The psychopathology of everyday art: a quantitative study
by
Suzanne Hacking November 1999
A dissertation submitted in fulfilment for the degree of
Doctor of Philosophy Department of Psychiatry School of Postgraduate Medicine University of Keele
i
ii
Abstract Analysis of psychiatric artwork has been largely based on its content or verbal reports of its meaning. This thesis presents an alternative approach to psychopathology of paintings, in the development of a new instrument, the Descriptive Assessment for Psychiatric Artwork (DAPA).
This thesis reports the
steps taken to validate the DAPA: through examination of the literature, initial study, reliability study and the main comparison of 86 patients with disabling psychiatric disorder and controls. The surface distribution of 12 operationally defined characteristics of paintings was recorded: 10 formal (red, yellow, green, brown, blue, black, intensity, painted and drawn line, and space covered by media) and 2 content characteristics (subjective emotional tone and dominant form) using a grid of twenty rectangles placed over the picture. These scores were collapsed to produce average scores for each painting. All paintings within subject were also collapsed to produce a subject profile of 12 continuous scales. Reliability assessment between six independent raters and the author were excellent. Intraclass correlations were 0.86-0.99 and Cronbach's alpha 0.91-0.99. Design: Subjects were classified using ICD-10 diagnostic classifications for research (depression, schizophrenia, personality disorder, substance abuse). 1-way ANOVAs were performed with post-hoc comparisons using the Duncan procedure. Discriminant analysis predicted patient/control classification and controlled interactions between variables. Results: ANOVA showed highly significant differences (p.60 >.60 >.60 NS NS >.60
NS NS NS NS psychotic depressives195 ** patient groups *196 neurotics * NS NS
dominant hue (69) (f) prominence (21) light/dark tone (69) brighter tone (69) brightness (69) brightness (38) dominant tone (69)
4 Acc. 3 .90 4 Acc. 4 Acc. 4 Acc. 2 >.60 4 Acc.
consistency of colour (38) (f) (69) 1/6+ 1 colour (56) masses 1 colour (38) decoration or outline in colour (38)
2 NS 4 NS 4 Acc. 2 >.60 2 >.60
NS NS NS
NS
3
NS
NS
colour fit (21) (c) (s) idiosyncratic colour (48) (49) colour harmony (69) colour relations (3)
NS neurotics *
.86
97 77 4 Acc. 3 .83
NS pers. disorder; dep. less (nf)
1-
reliability tests: 1 = % agreement; 2 = product moment correlation; 3 = correlation coefficient; 4 = association test Chi sq. or T; 5 = Kappa; 6 = Anova. ** p.60 >.60 >.60 .915 .84 .56
3 .92 2 >.60
organics ** NS
96
R.brain-d from L.brain-d197 Acute/Chronic schizophrenia*; grades in mental-ret'd. schiz.**; non-ret'd/retarded in schiz's.**
depressed from mania+organic** NS
100 77 96 4 good
NS
96
NS NS NS
1-
reliability tests: 1 = % agreement; 2 = product moment correlation; 3 = correlation coefficient; 4 = association test Chi sq. or T; 5 = Kappa; 6 = Anova. ** p.60 3 NS 90 5 .915 90 5 .915
NS nf nf
* - reliability tests: 1 = % agreement; 2 = product moment correlation; 3 = correlation coefficient; 4 = association test Chi sq. or T; 5 = Kappa; 6 = Anova. ** p.60 4 2 90 5 2 2 2 100 4 96 77 90 5
1-
reliability tests: 1 = % agreement; 2 = product moment correlation; 3 = correlation coefficient; 4 = association test Chi sq. or T; 5 = Kappa; 6 = Anova. ** p.60 2 >.60 4 Acc. 4 v.good
NS
NS NS patients more **
NS NS
reliability tests: 1 = % agreement; 2 = product moment correlation; 3 = correlation coefficient; 4 = association test Chi sq. or T; 5 = Kappa; 6 = Anova.
154
** p 1. cathartic/reflective; 2. communication;
3.
healing/symptom
relief;
developmental/social; 5. relationship
Std Res 1 2 3 4 5 Row Total ______________________________________________________ FORM OF 1 _ 9 _ 8 _ 4 _ 2 _ 4 _ 27 EXPRESSION _ 33.3% _ 29.6% _ 14.8% _ 7.4% _ 14.8% _ 45.8% _ 56.3% _ 40.0% _ 40.0% _ 25.0% _ 80.0% _ content _ .6 _ -.4 _ -.3 _ -.9 _ 1.1 _ ______________________________________________ 2 _ 0 _ 1 _ 0 _ 0 _ 0 _ 1 style _ .0% _ 100.0% _ .0% _ .0% _ .0% _ 1.7% _ .0% _ 5.0% _ .0% _ .0% _ .0% _ _ -.5 _ 1.1 _ -.4 _ -.4 _ -.3 _ ______________________________________________ 3 _ 1 _ 3 _ 1 _ 0 _ 0 _ 5 content _ 20.0% _ 60.0% _ 20.0% _ .0% _ .0% _ 8.5% and style _ 6.3% _ 15.0% _ 10.0% _ .0% _ .0% _ _ -.3 _ 1.0 _ .2 _ -.8 _ -.7 _ ______________________________________________ 4 _ 4 _ 4 _ 3 _ 3 _ 1 _ 15 behaviour _ 26.7% _ 26.7% _ 20.0% _ 20.0% _ 6.7% _ 25.4% _ 25.0% _ 20.0% _ 30.0% _ 37.5% _ 20.0% _ _ -.0 _ -.5 _ .3 _ .7 _ -.2 _ ______________________________________________ 5 _ 2 _ 3 _ 2 _ 2 _ 0 _ 9 verbal _ 22.2% _ 33.3% _ 22.2% _ 22.2% _ .0% _ 15.3% _ 12.5% _ 15.0% _ 20.0% _ 25.0% _ .0% _ _ -.3 _ -.0 _ .4 _ .7 _ -.9 _ ______________________________________________ 6 _ 0 _ 1 _ 0 _ 1 _ 0 _ 2 _ .0% _ 50.0% _ .0% _ 50.0% _ .0% _ 3.4% other _ .0% _ 5.0% _ .0% _ 12.5% _ .0% _ _ -.7 _ .4 _ -.6 _ 1.4 _ -.4 _ ______________________________________________ Column 16 20 10 8 5 59 Total 27.1% 33.9% 16.9% 13.6% 8.5% 100.0%
Chi-Square D.F. Significance 12.29713 20 .9055 Number of Missing Observations =
Min E.F. .085 8
365
Cells with E.F.< 5 27 OF 30 ( 90.0%)
4.
Reliability Study Chapter 4 - Methods. Tables and Plots 1-15. Tables 1-15 by variable showing: column 1, Raw data scores for each variable each rater( r1-7) over 7 pictures in sequence. Column 2, scoring differences between 6 raters and author on 7 rated pictures. Column 3, mean differences for raters 1-6 and standard difference to rater 7 (author). Plots 1-15 by variable showing individual rater differences around average rating of 6 independent raters and author.
366
Tables showing mean differences between 6 raters and author on 7 rated pictures. Raters R1-7 score for RED, pics 1-7 - R7 = author*
agreement exact (x); ±1 point (1); ±2 points (2)
R1 R2 R3 R4 R5 R6 R7* 0 0 0 6 6 6 5 9 9 10 15 12 5 7 5 0 0 0 11 11 11
0 0 6 6 8 5 12 8 5 5 5 0 12 11
0 6 6 11 7 0 9
0 6 9 14 6 0 10
Total Total % 1.
x 1 2 6 6 2 1 0 1 2 0 6 5 5 1 ---------24 9 2 57 21 5
mean for raters 1-6 and difference to R7 ratings mean R1-6 .00 6.00 7.00 11.33 5.67 .83 10.83
diff. R7 .00 .00 2.00 2.67 .33 -.83 -.83
Difference in mean interrater score/author score for RED (RATS - A) plotted against average (RATS + A)/2.
________________________________________ 4_ _ _ _ _ 1 _ _ 1 _ _ _ 0_1__________2___________________________ _ 1 1 _ _ _ _ _ _ _ -4_ _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
d i f f e r e n c e R-A
Raters R1-7 score for YELLOW pics 1-7 - R7 = author*
R1 R2 R3 5 4 6
5 5 6 16 14 13 13 0 0 8 10
R4 R5 R6 R7*
8 5 5 3 5 5 6 5 6 13 16 16 10 13 13 0 0 0 10 11 8
5 3 6 17 13 0 9
Total Total %
fig 2.
d i f f e r e n c e R-A
5 5 6 16 13 0 12
agreement exact (x); ±1 point (1); ±2 points (2) x 1 2 5 4 2 5 1 3 1 1 5 6 0 1 2 ----------28 5 3 67 12 7
mean for raters 1-6 and difference to R7 ratings. mean R1-6 5.50 4.17 5.83 15.33 12.50 .00 9.33
diff. R7 -.50 .83 .17 .67 .50 .00 2.67
Difference in mean interrater score/author score for YELLOW (RATS - A) plotted against average (RATS + A)/2.
________________________________________ 4_ _ _ _ _ 1 _ _ _ _ 1 1 1 _ 0_1__________1___________________________ _ 1 _ _ _ _ _ _ _ -4_ _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
367
Raters R1-7 score for ORANGE, pics 1-7 - R7 = author*
R1 R2
R3
R4 R5 R6 R7*
0 0
0 0 0 0 0 0 19 18 18 19 0 0 0 0 0 0 0 0 0 0 0 0 6 7 8 0
0 0 19 0 0 0 3
0 0 18 0 0 0 0
0 0 19 0 0 0 3
Total Total %
fig 3.
6 6 3 3 6 6 6 1 ----------34 3 81 7
mean R1-6 .00 .00 18.50 .00 .00 .00 4.00
diff. R7 .00 .00 .50 .00 .00 .00 -1.00
________________________________________ 4_ _ _ _ _ _ _ _ _ 1 _ 0_5______________________________________ _ 1 _ _ _ _ _ _ _ -4_ _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
R-A
Raters R1-7 score for PURPLE, pics 1-7 - R7 = author*
R1 R2 0 0 17 15 0 5 0
0 0 14 12 0 5 3
R3
R4 R5 R6 R7*
0 0 11 12 0 5 0
0 1 14 15 0 3 0
0 0 0 0 0 0 17 9 13 12 11 11 0 0 0 5 5 5 1 0 0 Total Total %
fig 4.
R-A
x 1 2
mean for raters 1-6 and difference to R7 ratings.
Difference in mean interrater score/author score for ORANGE (RATS - A) plotted against average (RATS + A)/2.
d i f f e r e n c e
d i f f e r e n c e
agreement exact (x); ±1 point (1); ±2 points (2)
agreement exact (x); ±1 point (1); ±2 points (2) x 1 2 6 5 1 0 2 1 1 3 6 5 0 1 4 1 ----------27 7 2 64 17 5
mean for raters 1-6 and difference to R7 ratings. mean R1-6 .00 .17 13.67 12.83 .00 4.67 .67
diff. R7 .00 -.17 -.67 -1.83 .00 .33 -.67
Difference in mean interrater score/author score for PURPLE (RATS - A) plotted against average (RATS + A)/2.
________________________________________ 4_ _ _ _ _ _ _ _ _ _ 0_3________1_____________________________ _ 1 1 _ _ 1 _ _ _ _ _ -4_ _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
368
Raters R1-7 score for GREEN pics 1-7 - R7 = author*
R1 R2 R3 R4 R5 R6 R7* 5 12 3 0 13 10 5
5 4 5 5 5 4 14 13 11 13 13 13 3 3 2 3 3 3 0 0 0 0 0 0 11 11 7 9 9 7 10 10 10 10 10 10 5 3 4 4 5 4
agreement exact (x); ±1 point (1); ±2 points (2) x 1 2 1 5 3 2 1 5 1 6 1 0 2 6 2 4 ----------24 12 3 57 29 7
mean for raters 1-6 and difference to R7 ratings. mean R1-6 4.83 12.67 2.83 .00 10.00 10.00 4.33
diff. R7 -.83 .33 .17 .00 -3.00 .00 -.33
Total Total %
fig 5.
Difference in mean interrater score/author score for GREEN (RATS - A) plotted against average (RATS + A)/2.
________________________________________ 4_ _ _ _ _ _ _ _ _ _ 0_1____1__1_________1____1_______________ _ 1 _ _ _ _ _ _ 1 _ -4_ _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
d i f f e r e n c e R-A
Raters R1-7 score for BLUE, pics 1-7 - R7 = author*
R1 R2 R3 R4 R5 R6
agreement exact (x); ±1 point (1); ±2 points (2) x 1 2
R7* 8
8
8
8
8
8
8 16 16 14 13 15 15 13 0
0
0
0
0
0
0 11 14
9 11 14 13
9 4
5
4
4
5
4
7
7
8
7 13 12
4
6 1 1 2 6 1 0 2 4 2 3 1 0 0 4 ----------21 4 8 50 10 19
mean for raters 1-6 and difference to R7 ratings. mean R1-6 8.00 14.83 .00 12.00 4.33 9.00 18.33
diff. R7 .00 -1.83 .00 -3.00 -.33 -2.00 -2.33
7 19 18 19 18 18
18
16 Total Total %
fig 6.
d i f f e r e n c e
Difference in mean interrater score/author score for BLUE (RATS - A) plotted against average (RATS + A)/2.
________________________________________ 4_ _ _ _ _ _ _ _ _ _ 0_1_______1______1_______________________ _ _ _ 1 1 _ _ 1 _ _ 1 _
369
-4_
_ ________________________________________ 0 5 10 15 20 Average 6 rats + author
R-A
Raters R1-7 score for BROWN, pics 1-7 - R7 = author*
R1 R2 R3 R4 R5 R6 R7* 0 0 0 0 0 0 0 1 2 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 8 7 12 0 4 2 0 3 0 6 0 10 10 9 10 4 4 10 14 10 12 13 12 16 12 Total Total %
fig 7.
6 4 1 1 6 2 2 0 1 3 1 2 1 2 ----------25 3 4 60 7 10
mean R1-6 .00 .50 .00 5.83 2.50 7.83 12.83
diff. R7 .00 -.50 .00 -5.83 -2.50 2.17 -.83
________________________________________ 4_ _ _ _ _ 1 _ _ _ _ _ 0_2______________________________________ _1 1 _ _ _ _ 1 _ _ _ -4_ _ _ _ _ 1 _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
R-A
Raters R1-7 score for WHITE, pics 1-7 – R7 = author*
R1 R2 R3 R4 R5 R6 R7* 0 0 6 0 0 0 0
0 0 7 0 0 0 0
0 0 0 0 0 0 0
0 0 7 0 0 0 0
0 0 7 0 0 0 0
0 0 4 0 0 0 0
Total Total %
d i f f e r e n
x 1 2
mean for raters 1-6 and difference to R7 ratings.
Difference in mean interrater score/author score for BROWN (RATS - A) plotted against average (RATS + A)/2.
d i f f e r e n c e
fig 8.
agreement exact (x); ±1 point (1); ±2 points (2)
0 0 7 0 0 0 0
agreement exact (x); ±1 point (1); ±2 points (2) x 1 2 6 6 3 1 6 6 6 6 --------39 1 93 2
mean for raters 1-6 and difference to R7 ratings. mean R1-6 .00 .00 5.17 .00 .00 .00 .00
diff. R7 .00 .00 1.83 .00 .00 .00 .00
Difference in mean interrater score/author score for WHITE (RATS - A) plotted against average (RATS + A)/2.
________________________________________ 4_ _ _ _ _ _ _ 1 _ _ _ 0_6______________________________________ _ _ _ _
370
c e
_ _ _ _ -4_ _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
R-A
Raters R1-7 score for BLACK, pics 1-7 - R7 = author*
R1 R2
R3
R4 R5 R6 R7*
12 14 8 19 19 1 12
12 14 6 18 18 1 11
12 14 9 20 18 0 12
12 15 8 20 17 1 10
9 12 12 14 14 14 8 8 9 18 19 20 19 18 18 0 0 0 11 11 10 Total Total %
fig 9.
x 1 2 5 5 1 1 4 2 2 2 3 3 3 3 1 3 2 ----------20 16 4 48 38 10
mean for raters 1-6 and difference to R7 ratings. mean R1-6 11.50 14.17 7.83 19.00 18.17 .50 11.17
diff. R7 .50 -.17 1.17 1.00 -.17 -.50 -1.17
Difference in mean interrater score/author score for BLACK (RATS - A) plotted against average (RATS + A)/2.
________________________________________ 4_ _ _ _ _ _ _ _ _ 1 1 1 _ 0___________________________1______1_____ _1 1 _ _ _ _ _ _ _ -4_ _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
d i f f e r e n c e R-A
Raters R1-7 score for INTENSITY, pics 1-7 - R7 = author*
R1 R2 R3 R4 R5 R6 R7* 11 16 20 19 14 9 20
14 17 15 13 12 11 18
14 20 20 17 13 10 20
17 18 20 15 15 10 19
19 14 19 19 15 18 18 20 20 19 14 16 15 12 15 9 8 10 18 20 18 Total Total %
fig 10.
d i f f e r e n c
agreement exact (x); ±1 point (1); ±2 points (2)
agreement exact (x); ±1 point (1); ±2 points (2) x 1 2 1 0 1 1 2 2 4 0 1 0 2 1 2 1 1 2 3 1 2 1 3 ----------12 9 10 29 21 24
mean for raters 1-6 and difference to R7 ratings. mean R1-6 14.83 17.44 18.83 16.22 13.44 9.56 19.22
diff. R7 3.83 .89 1.17 -.22 1.89 .44 -.89
Difference in mean interrater score/author score for INTENSITY (RATS - A) plotted against average (RATS + A)/2.
________________________________________ 4_ 1 _ _ _ _ _ _ 1 _ _ 1 1 1 _ 0______________________________1_________ _ 1 _ _ _ _ _
371
e R-A
_ _ -4_ _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
372
Raters R1-7 score for PAINTED LINE, pics 1-7 R7 = author* R1 R2 R3 R4 R5 R6 R 7* 8
12
4
6
6
6
14
14
4
8
0
0
4
4
fig 11.
9
7
7
9
11 15 4 6 7 6 4 5 4 7 11 7 15 9 13 8 12 11 11 12 0 0 0 0 0 3 5 6 4 4 Total Total % 6
x 1 2 0 1 2 0 3 0 3 1 0 2 2 1 2 6 3 2 1 ----------10 13 6 24 31 14
mean for raters 1-6 and difference to R7 ratings. mean R1-6 8.78 6.83 5.22 11.72 8.94 .00 4.33
diff. R7 2.56 .17 1.78 1.61 2.72 .00 -.33
Difference in mean interrater score/author score for PAINTED LINE (RATS - A) plotted against average (RATS + A)/2.
________________________________________ 4_ _ _ _ _ 11 _ _ 1 1 _ _ _ 0_1_______1____1_________________________ _ _ _ _ _ _ _ _ -4_ _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
d i f f e r e n c e R-A
Raters R1-7 score for DRAWN LINE, pics 1-7 - R7 = author*
R1 R2 R3 R4 R5 R6 R7* 0 0 0 0 0 5 1
0 0 0 0 0 4 0
0 0 0 0 0 0 0 0 0 0 4 10 0 0
0 0 0 0 0 6 0
0 0 0 0 0 5 0
Total Total %
fig 12.
d i f f e r e n
agreement exact (x); ±1 point (1); ±2 points (2)
0 0 0 0 0 5 0
agreement exact (x); ±1 point (1); ±2 points (2) x 1 2 6 6 6 6 6 2 3 5 1 ------37 4 88 10
mean for raters 1-6 and difference to R7 ratings. mean R1-6 .00 .00 .00 .00 .00 5.61 .17
diff. R7 .00 .00 .00 .00 .00 -.28 -.17
Difference in mean interrater score/author score for DRAWN LINE (RATS - A) plotted against average (RATS + A)/2.
________________________________________ 4_ _ _ _ _ _ _ _ _ _ 0_6_________1____________________________ _ _ _ _
373
c e
_ _ _ _ -4_ _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
R-A
Raters R1-7 score for SPACE, pics 1-7 - R7 = author*
R1 R2 R3
R4
15 10 4 6 4 16 4
10 14 13 5 10 9 4 4 4 7 6 6 4 4 4 15 14 16 4 4 4
14 9 4 7 4 15 4
15 9 4 8 4 15 4
agreement exact (x); ±1 point (1); ±2 points (2)
R5 R6 R7* 12 8 4 6 4 14 4
Total Total %
fig 13.
Raters R1-7 score for EMOTIONAL TONE, pics 1-7 R7 = author* R1 R2 11 16 18 10 14 14 14
R3 R4 18 19 20 11 10 15 16
14 18 17 9 8 16 13
R5
R6 R7*
12 16 19 7 9 17 8
13 16 16 9 8 16 13
15 15 20 7 8 18 13
Total Total %
d i f f e r e n c e
diff. R7 -1.77 -.87 .00 -1.00 .00 -.93 .00
________________________________________ 4_ _ _ _ _ _ _ _ _ _ 0________3_______________________________ _ 1 1 1 _ _ 1 _ _ _ _ _ -4_ _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
R-A
fig 14.
0 1 3 0 3 2 6 3 2 1 6 1 3 2 6 ----------22 9 8 52 21 19
mean R1-6 13.37 8.67 4.00 6.80 4.00 15.13 4.00
Difference in mean interrater score/author score for SPACE (RATS - A) plotted against average (RATS + A)/2.
d i f f e r e n c e
11 15 19 7 10 14 15
x 1 2
mean for raters 1-6 and difference to R7 ratings.
Agreement exact (x); ±1 point (1); ±2 points (2) x 1 2 0 1 1 1 3 1 2 1 2 0 2 2 1 2 0 1 2 2 1 1 ----------8 9 9 19 21 21
mean for raters 1-6 and difference to R7 ratings. mean R1-6 13.28 16.56 18.17 8.83 9.83 15.22 13.28
diff. R7 1.39 -1.22 1.83 -2.17 -1.83 3.11 .06
Difference in mean interrater score/author score for EMOTIONAL TONE (RATS - A) plotted against average (RATS + A)/2.
________________________________________ 4_ _ _ 1 _ _ _ _ 1 1 _ _ _ 0_________________________1______________ _ _ _ 1 1 _ _ 1 _ _ _
374
-4_
R-A
_ ________________________________________ 0 5 10 15 20 Average 6 rats + author
Raters R1-7 score for FORM, pics 1-7 - R7 = author*
R1 R2 R3
R4 R5 R6 R7*
0 0 0 0 7 8 8 7 5 7 5 7 0 0 0 0 8 0 0 0 16 16 16 16 3 3 3 3
0 7 7 0 0 16 3
3 7 5 0 0 16 3
0 8 5 0 0 16 3
Total Total %
fig 15.
d i f f e r e n c e R-A
agreement exact (x); ±1 point (1); ±2 points (2) x 1 2 5 2 4 3 0 3 6 6 6 6 -----------34 4 3 81 10 7
mean for raters 1-6 and difference to R7 ratings. mean R1-6 .50 7.33 6.00 .00 1.33 16.00 3.00
diff. R7 -.50 .67 -1.00 .00 -1.33 .00 .00
Difference in mean interrater score/author score for DOMINANT FORM (RATS - A) plotted against average (RATS + A)/2.
________________________________________ 4_ _ _ _ _ _ _ _ _ 1 _ 0_1____1_______________________1_________ _1 1 _ _ 1 _ _ _ _ _ -4_ _ ________________________________________ 0 5 10 15 20 Average 6 rats + author
375
Appendix 3 Table of Authorities 1. 2. 3. 4. 5. 6. 7. 8.
Impressionistic/Theoretical Studies Case Studies of Artists Case Studies - change of theme or content elements Case Studies - change of objective or formal elements Case Studies - change of behaviour Case Studies - therapeutic benefit - relationship Case Studies - therapeutic benefit - expression of feelings Controlled Studies
376
Table of Authorities Impressionistic studies Abraham, A. (1990), The projection of the inner group in drawing, Group Analysis, Dec., V.23(4):391401. Adler, R.F., Fisher, P. (1984), My self ... through music, movement and art, Arts in Psychotherapy, Fall, V.11(3):203-8. Adelman, E., Castricone, L. (1986), An expressive arts model for substance abuse group training and treatment, Arts in Psychotherapy, Spr., V.13(1):53-9. Albert-Puleo, N. (1980), Modern psychoanalytic art therapy and its application to drug abuse, Arts in Psychotherapy, V.7(1):43-52. Albert-Puleo, N., Osha, V. (1976), Art therapy as an alcoholism treatment tool, Alcohol Health and Research World, Win., V.1[2]28-31. Allan, J., Clark, M. (1984), Directed art counselling, Elementary School Guidance and Counselling, Dec., V.19(2):116-24. Allen, P.B. (1983), Group art therapy in short-term hospital settings, Am. J. Art Therapy, Apr., V.22(3):93-5. Allen, P.B. (1985), Integrating art therapy into an alcoholism treatment program, Am. J. Art Therapy, Aug., V.24(1):10-12. Amos, S.P. (1982), The diagnostic, prognostic, and therapeutic implications of schizophrenic art, Arts in Psychotherapy, Sum., V.9(2):131-143. Arrington, D. (1991), Thinking systems-seeing systems: an integrative model for systematically oriented art therapy, Arts in Psychotherapy, V.18(3):201-11. Atlas, J.A., Smith, P., Sessoms, L. (1992), Art and poetry in brief therapy of hospitalized adolescents, Arts in Psychotherapy, V.19(4):279-83. Assael, M., Popovici-Wacks, M. (1989), Artistic expression in spontaneous paintings of depressed patients, Israel J. of Psychiatry and Related Sciences, V.26(4):223-243. Assael, M. (1978), Spontaneous painting: means of communication, Confinia Psychiatrica, V.21(1-3):1024. Avstreih, A.K., Brown, J.J. (1979), Some aspects of movement and art therapy as related to the analytic situation, Psychoanalytic R eview, V.66(1):49-68. Ba, G. (1988), Strategies of rehabilitation in the day hospital, Psychotherapy and Psychosomatics, V.50(3):151-6. Bender, L., Wolfson, W.Q. (1983), Boats in the art and fantasy of children, Am. J. Art Therapy, Jul., V.22(4):125-8. Benveniste, D. (1985), Picture-time: a nondirective approach to art psychotherapy, Arts in Psychotherapy, Fall, V.12(3):171-180. Betensky, M. (1978), Phenomenology of self-expression in theory and practice, Confinia Psychiatrica, V.21(1-3):31-36. Betensky, M. (1973), Patterns of visual expression in art psychotherapy, Art Psychotherapy, Fall, V.1(2):121-9. Billig, O. (1973), The schizophrenic "artist's" expression of movement, Confinia Psychiatrica, V.16(1):127. Bishop, J. (1978), Creativity, art and play therapy, Canadian Counsellor, Jan., V.12(2):138-146. Bowers, J.J. (1992), Therapy through art. Facilitating treatment of sexual abuse, J. of Psychosocial Nursing and Mental Health Services, Jun., V.30(6):15-24. Breslow, D.M. (1993), Creative arts for hospitals: the UCLA experiment, Patient Education and Counselling, Jun., V.21(1-2):101-110. Brown, R.J. (1993), The fishing image: a preliminary study, Arts in Psychotherapy, V.20(2):167-171. Buchalter-Katz, S. (1985), Observations concerning the art productions of depressed patients in a shortterm psychiatric facility, Arts in Psychotherapy, V.12:35-8. Buck, L.A., Kardeman, E., Goldstein, F. (1985), Artistic talent in "autistic" adolescents and young adults, Empirical Studies of the Arts, V.3(1):81-104. Buckland, A., Bennett, D.L. (1995), Youth arts in hospital: engaging creativity in care, International Journal of Adolescent Medicine and Health, Jan-Mar., V.8(1):17-27. Burgess, A.W., Hartman, C.R., Grant, C.A., Clover, C.L., Snyder, W., King, L.A. (1991), Drawing a
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a psychotic patient with religious and sexual conflicts, Am. J. Art Therapy, Apr., V.17(3):85-90. Case studies - change of sign theme - objective measure 23 Aldridge, D., Brandt, G., Wohler, D. (1990), Toward a common language among the creative arts therapies, Arts in Psychotherapy, Fall, V.17(3):189-195. 20 Cagnoletta, M.D. (1983), Art work as a representation of object relations in the therapeutic practice, Pratt Institute Creative Arts Therapy Review, V.4:46-52. 26 Cronin, S.M., Werblowsky, J.H. (1979), Early signs of organicity in art work, Art Psychotherapy, V.6(2):103-8. 19 Fink, P.J. (1973), Art as a reflection of mental status, Art Psychotherapy, Apr., V.1(1):17-30. 27 Gerevich, J., Ungvari, G., Karczag, I. (1979), Further data on the diagnostic value of spontaneous drawing, Confinia Psychiatrica, V.22(1):34-48. 28 Hardi, I. (1977), Alcoholic diseases in the light of dynamic drawing tests, Psychiatrica Fennica, p.4761. 25 Heiman, M., Strnad, D., Weiland, W. (1994), Art therapy and alexithymia, Art Therapy, V.11(2):1436. 24 Heine, D., Steiner, M. (1986), Standardized paintings as a proposed adjunct instrument for longitudinal monitoring of mood states: a preliminary note, Occupational Therapy in Mental Health, Fall, V.6(3):31-7. 22 Hendrixson, B.N. (1986), A self-portrait project for a client with short-term memory dysfunction, Am. J. Art Therapy, Aug., V.25(1):15-24. 30 Holmes, C.B. (1983), Memory For Designs drawing styles of psychiatric patients, J. Clin. Psychology, Jul., V.39(4):563-566. 29 Kay, S.R. (1979), Significance of torque in retarded mental development and psychosis: relationship to antecedent and current pathology, Am. Psychologist, Apr., V.34(4):357-362. 31 Nikolaenko, N.N., Menshutkin, V.V. (1993), Co-ordinate displacement and visual space compression during right hemisphere inhibition, Human Physiology, Mar-Apr., V.19(2):104-8. 17 Roback, H.B., Gunby, L. (1984), A ten year comparison of human figure drawings by a psychologically decompensating patient, International J. Symbology, Nov., V.8(3):103-111. 18 Wald, J. (1984), The graphic representation of regression in an Alzheimer's disease patient, Arts in Psychotherapy, Fall, V.11(3):165-175. 21 Wolf, J.M., Willmuth, M.E., Watkins, A. (1986), Art Therapy's role in treatment of anorexia nervosa, Am. J. Art Therapy, Nov., V.25(2):39-46. Case studies, behaviour change Bowen, C.A., Rosal, M.L. (1989), The use of art therapy to reduce the maladaptive behaviors of a mentally retarded adult, Arts in Psychotherapy, Fall, V.16(3):211-218. Gale, I.G. (1990), Neuropsychological rehabilitation technique with a chronic schizophrenic patient, Behaviour-Change, V.7(4):179-184. Goren, A.R., Fine, J. (1995), Manaim, H., Apter, A., Verbal and nonverbal expressions of central deficits in schizophrenia., J. Nervous and Mental Disease, Nov. V.183(11):715-719. Olive, J.S. (1991), Development of group interpersonal skills through art therapy, Maladjustment and Therapeutic Education, Win., V.9(3):174-180. Case studies - main therapeutic benefit - relationship 7 Bondesen, C.L. (1984), Transference and countertransference in schizophrenia: The paranoic defense against homosexuality, Pratt Institute Creative Arts Therapy Review, V.5:22-32. 8 Buck, L.A., Goldstein, F., Kardeman, E. (1984), Art as a means of interpersonal communication in autistic young adults, J. Psychology and Christianity, Fall, V.3(3):73-84. 13 Davis, D.L., Boster, L. (1988), Multifaceted therapeutic interventions with the violent psychiatric inpatient, Hospital and Community Psychiatry, Aug., V.39(8):867-869. 18 Dreifuss, E. (1978), Some notes on a relationship between art therapist and patient, Am. J. Art Therapy, Jan., V.17(2):57. 17 Dunne, M. (1993), The integration of two theoretical models in treatment with art therapy, Pratt Institute Creative Arts Therapy Review, V.14:17-24.
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10 Fagin, I. (1983), Images of growth and mourning in the process of termination, Pratt Institute Creative Arts Therapy Review, V.4:53-60. 6 Ferrara, N. (1992), Adolescent narcissism and ego regression: an art therapy case illustration, J. Child and Youth Care, V.7(1):49-56. 12 Forrest, G. (1975), The problems of dependency and the value of art therapy as a means of treating alcoholism, Art Psychotherapy, V.2(1):15-43. 9 Gunther, M. (1992), Eros and the ego: the use of ego assessment in creatively addressing a sexualized transference, Pratt Institute Creative Arts Therapy Review, V.13:31-40. 4 Horovitz-Darby, E.G. (1992), Reflections: Countertransference: Implications in treatment and post treatment, Arts in P sychotherapy, V.19(5):379-389. 3 Izhakoff, S. (1993), Symbiosis and symbiotic relatedness: A bridge to schizophrenia, Pratt Institute Creative Arts Therapy Review, V.14:25-33. 5 Kaplan, F.F. (1983), Drawing together: Therapeutic use of the wish to merge, Am. J. Art Therapy, Apr., V.22(3):79-85. 2 Shapiro, J. (1988), Moments with a multiple personality disorder patient, Pratt Institute Creative Arts Therapy Review, V.9:61-72. 14 Stamelos, T., Mott, D.W. (1983), Learned helplessness in persons with mental retardation: art as a client centred treatment modality, Arts in Psychotherapy, Win., V.10(4):241-249. 19 Stamelos, T., Mott, D.W. (1986), Creative potential among persons labelled developmentally delayed:II. Meditation as a technique to release creativity, Arts in Psychotherapy, Fall, V.13(3):229-234. 11 Teirstein, E.G. (1991), Developing: Art, mastery, self, Pratt Institute Creative Arts Therapy Review, V.12:16-29. 1 Wolf, R. (1975), Art psychotherapy with acting-out adolescents: an innovative approach for special education, Art Psychotherapy, Vol.2(3-4):255-266. Case studies - main therapeutic benefit - expression of feelings Alanko, A. (1973), Psychosis and art, Psychiatria Fennica, p.153-158. Bemtovegna, S., Schwartz, L., Deschner, D. (1983), Case study: the use of art with an autistic child in residential care, Am. J. Art Therapy, Jan., V.22(2):51-6. Berkowitz, S. (1990), Art therapy with a Vietnam veteran who has post traumatic stress disorder, Pratt Institute Creative Arts Therapy Review, V.11:47-62. Bertoia, J., Allan, J. (1988), Counselling seriously ill children: use of spontaneous drawings, Elementary School Guidance and Counselling, Feb., V.22(3):206-221. Blasco, S.P. (1978), Case study: art expression as a guide to music therapy, Am. J. Art Therapy, Jan., V.17(2):51-56. Branch, J. (1992), Depression and feminine personality development, Pratt Institute Creative Arts Therapy Review, V.13:9-15. Cardone, L., Marengo, J., Calisch, A. (1982), Conjoint use of art and verbal techniques for the intensification of the psychotherapeutic group experience, Arts in Psychotherapy, Win., V.9(4):263-268. Carozza, P.M., Heirsteiner, C.L.(1982), Young female incest victims in treatment: stages of growth seen with a group art therapy model, Clinical Social Work J., Fall, V.10(3):165-175. Ciornai, S. (1983), Art therapy with working class Latino women, Arts in Psychotherapy, Sum., V.10(2):63-76. Cohen, F.W. (1974), Art therapy in the diagnosis and treatment of a transsexual, Am. J. Art Therapy, Oct., V.14(1):3-11. Cohn, R. (1984), Resolving issues of separation through art, Arts in Psychotherapy, V.11(1):29-35. Colli, L.M. (1994), Aims in therapy and directives in society: observations on individuation and adaptation (Trans. J. Leyland), Arts in Psychotherapy, V.21(2):107-112. David, I.R., Sageman, S. (1987), Psychological aspects of AIDS as seen in art therapy, Am. J. Art Therapy, Aug., V.26(1):3-10. Drachnik, C. (1978), Case study: art therapy with a girl who lived in two worlds, Am. J. Art Therapy, Oct., V.18(1):19-27. Eskridge, J.H. (1993), Healing the wounded female self, Pratt Institute Creative Arts Therapy Review, V.14:50-55.
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psychotics, Perceptual and Motor Skills, Apr., V.50(2):583-590. [V] 33. Kay, S.R. (1978), Qualitative differences in human figure drawings according to schizophrenic subtype, Perceptual and Motor Skills, 47:923-932. [C, V, R, M] 34. Kessler, K. (1994), A study of the Diagnostic Drawing Series with eating disordered patients, Art Therapy, V.11(2):116-118. [C, V] 35. Kirk, A., Kertesz, A. (1989), Hemispheric contributions to drawing, Neuropsychologia, V.27(6):881-886. [C, V, R, M] 36. Knapp, N.M. (1994), Research with diagnostic drawings for normal and Alzheimer's subjects, Art Therapy, V.11(2):131-138. [C, V, R, M] 37. Langevin, R., Raine, M., Day, D., Waxer, K. (1975), Art experience, intelligence and formal features in psychotics' paintings, Arts in Psychotherapy(study 1), V.2(2):149-158. [C, V, R] 38. Langevin, R., Raine, M., Day, D., Waxer, K. (1975), Art experience, intelligence and formal features in psychotics' paintings, Arts in Psychotherapy (study 2), V.2(2):149-158. [C, V, R, M] 39. Langevin, R., Hutchins, L.M. (1973), An experimental investigation of judges' ratings of schizophrenics' and non-schizophrenics' paintings, J. Personality Assessment, Dec., V.37(6):537-543. [V, R] 40. Larrabee, G.J., Kane, R.L. (1983), Differential drawing size associated with unilateral brain damage, Neuropsychologia, V.21(2):173-177. [C, V] 41. Lehman, E.B., Levy, B.I. (1971), Discrepancies in estimates of children's intelligence: WISC and human figures drawing, J. Clin Psychology, V.27:74-76. [V] 42. Lerner, C., Ross, G. The magazine picture collage: development of an objective scoring system, Am. J. of Occupational Therapy, Mar., V.31(3):156-161. [C, V] 43. Levy, B.I., Ulman, E. (1974), The effect of training on judging psychopathology from paintings, Am. J. Art Therapy, Oct., V.14:24-25. [C, V] 44. McGlashan, T.H., Wadeson, H.S., Carpenter, W.T., Levy, S.T. (1977), Art and recovery style from psychosis, J. Nervous and Mental Disease, V.164(3):182-190. [C, V, R, M] 45. McNiff, S., Oelman, R. (1975), Images of fear, Arts in Psychotherapy, V.2(3-4):267-277. [C, V] 46. Miljkovitch, M., Irvine, G.M. Comparison of drawing performances of schizophrenics, other psychiatric patients and normal schoolchildren on a draw-a-village task, Arts in Psychotherapy, V.9:203-216. [C, V, R, M] 47. Miller, A.L., Atlas, J.A., Arsenio, W.F. (1993), Self-other differentiation among psychotic and conduct-disordered adolescents as measured by human figure drawings, Percep Motor Skills, Apr., V.76(2):397-8. [C, V] 48. Mills, A., Cohen, B.M., Meneses, J.Z. (1993), Reliability and validity tests of the Diagnostic Drawing Series, Arts in Psychotherapy, V.20:83-88. [R] 49. DDS study 77 naive raters, unpublished reported in Mills, A., Cohen, B.M., Meneses, J.Z. (1993), Reliability and validity tests of the Diagnostic Drawing Series, Arts in Psychotherapy, V.20:83-88. [R] 50. Phillips, E.L., Geller, S.K. (1983), Ireland, M., Research on the use of art therapy in a university setting, Am. J. Art Therapy, Oct., V.23(1):26-29. [R] 51. Phillips, W.M., Phillips, A.M. (1976), Similarity between complexity on Role Construct Repertory Tech and articulation of Draw-A-Person test for patients and nonpatients, Perceptual Motor Skills, Dec. V.43(3):1256-1258. [C, V] 52. Rankin, A. (1994), Tree drawings and trauma indicators: a comparison of past research with current findings from the DDS, Art Therapy, V.11(2):127-130. [C, V, R] 53. Robins, C., Edward, B., Sidney, J., Ford, R.Q. (1991), Changes in human figure drawings during intensive treatment, J. Personality Assessment, Dec. V.57(3):477-97. [C, V] 54. Rosal, M.L. (1993), Changes in locus of control in behaviour disordered children, Arts in Psychotherapy, V.20(3:231-241. [C, V] 55. Rubin, J.A., Ragins, N., Shachter, J., Wimberly, F. (1979), Drawings by schizophrenic and non-schizophrenic mothers and their children, Arts in Psychotherapy, V.6(3):163-175. [C, V] 56. Russell-Lacy, S., Robinson, B., Benson, J., Cranage, J. (1979), An experimental study of pictures produced by acute schizophrenic subjects, B. J. Psychiatry, V.134:195-200. [C, V, R, M] 57. Sidun, N.M., Rosenthal, R.H. (1987), Graphic indicators of sexual abuse in Draw-A-Person tests of psychiatrically hospitalized adolescents, Arts in Psychotherapy, Spr., V.14(1):25-33. [C, V, R, M] 8. Silver, R., Ellison, J. (1995), Identifying and assessing self-images in drawings by delinquent adolescents, Arts in Psychotherapy, V.22(4):339-352. [R]
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59. part 2. Silver, R., Ellison, J. (1995), Identifying and assessing self-images in drawings by delinquent adolescents, Arts in Psychotherapy, V.22(4):339-352. [R] 60. Simmonds, D.W., Koocher, G.P. (1973), Perceptual rigidity in paranoid schizophrenics; use of projective animal drawings, Perceptual Motor Skills, Aug., V.37(1):247-250. [C, V] 61. Sims, J., Bolton, B., Dana, R.H. (1983), Dimensionality & concurrent validity of the Handler DAP anxiety index, Multivariate Experimental Clinical Research, V.6(2):69-79. [V, R] 62. Sullivan, E.V., Mathalon, D.H., Nim Ha, C., Zipursky, R.B., Pfefferbaum, A. (1992), The contribution of constructional accuracy and organizational strategy to nonverbal recall in schizophrenia and chronic alcoholism, Biological Psychiatry V.32(4):312-333. [C, V] 63. Tharinger, D.J.; Stark, K.D. (1990), A qualitative versus quantitative approach to evaluating the DrawA-Person and Kinetic Family Drawing:a study of mood and anxiety disorder children, Psychological Assessment, V.2(4):365-375. [V] 64. Van Hoof, J.J., Hulstijn, W., Van Mier, H., Pagen, M. (1993), Figure drawing and psychomotor retardation: preliminary report, J. of Affective Disorders, Dec., V.29(4):263-6. [C, V] 65. Verinis, J.S., Lichtenberg, E.F., Henrich, L. (1974), The Draw A Person in the rain technique: Its relationship to diagnostic categories and other personality indicators, (experiment 1), J. Clin. Psychology, Jul. V.30(3):407-414. [C, V] 66. Verinis, J.S., Lichtenberg, E.F., Henrich, L. (1974), The Draw A Person in the rain technique: Its relationship to Drawing categories and other personality indicators (experiment 2), J. Clin Psychology Jul. V.30(3): 407-414 [C, V] 67. Verinis, J.S Lichtenberg, E.F., Henrich, L.(1974), The Draw A Person in the rain technique: Its relationship to Drawing categories and other personality indicators (experiment 3), J. Clin Psychology Jul. V.30(3): 407-414 [C, V] 68. Wadeson, H., Carpenter, W.T. (1976), A comparative study of art expression of schizophrenic unipolar depressives and bipolar manic-depressive patients, J. Nervous Mental Disease, May, V.162(5):334-344. [C, V] 69. Wadlington, W.L., McWhinnie, H.J. (1973), The development of a rating scale for the study of formal aesthetic qualities in the paintings of mental patients, Arts in Psychotherapy, Win., V.1(3-4):201-220. [C, V, R, M] 70. Waldman, T.L., Silber, D.E., Holmstrom, R.W., Karp, S.A. (1994), Personality characteristics of incest survivors on the draw-a-person questionnaire, J. Personality Assessment, V.63(1):97-104. [C, V] 71. Walsh, F.W. (1979), Breaching of family generation boundaries by schizophrenics, disturbed and normals, Int. J. of Family Therapy, Fall, V.1(3):254-75. [C, V] 72. Walsh, S.M. (1993), Future images: an art intervention with suicidal adolescents, Applied Nursing Research, Aug., V.6(3):111-8. [C, V] 73. Wittels, B. (1982), Interpretation of the 'body of water' metaphor in patient artwork as part of the Diagnostic process, Arts in Psychotherapy, Fall, V.9(3):177-182. [C, V] 74. Wittlin, B.W., Augusthy, R. (1988), Comparison of art psychopathology and discharge diagnoses of diagnostic unit patients, Art Therapy, Dec., V.5(1):94-98. [V] 75. Wright, J.H., Macintyre, M.P. (1982), The family drawing depression scale, J. Clin. Psychology, V.38(4): 853-861. [C, V, R, M] 76. Wright, S.K., Ashman, A.F. (1991), The use of symbols in drawings by children, nondisabled adolescents and adolescents with an intellectual disability, Developmental Disabilities Bulletin, V.19(2):105-128. [C, V] 77. Yaguchi, K. (1981), A study of tree drawings in aged groups: An examination of formal indices of the drawings, J. Child Development, Jan., V.17:32-34. [C, V] 78. Young, N.A. (1975), Art therapy with chronic schizophrenic patients of a low socio-economic class in a short term treatment facility, Arts in Psychotherapy, V.2(1):101-117. [C, V] 79. Zucker, K.J., Finegan, J.K., Doering, R.W., Bradley, S.J. (1983), Human figure drawings of gender problem children: A comparison to sibling, psychiatric, and normal controls, J. Abnormal Child Psychology, 11:287-298. [V]
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Appendix 4 Development of the Descriptive Assessement for Psychiatric Artwork (DAPA) DAPA version 3: the rating guide used in the main study. Rating sheet for DAPA version 3. Helpsheet for DAPA rating guide version 3. Rating sheet for casenotes (main study). DAPA version 2: the rating guide used in the pilot study. Research questionnaire on dominant form for artists. Research rating sheet on dominant form for re-rating of form version 3.
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Page 1. Rating guide
DAPA Version 3. The rating guide used in the main study
DESCRIPTIVE ASSESSM ENT FOR PSYCHIATRIC ART RATING GUIDE S. HACKING AND D. FOREMAN 1999.
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D.A.P.A. DESCRIPTIVE ASSESSM ENT OF PSYCHIATRIC ARTWORK HACKING AND D. M . FOREMAN © 1999.
- S.
RATING GUIDE The pictures must be rated for the presence of 15 elements on 6 scales: colour, intensity, line, space, emotional tone and form.
A 5 column x 4 row grid drawn on acetate lies over the picture dividing it into 20 squares whatever the size of the paper. Borderlines done by the painter are ignored. This is laid according to the intended ‘right way up’ of the picture. The rating is done on the rating sheet which corresponds to the grid. Each scale in each division offers a choice which is marked off by the rater. Colour rating forces a present/absent in that square decision on each of 9 colours; the other scales use gradations of high/medium/low. A total of 300 decisions are required to rate one picture. However, time for picture rating typically varies from 5-15m. Each of the 20 scoring squares on the rating sheet contains 5 rows of boxes. Rows are identified left. Colour; Intensity; Line; Space; Emotional Tone. Example below. To score a box use diagonal line corner to corner. Each rating square scores the same grid square on the picture. If a picture square is unused, cross the whole rating square completely through. R
Y
O
P
G
B
N
W
K
COLOUR
INTENSITY
H
PAINTED LINE
H
1 DRAWN LINE N
2 H
N
L V
3
4 V
396
N 5
COLOUR COLOUR
R
Y
O
P
G
B
N
W
K
Colour is simple, one you know what the letters mean! Red, Yellow, Orange, Purple, Green, Blue, browN, White, blacK. DEFINITION: Colours are defined by their hue. Mark the letter of any colour appearing in the grid square no matter how little. Writing by the painter is included. Grey and pencil marks are scored ‘blacK’. The colour of the paper is not scored. See HELP for more information on colour description and examples.
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INTENSITY INTENSITY H
N
L
DEFINITION: Firstly, the brightness or pureness of the media used; secondly, the densit over the area covered by the media (not the unused portion of the square). If two intensities occur in the same square, use whichever covers the most area. If there is equal cover, score the highest. H – High strong, dense saturated colour – e.g. thick pure paint or very heavy pressured pencil or crayon. N – Neutral. ‘Muddy’ colour; e.g. the colour has been ‘greyed’ or toned down, perhaps mixed to darker or lighter shades. Medium pressure pencil lines are scored as ‘neutral’. L – Low intensity or ‘watery’ colour (especially paint), little pigment over a large area, e.g. light pressured crayon or pencil. See HELP for examples.
If colour is used in a single intensity or pressure, i.e. felt pen, pencils, crayon, neutral is scored when lines are deliberately overmarked in different colours. I.e. yellow overscored with black forms a ‘muddy yellow’ as it would if mixed together. LINE L I N E
PAINT
H
V
N
DRAW
H
V
N
Line is scored for Paint (media which fill the area; paint, pastel) and Draw (media which use marks such as crayon, pencil, felt tip). Both lines or one line can be used. DEFINITION: A line must be a distinct drawn or painted mark, loose scribble covering an area, pattern marks such as dots, outlines and writing ARE lines. Two areas of colour which come together or thin filled shapes or areas of colour tightly filled by drawing media ARE NOT lines. Leave blank if no lines appear in the square. Guideline: Scan the whole picture to identify the range of line. If the line appears constant, do not make very sensitive discriminations. Differences should be apparent. Lines such as pencil or felt pen used at the same pressure over the whole picture score as thin. Thick lines must be distinct. If the line is emphasised, i.e. redrawn 2 or 3 times, even at the same pressure, mark as thick. Refer to HELP for examples of varied lines.
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H – Majority of tHick, or heavy lines with high pressure. V – Varied lines when both thick and thin lines are present in roughly the same quantity. N – ThiN, or the majority at light pressure.
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SPACE >10%
>25%
>55%
>80%
>100%
DEFINITION: The largest UNUSED area of the square. Guideline: Identify the largest UNMARKED area in the square. It doesn’t matter if there are 2 or 3 unmarked areas, use only one. Imagine drawing a bubble shape around this space (bubbles can bend, be triangular, circular, square or elipse, but if you have a bubble with a narrow waist, you have two areas!). Does the bubble represent (1) 0-10%; (2) 10-25%; (3) 25-55%; (4) 55-80%; (5) 80-100% of the area of the square. Simply by quarters. (1-2) up to _; (3) up to _; (4) _ to _ ; (5) more than _ . Empty squares score 5. EMOTIONAL TONE E-TONE
+
0
-
Guideline: Scan the picture as a whole, decide which elements of the picture, taking account of what communicates TO YOU of the maker’s intent in content, colour, intensity, line and form. (+) positive or (-) negative. Mark the squares containing these elements first. The other squares are (0) neutral. Leave empty squares blank. DOMINANT FORM
DEFINITION: A shape enclosed by a boundary, explicit or implicit. It should be exceptional in, size or colour (contrasting hue, intensity or saturation). It is not always a recognisable shape or person. It is a LARGE SINGLE SHAPE. When multiple,
400
there is NO dominant form! The shape may be repeated, but repetitions will be smaller or less intense. Guideline: Scan the picture as a whole, decide where the dominant form is. Use closure for open forms. If more than 25% of the square is covered by the form, shade the corresponding square in the small grid at the top of the rating sheet .
Half Rating sheet for DAPA. Template. 1999 Hacking and Foreman ©
FORM ---!
COLOUR INTENSITY
R Y O P G B N W K N H L
L PAINT I
N DRAW
H
V
N
H
V
N
H
V
N
H
V
N
SPACE E-TONE
1
COLOUR
R Y O P G B N W K N H L
INTENSITY L PAINT I
2
SPACE
1
E-TONE COLOUR INTENSITY
3
4
+
N DRAW
R Y O P G B N W K N H L
0
5
1
-
2
3
4
+
0
5 -
R Y O P G B N W K N H L
H
V
N
H
V
N
H
V
N
H
V
N
2
3
+
4
5
1
0
2
3
+
4
R Y O P G B N W K N H L
5
0
R Y O P G B N W K N H L
L
H
V
N
H
V
N
I N DRAW
H
V
N
H
V
N
SPACE
1
E-TONE COLOUR INTENSITY
2
4
+ R
5
1
0
N DRAW 1
3
4
5
0
R Y O P G B N W K N H L
H
V
N
H
V
N
H
V
N
H
V
N
2 +
2 +
Y O P G B N W K N H L
L PAINT I
SPACE E-TONE
3
3
4 0
5 401 -
1
2 +
3
4 0
5 -
Part 2 Rating Sheet for DAPA: Hacking and Foreman 1999 ©
R Y O P G B N W K N H L
1
V
N
H
V
N
H
V
N
H
V
N
H
V
N
H
V
N
3
4
+
5
1
0
R Y O P H
4
5
1
2
3
+
4
5
0
G B N W K R Y O P G B N W K N N L H L
V
N
H
V
N
H
V
N
H
V
N
H
V
N
H
V
N
3
4
+
0
5
1
-
2
3 0
+
R Y O P G B N W K N H L
R Y O P H
4
5
1
-
2
3
+
4 0
5 -
G B N W K R Y O P G B N W K N N L H L
H
V
N
H
V
N
H
V
N
H
V
N
H
V
N
H
V
N
2
3
4
+
0
5
1
-
2
3 0
+
R Y O P G B N W K N H L
R Y O P H
4
5
1
-
2
3
+
4 0
5 -
G B N W K R Y O P G B N W K N N L H L
H
V
N
H
V
N
H
V
N
H
V
N
H
V
N
H
V
N
2 +
3 0
H
2
1
2 +
R Y O P G B N W K N H L
1
G B N W K R Y O P G B N W K N N L H L
H
2
1
R Y O P H
3
4 0
5
1
2 +
3 0
402
4
5
1
2 +
3
4 0
5
Help Sheet for DAPA version 3.
Main study. Hacking and Foreman 1999 ©
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Rating Sheet for Casenotes DAPA version 3. 1999. KEELE UNIVERSITY STAFFORDSHIRE. DEPT. OF PSYCHIATRY, SCHOOL OF P.G. MEDICINE. ICHRC. N. STAFFORDSHIRE HOSPITAL.
UNIT
NAME
WARD
M/F
MARRIED/SINGLE/SEP
ICD-10 DIAGNOSIS
MEDICATION
RACE
OCCUPATION/TRADE ED LEVEL ECT YES/NO
INPATIENT/OUT
404
EVER SECTIONED
AGE
Rating Guide Version 2. S. Hacking and D. Foreman 1994. © Descriptive Assessment for Psychiatric Art.
Rating Guide Descriptive Assessment for Psychiatric Art V.2 Used in the Pilot Study 1996.
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D.A.P.A. DESCRIPTIVE ASSESSM ENT OF PSYCHIATRIC ARTWORK Pilot Study - S. HACKING AND D. M . FOREMAN © 1994.
RATING GUIDE The pictures must be rated for the presence of 13 elements on 5 primarily structural areas: colour, intensity, line, area, emotional tone. These items are designed to describe the picture as objectively as possible. A grid is drawn over the picture forming 20 squares. Rating looks at each category one at a time in each division. Colour rating offers two options forcing a present/not present decision; the others offer optional descriptors of the form high, medium or low. A total of 260 decisions are required to rate one picture. However, time for picture rating typically varies from 5-15m. A transparent overlay divides the picture into 20 squares; 5 across and 4 down, taking account of the intended ‘right way up’. The squares are drawn from the edge of the paper, ignoring borderlines done by the painter. Each of the 20 scoring squares on the rating sheet contains 5 rows of boxes. Each row is identified on the left; Colour; Intensity; Line; Area; Emotional Tone. See the example below R
Y
O
P
G
B
N
W
K
COLOUR
INTENSITY
H
LINE
N
L
H N
10
20
30
V
40
50
60
O
P
G
70
80
90 100
AREA
Colour COLOUR
R
Y
406
B
N
W
K
Colour is simple, one you know what the letters mean! Red, Yellow, Orange, Purple, Green, Blue, browN, White, blacK. DEFINITION: Colours are defined by their hue. It doesn’t matter if the shade is dark or See HELP for more information on colour description and examples. If the colour appears anywhere in the square mark the identifying letter. Only the media on the paper is scored, not the colour of the paper. Writing on the picture done by the painter is scored in the same way. Pencil is scored black.
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Intensity INTENSITY H
N
L
DEFINITION: The brightness or pureness of the media used, not the surrounding space. If a hgih intensity dot sits in the middle of an otherwise empty square, the square is scored high. If the surrounding area is slightly tinted, however, the square is scored low. Durll and strong mixes of colour occurring in the same square are scored on whichever covers most of the area. If there is equal cover, score whichever colour is highest. Leave blank if the square is empty. H – High strong, dense saturated colour – e.g. thick pure paint or very heavy pressured pencil or crayon. N – Neutral or neither, also ‘muddy’ colour; e.g. the colour has been ‘greyed’ or toned down, perhaps mixed to darker shades. L – Low intensity or ‘watery’ colour especially paint, little pigment, e.g. light pressured crayon or pencil or thinly scattered media over the area. See HELP for examples.
Line H
LINE
V
N
DEFINITION: - Refer to help for examples. A line must be a distinct drawn or painted mark. A line is not two areas of colour which come together. Line can be used for scribble covering an area or pattern marks, but is not used to describe thin shapes filled with paint. Leave blank if no lines appear in the picture. Scored as H – Majority of tHick, or heavy lines with high pressure; V – Varied lines when both thick and thin lines are present; N – ThiN, or light pressure.
Area AREA
10
20
30
40
50
60
70
80
90
100
Guidelines: Estimate how much of the square is covered by the media and mark the coverage on the scale in tenths or by 10%. A used area has media over it, no matter how
408
thin or scattered. An unused area is completely empty. Emotional Tone E-TONE
+
0
-
DEFINITION: subjective overall assessment of whether the square, its colour, intensity, line and content TO THE RATER seems (+) positive or happy; (0) neutral or neither (-) negative or sad. This is the only category where if the square is empty, score as 0 or neutral. DO NOT LEAVE BLANK.
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Form sheet for Artists. Side 2. DAPA development 1994 © sue Hacking.
Age
Sex
m/f
Art Training (tick) A level; Foundation; Degree; Post Grad. Currently practising? Media most used: paint; print; sculpture; 3d; design; other write This test takes about 5 minutes. Thank you for your co-operation in this test. I am seeking to understand what is meant by artistic terms in practice. Please answer both questions as clearly as possible. 1. Look at the sheet of reproductions of works of art (other side). For each picture, delineate in red, the dominant form, as closely as you can to the contours of what you see as the single most dominant form in that picture. If the question is inapplicable to the picture, write ‘none’ at the bottom. 2. What do the words ‘dominant form’ mean to you in the above sentence? Give a brief definition of your understanding of what a form is. You may refer to the pictures if you wish. You can take from 2 to 3 sentences to half a page.
410
3. Research Questionnaire on Dominant Form for Raters. Test sheet1. DAPA Hacking and Foreman 1999 © Dominant Form This study is part of an experiment to find ways of describing a picture. This is not the whole of the study but one of the elements being tested. Please try to understand the explanation given by the experimenter as if you were part of a group trying to score exactly the same as everyone else. DEFINITION: An object or space enclosed by a boundary, explicit or implicit. It should be exceptional in Size and/or Colour Contrasting hue/intensity/saturation. It should be single (there must not be two opposing forms). The shape may be repeated, the repetitions will be smaller or less intense. It is usually a regular shape. What is going on in the picture (the content or narrative) is secondary to the structure. It need not be a recognisable shape or a person. When you have understood the explanation to the experimenter’s satisfaction, you will be asked to rate some pictures. Keep this explanation by you and refer to it every time. The experimenter will now describe the grid system. Please look at the picture as a whole first, can you see a shape which is large, singular and whose outline is generally echoed throughout the picture? Point out to the experimenter which squares the shape occupies. Cut off extremeties which are not integral to the regular shape. The shape must occupy more than 25% of the square to be counted.
411
Appendix 5 Permission for study, information for participants, and instructions for group leaders on treatment of pictures Consent forms for all participants in the pilot and for those in the main study who were saving their pictures from therapy groups were the same, pages 2 and 3 (oral and written). Information sheet for pilot study and for those in the main study who gave consent were the same (p.4). Instructions for group leaders in pilot study (p.5). Instructions for group leaders in main study (p.6).
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North Staffordshire Health Authority Research Ethics Committee PERSONAL CONSENT TO THE CONDUCT OF A RESEARCH INVESTIGATION
STUDY TITLE NAM E OF CLINICIAN
Describing pictures by different groups of patients Dr. D. Foreman and M s. S. Hacking
The aims and procedures of the clinical investigation in which I have been asked to take part have been explained to me by ward staff. I have read and understood the patient leaflet set out overleaf, and have been informed about the possible benefit to myself and about any foreseeable risks or discomfort. I have had the opportunity to ask questions and to consider the answers given. I understand that participation in the study is voluntary and that I may withdraw from the study at any time of my own accord. If I do withdraw it will not affect the future care and attention which I will receive from my doctors. I agree that the relevant parts of my medical records may be disclosed to Dr. Foreman provided they agree not to reveal my name. I hereby freely give my fully informed consent to taking part in this clinical investigation. Name ……………………………….. Signature ……………………………. Date ………………………………….
I confirm that I have explained the nature of the above investigation to the above named patient. Name ……………………………….. Signature ……………………………. Date ………………………………….
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North Staffordshire Health Authority Research Ethics Committee ORAL CONSENT TO THE CONDUCT OF A RESEARCH INVESTIGATION
STUDY TITLE NAM E OF CLINICIAN NAM E OF PATIENT
Describing pictures by different groups of patients Dr. D. Foreman and M s. S. Hacking
I have explained the aims and procedures of the above clinical investigation to the above named patient. He/she was informed of the possible benefits to him/herself and about any foreseeable risks or discomfort (and the information in the patient leaflet was also explained). He/she was given the time and opportunity to ask questions and to consider the answers given. The voluntary nature of participation in the study was emphasised, as was the right to withdraw from the study for any reason without prejudicing his/her relationship with myslef or any other of his/her medical advisors. I have explained that relevant parts of my medical records may be disclosed to Dr. Foreman. Names will not be disclosed. On this basis, I declare that the above named patient freely gave his/her consent to taking part in this clinical investigation. Witness to Oral Consent Name ……………………………….. Signature ……………………………. JOB TITLE OR RELATIONSHIP TO PATIENT …………………………….. Date ………………………………….
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Information sheet. Research into Art Therapy Painting for pleasure can have healing effects. Paintings may express what is deep inside the mind, that may not be easily put into words. Our understanding of a picture is often brought about through talking to people about it, but people's comments about their paintings are sometimes not helpful. This research is trying to discover a way of looking at the pictures themselves rather than what is said about them. We will be looking at a lot of pictures by people with the same kinds of problems, or with no problems at all. So any picture will be just one of a group. We do not just want 'special' pictures or particularly good pictures. It is more important to have a variety, so we would like a picture from anyone willing to do one. It does not matter if anyone cannot draw as well as they would wish as this is not an artistic project. You will be asked to paint a picture in a group. The picture will be numbered. Your name will not appear on it. No-one will see the picture but the people doing research. We have no connection with any treatment or ward. You will not be asked to discuss the pictures with anyone. The pictures will be taken away and used as a group study. We will keep a list of pictures for the time of the study and then the list will be destroyed. If you do not wish to help, it will not affect any treatment or care. I you want to do a picture, and then decide not to after all, or take your picture out of the study once it is done, this is your choice. Thank you for your help and co-operation.
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Psychiatry Dept., School P.G. M edicine. Researcher Sue Hacking. Research Project - DRAW A PICTURE. PROTOCOL.
Study 1.
If something goes wrong, or there is some alteration to the procedure, would you please write on the back of this paper what it was - and return it with the completed pictures. Allow about one hour for the session. Obtain consent from individuals before the series, using the information sheets and consent forms provided, if someone refuses, they may still attend their usual sessions with the group. On the reverse of this paper write ward no. and group leader. Give every participant a number beginning ______ so the first one would be ___1. Write the number and their names on the back of this paper, so they can be identified. Note the refusers like this: male/female who chose not to take part, no names. 1. M ake sure that each person has access to the following materials on their table: RED YELLOW ORANGE PURPLE GREEN BLUE BROWN WHITE BLACK, available for use, i.e. red and yellow do not provide orange, orange must be mixed and available. 2. Facilities to make thick and thin lines, preferably with different colours. 3. One piece of paper, A3 size - as big as 2 sheets of photocopy paper. Themed Sessions, one theme per session. 1. Draw yourself as you usually are. 2. Draw yourself as you might look if you were an animal. 3. Draw a picture of yourself doing something you like to do. 4. Draw a picture of your life with the past and the future on it. 5. Draw a picture of yourself as you are feeling now. Other instructions to the group: You can put anything in the picture and you can use any colours that you want to use. You will not have to show it to anyone, or talk about it, you have up to one hour to finish the picture. Function of the researcher as helper to the group leader. To ensure that the participants make as free a choice as possible as to what colours they should use, and what kind of picture they should draw. To encourage participants and discourage dropout if possible. Participants who finish early may do something else.
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Psychiatry Dept., School P.G. M edicine. Researcher Sue Hacking. Research Project - DRAW A PICTURE - PROTOCOL. KEEP THIS PAPER
Study 2.
Instructions for group leader. Please save the paintings from your themed or recreational sessions with patients. So that we can identify patients please follow these instructions. If something goes wrong, or there is some alteration to the procedure, would you please write on the back of this paper what it was - and return it with the completed pictures. Allow about one hour for the session. Obtain consent from individuals before the series, using the information sheets and consent forms provided, if someone refuses, they may still attend their usual sessions with the group. On the reverse of this paper write ward no. and group leader and the date. Give every participant, including staff who provide a picture, a number beginning ______ so the first one would be ___1. Write the number and their names on the back of this paper, so they can be identified. Note the refusers like this: male/female who chose not to take part, no names. Try to provide these materials on every table: RED YELLOW ORANGE PURPLE GREEN BLUE BROWN WHITE BLACK, available for use, i.e. red and yellow do not provide orange, orange must be mixed and available. 2. There should be facilities to make thick and thin lines, in colour, best achieved with paint and preferable for this research. 3. One piece of paper, A3 size - as big as 2 sheets of photocopy paper, placed so that the top (furthest away from the artist) is the longer side (landscape format). If there are limitations, please note them on the back of this paper. You can use any type of sessions for this research, themed or free sessions or personal work. Self portraits are particularly useful. Do not direct the participants as to colours used, or suggest a type of picture they should draw for the research. Participants should not do anything different than they usually do in their art session (i.e. talk about their pictures or show them to anyone else if they usually do not). Be encouraging and supportive and discourage dropout if possible. Write on the back of the picture, the numbers and not the names of all participants including staff. Keep for collection. Thankyou for your co-operation.
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