ART THERAPY ASSESSMENTS

There is no standardized or commonly accepted approach to using art

in assessment
Many different methods have been proposed but it is important that we
will consider getting to know the patients in some new ways using art.
UNSTRUCTURED AND SEMISTRUCTURED INTERVIEWS
FREE CHOICE
A free choice of media and topics
It involves asking the patient to choose what to use and what to make
from among a variety of materials (Rubin, 1973, 2005)
The basic idea of an unstructured art interview is that the way the
individual organizes the time reveals his or her general style of being
in the world. The persons behaviour with the therapist, with the art
materials, during the process, and in relationship to the products are
all diagnostic data.
Although some individuals work on one product for most of the time,
the majority end up creating more than one in the course of a session.
SEMI-STRUCTURED-THREE MEDIA
Edith Kramers Art Assessment
o also allows considerable choice of topic and sequence. However,
because she feels that each medium reveals different thing
about the artist, this interview requires the making of, first, a
pencil drawing; then a tempera painting; and finally a clay
sculpture (Kramer & Schehr, 2000)
o Originally designed for children, but can also be used on adults
o The patient chooses not only the subject matter of each piece,
but also the order in which the painting and modelling are done.
Ellen Horovitzs cognitive art therapy assessment
o individual is similarly required to do a drawing, a painting and a
clay sculpture (Horovitz-Darby, 1988)
o The patient decides on the order in which he or she will use the
materials
VISUAL STARTERS
One of the problems with free-choice procedures is that, except for
young children and gifted others; they can be quite threatening to the
non-artist and can cause considerable blocking and anxiety.

 For that reason, art therapists have developed a number of ways of

helping people to overcome their fear of the blank page, using what is
called visual starters.
o DOTS, LINES, and SHAPES
Something already on the paper, something for the artist
to elaborate and complete, is helpful to adolescents and
adults, and to inhibited children as well. It can be quite
simple, like a dot, a line, or a shape-or several dots, lines,
or shapes.
Patients can make the starters themselves and they can be
given the option to do it with eyes closed, which is less
threatening. If they are uncomfortable, the therapist can to
it for them or they can make something to model for the
patient.
At this point, patients are encouraged to find as many
images as they can in the starter, which is itself
informative. Then using the dot(s), line(s), or shape(s) as a
beginning, they are asked to make a drawing or painting of
whatever is suggested to them.
There are several procedures developed by therapists in
which the clinician draws something as a stimulus and the
patient is invited to complete it.
o EGG AND CAVE DRAWINGS
Developed by therapists in Japan (Tanaka, Kakuyama &
Urhausen, 2003
They incorporated the interactive aspects of Winnicotts,
(1971, 1989) squiggle game as well as universal themes
with resonance on many levels.
Procedure: therapist first draws a shape (an egg or a cave),
and the patient is then invited to fill it in imaginatively.
o SQUIGGLES AND SCRIBBLES

The Squiggle Game-Winnicott

Invented by a playful British psychoanalyst and
paediatrician named Donald W. Winnicott
A rapid way to get to know a child
An interactive approach where he (Winnicott) and the
child took turns making squiggles for the other to
complete and to name, using a pencil on writing
paper
Although game like, it is a very powerful interaction,
and it is important to monitor your responses so that

they are in the patients interest, always following his

or her lead

The Scribble Drawing-Cane

Primary goal was to stimulate spontaneity in their
creative expression.
Includes preparatory breathing and movement
exercises, and was done at an easel on large drawing
paper with soft pastels
Later taught by art therapy pioneer Margaret
Naumburg (1950, 1953, 1966)
Most helpful in overcoming anxiety and resistance
Instruction: Let the hand move freely, without trying
to draw anything in particular; to make a continuous
line, not lifting the hand from the paper; stop before
the line gets too complicated; use a relatively light
color.
Can be done with eyes closed-whichever is
comfortable
After making the scribble, patients are asked to turn
the paper all four possible ways, and to say what
images come to mind from each point of view
They are asked to find a picture.
They are then invited to develop one or more of the
images they have seen, omitting any lines that dont
belong and adding any lines, shapes and colors that
are necessary in order to help others to see what
they found
A Clay Scribble

o Stimulus drawings
Art therapist Rawley Silver (1978, 2001, 2002) worked for
many decades on an approach to assessment that began
in her work with deaf children
Three task in the Silver Drawing Test focus on cognitive
abilities: predictive drawing assesses the ability to
sequence; drawing from observation, the ability to
represent spatial relationships; and drawing from
imagination, the ability to deal with abstract concepts, as
well as creativity and the projection of emotions
For the third task and for the Silver Drawing Test, she uses
another kind of visual starter, the STIMULUS DRAWING
CARDS
o 50 line drawings of people, places and objects

o People are invited to select 2 images from a

group of 15 cards. Theyare then asked to
combine them in a new picture that tells a
story.
o In the Stimulus Drawing Assessment, all 50
cards are used.
INDIVIDUAL ASSESSMENTS
Brief
o
o
o
o
o

Art Therapy Screening Evaluation

Takes 30 minutes, so efficient and rich
Created by art therapist Nancy Gerber (1996)
Patient is asked to draw a picture in 5 minutes
Topic: Picture of two people doing something in a place
Done on a small sheet of white drawing paper,using 8 fine-tip
colored markers
o Request: Artist not to make stick figures
o Questions after drawing is complete

A Person Picking an Apple From a TRee

o For almost 30 years art therapist Linda Gantt has been working
to correlate elements in art product with psychiatric diagnoses
o Together with Carmello Tabone they collect drawings of A Person
Picking an Apple From a Tree
o Topic was first introduced by Victor Lowenfeld (1957) because it
helped children identify with the activity
o Gant and Tabone have been systematically securing PPAT
drawings
o They developed and refined FEATS (Formal Elements Art Therapy
Scale)
o Because any assessment of artwork has to include both content
and form, the scale contains categories in both areas
o It is a reminder of some of the things one can look at in a patient
artwork.
o It relies exclusively on global ratings, which have been found in
projective drawing research to be the most valid and reliable
measures.
LIFELINE
o While theres no substitute for a verbal history, lifeline adds
another dimension to the story of anyones life.
o Instructions: Ask the patient to show the story of his life using
shapes, colors, and images in a linear fashion, like a road or a
river.

o Identify significant periods and events using particular symbols

and colors
o Amplifies and enriches the picture you are able to obtain of
someones past from other sources.
PAST PRESENT & FUTURE
o In her assessment for adolescents, psychologist and art therapist
Mala Betensky included a task that she called adolescent window
triptych
o Patient is asked to create 3 drawings: one of the past, one of the
present and one of the future (Betensky 1995)
o Way to elicit visual reflections about time
LIFE SPACE
o Presents information about a persons social situation
o Conceptually related to Morenos sociogram and social atom
o Life space picture-shows the people, places and activities that
are most important in their lives at the present time

ART ASSESSMENT BATTERIES

There are numerous assessment batteries, designed by art therapists
for individuals that specify multiple products.
UPAP (Ulman Personality Assessment Procedure), and the
Diagnostic Drawing Series, as well as the MARI Card Test have
been in use for sometime now.
Each of these batteries is especially helpful to those who have
repeated them with different clients.
Levick Cognitive & Emotional Art Therapy Assessment (LECATA)
o Published by Myra Levick (2001)
o Originally designed for children but can be used for adults as well
o Six tasks to be done on 12x18 white drawing paper with 16 oil
crayon
o 1-free drawing, 2-self portrait, 3-scribble, 4-developed scribble,
5-a place, 6-a family
VARIOUS SPECIALIZED PROTOCOLS
o Marcia Sue Cohen-Liebman (2003)
For use in the forensic assessment of children for possible
abuse
o Judy Wald (2003)

Assessment of cognitive functioning and emotional state in

elderly stroke patients
Includes a wide variety of structured and unstructured
tasks
Includes: copying a geometric shape, drawing a clock,
choosing colors to represent how one is feeling, free
painting as well as the Silver Drawing Test
FAMILY PHOTOGRAPHS AND VIDEOTAPES
o Phototherapy
Becomes part of art therapy because it is visual and can be
similarly expressive as well as responsive
Show and tell
Way of getting history
Another way of exploring interpersonal relationships
NOTE :
If one decide to use drawings or other art products in assessment, you
would be wise to ask for more than one.

ART AND PSYCHOPATHOLOGY

Although all diagnostic inferences from art need to be approached with
caution, drawings can sometimes help in screening for problems.
They are especially useful when trying to pick up possible signs of
serious emotional disturbance, organicity and of acting out.
Art as a Warning
Judging Psychopathology from art
o Although neither found that success was related to years of
clinical experience, a subsequent investigation showed that
training art therapists in how to look at paintings did increase
their accuracy in identifying adult psychiatric inpatients.
Creating reveals Capacities
o Advantage of using art activities as part of assessment is that
they very often reveal peoples strength and abilities as well as
their problems and weaknesses.
o This is largely because, in order to use art materials to
sucessfully perform a creative task, a patient has to call on many
cognitive and emotional capacities.
o Art assignment calls on the individual to plan, to organize, to
manipulate materials and tools, and to create something that
fulfills the therapists request, whatever that is.
o In order to use art materials constructively and creatively,
patients, no matter how disabled they may be, heve to make use
of what is right with them, rather than what is wrong with them.

o Even if we cant translate drawing signs or ratings into neat

diagnostic classifications or predictive certainty, there is much to
be gained by adding art to the assessment of patients of all ages.
Reference: Rubin, J.A. (2005). Artful therapy. New Jersey: John Wiley & Sons

Ladybird R. Abaday