Revisiting the Bird's Nest Drawing assessment: Toward a global approach

The Bird's Nest Drawing (BND) (Kaiser, 1996. The Arts in Psychotherapy, 23, 333–340) is an art-based technique to assess attachment security. In the past 15 years, several studies have tested the validity of the BND mainly in adult clinical populations. In an attempt to strengthen the validity of the measure in children, the current study examined the associations between the BND and two other frequently used assessment techniques evaluating attachment security: Kaplan and Main's (1986. Instructions for the classification of children's family drawings in terms of representation of attachment. Berkeley, CA: University of California) Family Drawing Coding System and the Attachment Security Questionnaire (Kerns et al., 1996. Developmental Psychology, 32, 457–466) on a sample of elementary-school age children (n = 81) in Israel. BNDs were scored using specific indicators as well as global rating scales. The findings point to associations between the children's self-reported security score, and the BND indicators and global scales. Similarly, scores on both the specific indicators and global scales in family drawings were correlated with the BND global scales. Levels of BND scales varied as a function of the children's attachment orientations derived from their family drawings. Associations were also found between attachment orientations based on family and BND drawings. Results were interpreted as supporting the use of a global approach of rating in addition to a sign-based approach.     

Development of art therapy in South Africa: Dominant narratives and marginalized stories

Abstract

This paper asks whether Western empiricist, psychodynamic approaches may be unsuitable in South Africa, and narrative and social constructionist approaches more relevant. Using narrative theory the paper looks at the dominant story of the Health Professionals Council of South Africa (HPCSA) in its maintenance of power, and explores alternative stories that have become marginalized. The HPCSA's control of art therapy is questioned as yet further colonization in a postcolonial era. It asks how a South African approach to art therapy might be developed, so that art therapists and the HPCSA can develop an interest in, and respect for approaches to the use of artifacts in African healing.     

Accessible image analysis for art assessment

Until now, art therapists relied on manual ratings for instruments such as the Face Stimulus Assessment, which is a series of stimulus drawings used to garner projective information from clients [FSA, Betts, 2003; Hamilton, M. K. (2008). Developing a standardized rating system for the Face Stimulus Assessment (FSA) using nine scales adapted from the Formal Elements Art Therapy Scale (FEATS). Unpublished master's thesis, Avila University, Kansas City, MO]. The current study outlines several image analysis techniques intended to complement interpretive analysis through demonstrating public domain image analysis software (PDIAS) capabilities adapted for measuring formal elements [Gantt, L., & Tabone, C. (1998). The formal elements art therapy scale. Morgantown, WV: Gargoyle Press]. An FSA drawing completed by an individual formally diagnosed with schizophrenia serves as the model. This study also extends manual [Gantt, L., & Tabone, C. (1998). The formal elements art therapy scale. Morgantown, WV: Gargoyle Press] and computer-assisted ratings [Kim, S. I., Bae, J., & Lee, Y. (2007). A computer system to rate the color-related formal elements in art therapy assessments. The Arts in Psychotherapy, 34, 3] through this model by using readily available PDIAS. Case study results indicate that PDIAS is able to analyze accurately formal elements of an FSA drawing. Research implications include improved inter-rater reliability in the adapted Prominence of Color Scale [Gantt, L., & Tabone, C. (1998). The formal elements art therapy scale. Morgantown, WV: Gargoyle Press; Hamilton, M. K. (2008). Developing a standardized rating system for the Face Stimulus Assessment (FSA) using nine scales adapted from the Formal Elements Art Therapy Scale (FEATS). Unpublished master's thesis, Avila University, Kansas City, MO] and the development of highly accurate art therapy assessment rating scales for those without extensive computer analysis backgrounds.     

The Two-Way Mirror in My Therapy Room

Abstract

The mirror of self-reflection allows therapists to monitor our responses to clients' stories. This hallmark of supervision and clinician education is particularly necessary for work with families experiencing illness and loss, experiences that are universally shared by therapists and their clients. This paper exemplifies the integration of a therapist's experience of family illness with ongoing work with a family coping with AIDS.     

Art therapy with refugee children: a qualitative study explored through the lens of art therapists and their experiences

ABSTRACT

This article sets out to explore the use of art therapy with refugee children, from the perspective of art therapists and their experiences. Three semi-structured interviews were conducted to gain insights by capturing experiences and stories. Using thematic analysis, five themes were identified: (1) giving voice; (2) rebuilding trust, opening wounds; (3) sharing stories, healing pain; (4) exploring identity, discovering new-self; and (5) understanding art therapy. Upon reflection, two key aspects of art therapy were established, these were identified as: (1) providing refugee children with a safe space to heal and discover new-self, and (2) giving refugee children a voice to express and share stories. Despite the last of the five themes (understanding art therapy) being established as a factor that limits the use of art therapy, this has created an avenue for further research. From the findings, it was concluded that art therapy can be a useful form of psychotherapy for refugee children. Art therapy can provide these children with a safe space to heal, and give them a voice to be heard.

Plain-language summary

This research explores the use of art therapy with refugee children from the art therapist’s perspective. Three semi-structured interviews were carried out with art therapists who had experience of working with refugee children. Once interviews were collected, these were then analysed using a method of analysis which enables common themes to be found amongst the unique set of experiences and stories collected.

The analysis generated five themes, which were: (1) Giving Voice, (2) Rebuilding Trust, Opening Wounds, (3) Sharing Stories, Healing Pain, (4) Exploring Identity, Discovering New-self, and (5) Understanding Art Therapy. The first four themes suggested that art therapy is a useful form of therapy for refugee children. However, theme 5 (understanding art therapy) could be a limitation for art therapy with this client group, as art therapy is often unknown to them. Taking this research forward, it will be important to explore the use of art therapy with refugee children by carrying out further research with the children themselves.

In conclusion, art therapy can be a useful form of therapy for refugee children. Art therapy provides these children with a safe space to heal, and gives them a voice to be heard.     

Long term individual art psychotherapy. Art for art's sake: The effect of early relational trauma

Abstract

This is a retrospective analysis of individual art therapy lasting six years. Outcome measures, patient ratings and feedback, and the opinion of the therapist indicated improvement that was maintained up to three years follow-up. Process data, consisting of sessional outcome measures, indicated the severity of problems and a wide and dramatic fluctuation on a weekly basis. The examination of art work alongside data from researchers illustrated a series of phases in therapy. This material has been previously published and a summary is presented here. Given the patient's presentation, the long length of therapy was unexpected. In this paper the art therapist offers a formulation of the patient's problems and considers why art therapy was helpful when the patient had failed to improve from previous therapies. Concepts of attachment theory linked to neuroscience are used to enlighten the understanding of this case.     

Correlates of the real relationship in psychotherapy: A study of dyads

Abstract

This study examined several theoretical propositions regarding the role of the real relationship using a sample of 59 psychotherapy dyads. As hypothesized, positive associations were evident between therapist ratings of the real relationship and their ratings of the working alliance and client progress; negative associations were found between therapist ratings of the real relationship and attachment avoidance. For clients, significant and hypothesized associations were found between ratings of the real relationship and secure attachment to therapists as well as their perceptions of therapist empathy. Regression analyses showed that client ratings of the real relationship were significantly associated with their ratings of progress in treatment above and beyond their ratings of the working alliance, therapist empathy, and attachment.     

Learning New Ideas and Practices Together: A Cooperative Inquiry

This article recounts the learning processes and experiences of five family therapist colleagues from the Trondheim Family Therapy Center in Norway in learning to use challenging new conversational practices in their work with couples. These therapists undertook their learning together, adapting John Heron's Co-operative Inquiry to also make sense of the learning process itself. Through reading and viewing videotaped demonstrations, through team discussion and practice, from personal reflections, and through feedback from clients, these therapists learned to use Johnella Bird's relational language-making approach. Data from these different aspects of the learning process were mapped using Adele Clarke's Situational Analysis to depict the complexities of that process. The results are discussed with respect to the challenges faced by therapist teams wanting to learn and use new ideas and practices in a practice setting.     

Primary-school-based art therapy: exploratory study of changes in children’s social,emotional and mental health

ABSTRACT

AIM: This exploratory mixed methods study aimed to inform future research by investigating if teachers and children from one primary school perceived any changes in children’s social, emotional and mental health difficulties following art therapy and if so, what the children perceived as helpful about the sessions. METHODS: The study included 45 children and 10 class teachers within one UK primary school. The researchers analysed routine questionnaires from teachers and a children's evaluation interviews, triangulating these with data from a teacher focus group. RESULTS: The findings show significant and medium effect sizes for positive teacher-rated changes in children’s overall stress, conduct, hyperactivity, and procsocial behaviour and a large effect on perceived impact of children’s difficulties on their lives. Teacher-rated emotional distress and peer problems showed small changes that did not reach statistical significance. The positive changes were corroborated by the teachers' and children's qualitative reports. Aspects of art therapy which children found particularly helpful were; making and thinking about art; expressing, thinking and learning about thoughts and feelings; and sessions being fun. CONCLUSION: The study highlighted perceived positive changes and no negative changes in children’s SEMH difficulties. However, future research is necessary to examine clinical effectiveness.

Plain-language summary

In this article we describe a research study which aimed to explore if teachers and children perceived any changes to children’s social, emotional or mental health difficulties after the children attended art therapy within their primary school. We were also interested in learning from the children if they thought anything in particular had been helpful about their art therapy sessions in order to inform future research and the development of this particular approach to art therapy.

The art therapists asked the class teachers to fill out a Strengths and Difficulties Questionnaires at the beginning and end of art therapy. The class teachers also attended a focus group so we could learn more about their general observations of the children before and after attending art therapy. The art therapists also interviewed the children to learn if they perceived any changes since coming to art therapy and if so, what in particular they thought had helped bring about these changes.

We found that statistical analysis of the questionnaire scores mostly agreed with what the teachers and children said and that there was generally some positive change to the social, emotional and mental health difficulties the children had been experiencing. The teachers also let us know that some of the children still had residual problems. The children emphasised that making and thinking about art along with expressing, thinking and learning about thoughts and feelings had been particularly helpful. It was also important to the children that the sessions were fun.

In conclusion, the teachers and children in this primary school perceived art therapy as helpful to the children and that it merits further research in order to develop the approach used by the art therapists and to see if it is effective in larger research studies including more children, schools and art therapists.     

Rater Characteristics Influencing Rating on the Checklist of Psychotherapy Transactions-Revised

Using Kiesler and Goldston's (1988) procedures for rating interpersonal therapy behavior on the Checklist of Psychotherapy Transactions-Revised (CLOPT-R), 25 untrained, clinically inexperienced raters judged therapist and client interpersonal behavior in 127 sessions of brief psychotherapy. Rater bias was examined by relating several individual difference variables (gender, age, grade-point average, perceived attitude similarity between the rater and ratee, scores on the Checklist of Interpersonal Transactions scales of Control and Affiliation, and scores on the California Personality Inventory scales of Dominance and Submission) to ratings of therapists and clients on the CLOPT-R scales of Control and Affiliation. Results indicated that (a) individual difference variables between raters predicted CLOPT-R scores, particularly on the Affiliation axis of the CLOPT-R for both therapist and client ratings; and (b) mean differences existed between the raters on their CLOPT-R ratings, even after adjustment for the individual differences variables. The importance of personality variables as sources of bias, the vulnerability of the Affiliation axis to rater bias, and recommendations for controlling the effects of rater variables are suggested for further study.     

Volunteer client attachment moderates the relationship between trainee therapist attachment and therapist interventions

Abstract

This study explored the association between attachment security of therapists (alone and in interaction with clients' attachment) and therapist interventions in early sessions of short-term psychotherapy. Trainee therapists and volunteer clients (N=24) in short-term therapy completed the Experiences in Close Relationship Scale (Brennan, Clark, & Shaver, 1998) as a measure of adult romantic attachment orientations. Therapist interventions were identified and related to client and therapist attachment orientation. Results indicated that in early therapy sessions client attachment moderated the relationship between therapist attachment and therapist interventions. Specifically, avoidantly attached therapists intervened with more directive interventions when clients were high in attachment avoidance.     

Drawing on drawings

Abstract

Therapeutic experience shows that drawing can be used as an aid to communication in aphasia therapy. Not only can drawings be a means of expression for the patient, they also serve as a communicative aid for the respective partner who can draw in order to help the aphasic understand him. Experience also shows, however, that integration of ‘drawing’ into an aphasic's means of expression and communication can rarely be achieved without problems. It is therefore necessary to analyse these problems and to look for practical solutions. Lyon's essay seems to us to be an attempt to take another step in this direction.     

Online Training of Community Therapists in Observational Coding of Family Therapy Techniques: Reliability and Accuracy

A foundational strategy to promote implementation of evidence-based interventions (EBIs) is providing EBI training to therapists. This study tested an online training system in which therapists practiced observational coding of mock video vignettes demonstrating family therapy techniques for adolescent behavior problems. The study compared therapists ratings to gold-standard scores to measure therapist reliability (consistency across vignettes) and accuracy (approximation to gold scores); tested whether reliability and accuracy improved during training; and tested therapist-level predictors of overall accuracy and change in accuracy over time. Participants were 48 therapists working in nine community behavioral health clinics. The 32-exercise training course provided online instruction (about 15 min/week) in 13 core family therapy techniques representing three modules: Family Engagement, Relational Orientation, Interactional Change. Therapist reliability in rating technique presence (i.e., technique recognition) remained moderate across training; reliability in rating extensiveness of technique delivery (i.e., technique judgment) improved sharply over time, from poor to good. Whereas therapists on average overestimated extensiveness for almost every technique, their tendency to give low-accuracy scores decreased. Therapist accuracy improved significantly over time only for Interactional Change techniques. Baseline digital literacy and submission of self-report checklists on use of the techniques in their own sessions predicted coding accuracy. Training therapists to be more reliable and accurate coders of EBI techniques can potentially yield benefits in increased EBI self-report acumen and EBI use in daily practice. However, training effects may need to improve from those reported here to avail meaningful impact on EBI implementation.

Trial Registration: The parent clinical trial is registered at www.ClinicalTrials.gov, ID: NCT03342872 (registration date: 11.10.17).

     

The effects of an auditory subliminal message upon the production of images and dreams

The purpose of this research was to investigate what effect an auditory subliminal message, produced by speeding up the rate at which it was recorded, would have upon the imagery and dreams of a group of normal subjects. The auditory subliminal message was produced by speeding up a message that was sung until it could not be consciously understood. This message was mixed with a normal music recording and played to nine subjects in the experimental group. Nine subjects in the control group heard the normal music recording without the subliminal message. Both groups were asked to produce a pretest drawing before the tapes were played, an imagery drawing immediately after the tapes were played, and a dream drawing of any dreams they might have that night. A statistical analysis was performed from data collected on blind ratings given to all the drawings by two art therapists. The results indicated a significant difference between the dream drawings and the imagery drawings of the experimental group and the control group. When the drawings were examined, the effect of the subliminal message could be seen. Based on the statistical data and certain drawings collected in this study, it would appear that the auditory subliminal message did have an effect upon the imagery and dreams of the subjects in the experimental group. The results of this study appear to indicate that the unconscious/preconscious mind is able to perceive a recorded verbal message that cannot be consciously understood at the high rate of speed at which it was recorded.     

Visuoconstructive performance and regional cerebral glucose metabolism in alzheimer's disease

Abstract

The drawings of Alzheimer's disease (AD) patients and elderly control subjects were rated on a number of specific performance scales, such as attention to configuration, attention to detail, and stimulus boundedness. AD patients showed significantly poorer performance than controls on most drawing scales, and the drawing measures were differentially affected by disease severity. Regional cerebral glucose metabolism (rCMRglc) was assessed via positron emission tomography (PET, with ¹⁸FDG) in a subgroup of the AD patients. Partial correlations of rCMRglc with drawing measures (age, sex, and education served as control variables) were conducted. Five out of eight of the drawing measures were significantly correlated (p < .005) with rCMRglc in occipital and/or temporal-parietal regions, for both left and right hemispheres. Only one of the eight drawing measures, attention to detail, was significantly correlated with rCMRglc in both frontal and posterior regions of interest, again for both hemispheres. Overall dementia severity showed no significant correlations with rCMRglc in any of the regions. These findings are suggestive of a posterior-anterior differentiation, but no left-right hemisphere differentiation, in the relationship between drawing performance and cerebral metabolism in AD, which cannot be accounted for by overall dementia severity. Differences between the drawing performance of AD and unilateral brain damaged patients are discussed, and further applications of the rating scales (provided in the Appendix) are suggested.     

Material interaction in art therapy assessment

Diverse approaches to art therapy assessment agree that art materials should play a central role. However, relatively little research is done on the role of different art materials. This article describes the results of a qualitative study on the use of art materials by art therapists in art therapy assessments of adults with mental health problems in The Netherlands.Nine qualitative in-depth interviews were analyzed using Grounded Theory, which produced a theoretical framework of the use of art materials in art therapy assessments. This study showed that the way in which a client interacts with specific properties of art materials (i.e., the material interaction) reflects aspects of the client's mental health. Methodical application of specific properties of art materials enables art therapists to observe the client's material interaction and gain insight into the client's mental health. This observation helps art therapists with decisions to offer further treatment, formulate treatment goals and choose appropriate art interventions. Material interaction links art material properties to art making, art product and mental health, and it may connect the diverse approaches to art therapy assessment.     

The Social Function of Autobiographical Stories in the Personal and Virtual World: An Initial Investigation

Receiving another's autobiographical story may serve to elicit feelings of liking and empathy for the story sharer. Research has mostly examined social functions of autobiographical stories for in‐person communications. The current experiment (N = 60) examined whether levels of liking, closeness, and empathy felt for a stranger (female confederate) after receiving her story depended on if (a) the story was received in‐person or through instant message (IM), and (b) the story was positive or negative. Liking and having empathy for the stranger was higher in the in‐person conditions compared to IM conditions. This effect was mediated by how engaged participants were with the story. Participants liked the stranger more after receiving the positive autobiographical story, but they felt more empathy toward her after the negative autobiographical story. The discussion considers parameters of the communication platform and people's perceptions of stories as explanations for the results. Limitations are considered.