Patient ID: | Date: | |
---|---|---|
Doll Therapy Intervention: | Sham Intervention (cube): | |
 | Presence | Absence |
1. First stage: interaction between the patient and her child | ||
 1.a. Gaze direction: | ||
  Toward the child |  |  |
  Avoidant of the child |  |  |
  Other |  |  |
 1.b. Responses to the interaction with the child: | ||
  Smiling |  |  |
  Crying |  |  |
  Seeking closeness |  |  |
  Wandering |  |  |
  Moving away from the child |  |  |
2. Second stage: separation from the child | ||
 2.a. Responses to the separation from the child: | ||
  Acceptance |  |  |
  Complaining |  |  |
  Worrying |  |  |
  Lack of interest |  |  |
3. Third stage: behaviours during the absence of the child | ||
 Crying |  |  |
 Looking for the child |  |  |
 Lack of interest |  | |
 Wandering |  |  |
 Turning toward the stranger (the researcher) |  |  |
4. Fourth stage: behaviours during the reunion with the child | ||
 4.a. Gaze direction: | ||
  Toward the child |  |  |
  Avoidant of the child |  | |
  Between the child and the room |  |  |
  Other |  |  |
 4.b. Responses to the presence of the child: | ||
  Smiling |  |  |
  Crying |  |  |
  Screaming |  |  |
  Seeking closeness |  |  |
  Wandering |  |  |
  Moving away from the child |  |  |
NOTES: |