Her first book, Strengthening Emotional Ties Through Parent-Child-Dyad Art Therapy: Interventions with Infants and Preschoolers was published in 2003. It chronicles her pioneering work in child psychiatry and art therapy at the Montreal Children's Hospital promoting the significance of attachment metaphors and symbols within the artworks of parents and children. Within Attachment Informed Art Therapy: Strengthening Emotional Ties Throughout the Lifetime, Proulx shares a rich breadth of knowledge and experience to educate art therapists and allied professionals on attachment interventions from birth to the end of life. Lucille's artist identity informs her methods and materials. She attunes to client needs through sculpting, printmaking, sand play, collage, mandalas, found objects, body mapping, doll making, and through the unique properties of “goop” a modeling substance with both solid and liquid properties. Divided into three chronological life stages—early, middle, and end—the text is rich in research and experiential contributions. All three sections include theoretical foundations, developmental research, arts based interventions, and case studies with artifacts. Proulx identifies the purpose of the book as providing a structure for practice based on real life applications, or theory in action. The goal of the book offers a “solid, visible and empirically-grounded conceptual framework…[for] professionals who use attachment theory in clinical work…[and] for therapists working with populations of all ages and cultures, from birth to death” (p. xxvi).
In setting the stage for this analysis, there are some factors that underlie attachment throughout the lifespan. Proulx attributes inspiration for her attachment-focused practice and scholarship to research undertaken by developmental psychologist Mary Ainsworth. In the “Strange Situation” test, Ainsworth studied and assessed the reactions of young children when placed in a room with their mother, a stranger, and also when left alone. Based on her observations, she was able to categorize attachment styles ranging from secure, to anxious, to disoriented. Proulx details each style in the text. Given the right context and approach, art therapists can intervene in ways to support the ideals of secure attachment. These ideals are achieved when a child's expression of needs are consistently acknowledged and actively responded to. Within this foundation, the child learns they can venture away from their parent with the confidence the parent will remain available when needed.
Proulx strives throughout her work to utilize the therapeutic space to establish emotional bonding even within the most difficult relationships. Also influenced by the founder of attachment theory, psychologist and psychiatrist John Bowlby, Proulx identifies how art therapy can illustrate relationship patterns and the symbolic meaning of complex encounters. Although past attachment experiences can prevail into the present day, art therapy can proactively encourage new capacities for emotional bonding. Proulx's innovations within early childhood attachment transform parental ambivalence and withdrawal into child-centered responsiveness and mutuality. She encourages exploration and collaboration through arts-based activities, which foster sensory and verbal communication between parent and child.
Throughout her book Proulx offers a number of assessment approaches, each incorporating observations of a client's connections to others and art materials. Interventions focus on safe, stable therapeutic contexts, where attunement enables secure communication with a range of client groups. Proulx defines attunement as “creating a safe and secure place to receive clients…” (p. 14). She adds to this foundation the role of adaptation, which refers to how memories are stored, retrieved and acted upon in different ways. There are two different kinds of memories: those accessible to verbal recall (explicit) and those that typically reflect physical sensations, behavior patterns, and emotions (implicit). Art therapy has the capacity to access and make sense of both kinds of memory, which can be particularly useful in parent–child dyadic art therapy. “Dyad art therapy…is an organized adaptive strategy that produces an attentional/representational state that minimizes proximity seeking, reduces expectations, and shapes other attachment-related behaviors and mental processes accordingly” (p. 61).
The goal of art-informed attachment therapy during early life is to establish a secure enough foundation of relational communication to allow engagement and responsiveness to naturally occur between caregiver and child. Accordingly, the early life section of Proulx's book is devoted to children and their caregivers beginning from pregnancy through to birth and into childhood and adolescence. In this section Proulx continues her examination of parent–child dyads, while also including attachment techniques for children who are adopted or in foster care. She includes a noteworthy example of therapeutic interventions with an expectant mother, living with a history of trauma and depression and exhibiting unstable attachment approaches. Attachment-informed art therapy regards parents as more likely to provide emotional security for their children if they themselves have inherited relational confidence. In the case of the expectant mother, her sense of identity was strengthened through body mapping, which revealed “both the inside and the outside of…[herself],…choosing what she [wished] to reveal or conceal in her self-portrait” (p. 55). The body map, created over a number of sessions, reflected the adaptive nature of the woman's journey within an attuned therapeutic experience. The outcome was a stronger, more secure relationship style for the client to live and parent from.
In midlife, secure attachment is expressed through one's sense of autonomy and ability to create a secure base for new attachments. Among the midlife case studies is a contribution that speaks to attachment considerations in same sex relationships. An individual, from a long-term same sex relationship, volunteered that the experience of growing up with a sense of being different may enhance attachment among same sex couples. Although research on the topic of same sex relationships may be limited, one study revealed that ultimately the reasons for separation among same sex unions were no different than those in heterosexual relationships. However, there is “strong evidence that same sex couples are stable satisfied and committed” (p. 183).
Divorce is also covered in the midlife section. One case study details the results of a child caught in the fallout of a bitter divorce through which she became assigned as attachment figure to both parents. The client was referred to Proulx as a result of acting out at school. Proulx observed and assessed that the mother's interaction style was impacting both her own and her former husband's relationship with their daughter. At a tense initial meeting with mother, father, and child, Proulx observed the child to be withdrawn. She arranged a series of sessions with the child and recommended both parents receive individual therapy on their own. She then offered dedicated sessions with the child and each parent. Proulx offered the parents feedback based on her observations and asked the mother to resist intervening in the father–daughter relationship. This did not occur, and regrettably art therapy ended without the attachment injuries of either parent or child being resolved. In a separate example, Proulx was involved in a parenting group that helped divorced mothers and their children adapt to their new life situations. Through expression in a number of art activities, mothers demonstrated an increased self-awareness related to the current role they played in their children's lives. Through interactive art activities children were also offered the necessary ingredients to adjust and have closer relationships with their fathers.
In the final stages of life, art-informed attachment therapy seeks to assist individuals to engage and promote continuing bonds with their loved ones. For example, an art therapist in Bangkok, Thailand taught people with dementia how to create wrapped dolls to “determine whether they could relate to the human figure and…[to also] connect with attachment figures in childhood” (p. 207). She wanted to know how the processes of doll making and the use of the materials made clients feel, and determine whether or not they triggered any memories or insights about the clients' relationships past or present. In Thailand dolls can represent the sacred and offer an interactive connection to the spirit world. The clients were taught how to create wrap dolls with fabric within which they could incorporate any wish. Each participant shared the impact of doll making and the significance of their wish, which offered a means of interaction, an awareness of memories, and enhanced social connections to loved ones.
Attachment Informed Art Therapy is an optimal resource. It combines theoretical frameworks, interventions and recommendations for art therapists seeking greater understanding and skills in this field of practice. Proulx's key message is “attachment theory applies to all of humanity without exceptions” (personal communication February 11, 2018), a sentiment that is aptly demonstrated throughout this book reflecting her commitment to enhancing relationships within society as a whole.