Art Therapy Article Review

ARTICLE:
Kessler, K. (1994). A study of diagnostic drawing series with eating disordered patients. Art Therapy: Journal of the American Art Therapy Association, 11(2), 116-118.

SUMMARY:
The purpose of this article was to compare and contrast the content and structural elements taken from sample drawings of eating disordered (ED) patients. The subjects were female, ranging in age from 15 to 54 years old. The sample included 55 of the women diagnosed as bulimic, 17 diagnosed as anorexic, and 9 diagnosed with an eating disorder not otherwise specified (ED/NOS, or a combination of the two, anorexic and bulimic). There was also a control group that samples were compared with.

The Diagnostic Drawing Series (DDS) was the instrument used in this research. It consisted of three drawings per patient, with chalk pastels on white paper. Instructions for the drawings were as follows:
1. Make a picture using these materials
2. Draw a tree
3. Make a picture of how you are feeling using lines, shapes, colors

When there was a greater than 50% occurrence/nonoccurrence of a particular element in the tabulations of the sample, a profile was established for each picture. Some generalizations specific to ED drawings:

• no blending
• no idiosyncratic color
• no enclosure
• no groundline
• no people
• no animals
• no words

A few elements were emphasized in the study. In the control group, 70% of the drawings included a groundline, as compared to the ED sample's 72% of no groundline. In the tree drawing, 41% of the anorexics drew falling apart trees, compared with 14% of the bulimics and 22% of the ED/NOS. The largest contrast within the group was very interesting: the bulimic group had a 70% occurrence of knotholes drawn in the trees, vs. the anorexics having only a 17% occurrence (83% nonoccurrence) of knotholes.

These results were interesting, however, it was pointed out that the specifics of knotholes, no groundline, and falling apart trees did not necessarily indicate an eating disorder. It was also noted that the bulimic sample was nearly three times as large as the anorexic sample, and six times as large as the ED/NOS sample. Larger sample sizes in the later two groups could yield additional diagnostic data.

RESPONSE:
I found the information is this study fascinating. No groundline and no enclosure seem to be so appropriate for the eating disordered population. In a book by Lynne Hornyak and Ellen Baker, Experiential Therapies for Eating Disorders, there is a chapter on Art Therapy and Anorexics. One of the exercises was to make a drawing with an enclosure, to promote the feeling of safety and security, and also to provide a boundary. No groundline would appear to me to be the lack of control, or base of support that many of these patients feel, to spite them trying to control things through the disordered eating.

The higher occurrence of falling apart trees in the anorexics I found interesting, and once again appropriate. Their obsession with control, outward appearance, and rigid lifestyle is just a cover for what they are really feeling - if they ever let an inkling of feeling emerge. The falling apart tree would symbolize what they are really all about on the inside. The drawing wordlessly gives the description of the real truth of what is going on. I would be very curious to see what a larger sample of this diagnosed population would produce.

Knothole occurrence and the high percentage of it in the bulimic group (70%) was astounding. As we discussed in class, the knothole drawn in a tree was symbolic of a wound or something perhaps broken off. I am wondering what percentage of the knothole drawers had been sexually or physically abused. Equally as interesting was the low occurrence of the knotholes in the anorexic group (17%).

Although the article did not emphasize some of the other repeated occurrences, I pondered over the lack of blending of the colors and it's meaning. This would appear to me to be symbolic of the eating disordered clients lack of connection: the connection with others, the connection of the mind and body, and the connection with the self and emotions. They do not know how to connect their outer would with their inner would and thus have a lack of blending of the two to become a whole person. Perhaps the lack of people and animals in the drawings could be compared to their lack of relating to others. The lack of words could represent how this population has a lack of feeling or how they cannot put feeling into words.

I am beginning to develop a serious appreciation for the use of Art as a tool in helping to providing therapy. One could say that the "writing" (drawing in this case) is on the wall and so many issues come to light using these very simple, yet very telling techniques.

QUESTION:
I am wondering why Kessler did not try to even out the diagnosed groups so the sample could have been more balanced. I think a more equal numerical sample of subjects in each of the diagnosed groups would have provided a better sample.

The article basically just gave the information from the tabulation of samples. I am wondering what Kessler found to be the meaning of the information collected. This came from the Journal of the American Art Therapy Association, so I am assuming that their target audience would be mostly Art Therapists that would already be able to understand what the bottom line meaning of this information was. For me, the novice, I would have liked Kessler to provide a quick overview of the meaning or supposed meaning of each of the elements emphasized: the absence of a groundline, the knotholes, and the falling apart trees.

I am curious as to what they trees looked like that the subjects drew. I wonder if the trees were at all similar in type, size, or shape. They state there was no groundline in most of the drawings, were the trees drawn in the middle of the page? Did any of them branch up and over the top of the paper or the sides of the paper? It would be very interesting to me to have seen the drawings.

I am also curious as to what the drawings were in exercise one. Were there any line, shape, color, or image similarities? Did any of these drawings correlate to any other diagnosed groups such as Compulsive Obsessive Disorder (OCD) or perhaps some other addictive disorders?

IMAGE RESPONSE:
What kept coming to my mind, as I was reading this article, was an image drawn by one of my Art Therapy classmates. I can't remember (or never knew) her name, but I vividly remember her tree. It was the "scary tree" with all the branches cut off or rather hacked off mid-limb. I believe she also had a knot in her tree. I kept thinking she was trying to get somewhere and was constantly being cut off. Or something was stunting her growth as a person. She was actually trying to help her mother with bipolar disorder and a few other things and was getting nowhere. I kept thinking of this image because it kind of symbolized, to me, the falling apart tree in this article. Perhaps I also had this image on my mind because I really felt the tree drawing to be a very "telling" exercise and it certainly was when we did it in class.