The Multiple Self-States Drawing Technique

Creative Assessment and Treatment with Children and Adolescents

Susan C. Parente

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351272582
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

This book introduces the Multiple Self-States Drawing Technique (MSSDT), a creative, transdiagnostic, clinical assessment tool and treatment intervention for child and adolescent clients. The MSSDT provides clinicians and patients with a novel opportunity to bridge the gap in youngsters' selves-awareness of discrete emotional states.

Dr. Parente teaches clinicians how to guide clients through this contemporaneous version of projective figure drawing in order to discover and explore trauma-based, dissociative, and emotionally dysregulated self-states and to focus on adaptive, resilient states of well-being. Specific, step-by-step instructions are provided, and case illustrations demonstrating the proposed clinical advantages of the method are presented. Chapters show how this experiential, psycho-educational, arts-based activity can be flexibly applied to a broad range of ages and clinical populations and how using the MSSDT may support mental health professionals' clinical work.

Through this manual, clinicians will learn how to help clients foster a beneficial relational encounter, promote therapeutic self-expression, and develop an enhanced self and other awareness.

Chapter 1
Drawings—A Way of Understanding: An Introduction

The noblest pleasure is the joy of understanding.

—Leonardo da Vinci (DaVinci, n.d.)

The Multiple Self-States Drawing Technique (MSSDT) is a contemporaneously informed, clinical assessment tool, linked with a creative and self-expressive therapeutic treatment method, that can be utilized in child and adolescent psychotherapy across a broad range of ages and clinical populations. The development of the MSSDT was an outgrowth of my personal and professional commitment to explore, support, and promote meaningful understandings and psychological growth and healing for child and adolescent psychotherapy clients. This development had evolved organically over time, with assimilation of the varied therapeutic treatment modalities and spontaneous, play and arts-oriented approaches in which I had become immersed as a clinical practitioner. As well, I integrated a variety of inspiring theoretical constructs that had come to influence and vitalize my clinical work (for example, interpersonal neurobiology, attachment theory, affect regulation principles, and the mentalization model). Furthermore, my background and training in the practice of psychological evaluation was instrumental in laying the groundwork for exploring expanded notions of assessment practice.

The rigorous training, skill set, and competencies related to conducting psychological assessments well informed my career path as a mental health practitioner in myriad ways. I had come to work in public education as an early career professional, performing psycho-diagnostic evaluations for the special education system. In my subsequent 20-year tenure as a school-based psychologist, I directly interacted with children of many ages and stages, abilities and challenges, and with this I was able to have the opportunity to evaluate hundreds of young people of every chronological age, from preschool through high school, for learning, emotional, and developmental disorders. I came to value and respect engagement in the disciplined and analytical assessment processes, through which each child’s distinct profile and personality variables could be deciphered and appreciated. Every case presented an opportunity to unravel a unique human mystery.

As with all school-based psychological evaluators, my charge was to understand and bring to light the multiple psychological, intellectual, neurological, developmental, and behavioral patterns, challenges, and concerns of the students in question. Required as well were thoughtfully crafted reports that would disseminate meaningful information to families and concerned school staff. Through this practice, I cultivated the skills of observing and discerning the crucial features and needs of each examinee. Over the years, I gained indispensable professional experience by establishing and maintaining contact with so many students and their families as the children progressed through the grades, as well as by collaborating with teachers and administrators to create classroom and individually based intervention programs.

A customary test battery included normative educational and cognitive measures, standardized personality tests, and behavior rating scales, along with projective drawing tests such as the Draw-a-Person Test (DAPT; Machover, 1949), the House-Tree-Person Test (H-T-P Test; Buck, 1970), and the Kinetic Family Drawing (KFD; Burns & Kaufman, 1972). While the cognitive functioning information obtained from intelligence testing instruments was critical to educational decision making and determinations, I found that the psychological and emotional components of the assessment process were even more fascinating and personally appealing. I came to recognize that the use of these projective drawing tasks provided a comfortable, nonthreatening vehicle for children to express the kinds of emotional experiences they often could not articulate verbally or even sometimes consciously realize. As the children and teens drew and discussed their various figures, houses, trees, and families, their unique and personalized stories would frequently unfold through the process. These stories would often reveal substantive information about their development, personality, needs, and wishes and, in particular, their highly individualized perspectives. With regular implementation of these projective drawing measures, I gradually came to see that at minimum, the youngsters’ verbal communications could be substantially facilitated. More so, activity of this type would often lead the way toward uncovering unanticipated and striking aspects of a child’s thoughts, feelings, and life circumstances.

Occasionally I shared the drawings and accompanying stories with parents and teachers if they demonstrated a particularly telling theme or notable aspect of a student’s nature or struggles. One especially memorable incident involved the sharing of a certain middle-school student’s projective drawings with his primary classroom teacher. Ms. L. perceived Robbie, the student in question, to be an exceptionally troubled and provocative youngster. She had justifiably begun to lose patience after many months of withstanding what felt to her like this student’s unendingly defiant and disruptive classroom behavior. Their relationship had become “oil and water.” Driven by a host of questions and concerns from all of his teachers in fact, Robbie was referred to the child study team for evaluation to determine eligibility for special education support services.

As it unfolded, Robbie’s psychological interview and evaluation revealed that this young boy had been experiencing many difficulties in his home and family life. Unfortunately, this included antagonistic and shaming transactions between him and his parents as well as between him and his older brother. During this process Robbie disclosed that he frequently felt diminished, depressed, and angry.

Robbie was administered the often-used projective drawing task, the H-T-P Test, as part of his assessment. For his tree drawing, he sketched a smallish tree in the woods, nearly toppled over, with a disproportionately large man in the act of chopping it down with an axe. In the H-T-P Test, the tree was hypothesized to represent a projection of one’s Self, one’s Ego, according to my training in these projective drawing techniques. Utilizing the interpretive approach—a feeling approach emphasizing the clinician’s phenomenological experience of the drawing (Scribner & Handler, 1987)—I inferred, according to the theme and content of his drawing, that Robbie perhaps felt under attack, threatened, and powerless. Of course, we could not know this for sure. This interpretation was based on a general notion of projection of the meaning of the drawing and considered within the context of what I had come to learn about Robbie’s perceptions of his family life, coupled with the troubling behavioral manifestations of distress in the classroom setting. This supposition about what may have been occurring in Robbie’s mind was intuitive and clinical rather than scientifically validated. In this general impression method, assessors use their “phenomenological experience of the drawing, affective or visceral reactions to it, and their … impressions and associations” to interpret the meaning of the projective drawings (Scribner & Handler, 1987, p. 112).

Upon completing the assessment, I invited the weary, disgruntled, and somewhat resistant Ms. L. to the testing room, where Robbie’s drawings had been laid out on the conference table. I explained the premise of the projective drawings to her and the concept that the tree is said to represent “the Self.” Ms. L. sat at the table and stared silently at the picture, absorbing its impact and visual message. Momentarily, her face reddened and tears began to flow down her cheeks. She had suspected some degree of an unhappy home life for Robbie based on her own frequently discouraging interactions with the family. However, Ms. L. was now struck by, and had intuitively grasped the depth of, her young student’s emotional pain. Significantly, this occurred without disclosing any of my own interpretations—the drawing had spoken for itself. And very clearly at that moment Ms. L.’s heart opened with compassion and understanding.

Without remembering the precise evaluation outcomes in terms of school-based interventions for Robbie, I do distinctly recall that a decided shift took place in the teacher–student dynamic from that point on. This veteran teacher had been so emotionally impacted by this projective representation that she was inspired to dig more deeply into her wellspring of skill and talent to foster a more positive school experience for Robbie moving forward. Ms. L., a true professional, received and accepted this pivotal “teachable moment” presented to her by her very own student! The drawing, with its dynamic implicit message, had bridged the gap between two hurting and frustrated individuals, and had inspired and nurtured new levels of compassion and empathy.

This powerful and poignant experience has stayed with me to this day and has reminded me throughout my professional career how children’s innermost thoughts and feelings may be wondrously expressed through their drawings. So too, their engagement in the drawing process may generate invaluable psychological discoveries and understandings for those who are receptive to its utilization as a clinical tool and approach. In fact, the use of projective drawings in psychological assessment practice has a rich and fascinating history. This historical perspective will be discussed in the following chapter.

Chapter 2
Projective Drawing Measures in the Assessment of Children and Adolescents

We are all each of us riddles, when unknown one to the other …

—Mary Wollstonecraft Shelley (2015, p. 343)

Throughout my “testing years” in the public education setting, I continued to maintain a healthy regard for the clinical benefits and potential power of projective drawing to facilitate young people’s expressiveness, in the service of evaluative considerations. Mental health professionals can gain relevant insight into the idiographic psychological phenomena of child and adolescent patients through their artistic creations, especially by using their training as keen and perceptive behavioral observers and attuned clinical interviewers, as well as their skills of engaging in discerning therapeutic dialogue. Despite these fresh insights, however, the methodology of analyzing and interpreting commonly utilized projective drawing tests—and, in fact, projective test measures generally—has historically stirred much controversy in the world of psychological assessment practice.

The rationale for using projective drawing within the context of psychological assessment is based on the underlying assumption that distinctive aspects of self-expression—personality, perceptions, values, and attitudes—will be disclosed in the performance of the task (Klepsch & Logie, 1982). These “projected” expressions may then be either evaluated using a subjective, phenomenological approach (Tuber, 2012) or, alternatively, formally scored for various criteria utilizing relevant scoring systems. The usage controversy has centered around the potential limits of subjective versus empirically validated test result interpretations. In the case of projective drawing techniques, the extensive debate has focused on whether these drawings and their associated scoring systems could be accepted as valid measures of cognitive abilities or could enable diagnosis of specific personality characteristics and pathologies (Thomas & Jolley, 1998).

The History and Controversy of Projective Drawing Techniques

To clarify terms, Kline (2000) wrote, “a simplified definition of a projective test … is a stimulus which subjects have to respond to, so designed that it encourages [them] to project onto it their own feelings, desires and emotions” (p. 243). Because of the non-structured or ambiguous nature of the stimulus, in which there are no “right” or “wrong” answers, subjects are thought to project inner qualities in the construction of their response. Several types of assessment are considered projective tests, including: (a) self-report and sentence completion tasks, e.g., Beck Depression Inventory (2nd ed., BDI-II; Beck, Steer, & Brown, 1996); (b) ambiguous visual stimuli tests, e.g., Rorschach ink blots (Rorschach, 1921); (c) storytelling tests, e.g., Thematic Apperception Test (TAT; Murray, 1971); (d) solid objects, e.g., doll play and sand tray play; and (e) free drawing tests, e.g., the House-Tree-Person Test (H-T-P Test; Buck, 1970). The Multiple Self-States Drawing Technique (MSSDT) has its roots in the free drawing method of projective testing, specifically the Draw-a-Man Test (DAMT; Goodenough, 1926) originally, and its later revised version, the Draw-a-Person Test (DAPT; Machover, 1949). The DAPT has been one of the most utilized and perhaps most researched projective drawing measures in the field of psychological assessment (Imuta, Scarf, Pharo, & Hayne, 2013; Lally, 2001). Consequently, to understand the genesis of the MSSDT and place it within the context of assessment practices, it will be helpful to touch on the substantial historical background of its predecessors—the DAMT and the DAPT.

The use of human figure drawings (HFDs) in child assessment practices originated with the observations, postulates, and social considerations of late nineteenth- and early twentieth-century theorists, researchers, and educational psychologists (Klepsch & Logie, 1982). Children had come to be understood as persons in their own right, entitled to legal guarantees of education, health, protection, and fair treatment rather than as merely “defective adults” (p. v). During this period, Freudian psychoanalytic theory additionally contributed to an increased awareness of the child as possessing individually determined thoughts, feelings, and motivations. Child psychoanalysts such as Melanie Klein, Anna Freud, and Donald Winnicott furthered the perspective that a child’s inner world had a unique status by examining early infantile experience and object relations (Case & Dalley, 1999). “Childhood” was now established as a developmental phase of life and worthy of explorations and understandings. Within this historical and societal context, meaningful consideration of children’s drawings as an entrée into their inner emotional world became a point of interest for the scientific community (Klepsch & Logie, 1982).

Early observers and researchers uncovered important developmental aspects of children’s figure drawings. Specifically, they identified that the ability to draw the human figure commonly unfolded in stages, in a consistent sequential pattern correlated with age (Cronin, Gross, & Hayne, 2017). It was noted that in Western cultures, 2- or 3-year-old children commonly make scribbles as simplified representations of people and animals. Three-year-olds typically draw a person as a head with some facial features. Four-year-olds draw “tadpole” figures with a head and trunk as a single unit with a set of limbs. At 5 years of age, most children are able to draw a distinct head with basic facial features and a trunk with limbs. By the age of 6, children can usually construct recognizable human figures. Then, at each successive stage, more features are likely to be added, with drawings typically becoming more detailed and realistic with increasing age. Adolescents can normally execute a fully detailed human figure drawing (Oster & Gould, 1987).

Although drawings on the whole become more complex as children get older, the rate at which one develops the ability to produce a realistic and detailed human figure drawing varies from child to child. Noting the occurrence of individual differences across the developmental trajectory, early researchers postulated that children’s figure drawings might provide a surrogate measure of their cognitive ability (Imuta et al., 2013). In the early 1920s, prolific researcher, innovator, leading woman psychologist, and university professor Florence Goodenough (1886–1959) took up the mission to construct a method whereby children’s drawings could be systematically utilized as a nonverbal rapid estimate of intelligence or intellectual maturity (Johnson, 2015). Goodenough’s contributions to the field of child psychology included both participating in the development of the Minnesota Preschool Scale and serving as key researcher in Terman’s (1925) longitudinal study of gift ed children. Additionally, Goodenough championed descriptive and observational research extending beyond the controlled laboratory to “the home, the street, the classroom, the factory” to understand how people behave in everyday life (Johnson, 2015, p. 185).

Applying this research philosophy and methodology to the issue of child development and intelligence, Goodenough pioneered the collection of some 4,000 drawings from children in kindergarten through Grade 4 to determine age-related differences in the structure of their drawings (Handler, 2014). From this research, she concluded that children draw what they know and understand, not what they actually see (Young, 1926). As such, she maintained that figure drawings could therefore be used as an index of their mental construct formation and intellectual development (Weiner & Greene, 2008). Subsequently, in 1926, Goodenough published Measurement of Intelligence by Drawings: Introduction to Draw-A-Man Test, which was recognized as the first formal projective HFD test of cognitive development that utilized standardized procedures and a point scale system (Imuta et al., 2013).

For the DAMT, children were asked to produce their best possible complete drawing of a man, including as much detail as possible. Each drawing was scored by assigning points if the children included and accurately placed details such as specific body parts and clothing. Scores were summed to produce an overall estimate of cognitive ability (Cronin et al., 2017). This version was used in psychological assessment practice without modification until 1963, when Harris published the Goodenough–Harris Drawing Test (GHDT; Harris, 1963), including revised standardized scales and norms (Weiner & Greene, 2008). Since the original publication of the DAMT and the GHDT (Cronin et al., 2017), the procedure and scoring systems for these tests have been revised multiple times (e.g., Draw-A-Person: A Quantitative Scoring System [DAP:QSS]; Naglieri, 1988; Draw-A-Person Intellectual Ability Test for Children, Adolescents, and Adults [DAP:IQ]; Reynolds & Hickman, 2004).

In the decades after the 1926 publication of the DAMT test, Goodenough as well as her contemporaries became aware that above and beyond intellectual capabilities, the test seemed to be tapping the child subjects’ personality variables as well. For example, clinicians using the Goodenough DAMT observed that emotions such as hosti...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• About the Author
• Acknowledgments
• 1 Drawings—A Way of Understanding: An Introduction
• 2 Projective Drawing Measures in the Assessment of Children and Adolescents
• 3 The Multiple Self-States Model
• 4 Development of the Multiple Self-States Drawing Technique
• 5 The Multiple Self-States Drawing Technique Procedure
• 6 Proposed Values of the MSSDT
• 7 Early Childhood Case Study—Child With OCD
• 8 Early Adolescent Case Study—Teen With Relational Trauma History
• 9 Late Adolescent Case Study—College Student With Social Anxiety
• References
• Index