Measuring art: Methodical development of a quantitative rating instrument measuring pictorial expression (RizbA)

Relationship Aspects of Mothers and Their Adolescents with Intellectual Disability as Expressed through the Joint Painting Procedure

The quality of the interaction between mothers and their children with an Intellectual Disability (ID) plays a crucial role in their development and in particular during adolescence. This qualitative study was designed to provide a better understanding of aspects of the relationships between mothers and their adolescents with ID through an art-based tool, the Joint Painting Procedure. The qualitative analysis of six dyads of mothers and adolescents with severe, moderate and mild ID was based on the principles of narrative and phenomenological inquiry. The findings yielded three key themes that emerged from the relational dynamics during the JPP: (1) from dependency to autonomy, (2) the joint painting as a way to foster verbal communication, and (3) playfulness and enjoyment. The JPP appeared to serve as a meaningful art-based assessment of the implicit and explicit aspects of the relationships which evolved during the interaction. The findings underscore the potential of the JPP as a non-verbal, art-based tool that allows researchers and clinicians to learn more about the dynamics of relationships between mothers and their adolescents with ID. It also enables a context where the expression of relational issues can be communicated and even transformed.

Formal Elements of Art Products Indicate Aspects of Mental Health

Formal elements are often used in art therapy assessment. The assumption is that formal elements are observable aspects of the art product that allow reliable and valid assessment of clients' mental health. Most of the existing art therapy assessment instruments are based on clinical expertise. Therefore, it is not clear to what degree these instruments are restricted to formal elements. Other aspects might also be included, such as clinical expertise of the therapist. This raises the question of whether and how formal elements as observable aspects of the art product are related to clients' mental health. To answer this question, four studies are presented that look at: (1) a meta-theoretical description of formal elements; (2) operationalization of these formal elements so they can be analyzed reliably in clients' art products; (3) establishment of reliable and clinically relevant formal elements; (4) the relationship between formal elements and adult clients' mental health. Results show that the combination of the formal elements "movement," "dynamic," and "contour" are significantly interrelated and related to clients' mental health, i.e., psychopathology, psychological flexibility, experiential avoidance, and adaptability. These findings give insight in the diagnostic value of art products and how they may add to clients' verbal expression and indicate their potential to benefit from therapy.

The Anthroposophic Art Therapy Assessment Paint (AART-ASSESS-P): A peer-report instrument to assess patients' pictorial expression during Anthroposophic Painting Therapy

OBJECTIVE

Anthroposophic painting therapy (APT) is a specific form of art therapy that aims to activate self-healing capacities through painting aquarelles.

METHODS

The Anthroposophic Art Therapy Assessment-Paint' (AART-ASSESS-P) was developed to measure pictorial expression and validated in the framework of a comprehensive cohort design study. The validation study examined 68 breast cancer patients with fatigue. Art therapists made pre- and post-assessments of spontaneously drawn water-color paintings with a preliminary version of the AART-ASSESS-P (58 items). Inter-rater reliability (IRR) for the items was examined with Cohen's weighted Kappa (κw). Additionally, a reliability- and factor analysis (FA) were conducted. Convergence criteria were patients' self-report measures: the Satisfaction with Painting Therapy, Inner Correspondence with Painting Therapy and the Self-Regulation Questionnaire.

RESULTS

IRR for the items was heterogeneous (κ_w= 0.09-0.89, Mean κ_w= 0.40, SD = 0.17). Thirty-six items were excluded due to insufficient IRR and item-total correlation (κ_w= < 0.30, ρ_item-total< 0.30). A FA with 22 items revealed 5 subscales: Shape Development (6 items), Shape Arrangement (6 items), Order and Symmetry (5 items), Color Application (3 items), and Color Quality (2 items) explaining 61% of total variance. Psychometric properties for the AART-ASSESS-P were satisfying with Cronbach's alpha coefficients (r_α = 0.60-0.81) across subscales. Due to weak inter-subscale correlations (r = 0.18-0.48, p < 0.05) and the ambiguity of face validity a sum-score was not formed. Correlations between subscales and self-reports were small (all p < 0.05).

CONCLUSION

The AART-ASSESS-P is the first reliable instrument to measure pictorial expression during APT.

Creating Art Together as a Transformative Process in Parent-Child Relations: The Therapeutic Aspects of the Joint Painting Procedure

The relationships between parents and children contain implicit aspects, which are non-conscious and non-verbal, in addition to explicit ones. Both explicit and implicit aspects are central to understanding the dyadic dynamics and are implicated in psychotherapy processes and outcomes. Visual symbolization has a unique value as a channel of expression that can capture the implicit characteristics of relationships. Creating art together goes even further because it allows the presence of implicit representations of the relations in vivo. These representations can then be transformed through the joint process of creation, which has a unique potential to unleash reflective capacities when it is experienced in a playful and safe context. This paper presents a qualitative study that is part of larger mixed-methods research with 87 mother-child dyads (with children 9 to 12 years old). Dyads were administered the Joint Painting Procedure (JPP), which includes dyadic painting by the parent and child on the same paper and is used for evaluation and treatment in the field of parent-child therapy and art therapy. The study’s objectives were to uncover and better understand the unique therapeutic aspects that such method allows and its potential to impact parent-child relationships. The findings of the qualitative study indicated that the JPP enabled several dynamic processes such as pleasure and fun, bi-directionality, mutual regulation, mentalization, and mutual recognition, which together created a salient positive transformation in the relationship. Through the JPP, a new transformative aspect of relations emerges and enables new and different modes of communication and interactions in about half of the dyads and a lesser and partial positive transformation in about a third of them.

How Art Therapists Observe Mental Health Using Formal Elements in Art Products: Structure and Variation as Indicators for Balance and Adaptability

In clinical practice, formal elements of art products are regularly used in art therapy observation to obtain insight into clients' mental health and provide directions for further treatment. Due to the diversity of formal elements used in existing studies and the inconsistency in the interpretation, it is unclear which formal elements contribute to insight into clients' mental health. In this qualitative study using Constructivist Grounded Theory, eight art therapists were interviewed in-depth to identify which formal elements they observe, how they describe mental health and how they associate formal elements with mental health. Findings of this study show that art therapists in this study observe the combination of movement, dynamic, contour and repetition (i.e., primary formal elements) with mixture of color, figuration and color saturation (i.e., secondary formal elements). Primary and secondary elements interacting together construct the structure and variation of the art product. Art therapists rarely interpret these formal elements in terms of symptoms or diagnosis. Instead, they use concepts such as balance and adaptability (i.e., self-management, openness, flexibility, and creativity). They associate balance, specifically being out of balance, with the severity of the clients' problem and adaptability with clients' strengths and resources. In the conclusion of the article we discuss the findings' implications for practice and further research.