The diagnostic drawing series: A systematic approach to art therapy evaluation and research

If I1 worked in the hospital laboratory and had to screen specimens for the presence of toxins or viruses I would have tools to use, procedures to follow, even norms against which to measure whatever I might find. However, I work as an art therapist in a psychiatric facility and often have to screen art productions for indicators of mental disorders. What resources are available to me to aid in this complex and delicate task? At my immediate disposal are intuition and education, assets that all therapists share in varying degrees. The intuitive process is an important factor in psychotherapy, and has served art therapists well, particularly in their interpretive work. However, convincing other clinicians of the accuracy of one’s intuition or the scope of one’s education can itself be a challenge. The art therapy assessment tools in current use are designed for gathering information, but have never been formally researched, nor have their techniques been discussed in much detail in the literature. To confuse this process further, we are deprived of a standard baseline from which to measure deviation or change in the graphic productions of adults. Education, intuition, and literature aside, the clinician also has experience to draw upon. I see hundreds of patients; thousands of their drawings pass through my hands each year. I “know” the patients’ diagnoses and observe the nature of their graphic expression. I collect this information in my head and in portfolios. I compare it with the lore of psychiatric art. It is true that each patient is an individual. Artwork is highly personal. Still, I must help to formulate a label. When I am face to face with a skeptical psychiatrist or dodging an insurance company through a patient’s medical record, I want to know that the diagnostic decision I assist in formulating is based on more than subjective factors. I want to know that the diagnostic value of art expression is based on a sturdy foundation. The recognition of drawings as potential clinical indicators originated in Europe a century ago. First in France (Simon, 1888) and then in Germany (Mohr, 1906), a handful of psychiatrists began to use picture-making as an aid to diagnosis in psychiatric settings. Five decades of this work are discussed in an exhaustive review by Anastasi and Foley (1941). English-speaking people owe a great debt to them for making accessible writing published in non-English sources. The 1950s saw a great blossoming of drawing diagnostics in America. Although these tests were developed largely by psychologists, they have never been accepted by all practitioners within the mental health field. Despite repeated efforts the reliability and validity of these tests have never been satisfactorily established. The search for a better tool led to a number of symbolically-oriented “draw-a-this” and “draw-a-