r e n cou ld be d i s t i n g u i s h e d from non abused c h i l d r e n by the presence, s i z e and movement of inclement weather i n t h e i r drawings. Manning does not mention where t h i s p r o j e c t i v e technique o r i g i n a t e d . Sidun and Rosenthal (1987) found that the D . A . P . p r o j e c t i v e technique cou ld d i f f e r e n t i a t e between sexua l ly abused and non sexua l ly abused adolescents who had been h o s p i t a l i z e d on adolescent p s y c h i a t r i c u n i t s between 1975 and 1985. The abused group excluded hands and f ingers more of ten i n t h e i r drawings and were more l i k e l y to draw f igures with only a head and no body. The abused group inc luded i n t h e i r drawings more wedge l i k e objects and inc luded more c i r c l e s i n t h e i r drawings. The abused group were a l so found to be more l i k e l y to use uneven l i n e pressure i n t h e i r drawings. Sims (1974) found that K i n e t i c Family Drawings were a v a l i d technique for i n v e s t i g a t i n g d i s turbed p a r e n t a l r e l a t i o n s . Thus there e x i s t s a s u b s t a n t i a l body of s tudies t h a t ' i n d i c a t e that d i a g n o s t i c a l l y d i f f e r e n t groups of c h i l d r e n can be d i s t i n g u i s h e d by means of p r o j e c t i v e a r t therapy techniques . However, i n sp i t e of the promise that these s tudies o f f e r , there 13 remain problems with the general approach that they have taken. These problems are considered below. Common Methodological Problems Despite the s i g n i f i c a n t d i f f erences that have been found i n the imagery of d i f f e r e n t groups o f c h i l d r e n , p r o j e c t i v e a r t techniques remain fraught with methodological problems wi th regard to r e l i a b i l i t y and v a l i d i t y . Some of the more ser ious methodological problems are i n t e r - r a t e r agreement, t e s t r e t e s t and s t a t i s t i c a l versus c l i n i c a l s i g n i f i c a n c e . Inter Rater R e l i a b i l i t y . One main obstac le i n s tudies us ing p r o j e c t i v e a r t techniques i s the problem of o b t a i n i n g i n t e r - r a t e r agreement. Recent s tudies that c l a i m to have obtained r a t e r r e l i a b i l i t y can be c r i t i c i z e d because of methodological f laws. An example of t h i s i s a study by B l a i n , Bergner, Lewis, and G o l d s t e i n (1981), who used two t r a i n e d r a t e r s i n t h e i r study. An item was considered absent or present when both r a t e r s agreed. The authors do not report however how many times r a t e r s d isagreed or account for chance agreement. Cohen and Phelps (1985) avoided the problem by having two t r a i n e d r a t e r s , one who ra ted 111 sets of drawings and the other who ra ted 55 se t s . In a second study Cohen and Phelps (1985) t r i e d to r e p l i c a t e the f ind ings of t h e i r previous 14 study by having four r a t e r s . However they cou ld not o b t a i n i n t e r r a t e r r e l i a b i l i t y which caused them to r a i s e doubts about the v a l i d i t y of study one. Many s tudies such as Fleming (1974), Howe, Burgess, and McCormack (1987) and Sims, (1974) do not report on i n t e r r a t e r r e l i a b i l i t y . Manning (1987) uses a c o r r e l a t i o n ra ther than a Kappa c o e f f i c i e n t to obta in r e l i a b i l i t y . A c o r r e l a t i o n does not account for chance agreement whereas a Kappa does. Manning's study reports an i n t e r r a t e r r e l i a b i l i t y of r =» .74 which does not account for chance agreement or for the 26% e r r o r r a t e . Sidun and Rosenthal (1987) us ing Cohen's Kappa were unable to obta in r e l i a b i l i t y for four t r a i n e d r a t e r s . T h e i r s o l u t i o n was to use one t r a i n e d r a t e r whose scores were c l o s e s t to the standard c r i t e r i a used i n determining the Kappa. This r a t e r was g iven a d d i t i o n a l t r a i n i n g u n t i l each graphic feature was at k = .71. The 29% e r r o r rate was not accounted for by these w r i t e r s . Test Re Test R e l i a b i l i t y . No recent s tudies have adminis tered a p r o j e c t i v e a r t technique two or more times to the same subjects to determine i f a c o e f f i c i e n t of r e l i a b i l i t y could be obtained between the scores on each t e s t i n g ( s t a b i l i t y of s c o r e s ) . S t a t i s t i c a l S i g n i f i c a n c e Versus C l i n i c a l S i g n i f i c a n c e . Often s tudies us ing p r o j e c t i v e a r t techniques obta in s t a t i s t i c a l l y 15 s i g n i f i c a n t f ind ings that have no c l i n i c a l s i g n i f i c a n c e . A recent example of t h i s i s a study by Cohen and Phelps (1985) who found s t a t i s t i c a l l y s i g n i f i c a n t d i f f erences between sexua l ly abused and non s exua l ly abused p s y c h i a t r i c a l l y h o s p i t a l i z e d adolescents . The d i f f erences found were so smal l that a c l i n i c i a n cou ld not use them as a r e l i a b l e assessment technique to determine abuse. This s e c t i o n has reviewed some of the major problems that have beset the attempts by researchers to u t i l i z e p r o j e c t i v e a r t techniques for assessment and d iagnos t i c purposes. The present study has two aims. F i r s t l y i t attempts to s t a t i s t i c a l l y substant ia te the d i f f erences observed by A l l a n and C r a n d a l l (1986) between the drawings of rosebushes done by sexua l ly abused, p h y s i c a l l y abused, emot ional ly neg lected and nontraumatized c h i l d r e n . Secondly i t attempts to improve upon the t r a d i t i o n a l a d m i n i s t r a t i o n of a p r o j e c t i v e a r t technique with c h i l d r e n by overcoming some of the major methodological problems. In the fo l l owing s e c t i o n , the study us ing the R . V . T . by A l l a n and C r a n d a l l (1986) i s descr ibed . Next, the ways i n which the present study attempts to overcome some of the common methodological problems i s d i scussed . F i n a l l y , the r a t i o n a l e and hypothesis of the present study i s presented. 16 Rosebush V i s u a l i z a t i o n Technique The RVT was f i r s t descr ibed as a G e s t a l t exerc i se of guided imagery by Stevens (1971). Oaklander (1978) l a t e r descr ibes i t as a p r o j e c t i v e a r t technique i n her book Windows to Our C h i l d r e n . A l l a n and C r a n d a l l (1986) u t i l i z e d t h i s technique i n t h e i r study and the present research i s based on t h e i r f i n d i n g s . In the study done by A l l a n and C r a n d a l l (1986) three r a t e r s with an 80% agreement r a t e , found s i g n i f i c a n t d i f f erences between the drawings of coping and non coping c h i l d r e n . In a fo l low up a n a l y s i s of the study ( A l l a n & C r a n d a l l , 1986) i t was found that the v i s u a l imagery contained c e r t a i n themes that d i f f e r e n t i a t e d four known groups of c h i l d r e n : Normal, p h y s i c a l l y abused, emot ional ly neglected and sexua l ly abused. The set o f 24 drawings of rosebushes used i n t h i s study were se l ec ted from the A l l a n & C r a n d a l l (1986) study, with some a d d i t i o n a l drawings from A l l a n which were added to make the p i c t u r e sor t more f u l l y representa t ive of the four experimental groups. Thus there i s evidence to suggest that the p i c t u r e s use i n the present study are indeed representat ive of the range of trauma that was to be s t u d i e d . Observations about the general nature of the p i c t u r e s drawn by each group i n the A l l a n and C r a n d a l l study (1986) i s d e t a i l e d below. Normal C h i l d r e n . I t was observed that normal c h i l d r e n drew 17 p i c t u r e s with very p o s i t i v e images, f or instance the roses blooming and the sun s h i n i n g . Sexual ly Abused C h i l d r e n . In contras t to the normal c h i l d r e n , the imagery of the sexua l ly abused c h i l d r e n revea led three themes. Sexual imagery such as c a t e r p i l l a r eggs on leaves; v i o l a t i o n of the core s e l f such as a hand that i s going to grab the f lower; and p r o t e c t i o n , many of the rosebushes done by t h i s group of c h i l d r e n had fences around them. P h y s i c a l l y Abused C h i l d r e n . D i d drawings which conta ined images o f p h y s i c a l v i o l e n c e . One c h i l d drew a cracked ruptured road l ead ing to a house with smashed windows and b a r r e d doorways. Neglected C h i l d . The neglected c h i l d drew a s i n g l e flower cut o f f at the stem i n a smal l amount of water. The p i c t u r e contained no other images and the p i c t u r e conveyed a sense of impoverishment and emptiness. P i c tures Sample i n Present Study P i c t u r e s i n the present study were taken from the sample of drawings done by the four groups of c h i l d r e n i n the R . V . T . study of A l l a n and C r a n d a l l (1986). The drawings i n the Q sample were chosen because they represented a range of trauma and h e a l t h which ranged from moderate to severe. For ins tance , i n the group of drawings represent ing the 18 s exua l ly abused group, the most moderate drawing was done by a c h i l d who had rece ived treatment for two years . The drawing was of a rosebush with red flowers with a fence at a d is tance i n f r o n t of i t . A l l a n and C r a n d a l l (1986) observed that with treatment themes of abuse, such as p r o t e c t i o n represented by fences, tended to change and transform. Thus i n one p i c t u r e the fence i s at a d is tance from the rosebush i n contras t another p i c t u r e i n the s e r i e s , drawn by a g i r l who was r e c e n t l y s exua l ly abused, where the fence i s immediately i n f r o n t the rosebush. The p i c t u r e represent ing the most severe sexual abuse i n t h i s s e r i e s was drawn by a c h i l d who was a n a l l y raped. The drawing i s stormy and has two b lack mountains wi th a b l a c k tree devoid of leaves growing out of i t . The group of drawings represent ing the emot ional ly neg lected group ranges from the most moderate, a b lack and white drawing of a rosebush with flowers and roots to the most severe a dying rosebush next to a dead rosebush i n the dessert wi th a s e t t i n g sun. The p h y s i c a l l y abused group ranges from a drawing of rosebushes represent ing a fami ly with accentuated thorns to a p i c t u r e of a cracked, ruptured road l ead ing to a house with smashed windows and barred doorways. The drawings represent ing the non traumatized group range 19 from drawings that conta in themes from sexua l ly and p h y s i c a l l y abused groups to drawings that s o l e l y conta in hea l thy imagery. The three most moderate drawings i n t h i s group for instance c o n t a i n p a r t i a l fences, a symbol common to the s exua l ly abused group of drawings. The most moderate drawing i n t h i s group has large thorns on the rosebush a symbol found repeatedly i n the p h y s i c a l l y abused group. Present Study The present study, us ing the RVT, i s based on the observat ions made by A l l a n and C r a n d a l l (1986) that the imagery i n the drawings of rosebushes by four groups of c h i l d r e n , normal, p h y s i c a l l y abused, emot ional ly neglected and sexua l ly abused d i f f e r e n t i a t e d these groups. This study attempts to r e p l i c a t e these f ind ings s t a t i s t i c a l l y by us ing Q Methodology to overcome some of the methodological problems found i n recent research us ing p r o j e c t i v e a r t techniques. Descr ip t ions of some of the ways that the researcher has taken to overcome some of the more common methodological problems are as fo l lows . H o l i s t i c Versus Symbolic Approach. As was the case i n the A l l a n and C r a n d a l l (1986) study, the present study a l so w i l l use a h o l i s t i c approach. Thus i n the s e l e c t i o n of drawings done by c h i l d r e n for the Q - s o r t , a d e c i s i o n was made to represent the 20 p i c t u r e as a whole ra ther than to separate out s i g n i f i c a n t symbols and make composite p i c t u r e s for the c h i l d r e n to s e l e c t . I t i s a l so assumed that the c h i l d r e n w i l l be making dec i s ions based on the whole of the p i c t u r e s ra ther than any p a r t i c u l a r symbol conta ined w i t h i n i t . Inter r a t e r R e l i a b i l i t y . In t h i s study the p a r t i c u l a r method used , that of having the subjects rank other c h i l d r e n ' s drawings ra ther than draw t h e i r own, i s thought to s i g n i f i c a n t l y reduce the e r r o r var iance attached to the r a t i n g of c h i l d r e n ' s p i c t u r e s by adul t r a t e r s . I t i s thought that the assessment of abused c h i l d r e n w i l l be a ided by t h i s change i n methodology. Test Re Test R e l i a b i l i t y . Test Re Test R e l i a b i l i t y i s addressed i n the present study by the use of very c a r e f u l data c o l l e c t i o n . A f t e r s o r t i n g the drawings each subject i s asked, a f t e r a break, to recons ider and change i f necessary t h e i r s o r t u n t i l they are sure that i t represents how they imagined themselves. This thorough method of data c o l l e c t i o n means that there i s very l i t t l e chance for random e r r o r . Research Questions Fol lowing from A l l a n and C r a n d a l l (1986), who found that c e r t a i n imagery c h a r a c t e r i z e d d i f f e r e n t i a l l y diagnosed c h i l d r e n , i t was hypothes ized that c h i l d r e n would s e l e c t drawings created by 21 s i m i l a r l y diagnosed peers . The A l l a n and C r a n d a l l (1986) study prov ided some confidence that s i m i l a r l y diagnosed c h i l d r e n express themselves through the use of r e l a t e d imagery. The quest ion emerged, g iven that c h i l d r e n tended to represent t h e i r inner r e a l i t y i n r e l a t i v e l y s i m i l a r ways, would they a l so tend to s e l e c t or p r e f e r a r t or drawings represent ing a s i m i l a r inner Z e i t g e i s t ? Hypothesis I t was hypothesized that c h i l d r e n would s o r t the drawings of Rosebushes demonstrating a preference f o r the drawings that represent the group that they belong to . 22 CHAPTER 111 METHOD This chapter describes the method used i n the present study. I t f i r s t o u t l i n e s the s e l e c t i o n of subjects and discusses the d e f i n i t i o n a l problems that occur i n dec id ing what group an i n d i v i d u a l c h i l d belongs to because of the overlap that confounds the d i v i s i o n of abuse experiences . Next the Q - s o r t instrument used i s descr ibed and the Procedures used and f i n a l l y the Data A n a l y s i s of the Q-sorts i s expla ined . Subj ects The subjects were f o r t y two c h i l d r e n , female and male, from ages 8 years to 13 years i n c l u s i v e who were p r e - s e l e c t e d on the bas i s of membership to one of four groups: s exua l ly abused; p h y s i c a l l y abused; emotional ly neglected and c h i l d r e n who had experienced no abuse or neg lec t . The mean ages of the groups was 9.5 for the s exua l ly abused group, 10.75 for the p h y s i c a l l y abused group, 9.0 for the emotional ly neglected group and 9.7 for the non traumatized group. The c h i l d r e n i n the three abuse groups had been assessed by a mental h e a l t h p r o f e s s i o n a l w i t h i n the l a s t two years as be longing to one of the four groups. The non traumatized subjects were s e l ec t ed from the l o c a l popu la t ion of c h i l d r e n who 23 l i v e d at home, attended l o c a l schools and were deemed to have experienced no trauma by t h e i r teachers and parents . I t should be noted that there are d e f i n i t i o n a l problems i n d e c i d i n g j u s t what group a c h i l d who has experienced a p a r t i c u l a r type of trauma belongs to . Although c h i l d r e n who have experienced abuse are d i v i d e d in to three main groups, sexual , p h y s i c a l , and emotional there i s the problem of overlap that confounds such d i v i s i o n s . C h i l d r e n who have suf fered one form of abuse have of ten a l so experienced other forms of abuse, although these other abuse experiences may or may not have been assessed. In a d d i t i o n , d e f i n i t i o n a l problems e x i s t of what a p a r t i c u l a r type of abuse i s . For example, many c l i n i c i a n s regard emotional and or p h y s i c a l abuse as always o c c u r r i n g when sexual abuse occurs . D e f i n i t i o n a l problems a l so e x i s t with the c o n t r o l groups of non traumatized c h i l d r e n i n most s tudies as many c h i l d r e n have experienced some degree of trauma and some of the c o n t r o l group may have experienced unreported abuse. These cons iderat ions as ide the fo l lowing d e f i n i t i o n s by Tzeng & Jacobsen (1988) are representat ive of the d e f i n i t i o n s of abuse commonly used i n the f i e l d . I t i s b e l i e v e d that the c h i l d r e n i n the var ious groups met these d e f i n i t i o n s . Sexual Abuse: Includes any sexual a c t i v i t y with a c h i l d . Sexual abuse may be a s s a u l t i v e or non a s s a u l t i v e , chron ic or a one 24 time i n c i d e n t . P h y s i c a l Abuse: Is the non a c c i d e n t a l i n j u r y of a c h i l d that may occur repeatedly or by a s i n g l e episode. Emotional Neglect: D e p r i v a t i o n of n e c e s s i t i e s i n c l u d i n g neg lec t i n p r o v i d i n g nourishment, s h e l t e r , c l o t h i n g , h e a l t h c a r e , l ack of s u p e r v i s i o n , educat ional neg lec t , and u n s p e c i f i e d d e p r i v a t i o n of n e c e s s i t i e s . The subjects who had experienced trauma, were s e l ec t ed from non r e s i d e n t i a l and r e s i d e n t i a l s e t t i n g s . E ight subjects were s e l ec t ed from The C h i l d r e n ' s Foundation which i s a r e s i d e n t i a l treatment centre for c h i l d r e n who come from unstable or abusive home environments or who have behaviour problems. S ix of the e ight subjects were abused or neglected , two were i n treatment for behaviour problems. S ix subjects were s e l ec t ed from Surrey Mental Heal th Centre which i s a non r e s i d e n t i a l treatment centre . F ive of these subjects had experienced emotional neglect or abuse and one subject had experienced sexual abuse. There were four non r e s i d e n t i a l subjects who had experienced abuse who were seeing a mental h e a l t h p r a c t i t i o n e r i n h i s o f f i c e . Twenty one subjects who had experienced no abuse formed the c o n t r o l group and were se l ec ted by teachers , counse l lors and parents . These adul ts were interviewed by the researcher to 25 determine the p o s s i b i l i t y of the c h i l d r e n having experienced abuse. The mean age of t h i s group was 9.7 years . Instrument The instrument used was the Rosebush Q Sample which i s a m o d i f i c a t i o n of the Rosebush technique used i n the A l l a n and C r a n d a l l (1986) study. The Q sample cons i s t s of 24 drawings (Appendix D) of rosebushes drawn p r e v i o u s l y by c h i l d r e n from the four groups, s exua l ly abused, p h y s i c a l l y abused, emot ional ly neg lected and c h i l d r e n who had not experienced abuse or neg l ec t . E ight drawings represented the non traumatized group, f i v e drawings the s exua l ly abused group, f i v e drawings the emot ional ly neglected group and s i x drawings represented the p h y s i c a l l y abused group. Each group of drawings represented a range of trauma or h e a l t h from moderate to severe. The technique as o r i g i n a l l y conceived by A l l a n and C r a n d a l l (1986) has three stages. The f i r s t stage cons i s t s of the i n d i v i d u a l being l e d through a guided v i s u a l i z a t i o n of themselves as a rosebush. The second stage cons i s t s of the i n d i v i d u a l drawing what they v i s u a l i z e d . In the t h i r d stage the i n d i v i d u a l answers questions about t h e i r drawing such as "What are your leaves l i k e ? " . In the m o d i f i c a t i o n used i n the present study the guided v i s u a l i z a t i o n i s omitted and the c h i l d r e n are asked to take 26 a minute or two to imagine themselves as a rosebush. A f t e r t h i s , but before drawing t h e i r own v i s u a l i z a t i o n , the subjects are asked to s e l e c t from a set of 24 drawings of others rosebushes those rosebushes that are most and l e a s t s i m i l a r to t h e i r own. They then proceed to rank order , i n regards to preference and non preference , the p i c t u r e s i n a Q - s o r t . Fo l lowing t h i s the c h i l d r e n ' s rankings of the drawings are analyzed us ing a Q-sor t A n a l y s i s . These analyses are p a r t i c u l a r l y u s e f u l for smal l sample s i z e s . Procedures Each subject was seen i n d i v i d u a l l y by the author for approximately one hour. The treatment for t h i s study cons i s t ed of four phases. 1. Each c h i l d was asked to take a minute or two to imagine themselves as a Rosebush. 2. Next the 24 p i c t u r e s were spread out, i n no p a r t i c u l a r grouping, on a large table i n order for the c h i l d to get a h o l i s t i c view of the Rosebush Q Sample before examining the p i c t u r e s i n d e t a i l . Each subject was then asked to look at a l l 24 p i c t u r e s for a minute or two. The subject was then i n s t r u c t e d to put the 24 drawings in to two equal p i l e s , those that were l i k e how they imagined themselves as a 27 rosebush and those not l i k e how they imagined themselves. Then each subject was i n s t r u c t e d to rank the drawings and as they d i d so the author p laced them on the f l o o r to form the Q - sor t (a forced d i s t r i b u t i o n ) as fo l lows (see f i g u r e 1) . Each c h i l d was i n s t r u c t e d to choose the one drawing most l i k e how they imagined themselves as a Rosebush and t h i s drawing was p laced under the number 10. The subject was then asked to p i c k the one drawing that was l e a s t l i k e how they imagined themselves as a rosebush and t h i s drawing was p laced under number 1 . Then each subject was asked to s e l e c t the next two drawings most l i k e how they had imagined themselves and these drawings were p laced under number 9. Then the next two l e a s t l i k e which were p laced under number 2. The c h i l d continued the s o r t by s e l e c t i n g the next two drawings that were most l i k e and which were p laced under number 8 and the next two that were l e a s t l i k e which were p laced under number 3, the next three most l i k e p laced under number 7 and next three u n l i k e which were p laced under number 4. The remaining 8 drawings, 4 from each p i l e were p laced i n the centre of the sor t under numbers 6 and 5. 3. A r e l i a b i l i t y check was done by asking each c h i l d to check t h e i r s o r t and change i t i f necessary to ensure that i t represented them. 2 8 FIGURE 1 Rosebush Q-sort L I K E ME NOT L I K E ME 10 • • • • • • • • • • • • • • • • • • • • • • • • 29 Data A n a l y s i s of Q-sor t A p r o f i l e was taken from each subjects Q scores (McKeown & Thomas,1988). The p r o f i l e s or s o r t i n g pat terns from a l l the subjects were then i n t e r c o r r e l a t e d and fac tored in to groups. These f a c t o r s were analyzed to determine i f there was any c l i n i c a l s i g n i f i c a n c e . Fo l lowing t h i s again us ing a Q A n a l y s i s , the Q -sor t s were f a c t o r analyzed us ing a scree t e s t as a guide and these fac tors analyzed f o r c l i n i c a l meaningfulness. Next an A n a l y s i s of Variance (Glass & Hopkins, 1984) was c a r r i e d out to determine wether the subjects sor ted the p i c t u r e s randomly and i f not how they d i d sor t them. The Anova procedure used was a Repeated Measures design with one between group f a c t o r and one repeated measures f a c t o r . Computer programs used were UBC FACTO, WBOL: Q - ANALYSIS and BMD P 2V ANOVA. 30 CHAPTER IV RESULTS Thi s chapter reports on the e m p i r i c a l r e s u l t s obtained from the rosebush Q - s o r t s . A d i s c u s s i o n of the researchers observat ions i n regards to p i c t u r e content and the c h i l d r e n ' s s o r t i n g w i l l be d i scussed i n the fo l l owing chapter . Q-Sort Analyses I n i t i a l l y a Q-sor t A n a l y s i s of the data was c a r r i e d out . This a n a l y s i s was done i n order to determine wether there were d i scernab le patterns i n the s o r t i n g of the p i c t u r e s which were unique to the four groups of c h i l d r e n . The Q A n a l y s i s d i v i d e d the 42 c h i l d r e n in to e leven f a c t o r s . These e leven fac tors were d i f f i c u l t to i n t e r p r e t because there was not the r e l a t i o n s h i p between the e leven fac tors and the four groups of c h i l d r e n that the experimenter had expected. For instance there was no homogeneity i n the eleven fac tors i n regards to trauma experienced or the type of treatment of the subjec ts . To i l l u s t r a t e t h i s l ack of homogeneity the l a r g e s t f a c t o r , # 1, which contained 16 subjects i s descr ibed . The group inc luded 5 males who had su f f ered no trauma, four females who had suf fered no trauma, 2 p h y s i c a l l y abused boys who l i v e d at home and saw a t h e r a p i s t 31 p r i v a t e l y , 1 sexua l ly abused-male l i v i n g at C h i l d r e n ' s Foundation, 3 emot ional ly abused males l i v i n g at C h i l d r e n ' s Foundation and 1 emot ional ly abused male who l i v e d at home and was at tending treatment at Surrey Mental h e a l t h . Next, again us ing a Q A n a l y s i s , the Q-sorts were f a c t o r analyzed us ing a scree t e s t as a guide and two, three and four fac tors were obtained i n t h i s way. As with the e leven groups fac tored i n the f i r s t Q A n a l y s i s , the two, three and four f a c t o r s d i d not have the homogeneity expected. A l l three f a c t o r analyses contained an almost even s p l i t o f the Non Traumatized Group and the three Traumatized Groups of c h i l d r e n . A c l i n i c a l d iagnos is or c a t e g o r i z a t i o n of the 42 subjects in to traumatized and non traumatized groups was there for not subs tant ia ted by the Q A n a l y s i s . A n a l y s i s of Variance Because the expectat ions of the Q A n a l y s i s were not met, i n that the s o r t i n g of the p i c t u r e s by the subjects d i d not separate them into meaningful groups, an A n a l y s i s of Variance ( ANOVA) was c a r r i e d out . An ANOVA i s a s e n s i t i v e tes t u s e f u l with a r e l a t i v e l y small number of subjec ts . The Anova was used to determine f i r s t l y whether or not the s o r t i n g was done randomly and secondly to a s c e r t a i n i f the s o r t i n g of drawings had not been 32 c a r r i e d out randomly, how the subjects had sor ted them. The Anova was c a r r i e d out by d i v i d i n g the 42 subjects in to two groups made up of Group NT, 21 Non Traumatized c h i l d r e n and Group T , 21 traumatized c h i l d r e n . The sexua l ly abused, p h y s i c a l l y abused and emot ional ly abused groups were combined to form the Traumatized Group s ince t h e i r numbers d i d not permit i n d i v i d u a l analyses . D e s c r i p t i v e R e s u l t s . P r i o r to d i s c u s s i n g the r e s u l t s of the a n a l y s i s a table of mean scores and standard dev ia t ions d e s c r i b i n g how the two groups of subjects responded to the 24 p i c t u r e s i s presented. TABLE 1 Table of Means and Standard Deviat ions for the Two Groups on 24 Pictures MEANS STANDARD D E V I A T I O N S C1 1 7 . , 0 4 7 6 2 6 . . 6 1 9 0 5 1. . 8 8 3 5 1 2 . , 2 0 1 7 3 C 2 2 5 . 4 2 8 5 7 4 . 4 2 8 5 7 1 , . 7 4 8 4 7 1 , . 6 3 0 0 7 C 3 3 4 . 0 9 5 2 4 4 . 0 9 5 2 4 1 . , 7 5 7 9 8 1 . , 9 4 6 9 1 C4 4 7 . . 5 2 3 8 1 7 . 0 9 5 2 4 2 . . 4 6 2 0 9 2 . . 3 4 3 1 8 C 5 5 3 . , 1 4 2 8 6 3 . 8 5 7 1 4 2 . . 1 0 4 4 2 1 . . 7 6 8 7 8 C6 6 4 , 7 6 1 9 0 5 . 4 7 6 1 9 1 . . 3 3 8 0 9 2 , . 1 1 2 3 2 C7 7 5 . . 6 6 6 6 7 5 . 3 3 3 3 3 1 . . 5 5 9 9 1 2 . 1 0 5 5 5 C8 8 6 . . 0 4 7 6 2 6 . 7 6 1 9 0 1 , . 7 1 6 8 6 1 , . 7 5 7 9 8 C 9 9 6 . . 4 2 8 5 7 5 . 5 7 1 4 3 1 , . 4 3 4 2 7 1 , . 5 0 2 3 8 C 1 0 10 3 . . 7 6 1 9 0 5 . 8 5 7 1 4 2 . . 0 2 2 4 9 2 . , 5 1 5 6 7 C 1 1 11 4 . 9 5 2 3 8 4 . 6 6 6 6 7 1 . . 3 9 5 5 7 1 . 6 5 3 2 8 C 1 2 12 6 . 7 1 4 2 9 5 . 5 2 3 8 1 1. . 7 9 2 8 4 1 . 8 3 3 5 5 C 1 3 13 4 . 6 1 9 0 5 5 . 5 2 3 8 1 1 . 4 6 5 4 8 2 . 5 0 2 3 8 C 1 4 14 3 . 9 5 2 3 8 4 . 4 2 8 5 7 2 . . 2 2 4 3 2 1 . . 9 3 8 3 4 C 1 5 15 3 . 0 0 0 0 0 3 . 3 3 3 3 3 1 , . 6 4 3 1 7 1 , . 7 7 0 1 2 C 1 6 16 4 . 8 0 9 5 2 5 . 0 0 0 0 0 2 . . 0 6 4 4 4 1 . . 8 4 3 9 1 C 1 7 17 6 . 3 8 0 9 5 6 . 9 0 4 7 6 1 , . 3 5 9 2 7 2 . 3 2 1 7 4 C 1 8 18 6 . 5 7 1 4 3 5 . 5 2 3 8 1 1 . . 8 3 2 2 5 2 , . 1 3 5 8 6 C 1 9 19 6 . 9 5 2 3 8 6 . 0 4 7 6 2 1. . 5 3 2 1 9 2 . 6 5 4 7 4 C 2 0 2 0 5 . 1 9 0 4 8 5 . 3 8 0 9 5 2 . . 5 4 2 0 3 2 . . 5 5 8 8 3 C 2 1 21 7 . 2 3 8 1 0 6 . 8 0 9 5 2 1 . . 5 4 6 1 2 2 . 2 0 4 9 7 C 2 2 2 2 8 . 1 4 2 8 6 6 . 9 0 4 7 6 2 . 1 7 4 5 3 2 . . 1 4 2 5 4 C 2 3 2 3 3 . 0 9 5 2 4 4 . 2 3 8 1 0 2 . . 1 1 9 0 7 3 . 0 4 8 0 3 C 2 4 2 4 6 . 4 7 6 1 9 6 . 5 7 1 4 3 2 . 0 6 4 4 4 1 , . 7 7 6 8 4 M A R G I N A L 5 . 5 0 0 0 0 5 . 4 9 8 0 2 COUNT 21 21 34 A n a l y s i s of Variance Resu l t s . The A n a l y s i s of Var iance procedure used was a Repeated Measures design with one between group f a c t o r and one repeated measures f a c t o r . Th i s des ign i s dep ic ted schemat ica l ly below i n table 2. TABLE 2 Schematic Repeated Measure Design PS O P I C T U R E S p u 5 T K n o W 1 2 1 4 3 ( 7 I t 10 11 12 1 1 1 4 1 5 11 17 I t 11 2 0 2 1 2 2 2 1 2 4 1 2 X 1 4 3 1 7 1 > 10 N T 11 12 1 1 1 4 1 5 11 I T 11 11 2 0 2 1 2 2 2 3 2 4 2 3 2 1 2T 2 i 2 1 1 0 T 1 1 1 2 1 1 1 4 3 3 11 3 7 3 1 It 4 0 4 1 4 2 X denotes Q score for subject 2 on p i c ture 2 Results of A n a l y s i s . The resu l t s of the analys i s are presented in the table below. TABLE 3 Anova Table sound SUM or DECREES OF HEAR F TAIL GREENHOUSE SQUARES FREEDOM SqUARE PROt. GEISSER GROUPS HEAR 3 0 * 1 1 . 0 0 0 9 9 1 3 0 * 8 1 . 0 0 0 9 9 1 1 7 2 7 0 * . 0 0 0 . 0 0 0 0 1 A 0 . 0 0 0 9 9 1 0 . 0 0 0 9 9 0 . 0 * 0 . 8 * 6 1 ERROR 1 . 0 3 9 6 1 * 0 0 . 0 2 5 9 9 PICTURES C 1 * 7 3 . 3 0 8 5 3 2 ) 6 * . 0 5 6 8 9 1 5 . * 2 0 . 0 0 0 0 0 . 0 0 0 0 2 CA 1 U . 1 7 9 9 6 2 ) 7 . 3 * 2 6 1 1 . 7 7 0 . 0 1 * 5 0 . 0 5 2 2 ERROR 3 8 2 2 . 7 6 9 8 * 9 2 0 4 . 1 5 5 1 8 mot EPSILOU FACTORS FOR DECREES OF FREEDOM ADJUSIHKIfl TERM (HtESmOOSE-GSISSER 2 0 . 3 1 2 4 37 The table shows that the main e f f e c t of groups was not s t a t i s t i c a l l y s i g n i f i c a n t at the .05 l e v e l but that the main e f f e c t of the p i c t u r e s was s i g n i f i c a n t at the .05 l e v e l . The i n t e r a c t i o n or j o i n t e f f e c t of p i c t u r e s and groups was s t a t i s t i c a l l y s i g n i f i c a n t at the .05 l e v e l . Further the major assumption under ly ing the model used for a n a l y s i s , that of compound symmetry, was adequately met for the i n t e r a c t i o n e f f e c t (e = .05) . Of p a r t i c u l a r importance was the i n t e r a c t i o n e f f e c t . As the i n t e r a c t i o n e f f ec t s i n d i c a t e d that the p i c t u r e s s i g n i f i c a n t l y d i f f e r e n t i a t e d the two groups of c h i l d r e n these e f f ec t s were examined f u r t h e r . F i r s t the i n t e r a c t i o n e f f ec t s were c a l c u l a t e d for each group and then the r e s u l t s were graphed as shown on the next page. TABLE 4 Interact ion Ef fec t s B 0.60* A A B A A B A A B | B - A A B B A* A A B B B 0.00* S e-B B A A A ? B _ _ _ A A B A A~ A " B B A B B •0.80* B B A A 5.0 10.0 15.0 20.0 A = CI v«. C3 8 = C2 vs. C3 Nontraumatized Group Traumatized Group 39 A c a r e f u l examination of the graph shows that there were some p i c t u r e s which i n t e r a c t e d i n s i g n i f i c a n t l y with the groups and these p i c t u r e s were considered r e l a t i v e l y unimportant. There were no s i g n i f i c a n t i n t e r a c t i o n e f f ec t s f or the p i c t u r e s which f a l l between the dotted l i n e s . These were p i c t u r e s # 1,3 and 4 from the sexua l ly abused Group of drawings, #7 and 11 from the p h y s i c a l l y abused group, #14,15 and 16 from the emot ional ly abused group and #,17,20,21 and 24 from the non traumatized group. The i n t e r p r e t a t i o n was centred on those p i c t u r e s where the values l a y outs ide of the dotted l i n e s . For the f o l l o w i n g p i c t u r e s d i s t i n c t i o n s were made between Group NT and Group T. With respect to Group T, Group NT r a t e d the fo l l owing p i c t u r e s 2, 9, 12, 18, 19, and 22 as more l i k e what they would draw than Group T. P i c t u r e 2 i s a drawing from the sexua l ly abused group of drawings, p i c t u r e 9 i s from the p h y s i c a l l y abused group, p i c t u r e 12 i s from the emotional ly abused group and p i c t u r e s 18,19 and 22 are from the normal group of drawings. In regards to the s o r t i n g by the subjects t h i s ana lys i s i n d i c a t e s that on average the Nontraumatized Group ra ted these drawings as more p r e f e r r e d than the Traumatized Group. With respect to Group NT, Group T r a t e d p i c t u r e s 5, 6, 8, 10, 13, and 23 as more l i k e what they would draw than Group NT. P i c t u r e 5 i s from the sexua l ly abused group, p i c t u r e s 6, 8 and 10 are from the p h y s i c a l l y abused group, p i c t u r e 40 13 i s from the emotional ly neglected group and p i c t u r e 22 i s from the normal group. The r e l a t i v e importance for d i s t i n c t i o n s made by the p i c t u r e s was about the same magnitude except for p i c t u r e #10 which made the most d i s t i n c t i o n between the two groups. Summary In summary a Q A n a l y s i s d i d not categor ize the subjects in to the expected groups. A fur ther ana lys i s however, that of a Repeated Measure A n a l y s i s of Var iance , supported the theory that c e r t a i n p i c t u r e s would d i s t i n g u i s h the two groups of Non Traumatized and Traumatized c h i l d r e n . The d i s t i n g u i s h i n g p i c t u r e s d i d not n e c e s s a r i l y belong to the group that showed a preference for them. That i s both groups showed a preference for some drawings from both the Traumatized and Normal groups of p i c t u r e s . 41 CHAPTER IV DISCUSSION The purpose of t h i s study was to evaluate the e f f ec t iveness of the Rosebush V i s u a l i z a t i o n Technique i n conjunct ion with Q Methodology for assess ing trauma i n c h i l d r e n . For ty two c h i l d r e n were used i n the study: twenty one who had experienced no trauma and twenty one who had experienced e i t h e r sexual abuse, p h y s i c a l abuse or emotional abuse. The hypothesis proposed i n the present research and the a c t u a l f ind ings w i l l be reviewed i n t h i s chapter under the heading of the s t a t i s t i c a l analyses used, Q-sor t A n a l y s i s and Anova. Next i m p l i c a t i o n s for c l i n i c a l p r a c t i c e and the conceptual i ssues invo lved i n the research are descr ibed . In a d d i t i o n , d e s c r i p t i v e r e s u l t s p e r t a i n i n g to both p i c t u r e s drawn by the subjects and sor ted by them are descr ibed . F i n a l l y i m p l i c a t i o n s f o r f u r t h e r research i n regards to the usefulness of the modif ied RTV are presented. Q-sort A n a l y s i s The hypothesis s ta ted that c h i l d r e n would s o r t the drawings of Rosebushes demonstrating a preference for the drawings that 42 represented the group to which they belonged. That i s f or instance that sexua l ly abused c h i l d r e n would show a preference f o r drawings done by other sexua l ly abused c h i l d r e n . A Q A n a l y s i s d i d not substant iate a c a t e g o r i z a t i o n of the 42 subjects in to the expected four groups of Traumatized and Non Traumatized groups. Rather the 42 c h i l d r e n were f a c t o r e d in to e leven groups which had no homogeneity or the expected c l i n i c a l c h a r a c t e r i s t i c s . A fur ther Q A n a l y s i s was done which f a c t o r analyzed the s o r t s . Using a scree t e s t as a guide two, three and four f a c t o r s were obtained. These groups a l so d i d not have the c h a r a c t e r i s t i c s expected. Thus i n t h i s study there was no r e l a t i o n s h i p between group membership and type of drawing s e l e c t e d . Therefore , the hypothesis was not supported as the c h i l d r e n d i d not show a preference for drawings which represented the group that they belonged to . A n a l y s i s of Variance Because the Q A n a l y s i s had not d i v i d e d the c h i l d r e n in to groups as the hypothesis had p r e d i c t e d , i t was decided to determine whether the c h i l d r e n had sor ted the p i c t u r e s randomly and i f not , how they had sor ted them. An Anova was used and was c a r r i e d out by d i v i d i n g the 42 subjects in to two groups. Th i s was done by combining the three abused groups in to one group of 21 43 traumatized c h i l d r e n i n order to have a s u f f i c i e n t sample s i z e to c a r r y out a s t a t i s t i c a l a n a l y s i s . The two groups were: Group NT (21 non traumatized subjects) and Group T(21 traumatized s u b j e c t s ) . The A n a l y s i s of Variance procedure used was a Repeated Measures design with one between group f a c t o r and one repeated measures f a c t o r . The Anova i n d i c a t e d that the c h i l d r e n had not sor ted the drawings randomly. Of p a r t i c u l a r importance'was the i n t e r a c t i o n e f f e c t of p i c t u r e s and groups which showed that p i c t u r e s had d i f f e r e n t i a t e d the Traumatized Group of c h i l d r e n from the Non Traumatized Group of c h i l d r e n . However not a l l the p i c t u r e s d i f f e r e n t i a t e d between the groups equa l ly w e l l . The fo l l owing p i c t u r e s therefore d i d not d i s t i n g u i s h between the Traumatized and Non Traumatized groups: 1,3, and 4 from the sexua l ly abused group; 7 and 11 from the p h y s i c a l l y abused group; 14, 15 and 16 from the emotional ly abused group; and 17,20, 21 and 24 from the non traumatized group. The p i c t u r e s which s i g n i f i c a n t l y d i f f e r e n t i a t e d the two groups at the .05 l e v e l were the f o l l o w i n g . With respect to Group T, Group NT ra ted p i c t u r e 2,9,12,18,19 and 22 as more l i k e how they imagined themselves than Group T. P i c t u r e 2 belongs to the s exua l ly abused group of drawings, p i c t u r e 9 to the p h y s i c a l l y abused group, p i c t u r e 12 to the emotional ly abused group and 44 p i c t u r e s 18,19 and 22 to the normal group of drawings. In other words the nontraumatized c h i l d r e n on average r a t e d these drawings h igher on t h e i r Q-sor t than the traumatized c h i l d r e n d i d . With respect to Group NT, Group T r a t e d p i c t u r e s 5 ,6 ,8 ,10 ,13 and 23 as be ing more l i k e how they imagined themselves than Group NT. P i c t u r e 5 belongs to the sexua l ly abused group of drawings, p i c t u r e s 6,8 and 10 belong to the p h y s i c a l l y abused group, p i c t u r e 13 belongs to the emotional ly neglected group and p i c t u r e 23 to the normal group. Again i n reference to the hypothesis i t can be seen that the preferences of the Traumatized and Non Traumatized groups of c h i l d r e n were not r e s t r i c t e d to drawings done by c h i l d r e n with s i m i l a r abuse experiences . Rather the Traumatized and Non Traumatized subjects p r e f e r r e d drawings from each of the i n i t i a l four groups of drawings. With reference to the f i n d i n g from the Anova, many of the drawings were powerful d i s c r i m i n a t o r s of the two groups of c h i l d r e n , Traumatized and Non Traumatized. Summary of Resul ts Hypothesis - The hypothesis s ta ted that c h i l d r e n would s o r t the drawings of rosebushes that represented the group to which they belonged. This hypothesis was not supported. Us ing Q-sor t 45 Analyses , the c h i l d r e n fac tored in to 11, 2, 3 and 4 groups and these groups had no c l i n i c a l s i g n i f i c a n c e i n that there was no r e l a t i o n s h i p between the groups and experience o f trauma or type of treatment centre attended. Because the Q A n l y s i s had not d i v i d e d the c h i l d r e n in to groups as the experimentor had p r e d i c t e d , a Repeated Measures design with one between group f a c t o r and one repeated measures f a c t o r was used to analyze the subjects Q - s o r t s . The Anova showed that the c h i l d r e n had not sor ted randomly. Of p a r t i c u l a r importance was the i n t e r a c t i o n e f f e c t which i n d i c a t e d that c e r t a i n p i c t u r e s had d i f f e r e n t i a t e d the two groups of c h i l d r e n at the .05 l e v e l of s i g n i f i c a n c e . D e s c r i p t i v e Resul ts Subject ' s r e a c t i o n to task. The subjects reported that they had enjoyed the exerc i se and with a few except ions , tha t they had not found the task of s o r t i n g d i f f i c u l t . The experimenters d iscovered that the age of 8 was approximately the youngest age at which a subject was able to comprehend the task of s o r t i n g . This i n a b i l i t y of younger c h i l d r e n to s o r t the p i c t u r e s i s supported by P iage t ' s theory that c h i l d r e n are i n the preopera t iona l p e r i o d between the ages of 4 46 and 7 and are unable to order things on the bas i s of a p a r t i c u l a r dimension (Hetherington & Parke, 1986). However younger c h i l d r e n had no trouble imagining themselves as rosebushes or i n drawing t h e i r v i s u a l i z a t i o n and enjoyed these a c t i v i t i e s . Two subjects who d i d these aspects of the RVT were not inc luded i n the study. The few subjects who had some d i f f i c u l t y s o r t i n g the p i c t u r e s were he lped to overcome t h i s by the experimenter breaking the task down for them, for example by s t a t i n g , "Of these two p i c t u r e s which one i s more l i k e you?, and so on u n t i l the s o r t was f i n i s h e d . C r i t e r i a for s o r t i n g I t was d i f f i c u l t f o r the experimenter to determine what c r i t e r i a the c h i l d r e n had used to s o r t the p i c t u r e s , f o r instance whether they had taken a h o l i s t i c or symbolic approach. Some of the subjects appeared to take a h o l i s t i c approach which combined a f f e c t and symbols. For example, by s t a t i n g that the p i c t u r e s j u s t f e l t more l i k e them and that they a l so contained s i m i l a r symbols as i l l u s t r a t e d by one subjec t ' s statement: " mine was d e f i n i t e l y a sunny day and i t was hard to t e l l whether the p i c t u r e s were a sunny day". Other subjects appeared to take a symbolic approach and reported choosing p i c t u r e s which contained the same symbols. For example, one subject s ta ted " I chose the ones that were l i k e my image trees , sunshine, water, I had a r i v e r 47 n e x t t o m i n e . R o s e b u s h e s t h a t w e r e t h o r n y w i t h n o f l o w e r s w e r e n o t l i k e my r o s e b u s h " . S o m e s u b j e c t s w e r e u n s u r e o f w h a t c r i t e r i a t h e y h a d u s e d t o s o r t w h i l e o t h e r s s t a t e d : " t h e s e w e r e j u s t l i k e h o w I i m a g i n e d m y s e l f " , w h e n t o t h e e x p e r i m e n t e r t h e d r a w i n g s p r e f e r r e d b y t h e s u b j e c t w e r e d i s s i m i l a r t o t h e s u b j e c t s o w n d e p i c t i o n o f t h e i r v i s u a l i z a t i o n . C h a r a c t e r i s t i c s o f d i f f e r e n t i a t i n g p i c t u r e s T h e A n o v a h a d i n d i c a t e d t h a t t h e t w o g r o u p s o f c h i l d r e n d i f f e r e n t i a l l y p r e f e r r e d t h e d r a w i n g s , w h e r e a s t h e Q - s o r t h a d i n d i c a t e d t h a t t h e s u b j e c t s d i d n o t p r e f e r d r a w i n g s d o n e b y s i m i l a r l y d i a g n o s e d c h i l d r e n . A s t h e t w o g r o u p s h a s n o t s h o w n a p r e f e r e n c e f o r t h e p i c t u r e s w h i c h r e p r e s e n t e d t h e g r o u p t h e y b e l o n g e d t o , t h e e x p e r i m e n t e r d e c i d e d t o v i s u a l l y e x a m i n e t h e p i c t u r e s i n o r d e r t o s p e c u l a t e w h a t c h a r a c t e r i s t i c s o f t h e d r a w i n g s m i g h t h a v e i n f l u e n c e d t h e s u b j e c t s c h o i c e . I n a s u b j e c t i v e a n a l y s i s t h e e x p e r i m e n t e r n o t e d t h a t t h e N o n T r a u m a t i z e d G r o u p h a d s h o w n a p r e f e r e n c e f o r d r a w i n g s t h a t w e r e c o l o u r f u l a n d a e s t h e t i c a l l y p l e a s i n g w i t h a b a l a n c e d d e s i g n . T h e p i c t u r e s t e n d e d t o c o n t a i n p o s i t i v e l i f e q u a l i t i e s w i t h s y m b o l s o f s u n s h i n e , f l o w e r s a n d l e a v e s . T h e p i c t u r e s o f t e n c o n t a i n e d a h o r i z o n l i n e a t t h e m i d p o i n t p o s s i b l y r e p r e s e n t i n g a b a l a n c e b e t w e e n t h e s u b j e c t s c o n s c i o u s a n d u n c o n s c i o u s l i f e ( A l l a n , 1 9 8 8 ) . 48 In contras t to the Traumatized Group, the p i c t u r e s of the Non Traumatized Group showed a preference for l i g h t backgrounds. However, the p i c t u r e s that the Traumatized Group showed a preference for had thorns . These p i c t u r e s tended to have dark backgrounds which the experimenter speculated might have acted as an avers ive c h a r a c t e r i s t i c to the Non Traumatized c h i l d r e n . The p i c t u r e s of ten contained s i n g l e , l o n e l y f i g u r e s . P i c t u r e 13 for ins tance , i s of a s ing l e flower and i s one of the saddest p i c t u r e s i n the Q Sor t . A l s o , the p i c t u r e s , with the except ion of p i c t u r e 6 a p h y s i c a l l y abused drawing, do not conta in a midpoint h o r i z o n l i n e and were s t a r t e d at the bottom of the page, which i s o f ten an i n d i c a t o r of low s e l f concept (Bolander, 1977). Comparison of Q-sor t drawings with the subjects 'drawings The experimenter then examined the c h a r a c t e r i s t i c s of the drawings i n the Q-sor t which the two groups T and NT showed a preference f o r . This was attempted by determining whether these c h a r a c t e r i s t i c s were a lso to be found i n the drawings done by the c h i l d r e n i n the present study. The researcher v i s u a l l y compared the p i c t u r e s that the two groups of subjects had drawn of t h e i r v i s u a l i z a t i o n s wi th the p i c t u r e s that the two groups had shown a preference or non preference for i n the Q - s o r t . C h a r a c t e r i s t i c s which had 49 a t t r a c t e d or r e p e l l e d c h i l d r e n to c e r t a i n drawings i n the Q - s o r t were not observed by the experimenter to be present or absent i n the p i c t u r e s drawn by the c h i l d r e n . The experimenter noted that aga in , as with the f i r s t Q-sor t hypothes i s , a l o g i c a l or theory based approach had not worked. However, the experimenter, when comparing the two samples of drawings, d i d observe that there was a s i g n i f i c a n t d i f f e r e n c e i n the developmental l e v e l . The drawings done by the Traumatized Group were impoverished when compared to both the drawings done by the Non Traumatized group and a l l the groups i n the Q - s o r t set . The experimenter expla ined t h i s by not ing that the c h i l d r e n i n Group T were more severe ly traumatized than the traumatized c h i l d r e n i n the previous study, a l l of whom were able to f u n c t i o n w i t h i n the school system and who l i v e d at home. The low developmental l e v e l of Group T ' s drawings r e i n f o r c e d the no t ion of severe t raumat i za t ion as developmental delay i s one of the recognized sequelae of t raumat i za t ion . Conceptual Issues of Research In developing the modif ied RVT the experimenter took a theory d r i v e n approach to tes t c o n s t r u c t i o n . I t was thought l o g i c a l l y that abused c h i l d r e n ' s drawings would appeal to s i m i l a r l y abused c h i l d r e n and that the drawings done by non 50 traumatized c h i l d r e n would appeal to other non traumatized c h i l d r e n . In t h i s study the theory under ly ing the development of the RVT was not supported. However the f ind ings from the present study support the no t ion that the development of the RVT holds s i g n i f i c a n t promise as a t o o l to help i d e n t i f y traumatized c h i l d r e n . The r e s u l t s of the present study suggest that f u r t h e r development of the t e s t should be based on an e m p i r i c a l approach to t e s t c o n s t r u c t i o n . That i s an e m p i r i c a l a n a l y s i s of which p i c t u r e s d i f f e r e n t i a t e between groups of c h i l d r e n . I t i s p o s s i b l e that future subjec t ive analyses of these p i c t u r e s may help to i d e n t i f y the d i f f e r e n t i a t i n g c h a r a c t e r i s t i c s of the p i c t u r e s and subsequently that t h i s w i l l l ead to a l o g i c a l theory of the t e s t c o n s t r u c t i o n that w i l l p a r a l l e l t h i s e m p i r i c a l data . Impl icat ions of Modi f i ed RVT f o r C l i n i c a l P r a c t i c e H i s t o r i c a l l y the use of p r o j e c t i v e a r t techniques, as a u s e f u l way of l e a r n i n g about the inner experiences of c h i l d r e n , has been widely acknowledged and u t i l i z e d . There has been, however, much c r i t i c i s m of c l i n i c i a n s who use these techniques because of the l ack of e m p i r i c a l support for them. One of the c r i t i c i s m s of s tudies support ing the use of these techniques i s that when group d i f f erences have been found experimenters have not reported how accura te ly t h e i r method cou ld be used to c o r r e c t l y c l a s s i f y c l i e n t s in to groups. The present study i s a l so unable to p r e d i c t how accura te ly the p i c t u r e s that d i f f e r e n t i a t e d the two groups cou ld be used for c l a s s i f i c a t i o n purposes. The reason for t h i s i s that the subjec t ' s ra t ings or scores on i n d i v i d u a l p i c t u r e s i n the Q sample are not independent so that a l l s t a t i s t i c a l analyses which look at p r e d i c t i o n or c l a s s i f i c a t i o n are d i f f i c u l t to use. The non independence of the p i c t u r e s has the e f f e c t of maximizing the i n d i v i d u a l var iance on p i c t u r e r a t i n g s thus exaggerating a subjects score on a p a r t i c u l a r p i c t u r e . Summary and Impl icat ions for Further Research In the present study the hypothes i s , based on a l o g i c a l approach to t e s t development, proposed that c h i l d r e n would s o r t the drawings of Rosebushes demonstrating a preference f o r the drawings that represented the group that they belonged to . Us ing Q methodology t h i s hypothesis was not supported. The a c t u a l f i n d i n g of t h i s study supports an e m p i r i c a l approach to t e s t c o n s t r u c t i o n . With the use of A n a l y s i s of Variance i t was found that the two groups of c h i l d r e n were d i f f e r e n t i a t e d by t h e i r preference for c e r t a i n drawings but not on the bas i s expected. Four suggestions for fur ther research i n the development of the RVT as an assessment t o o l are as fo l lows . F i r s t l y , t h i s study needs to be r e p l i c a t e d i n order to assess the g e n e r a l i z a b i l i t y of the present f i n d i n g s . Secondly, the use of a l a r g e r sample i s recommended i n order to provide s u f f i c i e n t numbers for an ANOVA to be c a r r i e d out on the three groups of abuse ra ther than c o l l a p s i n g them into one traumatized group as was the case i n the present study. T h i r d l y , the r e s u l t s of the present study suggest that f u r t h e r development of the RVT should be based on an e m p i r i c a l ra ther than a theory based approach to t e s t c o n s t r u c t i o n . That i s , future s tudies should employ an e m p i r i c a l a n a l y s i s of which p i c t u r e s d i f f e r e n t i a t e between groups of c h i l d r e n . F i n a l l y , future s tudies could incorporate in to the p i c t u r e sor t s some drawings which are at a low developemental l e v e l . I n c l u s i o n of the drawings from a range of developmental l e v e l s may increase the d i f f e r e n t i a t i o n between the traumatized and non traumatized c h i l d r e n . 53 REFERENCES A l l a n , J . (1988). Inscapes of the c h i l d ' s wor ld . D a l l a s , Texas: Spr ing . A l l a n , J . , & C l a r k , M. (1984). D i r e c t e d a r t c o u n s e l l i n g . Elementary school guidance & c o u n s e l l i n g . 19, 116-124. A l l a n , J . , & C r a n d a l l J . (1986). The rosebush: A v i s u a l i z a t i o n s trategy for p o s s i b l e i d e n t i f i c a t i o n of c h i l d abuse. Elementary School Guidance & C o u n s e l l i n g . 21, 44-51. Amundson, N. 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Sexual Offenses Against C h i l d r e n . (1984). Report of the Committee on Sexual Offenses Against C h i l d r e n and Youths appointed by The m i n i s t e r of J u s t i c e and Attorney General of Canada. The m i n i s t e r of Nat iona l Heal th and Welfare . Canada: Canadian Government P u b l i s h i n g Centre . S g r o i , S. M. (1982). Handbook of c l i n i c a l i n t e r v e n t i o n i n c h i l d  sexual abuse. Toronto: Lexington Books. 56 Sidun, N. & Rosenthal , R. (1987). Graphic i n d i c a t o r s of sexual abuse i n Draw-A-Person tes ts of p s y c h i a t r i c a l l y i l l h o s p i t a l i z e d adolescents . The A r t s i n Psychotherapy. 14, 25-33. Sims, C. (1974). K i n e t i c fami ly drawings and the fami ly r e l a t i o n s i n d i c a t o r . J o u r n a l of C l i n i c a l Psychology. 30, 87-88. Stevens, J . (1971). Awareness: E x p l o r i n g , experimenting,  exper ienc ing . Moab, UT: Real People Press . Thompson, F . & A l l a n , J . (1985). A r t s c o u n s e l l i n g i n the elementary schools: a method of ac t ive i n t e r v e n t i o n . The  B . C . Counse l l or . 7. 43-57. Tzeng, O . C . S . & Jacobsen, J . J . (Eds. 1988). Sourcebook for c h i l d  abuse and neg lec t . S p r i n g f i e l s , 11: Charles C. Thomas. 57 APPENDIX A Ins truc t ions to subjects I would l i k e you to take a minute or two to imagine y o u r s e l f as a rosebush. Imagine what you look l i k e as a rosebush and anything that might be around you. Now I am going to show you drawings of rosebushes that other c h i l d r e n have drawn. I want you to put the drawings in to two p i l e s , i n t h i s p i l e (on the l e f t ) those drawings of rosebushes that are most or even a l i t t l e l i k e how you imagined y o u r s e l f as a rosebush and i n t h i s p i l e (on the r i g h t ) the drawings that are no't l i k e your image of y o u r s e l f as a rosebush. From the p i l e of drawings that are most l i k e you I would l i k e you to s e l e c t the one rosebush that i s most l i k e you. From the p i l e of drawings that are l e a s t l i k e you I would l i k e you to s e l e c t the one rosebush that i s the most d i f f e r e n t from you. Now out of the p i c t u r e s l e f t i n the two p i l e s cou ld you p i c k the next two rosebushes which are most l i k e you and the next two rosebushes that are l e a s t l i k e you. From the two p i l e s could you p i c k the next two rosebushes which are most l i k e you and the next two which are l e a s t l i k e you. (a f ter a short break) When looking at how you have put the drawings in to p i l e s are there any changes that you would l i k e to make? Is the rosebush that you chose as being most l i k e you s t i l l the one that you would choose as most l i k e you? Is the rosebush that you chose as being l e a s t l i k e you s t i l l the one that you th ink i s l e a s t l i k e you? How about your choices , do you want to change any of them? 58 APPENDIX B I n i t i a l contact to parents Dear Parent / Guardian: Recently a U n i v e r s i t y of B r i t i s h Columbia graduate student i n C o u n s e l l i n g Psychology contacted us for permiss ion to do research i n v o l v i n g some of the c h i l d r e n at tending . We support t h i s research p r o j e c t and request your permiss ion to give her your name(s) i n order that she may contact you regarding her research p r o p o s a l . This l e t t e r merely seeks to get your approval f o r contact . Should the research p r o j e c t be acceptable to you we would send another consent form. Could you check the appropr ia te box below. Please understand that denying consent w i l l not j eopard ize any treatment that your c h i l d w i l l rece ive from I do consent for contact and my telephone number i s I do not consent for contact 59 APPENDIX C Consent form TITLE OF THESIS: Rosebush Q Sor t . INVESTIGATOR: Sara Bowden, M.A. thes i s i n the department of C o u n s e l l i n g psychology U n i v e r s i t y of B r i t i s h Columbia. PURPOSE OF THE THESIS: The purpose of t h i s thes i s i s to determine whether c h i l d r e n who have been assessed by a mental h e a l t h p r o f e s s i o n a l as having experienced sexual abuse, p h y s i c a l abuse, emotional neglect or trauma that does not inc lude neg lec t or abuse, w i l l s e l e c t p i c t u r e s drawn by c h i l d r e n who have experienced a s i m i l a r trauma. Each c h i l d w i l l be asked to sor t out from 24 drawings of rosebushes done by other c h i l d r e n , those drawings that are most or i n any way l i k e how they would imagine themselves l ook ing i f they imagined themselves be ing a rosebush, and those drawings that are not l i k e how they would imagine themselves. Approximately one hour of the c h i l d ' s time w i l l be invo lved . Pr ivacy of c h i l d r e n w i l l be maintained. None of the content of the p i c t u r e s w i l l be d iscussed with the subjec t s . I understand that the study involves d i s c l o s u r e on a s t r i c t l y c o n f i d e n t i a l b a s i s . Only those aspects of my c h i l d ' s h i s t o r y that are re l evant to t h i s study w i l l be made a v a i l a b l e for t h i s research p r o j e c t . The r e s u l t s of t h i s study w i l l be reported i n such a way that the p r i v a c y and c o n f i d e n t i a l i t y of a l l p a r t i c i p a n t s w i l l be preserved. The i n v e s t i g a t o r w i l l be a v a i l a b l e on a regu lar weekly bas i s to e x p l a i n the procedures and to answer any questions that parents or h e a l t h p r o f e s s i o n a l s may have about the methods. The subject has the r i g h t to withdraw from treatment at any time and such a withdrawal w i l l not j eopardize any of the other treatments o f f e r e d by I consent \ I do not consent to p a r t i c i p a t i o n i n t h i s study. I acknowledge r e c e i p t of a copy of t h i s consent form. Parent 60 APPENDIX D S e x u a l l y a b u s e d p i c t u r e s e t MllliJiil MM 6 1 E m o t i o n a l l y a b u s e d p i c t u r e s e t # 1 7 Non t r a u m a t i z e d p i c t u r e s e t # 1 8 69 # 1 9 

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