Why projective drawings help with trauma?

According to research by a number of current psychologists and psychotherapists (Elbrecht, 2006; Kuban and Steele, 2008, Levine, 2005, Malchiodi, 2008; Oster, 2004; Peterson & Hardin, 1997; Sander, 2006; Silva, 2004, van der Kolk, McFarlane, & Weisaeth, 1996), sensory interventions rather than cognitive approaches can better help children overcome or minimize the learning, emotional and behavioral problems resulting from the traumatic arousal. The scholars mentioned believe that sensory-based interventions are more effective in assisting clients overcome the negative effects of their implicit memories caused by trauma and to restore effective emotional functioning. As a result, clearer thinking and positive coping strategies will become possible.

As indicated in the research of Steele (2009), traumatic memories are experienced at a sensory level and must be reactivated in a safe environment in order to be moderated and tolerated with a sense of power and feeling of safety. Traumatized people need to feel safe on a sensory level to restore the functions of the right brain and subsequently regain the ability to respond appropriately to future stress and/or crisis. Three components of structured sensory intervention for traumatized children, adolescents and parents (SITCAP; Steele and Raider, 2009), namely exposure, trauma narrative, and cognitive reframing, were designed to help people heal from traumatic effects.

As children have difficulty in verbalizing traumatic events (Gil, 2006; Malchiodi, 1998; Sander, 2006), drawings are ideal for them as well as nonverbal adolescents and adults. Robinson (2011) pointed out that using drawings with children are much shorter in terms of time and much more cost-effective to administer than known measures of mood and thought disorder. It takes less than 20 minutes and requires very simple materials such as 8.5” x 11” white paper and color pencils. Therapeutically speaking, using drawings can be much safer and freer to explore the inner world of the client who is a victim of abuse, illness or injury, or a child traumatized by natural disaster, family transition or violence. According to DiLeo (1983), unconscious expression of feelings and attitudes may imbue a child’s drawings and give expression to his/her characters and they can convey directly feelings of joy and sorrow, hostility and fear.

Recent research results suggest that projective drawing continue to be popular with a large number of psychologists, psychotherapists, and social workers (Bekhit, Glyn, & Richard, 2005; Hojonski, Morrison, Brown, & Mattews, 2006, Robinson, 2011). Through using projective drawings therapeutically, insight into the person’s “inner world” would be provided and the person’s intrapersonal themes, conflicts, psychological and emotional defenses, and indications of a psychological disorder would become conscious from unconscious (Groth-Marnet & Roberts, 1998).

For the use of projective drawings, Robinson (p.4-5) states that:

Drawings were noninvasive, nonthreatening, and ideal for people who would not or could not speak of their troubles. Projective drawings have been used to capture and describe emotional and psychological processes over the past century. Developed within the psychoanalytic and psychodynamic literature, drawings were used a way to view the inner world of the individual. Drawings were used to not only assess a person’s emotional state, but also his or her inner conflicts. Drawings were used to assess unconscious processes such as wishes, desires, and fear. As a result of this interest, projective drawing drew together the fields of psychology, psychiatry, and art and art therapy.

Children’s drawings have been used in evaluation of personality, development, and cognitive abilities for over 100 years (Golumb, 1990). The study of children’s drawings has such a long tradition in the field of psychiatry, psychology, art therapy and education (Malchiodi, 1998). Children’s drawings have generated significantly important information on how children use drawings to express themselves which the helping professionals should know.

Rubin (2005) pointed out that the making of art products was a kind of acceptable exhibitionism and not only was art a path to permissible regression, but also a way to acceptable aggression. Talking about an artwork of grief, Rubin described:

            It was a cry, a scream caught and tamed. It was a new object in the world, a symbolic for he who was lost, a mute, tangible testament. The doing of it afforded tremendous relief. It did not take away the hurt and the ache, but it did help in releasing some of the rage, and in giving form to a multiplicity of feelings and wishes (p. 4).

Naumburg (1950, 1953, 1966) also stated that art was a kind of symbolic speech from unconsciousness such as dreams and free association. As a “royal road” to unconsciousness, art requires art expression and verbalization as well as self awareness. Kramer (1971, 1979, 2000, 2001) argued that art was a “royal road” to sublimation which helping the ego to control, manage, and integrate via the creative process itself. For more than half a century, both approaches are still seen as pioneers in the rapid growth field of projective drawing and art therapy. “This rapid development reflects the power of art as a therapeutic modality (p. 8, Rubin, 2005).

Using projective drawing as a therapeutic tool, the psychoanalytic perspective is the most helpful to conceptualize the psychodynamic aspects of conflict between basic fear and basic desire (Blos, 1962; Cassidy & Shaver; 1999, Erikson, 1950, 1959; Frailberg, 1955: A. Freud, 1936, 1946, 1965; Starnoff, 1976; Tyson & Tyson, 1990).

As indicated by Rubin, “Without a conceptual framework to which to relate the child’s symbolic and behavioral messages in assessment or treatment, one’s work remains fuzzy and unfocused” (p. 58). In other words, it is vital that a conceptual framework to be chose and used both in assessment and therapeutic process.

Drawings have been used by many psychologists to find out the development as well as the personality of children (Harris, 1963; Koppitz, 1968, 1984). It is always a fascinating question to ask what children’s drawings tell clinicians about their psychological state and possible psychopathology (Buck, 1948; DiLeo, 1974, 1983; Dracknik, 1995; Klepsch & Logie, 1982; Machover, 1949; Malchiodi, 1998; Oster & Crone, 2004; Rubin, 2005; Schildkrout, Shenker, & Sonnenblick, 1972).

Therapeutically speaking, using drawings can be much safer and freer to explore the inner world of the client who is a victim of abuse, illness or injury, or a child traumatized by natural disaster, family transition or violence. According to Di Leo (1983), unconscious expression of feelings and attitudes may imbue a child’s drawings and give expression to his/her characters, conveying directly feelings of joy and sorrow, hostility and fear.

This is the prelude to my dissertation: Use projective drawings therapeutically with children who have experienced trauma. I will attempt to explore the use of projective drawings therapeutically with children who have experienced trauma, and scaffold a new clinical model for clinicians in Hong Kong, to help heal the children who have experienced trauma by using projective drawings therapeutically. 

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                                         A brief history of Projective Drawing

Projective drawing has been used by many clinicians for finding out the developmental status as well as the personality of children (Harris, 1963; Koppitz, 1968, 1984). Drawings were originally used as one kind of children’s intelligence test. Goodenough (1926), a pioneer in projective drawing techniques, made efforts to determine children’s intelligence through studying their drawings. Although it was not the intention of Goodenough to conduct tests for evaluating children’s emotions or in the diagnosis of psychopathology, he discovered that drawings were useful for these purposes. Goodenough believed that “children draw from the world they know rather than the world they see” (Burgess & Hartman, 1993). Falk (1981) noted that children are more likely than adults to get engaged in drawing because they tend to communicate through symbols, especially when they find it difficult to express or too fearful to tell others about their feelings. According to West (1998), for “children who may have been sexually abused by a family member, the projective is a way to disclose when the children do not have the vocabulary to disclose and a way to tell without telling” (p. 1163).

Goodenough’s method initially used to evaluate intelligence, the Draw-A-Man (DAM) test, was re-evaluated by Harris (1963), focusing on evaluation on a number of domains of cognition other than only general intelligence. The Goodenough-Harris Drawing Test (Harris, 1963) is a screening tool for clinicians to assess the cognitive ability of children. “Of all intellectual screening measures, it is probably the briefest and most convenient to use” (Oster & Crone, 2004).

Since the 1940’s, children's drawings have also been used as nonverbal measures of personality (Buck, 1948; Machover, 1949) and emotional difficulties (Koppitz, 1966, 1968). It became apparent to many clinicians that certain drawing tasks tended to tap personality factors in addition to intellectual and conceptual capabilities (Burgess & Hartman, 1993; Hammer, 1980). Apart from human figure drawings, a number of other projective drawing tests have been applied therapeutically with children. Within this context, drawings provide a valuable source of information about a child's psychological realities (Klepsch & Logie, 1982; Naglieri, 1988; Wilson & Ratekin, 1990; Gross & Hayne, 1998). One of the most well-known projective drawing techniques is Buck’s (1948, 1966) House-Tree-Person (HTP). The house drawing is thought to carry information on issues related to the home and those living in it, whereas the tree is believed to represent the drawer’s projection of his/her mother figure. The presence or absence of certain features, details, proportions, perspective, and the use of color is believed to reveal the unconscious realities of the drawer.

Other projective techniques commonly used to assess children's thoughts and feelings include the Draw-A-Family Test (Hulse, 1951) and the Kinetic Family Drawing Test (Burns & Kaufman, 1972). In these tests, children are asked to draw their family members and themselves engaging in certain activities. By examining particular features of the drawings, including the relative sizes, proximity, and placement or omission of various family members, the clinician will be able to make inferences on the dynamics of the relationship between the child and his/her family members (Chandler, 1990; Oppawsky, 1991; Sourkes, 1991). In certain legal settings, these drawings have been used to make decisions regarding child custody (Levick, Safran, & Levine, 1990; Lyons, 1993). In 1990’s, human figure drawings were found to be one of the top ten instruments used by clinicians working with children (Archer, Maruish, Imhof, & Piotrowski, 1991; Gross & Hayne, 1998).

Recent research shows that projective drawing continues to be popular among psychologists, psychotherapists, and social workers (Hammer, 1997; Hojnoski, Morrison, Brown and Matthews, 2006; McNeilly & Gilroy, 2000; Safran, 2002; Silver, 1996; West, 1998; Yellow, 2008). Leibwitz (1999) indicated that projective drawing tests, such as House-Tree-Person (HTP), Draw-A-Person (DAP), Human Figure Drawing (HFD), and Kinetic Family Drawings (KFD), “are commonly included in diagnostic batteries, assessment procedures, and as a method to measure change resulting from psychotherapy” (Leibwitz, 1999, p. IX). Robinson (2011) stated that:

Drawings were noninvasive, nonthreatening, and ideal for people who would not or could not speak of their troubles. Projective drawing has been used to capture and describe emotional and psychological processes over the past century. Developed within the psychoanalytic and psychodynamic literature, drawings were used in a way to view the inner world of the individual. Drawings were used to not only assess a person’s emotional state, but also his or her inner conflicts. Drawings were used to assess unconscious processes such as wishes, desires, and fear. As a result of this interest, projective drawing drew together the fields of psychology, psychiatry, and art therapy. (p. 4-5)

Clinicians who use drawings as a means for assessment as well as therapy permit children to draw whatever they like with or without a theme in any way that they feel comfortable. In comparison to cognitive interventions, projective drawing represents a more direct means for interacting with children because emotions such as sadness cannot be adequately explained by words, where the subtlety of bodily responses including tension and sensations can be fundamental markers in understanding the current perceptions and stress of children (Burgess & Hartman, 1993). Regarding the interpretation of drawings, DiLeo (1983) made a crucial point that children should be encouraged to tell what they have drawn in a general way which is nonspecific. The children’s narration as well as the drawings, comprising the signs, symbols, shapes, colors and line quality, which reflect the children’s unconscious memories, help the clinicians better communicate with their little clients (Burgess & Hartman, 1993; Yellow, 2008). Thanks to Hammer and Buck’s contributions to a number of handbooks, research literature was consolidated in an attempt to attribute meanings to the various aspects of projective drawing (Bieliauskus, 1980; Buck, 1966, 1992; Jolles, 1971; Leibwitz, 1999; Mitchell et al., 1993; Ogdon, 1967, 1981; Urban, 1963; Wenck, 1977).

In the past two decades, a renewed interest regarding drawings to be used in the assessment process has developed (Hammer, 1997; McNeilly & Gilroy, 2000; Safran, 2002; Silver, 1996). Oster and Crone (2004) stated that drawings within the psychological battery “serve a special function by offering a minimally threatening, yet maximally absorbing introduction” (p. 22). Koppitz (1968) believed that drawings could be seen as a language, which can be analyzed in terms of structure, quality, and content. Thus, drawings play a role as the bridge between clinician and client and facilitate communication. Hammer (1967, 1997), Harris (1963), Klepsch and logie (1982), Leibowitz (1999) and other researchers on projective drawing have documented the clinical use of projective drawing in the assessment of clients’ personality strengths and weaknesses, attitude, emotional characteristics, status of behavioral and cognitive development, and even the ability to mobilize their inner resources to cope with interpersonal and intrapsychic conflicts (Oster & Crone, 2004).