Bridge drawing to assess psychosis

A recent article (in press) in The Arts in Psychotherapy discusses new research on drawing indicators.  A small sample of drawings from in patients (n=34), out patients (n=26) and comparison group (n=29) were contrasted to establish the validity of certain formal drawing characteristics as indicators of psychotic features. Patients in the study were all diagnosed with illnesses that involved psychotic episodes and had experienced an episode within five days of taking the drawing test; all were on medication at the time of the study. Age range 18-56 males and females.

Formal art characteristics were chosen. They involve more objective measures than theme content. Formal art characteristics such as color, line, placement, directionality,  word/number inclusion were selected.

Drawing directive given was : « Draw a bridge connecting where you are now to where you would like to be. Place yourself somewhere in the picture »

Inter-rater reliability was met for color (use, choice and prominence) and movement and placement.

  1. It was found that monochromatic color choices (one color) was more prominent in the inpatient group (33%), decreased to 20% in the outpatient group while only one person used a single color in the control group.
  2. Idiosyncratic color was found to be more prominent in the control group. The psychiatric in and out patients tended to use more realistic colors. This contradicts popular belief.
  3. Some colors were infrequently chosen by patient groups. These were yellow, green, blue, purple and brown.
  4. Color use tended to be restricted to outlines in patients rather than fill in forms.
  5. Placement for the future was found to be consistently on the right of the page for the control group while most in and outpatients tended to have undetermined future placements.

In summary and contrary to popular belief, patients who experienced psychosis, were more restrained in their color use (type of color, use of color (outlines) and variety in color choices), restricting their choices to more realistic color choices and were more ambivalent about the direction of their future.

The important medication variable is not taken into account in this study. Controlling for  timing, short term adjustment to medication effects, may produce important effects that could skew the results of this study in important ways. Intuitively I would tend to read indicators that consistently reflect restriction, restraint and decreased creative flexibility, as indicators that approximate the effects of medication on symptoms that is: curb more florid manifestations of the illness. Studies tracking change over time in a body of works by a group of patients may more accurately reflect symptoms and changes in symptomatology. Single drawing assessments are in my opinion very problematic. However ambivalence in future direction seems logical given trust in ones self is certainly shaken when one has suffered psychotic episodes. Color flexibility and increase in choices in less ill patients and control groups also seems to logically reflect a direction towards more health.

As I mentioned in earlier postings, studies that attempt to correlate visual indicators with psychopathology in drawings are few in the art therapy literature. The exceptions are mostly found in the US  such as the DDS or Diagnostic Drawing Series research (Cohen et al.) and  FEATS Formal Elements Art Therapy Scale (Gantt & Tibone). UK practitionners tend to find

Article discussed: Teneycke, T., Hoshino, J and Sharpe, D (2009). The bridge drawing: An exploration of psychosis. The Arts in Psychotherapy, xx, xxx.

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Catégorisé dans Arts, Thérapie.

Publié le 30 sept 2009

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Un commentaire à Bridge drawing to assess psychosis

  1. Marie-Ève
    Le 1 oct 2009 à 12:31

    Le manque de flexibilité est aussi réflété au niveau des tâches cognitive, par exemple dans le test du « Wisconsin card sorting task », où les patients ont de la difficulté à s’ajuster losque l’on doit changer la règle du classement des cartes… Les couleurs restreintes et réalistes ne sont peut-être pas si surprenantes dans ce contexte.