Art Therapy
Education Materials
Donna Betts

Art Therapy Assessment

A Systematic Analysis of Art Therapy Assessment and Rating Instrument Literature

Doctoral Dissertation, 2005

by Donna J. Betts, PhD, ATR-BC

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Art-based assessment instruments are used by many art therapists to: determine a client’s level of functioning; formulate treatment objectives; assess a client’s strengths; gain a deeper understanding of a client’s presenting problems; and evaluate client progress. To ensure the appropriate use of drawing tests, evaluation of instrument validity and reliability is imperative. Thirty-five published and unpublished quantitative studies related to art therapy assessments and rating instruments were systematically analyzed. The tools examined in the analysis are: A Favorite Kind of Day (AFKOD); the Bird’s Nest Drawing (BND); the Bridge Drawing; the Diagnostic Drawing Series (DDS), the Child Diagnostic Drawing Series (CDDS); and the Person Picking an Apple from a Tree (PPAT). Rating instruments are also investigated, including the Descriptive Assessment of Psychiatric Art (DAPA), the DDS Rating Guide and Drawing Analysis Form (DAF), and the Formal Elements Art Therapy Scale (FEATS).

Descriptive results and synthesis outcomes reveal that art therapists are still in a nascent stage of understanding assessments and rating instruments, that flaws in the art therapy assessment and rating instrument literature research are numerous, and that much work has yet to be done.

The null hypothesis, that homogeneity exists among the study variables identified in art therapy assessment and rating instrument literature, was rejected. Variability of the concurrent validity and inter-rater reliability meta-analyses results indicates that the field of art therapy has not yet produced sufficient research in the area of assessments and rating instruments to determine whether art therapy assessments can provide enough information about clients or measure the process of change that a client may experience in therapy.

Based on a review of the literature, it was determined that the most effective approach to assessment incorporates objective measures such as standardized assessment procedures (formalized assessment tools and rating manuals; portfolio evaluation; behavioral checklists), as well as subjective approaches such as the client’s interpretation of his or her artwork. Due to the inconclusive results of the present study, it is recommended that researchers continue to explore both objective and subjective approaches to assessment.


A Teaching Tool for Art Therapy Educators:

Art therapy assessments and rating instruments: Do they measure up?

A PowerPoint Presentation delineating types of rating scales used in conjunction with art therapy assessments, presented at the 2007 AATA conference.

The Descriptive Assessment for Psychiatric Art (DAPA)

This doctoral dissertation provides a comprehensive literature review of the art therapy assessment research:

The Psychopathology of Everyday Art: A Quantitative Study by Suzanne Hacking, 1999


There are a variety of art therapy assessment tools that are used clinically and in research. Some of these assessments are listed below. Please be aware that art therapy assessments should be administered only by art therapists who are trained to use them. For information on training in each assessment, please refer to the contact name provided.

Seeking information about published and unpublished studies (Paper Presentations, Masters' theses, Doctoral Dissertations) on all the instruments currently in use or being developed. Please contact Donna Betts) if you have information you would like to contribute. Looking for names of art therapy assessment instruments, the original publications, the sources for other studies, etc.




Bridge Drawing











The Attachment Potential Art Therapy Assessment (APATA) Manual and Scoring Guide is an economical, user-friendly, art-based clinical tool for use by mental health professionals. It is designed to measure, by concrete score, a person's current attachment potential (AP). It also aids in identifying other possible client issues, weaknesses and strengths valuable in assisting the clinician in making better clinical decisions and in creating more effective treatment service plans. The APATA is versatile in that it can be utilized with different age groups, in a variety of settings and with many other populations beyond those diagnosed with a specific Attachment Disorder.

To order the APATA one need send a check for $36.00, which includes both postage and handling, made out to its author, Richard C. Rule-Hoffman to be sent to the following address:

Art Therapy Services of Northeast Ohio
c/o R.C. Rule-Hoffman
3700 Walnut Hills Road
Orange Village, Ohio


The Art Therapy-Projective Imagery Assessment (AT-PIA) is a structured clinical interview through the use of a series of six specific projective drawing tasks collected under standardized conditions as described in the Art Therapy–Projective Imagery Protocol Manual. The AT-PIA was developed to provide a systematic method of assessment that is compatible with psychological tests and psychiatric evaluations. The AT-PIA is to be administered and interpreted by art therapists or art therapy students (under supervision of an ATR) who are trained to assess mental status, personality dynamics, and diagnostic indicators expressed through artwork, verbal associations, and behavior. The AT-PIA is based on standard clinical use of projective drawing tasks, clinical observations, interview procedures, and professional documentation. Currently, the use of the AT-PIA is taught only at Eastern Virginia Medical School. A version of the manual is being developed for purchase and should be available in the spring of 2007.

For more information, contact Matthew Bernier, MCAT, ATR-BC
Associate Profes
Graduate Art Therapy Program
Eastern Virginia Medical School
P.O. Box 1980
Norfolk, VA 23501-1980

Horovitz, E.G. (2002). Rochester, NY: Julia Production, 6-minute film: Designed by Dr. Ellen Horovitz, allows the viewer to glean an understanding of how to conduct the BATA both as an administrant and clinician. The videos take the guesswork out of what materials to use and how to work with thus projective assessment battery. Approximately 6 minutes in length. Available in CD-ROM or VHS - $35 (US)

To order: send check or money order made out to Dr. Ellen Horovitz. Please add $3.00 for shipping and handling. New York State residents add 8% sales tax. Allow two weeks for delivery.

Mail to: Dr. Ellen G. Horovitz, ATR-BC, c/o Julia Productions, 28 Laureldale Drive, Pittsford, NY USA 14534

The Bridge Drawing technique was originated by Hays & Lyons (1981). More recently, others have further standardized the technique, and created a more formal rating system. Research is being conducted at George Washington University to further improve the Bridge Drawing as an assessment tool. For more information, contact Donna Betts.

Horovitz, E.G. (2002). Rochester, NY: Julia Production, 6-minute film: Designed by Dr. Ellen Horovitz, allows the viewer to glean an understanding of how to conduct the CATA both as an administrant and clinician. The videos take the guesswork out of what materials to use and how to work with thus projective assessment battery. Approximately 6 minutes in length. Available in CD-ROM or VHS - $35 (US)

To order: send check or money order made out to Dr. Ellen Horovitz. Please add $3.00 for shipping and handling. New York State residents add 8% sales tax. Allow two weeks for delivery.

Mail to: Dr. Ellen G. Horovitz, ATR-BC, c/o Julia Productions, 28 Laureldale Drive, Pittsford, NY USA 14534

For information regarding the DDS and requests for trainings, contact: Barry M. Cohen, ATR-BC: or visit

DDS Price List:

Clinician's Packet: $20. Includes: Handbook, Drawing Inquiry, Rating Guide, Resource List, Style Guide, How to write up an evaluation.
Researcher's Packet: $20. Includes: Handbook, Rating Guide, researcher number, Master List, sample release form, Drawing Analysis Form, Drawing Inquiry, Resource List, Style Guide, and other materials for setting up a research project.
Diagnostic Drawing Series Network Membership: $5 (covers annual subscription)

If you indicate that you wish to receive DDS news and training opportunities, you will be placed on the mailing list. If you wish to receive a free electronic newsletter, send your email address.
Translations: $2 each (free to overseas researchers). Basic DDS instructions in Dutch, French, German, Japanese, or Spanish.

Please send orders to: Barry M. Cohen, P.O. Box 9853, Alexandria, Virginia, USA 22304. US residents, please allow six weeks to receive your order. Please make cheques payable to: The DDS Project. Sorry, our banking system makes it prohibitive to accept any currency other than US dollars. If you live overseas and are ordering items that are not free, please send a money order in US dollars or the equivalent in international postal orders. Thank you! Your order helps defray costs, including the DDS Research Award and the DDS Archive.


For information regarding these assessments, contact Rawley Silver, Ed.D, ATR, HLM or visit

Draw A Story, Screening for Depression (DAS)
New studies have found that DAS can be used to identify children and adolescents at risk for harming others and/or themselves, as reported in a book, Aggression and Depression Assessed Through Art, published in 2005 by Brunner-Routledge ($34.95, ISBN 0-415-95015-5). Significant differences emerged between aggressive and non-aggressive groups in Emotional Content and Self-Image. Chapters also compare subgroups, individuals, and cultures, and report changes and consistencies in emotional states.

First published in 1988 and revised in 1993 and 2002, DAS is now in a book, Three Art Assessments, published by Brunner-Routledge ($34.95, ISBN 1-58391-352-1). Like the other two assessments, DAS uses stimulus drawings to elicit response drawings that are assessed on 5-point rating scales. Chapters include administering and scoring, studies of reliability and validity, and use with clinical and non-clinical populations. Test booklets can be downloaded at no charge from

The Silver Drawing Test of Cognition and Emotion (SDT)
SDT includes three subtests: predictive drawing, drawing from imagination, and from observation. First published in 1983, and revised in 1990, 1996, and 2002, SDT also is published in Three Art Assessments, which includes chapters on administering and scoring, reliability and validity, normative data, outcome studies, age and gender differences, correlations between assessments, uses of humor, and cross-cultural studies.The book was a main selection of the Behavioral Science Book Service. Test booklets can be downloaded at no charge from

Stimulus Drawings and Techniques (SDS)
The book's third assessment, SD was first published in 1982, and revised in 1986, 1989, 1991, and 2002. It includes 50 stimulus drawings and presents techniques in therapy, development, and assessment.

Some journal articles reporting studies that used the assessments can be downloaded at no charge from

THE FACE STIMULUS ASSESSMENT (FSA) For information regarding the FSA and current research, contact: Donna J. Betts, PhD, ATR-BC: or visit

The FSA was developed from 1998-2000 and was presented at the 31st Annual AATA conference in Albuquerque, NM, November 2001, as a paper entitled: "Projective Drawing Research: Assessing the Abilities of Children and Adolescents with Multiple Disabilities."

A standardized rating scale for measuring the FSA has been pilot tested, but further reliability and validity testing needs to be conducted. As such, art therapists are encouraged to use this assessment tool in research.

Although the tool was originally designed for use with clients who have communication disorders and are non-verbal, it is also applicable for use with clients of all age groups and cultural backgrounds.

Clinician's Packet: $20 US. Includes: Assessment Templates (Adobe PDF file), FSA Administration & Rating Guidelines, Reference List.

Researcher's Packet: $20 US. Includes: Assessment Templates (Adobe PDF file), FSA Administration & Rating Guidelines, Reference List, researcher number, sample informed consent form.

Please send orders to: Donna Betts, PhD, ATR-BC, The George Washington University,
Art Therapy Program, 1925 Ballenger Ave., Suite 250, Alexandria, VA, 22314. The packet is sent via email.

Reference: Betts, D. J. (2003). Developing a projective drawing test: Experiences with the Face Stimulus Assessment (FSA). Art Therapy: Journal of the American Art Therapy Association, 20(2), 77-82.

For information regarding the LECATA and current research, visit: or contact: Myra F. Levick, PhD, ATR-BC, HLM: or 19730 Dinner Key Drive, Boca Raton, FL 33498, (561) 482-0114

The LECATA was developed in 1986 at the request of Janet Bush, then Director of the Miami-Dade Clinical Art Therapy Program for Exceptional Children. It is based on the original work described in Myra Levick's text, They could not talk and so they drew: Children's styles of coping and thinking and was copyrighted in 1989.

In 2009, the Levick Emotional and Cognitive Art Therapy Assessment: A Normative Study (paperback) was published.

Collaboration with others collecting drawings from typical children is welcome.

For information regarding the PPAT, contact: Linda Gantt, PhD, ATR-BC:

Bucciarelli, A. (2007). Normative study of the PPAT assessment on a sample of college students. Unpublished thesis, Florida State University, Tallahassee.

PPAT Rating Manual: The Formal Elements Art Therapy Scale (FEATS) copyright 1997by Linda Gantt, PhD, ATR-BC, & Carmello Tabone, MA, ATR

The FEATS scales rate on 14 different pictorial elements of the PPAT.

Also available: teaching cards, trauma treatment manual, video. contact Gargoyle Press:


For information regarding the MARI and requests for trainings, visit:
Mandala Teacher & Research Associates

For information regarding the UPAP and requests for trainings, contact: Dr. Gladys Agell, ATR-BC:


This is a list of literature (published and unpublished) on the research that has been conducted (reliability & validity studies, normative studies, etc.) to further validate/study art therapy assessment rating manuals.

The Formal Elements Art Therapy Scale (FEATS)
Original sources:

Gantt, L. (1990). A validity study of the Formal Elements Art Therapy Scale (FEATS) for diagnostic information in patients' drawings. Unpublished doctoral dissertation, University of Pittsburgh, Pittsburgh, PA.

Gantt, L. (1993). Correlation of psychiatric diagnosis and formal elements in art work (chapter 16). In F. Bejjani (Ed.), Current research in arts medicine. Pennington, NJ: A Cappella Books.

Gantt, L., & Tabone, C. (1998). The Formal Elements Art Therapy Scale: The Rating Manual. Morgantown, WV: Gargoyle Press.


The International Art Therapy Research Database (IATRD):

The Buros Institute: This website provides information about various types of assessment tools

American Educational Research Association Standards for Educational and Psychological Testing:

Hungarian assessment researcher Dr. Vass Zolten:

How to compute Kappa (statistic used for determining inter-rater reliability):

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