Page 18 - ART FORM AND MENTAL HEALTH - Ingrid Pénzes

bright invites the emergence of unconscious images, emotions, thoughts and memories (Hilbuch, Snir, Regev, & Orbiki, 2016). The empirical status of transferential responses to both the art materials and the psychotherapist during the art-making process is far from uncontroversial (Schaverien, 2005). As for the art product, this perspective focuses on the symbolic content of the art product, assuming that this represents the inner image revealing unconsciousness and the psychological conflicts of a person (Hacking, 1999; Naumburg, 1966, 2001; Simon, 2001; Ulman & Bernard, 2001). The art product also assumes to serve as a transactional object through which, on an unconscious level, clients negotiate their experience with themselves and with the psychotherapist, as the content may also reflect the client’s unexpressed feelings and thoughts about the psychotherapist (Hilbuch, Snir, Regev, & Orbiki, 2016). For this purpose, projective drawing tests have been developed which originated as intuitive-based – as opposed to evidence-based – techniques. Empirical evidence for this assumption is weak at best. This approach has been seriously criticized because of its reliability and validity due to the subjectivity of interpreting the symbolic content of art products (Betts, 2006, 2014, 2016; Joiner, Schmidt, & Barnett, 1996; Kahill, 1986; Kaplan in Malchiodi, 2012; Motta, Little, & Tobin, 1993).
Other art-based perspectives focus on the global ratings of formal elements of art products such as line, color and movement. Authors within this perspective state that the formal elements are visual expressions of how clients make art, and they consider the rating of formal elements of the art product to be most objective (Eytan & Elkis-Abuhoff, 2013; Gantt, 2004, 2001; Kaplan in Malchiodi, 2012; Mattson, 2009; Thomas & Cody in Gilroy et al., 2012; Kim et al., 2012; Thyme et al., 2013). The formal elements are supposed to reflect the client’s symptoms in line with the disorders classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Statistical Classification of Diseases and Related Health Problems (ICD) (Cohen, 1986, 1994; Cohen, Hammer & Singer; Elbing & Hacking, 2001; Conrad, Hunter, & Krieshok, 2011; Gannt & Tabone, 1998; Hacking, 1999; Schoch, Ostermann & Gruber, 2017; Stuhler-Bauer & Elbing, 2003). Several assessment instruments have been developed to rate all of these formal elements. Research on the rating of global formal elements shows promise as descriptors of clinical states (Cohen, Mills, & Kijak, 1994; Gantt & Tabone, 1998). However, it has been argued that these developed art-based assessments use poor rating methods (Betts, 2006; Nan & Hinz, 2012) and inappropriate statistical methods for measuring inter-rater
16 | Chapter 1