اثر متقابل مواد در ارزیابی هنردرمانی

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 aim of art therapy assessment is to gain a perspective on a client's mental health, assess a client's strengths and weaknesses and gain an understanding of a client's functioning. Assessment assists in decisions about further treatment. There is great variety in art therapy assessment approaches, which are rooted in diverse perspectives and draw on diverse theoretical/historical roots and discourses (Edwards, 2013 and Gilroy et al., 2012). One important approach in art therapy assessment was developed within the context of “analytical art therapy”, also referred to as “art psychotherapy”. This approach draws on psychodynamic or psychoanalytical theory, and it originates from the perspective ‘art in therapy’, which was initially described by Naumburg (1950). The use of this perspective in art therapy assessment emphasizes the symbolic meaning of art products by assuming that the content of an art product represents the unconsciousness, psychological conflicts of a person's mind ( Hacking, 1999, Naumburg, 2001, Simon, 2001 and Ulman and Bernard, 2001). The art product is seen as an object of transference and countertransference within the relationship between client and therapist ( Schaverien, 1999). Several projective drawing tests were developed as assessment tools in the first half of the 20th century based on this perspective ( Hinz, 2009), such as the House-Tree-Person Test (HTP) ( Buck, 1948) and the Thematic Apperception Test (TAT) ( Murray, 1943). These tests only involved drawing, and the art materials and their role in art therapy assessment were restricted. Quantitative research became more important with an increasing emphasis on evidence-based practices in the health care system. Instead of focusing on the symbolic meaning of what clients drew, the focus of research shifted to the formal, more objective elements of an art product, such as color, line and space. Several assessment tools and observation rating scales were developed based on this perspective, such as the Diagnostic Drawing Series (DDS) (Cohen, 1986/1994 and Cohen et al., 1986). The Person Picking an Apple from a Tree (PPAT) and the matching Formal Elements Art Therapy Scale (FEATS) (Gannt & Tabone, 1998). These tests focus on the production of a particular image using specific art materials to assess a client's functioning, formulate treatment goals, assess a client's strengths and gain a deeper understanding of a client's presenting problems (Betts, 2006). However, attention to the role of art materials in the assessment is limited. Another approach to art therapy assessment originated from the perspective of ‘art as therapy’, which was first described by Hill (1948) and Kramer (1958). This approach is called “creative art therapy”, and it focuses on the inherently therapeutic nature of art making. This approach emphasizes the intrinsic healing properties of the creative process and the primary role of art and creating art in the therapeutic process ( Rubin, 2009). Early art therapists wrote about art materials and the influence of these materials on the art process and product ( Betensky, 1973, Kramer, 1971, Kramer, 1975, Lowenfeld, 1952, Naumburg, 1966, Rhyne, 1973, Rubin, 1984, Rubin, 2009 and Wadeson, 1980), but theories and research on the role of art materials and art properties focused on ongoing art therapy more than the initial assessment. A more eclectic approach was used in recent literature on art materials ( Hinz, 2009 and Moon Hyland, 2010), which integrated diverse perspectives. For example, Hinz (2009) describes the Expressive Therapies Continuum (ETC) based on the work of Kagin and Lusebrink (1978). They developed the ETC from their observations of developmentally challenged and acutely psychotic individuals. The ETC extensively describes the role of “media”, which is categorized on continua from fluid to resistive. Hinz discusses the influence of media choice on image formation and information processing ( Hinz, 2009). The ETC describes information processes in four levels based on developmental hierarchy: the kinesthetic/sensory level, perceptual/affective level, cognitive/symbolic level and creative level. The ETC can assess clients’ preferred levels of information processing, but it is especially useful in decision making of media choice in art therapy to evoke diverse therapeutic experiences. Despite obvious differences, these approaches agree that art therapy assessment has unique characteristics compared to other forms of assessment (Gannt, 2001 and Gilroy et al., 2012). These unique characteristics are reflected in the ‘triangular relationship’ between the client, therapist and art form (Schaverien, 2000 and Schweizer et al., 2009). The three axes of the triangle refer to the dynamics between client, therapist and art form. Different art therapy approaches place greater or lesser emphasis on each axis, but the role of ‘art’ is present in all axes. All orientations agree that the art form itself provides essential, valuable information about a client's mental health. Assessments for further treatment also involve the formulating of treatment goals and interventions. The therapeutic application of art materials is the core feature of art therapy (Edwards, 2013, Hinz, 2009, Jones, 2005, Moon Hyland, 2010, Rubin, 2011, Schaverien, 2000 and Schweizer et al., 2009), but little attention is paid to the role of art materials in art therapy assessment research (Moon Hyland, 2010 and Snir and Regev, 2013). It is remarkable that our understanding of art materials and their use in art therapy assessments is so poor despite the claimed importance of these materials in the literature. Research on this topic is scarce, which creates ample opportunity for speculation. For example, the assumption is that the use of art materials is so self-evident and taken for granted that it is simply forgotten in research (Rubin, 1999). Therefore, our present knowledge remains tacit (Gilroy et al., 2012). The current research asked experienced art therapists about their use of art materials in their assessments of adult clients with mental health problems to investigate the use of art materials in art therapeutic assessments. Our aim was to describe and theorize the application of visual art materials in art therapists’ practice of assessing adult clients with mental health problems.

Art therapists methodically apply the properties of art materials to gain insight into the client's art making. A client's material interaction provides valuable information about the client's characteristics. Material interaction may be a strong concept in art therapy assessment because it stresses the importance of art materials in the assessment of adult clients’ mental health and links art making with the art product. Therefore, material interaction has the potential to connect different approaches in art therapy assessment. The results of this study are a firm base for further articulating and theorizing the unique properties of art therapy assessment, which distinguish it from other forms of adult mental health care assessment.