In the previous post, The Trials of Art Therapy: An Introduction, I indicated “art is a viable assessment tool that can ascertain mental health status at the time of both the crime and trial or hearing”. Assessing the art was my primary responsibility in Kevin Ward’s murder trial, and merits close examination. However, before I explain how and why I used the particular approach, a summary of projective assessments may be necessary. Therefore, the topic will be divided between two posts.
[Many sections of this post are adapted from the book Art on Trial, with permission from, well…me (and Columbia University Press).]
Brief overview
In projective testing or assessments, the person being assessed projects meaning onto a neutral image or prompt. A person may be assessed by how they respond to ambiguous images such as with the Thematic Apperception Test (TAT). Although not art-based, understanding such procedures provide the art therapist tools by looking for patterns and themes that a client may project onto images they create. An art therapist takes this further: clients may be asked to create their own scene and tell a story about it. With the right dialogue, the therapist can understand the client’s cognitive and personality characteristics. The very nature of the projective assessment, however, relies upon the individual’s personal reflection; such open-ended responses stress that there are as many responses as there are individuals.
Psychologists originally developed projective drawing assessments, including Draw a Man, Draw a PersonHouse-Tree-Person, Draw a Family, and the House-Tree-Person, and later the Chromatic House-Tree-Person. These assessments were established to evaluate cognitive functioning and personality traits. Some added new dimensions to invoke further personal meaning, such as the Kinetic Family Drawing and the Kinetic House Tree Person. What the figure is doing and the relationship of the items on the page are supposed to indicate how the client interacts with others, his or her relationships and cognitive processing.
What also emerged was the significance of theformal elements of the drawing; that is how the drawing was done, not the symbolic content. Briefly, a shaky or sketchy line quality may indicate anxiety; a dense, pressured line may indicate frustration or aggression; faintly drawn lines may indicate loss of energy. The space used on the page may also be meaningful. The smaller the image and the greater space left on the page, the more likely the person was depressed, sad, un-invested or just plain lazy. Once color was introduced, it added a whole new dimension; while some subscribe symbolic importance to colors, what is more significant is the number of colors used (color prominence) and the use of colors for accurate representation (color fit).
Psychological to Art Therapy Assessments
Such procedures naturally informed art therapy assessments.Art therapy pioneer Margaret Naumburg has been credited with providing a bridge between psychologically based to art-based therapy assessments, through her book chapter in Hammer’s The Clinical Application of Projective Drawings (1980).
There has been a plethora of art therapy assessments developed throughout the field’s history. Some art therapists borrowed elements of previously designed procedures, others invented their own out of whole cloth, and some fell somewhere in between. In a 1991 survey conducted by the American Art Therapy Association, it was revealed that many art therapists either modified existing procedures or created new ones, rarely relying on published tools (Mills & Goodwin, 1991). Some art therapists developed their art-based assessments through their own experiences—what they felt provided them valuable information about their own clients. Some art therapy assessments were loosely administered, whereas others were highly structured. Some focused on particular populations, whereas others had more general application. [For a comprehensive overview of art therapy assessments please refer to Donna Betts’ website http://www.art-therapy.us/assessment.htm and Brooke’s Tools of the Trade (2004)].
Particularly pertinent to Ward’s defense was the standardized yet simpleassessment procedure, Gantt and Tabone’s (1998) Person Picking an Apple from a Tree in which a person is asked to draw what the title of the directive implies. This drawing is then rated with the Formal Elements Art Therapy Scale (FEATS), found to be valid and reliable. Intended for adults, this assessment relied simply on the formal elements of the drawing along 12 separate scales. In combining scales that evaluated indivdual elements, it demonstrates remarkable accuracy in ascertaining Schizophrenia, Major Depression, Bi-polar: Mania, and Organicity. Since the manual’s publication, there have been several independent research articles that relied on this assessment, and found it limited but effective.
Of course, there are factions that support and reject the use of art-based assessment procedures.
For/Against
Some art therapists subscribe to the value of such assessments, recognizing these instruments as “alluring with their ability to illustrate concrete markers of the inner psyche” (Oster & Gould Crone, 2004, p.1). They consider them less threatening than other tests and easily applied (Anderson, 2001). Gantt acknowledged that assessment and reassessment is the center of good art therapy practice (2004) and Betts (2006) recognized that “standardized assessments are fundamental to all disciplines that deal with intervention and change” (p. 425). The images themselves illustrate change that occurs in therapy.
Nevertheless, projective assessments have become less popular in the psychology field. Groth-Marnat (2003) removed the projective drawings chapter from later editions of the Handbook of Psychological Assessments:
Because of the decreasing use of projective drawings combined with continued research that questions the validity of many, if not most, of the interpretations based on projective drawing data, the chapter on projective drawings included in the previous three editions was omitted to make room… (p. xiv).
Even art therapists have challenged their use. Art therapists have recognized that after 50 years of research on projective drawings, there have only been mixed results (Gantt & Tabone, 1998). Some attest to their lack of scientific rigor; McNiff indicated that ‘interpreting’ pictorial imagery is subjective (1998). Hacking, in her 1999 dissertation, cited many art-based assessments that used unsuitable methods to determine reliability. Several have argued, “art-based instruments are counter-therapeutic and even exploit clients” (Betts, 2006, p. 228). Wanting “magical tools” (Wadeson, 2002) to discover hidden pathologies, the art is reduced to a rigid classification, bypassing the creative expression originally intended. McNiff (1998) even argued that all of this is beside the point: art-based assessments are ineffective, regardless that the variance within all of our clients will yield a variety of imagery, making it futile to find meaning. Rather, we should focus on the art’s ability to transform and overcome any difficult conditions. While these arguments may be rejected or accepted, an art therapist should be careful when using assessments to acknowledge the human behind the image, and be sure they are properly administered with robust research behind them. 
What I think
Whether or not an art therapist plans on using formal assessments in their practice, it behooves the art therapist to learn how to use them. Even if one is not administered, the therapist needs to constantly informally assess clients’ artwork to gauge progress and guide treatment. While one may not ask the client to draw a picture of a person picking an apple from a tree, the therapist can still use knowledge of the formal elements to informally evaluate the client’s treatment evolution.
Likewise, simple assessment procedures work well as clinical directives. For example, many art therapists use the scribble drawing. This simple procedure asks the client to scribble on a sheet of paper and then find images within those lines. Whether they know it or not the clinicians are administering a projective tool; several art therapy assessments rely on this directive as part of their process. It is a true projective technique in that the viewer projects onto an ambiguous form—the tangles lines— an image, which may contain meaning for a person. For this reason, many continue to administer it, as it is useful in its ability to amuse the client while simultaneously providing information.
Granted, I must confess, I believe that the art therapy community needs to do more to scientifically evaluate, standardize, and meticulously review art-based assessments to make them more valid, reliable, and in essence, effective tools. Yet, what we learn from assessing the art, when done correctly, can be quite informative.
Art therapists have drawn upon their skills as evaluators and assessors to provide support and expert testimony in court. Part 2, in which I explain the how and why I used a particular art-based assessment approach for Kevin Ward’s murder trial— and its effectiveness—will be uploaded shortly so stay tuned.
References
Anderson, F. (2001). Needed: A major collaborative effort. Art therapy: Journal of the American Art Therapy Association, 18(2), 74-78.
Betts, D.J. (2006). Art therapy assessments and rating instruments: Do they measure up? The Arts in Psychotherapy, 33(5), 422-434).
Brooke, S.L. (2004). Tools of the Trade. Springfield, IL: Charles C. Thomas, Publishers, Ltd.
Buck, J. N., & Hammer, E. F.(1969). Advances in House-Tree-Person technique: Variation and techniques. Beverly Hills, CA : Western Psychological Services.
Cohen-Liebman, M.S. (2003) Using drawings in forensic investigations of child sexual abuse. In C. Malchiodi’s (Ed.) Handbook of clinical art therapy. New York, NY: Guilford Press.
Gantt, L. (2004). The case for formal art therapy assessments. Art therapy: Journal of the American Art Therapy Association, 21(1), 18-29.
Gantt, L., & Tabone, C. (1998). The formal elements art therapy scale: The rating manual. Morgantown, WV: Gargoyle Press.
Groth-Marnat, G (2003). Handbook of Psychological Assessment (4th ed.). New York, NY: Wiley & Sons, Inc.
Hacking, S. (1999). The psychopathology of everyday art: A quantitative study. Dissertation, University of Keele, Sheffield, IK.
McNiff, S. (1998). Art-based research. Philadelphia, PA: Jessica Kingsley, Publishers.
Mills, A., & Goodwin, R. (1991). An informal survey of assessment use in child art therapy. Art Therapy: Journal of the American Art Therapy Association, 8(2), 10–13.
Naumburg, M. (1980b). Case illustrations: Art therapy with a seventeen year old schizophrenic girl. In E. F. Hammer, (Ed.), The clinical application of projective drawings (pp. 518–561). Springfield, IL: Thomas.
Oster, G.D. & Gould Crone P. (2004). Using drawings in assessment and therapy: A guide for mental health professionals. New York, NY: Brunner/Mazel, Publishers.
Wadeson, H. (2002). The anti-assessment devil’s advocate. Art therapy: Journal of the American Art Therapy Association, 19(4), 168-170.