Aggression and Depression Assessed Through Art: Using Draw a Story to Identify Children and Adolescents at Risk

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Aggression and Depression Assessed Through

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Aggression and Depression Assessed Through

ART Using Draw-A-Story to Identify Children and Adolescents at Risk

Edited by Rawley Silver, E d .D., ATR BC, HLM

NEW YORK AND HOVE

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Cover design: Elise Weinger Published in 2005 by Brunner-Routledge 270 Madison Avenue New York, NY 10016 www.brunner-routledge.com Published in Great Britain by Brunner-Routledge 27 Church Road Hove, East Sussex BN3 2FA www.brunner-routledge.co.uk Copyright © 2005 by Rawley Silver Brunner-Routledge is an imprint of the Taylor & Francis Group. Printed in the United States of America on acid-free paper. All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. 10 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Aggression and depression assessed through art : using Draw-A-Story to identify children and adolescents at risk / edited by Rawley Silver. p. ; cm. Includes bibliographical references and index. ISBN 0-415-95015-5 (pbk. : alk. paper) 1. Draw-A-Story. 2. Aggressiveness in children—Testing. 3. Aggressiveness in adolescence— Testing. 4. Depression in children—Testing. 5. Depression in adolescence—Testing. 6. Projective techniques for children. 7. Art therapy for children. DNLM: 1. Projective Techniques. 2. Aggression—psychology. 3. Art Therapy—methods. 4. Depressive Disorder—diagnosis. 5. Risk Assessment. WM 145.5.P8 A266 2005] I. Silver, Rawley A. II. Title. RJ506.A35A355 2005 155.4’18—dc22 2004009363

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Contents

List of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii List of Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Editor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Foreword by Linda Jo Pfeiffer, EdD, ATR-BC. . . . . . . . . . . . . . . . . . xvii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi

PART I: OBSERVATIONS AND PREVIOUS STUDIES Chapter 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Chapter 2. Previous Studies of Aggression, Depression, and the Role of Art . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Chapter 3. Draw-A-Story, Screening for Depression . . . . . . . . . . . . 19 Chapter 4. The Pilot Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

PART II: THE CURRENT STUDIES Chapter 5. Rating Scales Used in the Current Studies. . . . . . . . . . . . 41 Chapter 6. Response Drawings and Histories of Aggressive Students . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Cheryl Earwood, Melinda Fedorko, Eileen Holzman, and Linda Montanari v

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Contents

Chapter 7. Comparing Aggressive and Control Groups, Subgroups, and Individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Chapter 8. Changes and Consistencies in the Emotional States of Aggressive and/or Depressed Students . . . . . . . . . . . . . 121 Melinda Fedorko and Linda Montanari Chapter 9. Cultural Differences and Similarities . . . . . . . . . . . . . . . 141 Alexander Kopytin, Helen Svistovskaya, and Vlada Sventskaya

PART III: SUMMARY AND IMPLICATIONS Chapter 10. Concluding Observations . . . . . . . . . . . . . . . . . . . . . . 161 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197

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List of Figures

Figure Title Page 3.1 The Draw-A-Story Assessment; Form A, Stimulus Drawing Task 20 3.2 Distribution of DAS Scores of Normal and Emotionally Disturbed Adolescents 31 4.1–2 Relationships of Aggression to Emotional Content and Self-Image 35 4.3–4 Relationships of Gender to Emotional Content and Self-Image 36 5.1 Lethal and Morbid Humor—“Godzilla vs. Mighty Mouse” 50 5.2 Gallows Humor—“Amy found that James only married . . .” 50 5.3 Disparaging Humor—“The Scared Dragon” 51 5.4 Self-Disparaging Humor—“I am a Picses. So where is the other fish?” 51 5.5 Ambivalent or Ambiguous Humor—“The Snake and the Mouse” 52 5.6 Resilient Humor (mouse overcomes dinosaur) 53 5.7 Playful Humor—“Lyin’ in the livingroom” 53 6.1 “When Dinosaurs Rule America” 58 6.2 “The mouse was killing people from around the world” 59 6.3 “There was a girl and a snake and the snake was attacking . . .” 60 6.4 “There was a [“girl” crossed out] balloon and the balloon was cut . . .” 61 6.5 “The volcano is blowing up the castle” 62 6.6 “A big baby chick is attacking the castle . . .” 63 6.7 “The dinosaur is looking for food . . .” 64 6.8 “The snake is going to the top of the volcano . . .” 65 6.9 “This story is about a mouse that is saying, ‘Help me . . .’” 66 vii

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6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17

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List of Figures

“I don’t like chickens! The chicken is going to die.” “Chick: ‘Don’t hurt me. I want to live’ . . .” “The man is going to die o no” “The knive stabbed the snake . . .” “Guy saving his girl friend. Evil guys are trying to kill him.” “A boy poisin by a snat from getting bit . . .” “The rat was walking in the snake territory . . .” “Princess in Danger” “Shooting Spree” “Vocanola urupt—next it will all . . .” “Pick on someone your own size!” “There’s a princess stuck in a castle . . .” “The story is about are you my mother? . . .” “That a man likes sports . . .” “The man is smoking and watching the little rat having fun . . .” “The Volcano Blast” “Air Force Ejection” “Volcano Monster” “One day there was a princess who lived in a castle.” “The cold mouse sees a place to stay for the winter . . .” “A Girl Changing into a Snake” “Stress messes with everyone . . .” “The prencess kill’d herself because she is not happy . . .” “The bride is sad . . . into self-mutilation . . .” “Help me! Help somebody help . . .” “ . . . knife is falling . . . and about to slice the little chick in hafe . . .” “The Bleeding Tree . . .” “ . . . guy who went skydiving and he lost control . . .” “ . . . lonely little baby chick doesn’t have many friends . . .” First responses to the DAS task by five students in the Aggressive group “I was sitting down and a snake said . . .” “I turned Super Ryan . . .” “The snake eats the mouse climbing a tree in the jungle.” “The cowboy . . . blew his head off with his gun.” “ . . . crazy boy with one leg . . . and a blond hair girl . . .” “The guy in the parachute through a knife at the snake . . .” “The cowboy saw the dinosaur trying to eat the parachutist . . .” “A rat just ate a cat well eating a rat, and the snake . . .”

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 92 92 93 93 94 94 95 95 97 99 100 101 102 102 103 103 104

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7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 8.1 8.2 8.3 8.4 8.5 8.6 8.7 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9

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Shaun’s responses to the drawing task, suggesting predatory aggression 105 Responses to the drawing task by Gus 107 Responses to the drawing task by Carl 108 Responses to the drawing task by Sam 109 Positive (resilient) humor by a nonaggressive student 110 Positive humor by another nonaggressive student 111 Sad and Lonely Princess 114 Snake Gets Princess 114 Volcanoes Explode 115 Princess Saves Chick and Mouse 116 “She was a beautiful queen and she was very happy . . .” 117 “The princess got married and is going to her castle . . .” 117 Gender differences in Self-Image and Emotional Content 118 Changes in responses to the drawing task by Larry, age 17 124 Responses to the DAS and SDT tasks by Lanette, age 12 126 Responses to the drawing task by Victoria, age 17 128–129 Responses to the drawing task by Greg, age 11 131 Responses to the drawing task by Leroy, age 8 133 Responses to the drawing task by George, age 10 134–135 Responses to the drawing task by Joseph, age 10 137 “A mouse walked around and jumped . . .” 147 “There was a biggest volcano in the mountains . . .” 147 “Once a boy thrust a knife into his head . . .” 148 “The girl went to a forest to gather mushrooms . . .” 152 “There was a fish in a shoal . . .” 155 “Cats are wondering creatures . . .” 155 “There was a chicken who pecked millet . . .” 156 “A ship drifted in the sea . . .” 157 By an American aggressive adolescent 177 By a Russian delinquent adolescent 177 By a Russian delinquent adolescent 178 By an American aggressive adolescent 179 Response from the American control group 180 From a Russian delinquent 181 From an American aggressive 181 From a Russian delinquent 182 American but not aggressive 183

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List of Tables

Table 3.1 3.2 5.1 5.2 7.1 7.2 9.1 9.2

9.3 9.4 9.5

Title Page Rating Scale for Assessing the Story Content of Responses to DAS Form A 21 Comparing DAS Scores of 95 Disturbed Adolescents, ages 13–16, with 68 Controls 30 Scale for Assessing Emotional Content and Self-Images 42 Scale for Assessing the Use of Humor 49 Comparing the Emotional Content Scores of Aggressive and Nonagressive Students 90 Comparing the Self-Image Scores of Aggressive and Nonaggressive Students 91 Rating Scale for Assessing the Story Content of Responses to DAS 144 Means and Standard Deviations in the Rating Scale for Assessing the Story Content of Responses and the Self-Image Scale in Groups of Delinquent and Nondelinquent Children and Adolescents 146 Different Categories of Responses According to Criteria of the Rating Scales 149 Appearance of Different Categories of Responses in Clinical and Control Groups 150 Means and Standard Deviations According to Rating Scale for Assessing the Story Content of Responses in the Clinical and Control Groups 154

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Editor

Rawley Silver, EdD, ATR, was elected to Honorary Life Membership in the American Art Therapy Association in 1983, and received its annual award for research in 1976, 1980, 1992, and 1996. She has conducted research projects supported by grants from the United States Office of Education, the National Institute of Education, and the New York State Department of Education. Author of more than 70 journal articles and other publications, her books include Art as Language, Access to Thoughts and Feelings Through Drawings; Developing Cognitive and Creative Skills Through Art; and Three Art Assessments: Silver Drawing Test, Draw-A-Story, and Stimulus Drawings & Techniques. Her paintings have been shown in 16 invitational and one-person exhibitions, and since 1980, she has been listed in Who’s Who in American Art.

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Contributors

Cheryl Earwood, MA, ATR-BC, received her Master of Arts in Art Therapy degree from George Washington University, and has been a clinical art therapist in Florida schools for the past 20 years. Previously, she was an art therapist at Appalachian Hall, a private psychiatric hospital in Asheville, North Carolina. Melinda Fedorko, MA, ATR-BC, received a Master of Arts in Art Therapy degree from the University of Louisville Institute of Expressive Therapies, and is a registered art therapist as well as a licensed marriage and family therapist. She has been employed as a clinical art therapist in Florida for the past 13 years. Previously, she was an art therapist, addiction specialist, and marriage and family therapist in hospitals, mental health centers, and private practice. Eileen Holzman, MA, ATR-BC, is an art therapist at the Bergen Family Center and the Rockland Family Shelter. Previously, she was an art educator in public schools for 35 years. She also works with seniors, serves as a studio art consultant, and teaches watercolor/mixed media and drawing at the Ramapo Adult School. Alexander Kopytin, MD, CMS, a psychiatrist/therapist, is an assistant professor at the Department of Psychology, St. Petersburg xv

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Contributors

State Academy of Post-Graduate Pedagogical Training (heading, in particular, the post-graduate diploma course in art therapy) and the Department of Psychotherapy, St. Petersburg State Medical Academy in the name of I.I. Mechnicov. He is also editor of The Healing Art: International Journal of Art Therapy (published in Russian) and chairman of the Russian Art Therapy Association. Linda Montanari, MA, ATR, LMFT, has been a clinical art therapist in Florida schools for the past 10 years. She trained at the University of Bridgeport, Connecticut, and was employed for three years at the Yale New Haven Hospital Inpatient Children’s and Adolescent Psychiatric Units. She also holds two masters degree in counseling. Vlada Sventskaya, CPS, is a psychologist who graduated from St. Petersburg State University, and is currently an assistant professor in the Department of Psychology and Pedagogy. She is taking postgraduate training in art therapy and works in the specialized psychiatric unit, providing intensive care in group art therapy. Helen Svistovskaya, MD, is a psychiatrist and pediatrician who is taking post-graduate training in art therapy. She is a psychiatrist in the Psychological-Medical-Pedagogical Counseling Center in St. Petersburg, and in the Children’s Residential Home, where she also provides art therapy.

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Foreword

Art tells a story. Through pictures, images and symbols, the art maker communicates feelings and thoughts and creates pathways for others to understand what often lies just beyond the realm of verbal awareness. What is being communicated by today’s youth may be a warning sign or “red flag” to the watchful eye of an intent observer. In this latest piece of research, Rawley Silver has once again provided a remarkable tool designed to alert and inform professionals working with children and adolescents. Rawley Silver’s Aggression and Depression: Identifying Children and Adolescents at Risk is a timely piece of literature that focuses our attention on the underlying messages being sent to us by today’s troubled youth through their drawings. Using her Draw-A-Story (DAS) art assessment technique to identify youth at risk, Rawley Silver has presented us with a carefully researched methodology and screening device to alert professionals to those students who may be victims or victimizers. Students prone to violence toward others or those likely to engage in self-injurious behaviors were administered the DAS. They were scored on both the Self-Image scale and the Emotional Content scale components of the test. In this publication, Dr. Silver offers case after case wherein youths, known to be outwardly aggressive scored high on the DAS Self-Image scale and low on the Emotional Content area. It appeared that these aggressive youths had enormous amounts of xvii

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Foreword

negativity directed toward others and yet felt competent in their abilities to succeed in their endeavors. Those students at risk for suicidal behaviors also had low scores on Emotional Content but, whereas aggressive youths had high self-images, these depressed youths had very poor self-images and scores low on the Self-Image scale. The timeliness of this piece of literature cannot be overemphasized. The potential for today’s youth to outwardly express their rage in the school setting is beyond frightening. Violence prevention has become a number-one priority in our schools. Bully prevention curricula are being set into place throughout the nation. However, these programs appear to be focused on those students who have already been identified as potential victimizers. Falling through the cracks are those quiet, introverted, angry students whose explosive rage fills the new casts. As I write this, I am reminded of a recent stabbing and death of a 14-year-old honor student by another honor student in the middle school where my own children had gone to school. The DAS, as a valid and reliable instrument, appears to be a worthwhile test to screen for aggression that is potentially predatory or reactive in nature in our youth. It also has a high potential for identifying children and adolescents at risk for self-injurious behaviors. The DAS is both brief to deliver and brief to score, and can be delivered to groups of children or individually. As the chairperson of a large art therapy department since 1999, I have been particularly privileged to work with Dr. Silver in promoting the use of the Silver Drawing Test of Cognition and Emotion (SDT) and the DAS to design individualized treatment plans for children and adolescents identified as having emotional handicaps and placed in special education programs in the public school system. As a school art therapist, it was reaffirming to note statistical improvements in the DAS scores of those students participating in this study who were receiving clinical art therapy services. With this latest publication, Rawley Silver continues to build on her research and study to provide us with a timely piece of literature. Her pioneering efforts in the field of art therapy research and study and ground-breaking industry truly make her a monumental advocate of

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children’s mental health. This publication is a testament to her breadth of knowledge and commitment to the helping profession. As in all her publications, Dr. Silver keeps readers looking for more by initiating provoking questions that beg for continued research. Linda Jo Pfeiffer, EdD, ATR-BC Chairperson, Clinical Art Therapy Department Miami-Dade County Public Schools Miami, Florida

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Acknowledgments

Many people have contributed to this book, directly and indirectly. My first thanks go to the seven art therapists who wrote chapters 3, 6, and 7, providing the evidence on which the studies are based, and to psychologist Brooke Butler, PhD, of the University of South Florida, who analyzed the data they provided. Many more have contributed indirectly for many years, making the Draw-A-Story (DAS) assessment possible by volunteering to present the drawing task to more than a thousand of their patients or students, as well as to control groups, beginning in 1985 and continuing into 2003. Some also scored responses, participated in studies of retest and scorer reliability, or conducted studies that provided quantifiable evidence that the assessment has validity. Their assistance and my appreciation are gratefully acknowledged, and the test booklets they contributed have been donated to the archives of the American Art Therapy Association so that others can use them for research. The following art therapists and educators contributed to the first publication of the DAS manual in 1988: Andrea Bianco-Riete, MA, ATR; Fran Chapman, MA; Linda Chilton, MA, ATR; Bette Conley, MA, ATR; and Sylvia Corwin, MA. The following art therapists and art therapy students contributed to the 1993 and 2002 editions: Victoria Anderson, MA; Allison xxi

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Acknowledgments

Berman, MA, ATR; Michele Brandt, MA; C.M. Coffey; Peggy DunnSnow, MA, ATR; Madeline Ginsberg, MA, ATR; JoAnne Ellison, MS, ATR-BC; Patricia English, MA; Hope Larris-Carroll, MA, ATR; Eva Mayro, MA, ATR; Yetta Miller, MA, ATR; Bernice Osborne, MA, ATR; Ruth Obernbriet, MA, ATR; Anne Prager, MA, ATR; Marcia Purdy, MA, ATR-BC; Lillian Resnick, MA, ATR; Michele Rippey, MA, ATR-BC; Kimberly Sue Roberts, MA, ATR; Yvonne Schatzman, MA; Christine Turner, ATR-BC, LPC, NCC; Mary Waterfield, MA; Mary Wilson, MA, ATR; and Shelly Zimmerman, MA, ATR-BC.

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Part I Observations and Previous Studies

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1 Introduction

PROBLEMS OF AGGRESSION Aggressive incidents occur frequently in schools, and although some schools address them effectively, others are overwhelmed with responsibilities and potentially violent students may be overlooked. Although teachers have reported that bullies victimize only about 15% of their students, students tend to disagree. MacNeil (2002) cites studies that found 50% of students had been bullied, 65% had witnessed bullying, and students in urban, suburban, and rural schools reported similar rates. Violent behavior seems to be increasing. The number of seriously injured children nearly quadrupled from 1986 to 1993 (Bok, 1998). Other children had inflicted a substantial proportion of their injuries, and homicide has become the second leading cause of death for Americans aged 15 to 45. The prevention of violence has become a priority in schools throughout the country, but whereas preventive programs focus on 3

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Aggression and Depression Assessed Through Art

students with histories of violent behavior, quiet but angry students may be overlooked, as noted by Dr. Pfeiffer, who wrote the foreword to this book. She was reminded of the recent stabbing and death of a 14-year-old honor student by another honor student in the school her children attended.

PROBLEMS OF DEPRESSION Suicide is among the leading causes of death among children and adolescents ages 10 to 19, and ranks third among adolescents, exceeded only by homicides and accidents (Goldston, 2003). A study of 100 consecutive suicides by children found that a majority had manifested antisocial behavior (Shafer & Fisher, 1981), suggesting that the expression of aggressive feelings is not likely to deter a child from suicide. Pfeffer (1986) observed that suicidal children can be distinguished from nonsuicidal children by feelings of hopelessness, depression, and the wish to die. Some children mask depression with antisocial behavior, expressing fantasies of violence, explosions, annihilation, and death with bad outcomes for principal subjects (McKnew, Cytryn, & Yahries, 1983). Studies of major depressive disorders among students have found that they show an increased risk for homicidal as well as suicidal ideation (Connor, 2002). Connor also notes that depressed children and adolescents do not suppress their anger, unlike depressed adults who tend to suppress angry feelings. Three major patterns of depression were cited by Beck, Rush, Shaw, and Emory (1979): negative views of self, negative views of the future, and a tendency to interpret one’s experiences in a negative way. These patterns appear frequently in responses to a drawing task that illustrate the chapters that follow.

OBJECTIVES AND PROCEDURES The aim of this book is to provide a technique for identifying children and adolescents who may harm others or themselves. The book builds on previous studies that found responses to the drawing task

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useful as a first step in identifying children and adolescents at risk for aggression and depression. Chapter 2 presents background literature about the nature of aggression and depression observed by clinicians and other specialists. It also discusses the role of art in cognition, assessment, and treatment, as well as its clinical and educational implications. Chapter 3 reviews Draw-A-Story (DAS) and the Silver Drawing Test (SDT), the assessments used in the studies reported here, and chapter 4 reviews the pilot study and questions it raised leading to the current studies presented in Part Two. Part Two begins with the three rating scales used to assess responses to the drawing task (chapter 5). The scales assess Emotional Content, Self-Images, and the Use of Humor, and each is a continuum ranging from strongly negative, scored 1 point, to strongly positive, scored 5 points. Chapter 6 presents scored responses to the drawing task by each child or adolescent in the aggressive group, together with histories of their behaviors. Chapter 7 presents the differences found between this group of aggressive students and a control group of nonaggressive students. It also examines subgroups that emerged as well as individual case histories. Chapter 8 discusses the changes and consistencies that emerged in the emotional states of aggressive and/or depressed students after intervals of time. Chapter 9 presents a study of cultural differences and similarities observed in responses to the DAS task by Russian children, adolescents, and adults with histories of violent behavior. Part Three concludes the book with summaries of the findings, including gender and cultural differences and similarities. It also discusses their clinical and educational implications and offers suggestions for further investigation.

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2 Previous Studies of Aggression, Depression, and the Role of Art

AGGRESSION Lorenz (1963) defines aggression as an instinct, the fighting instinct directed against members of the same species by animals as well as people. He notes the happy expression of a dog about to catch a hunted rabbit, and that hunting is a pleasurable sport for some human beings as well. Depending on circumstances, aggression may be appropriate or inappropriate. Connor (2002) defines inappropriate aggression as maladaptive and dysfunctional, an angry reaction to real or perceived danger, and it may include depression. Some depressed children are angrier than normal children, and unlike adults, do not appear sad, or suppress anger, as noted in chapter 1. He defines appropriate aggression as 7

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adaptive, its social values changing as societies change, and suggests that there is a continuum from appropriate to inappropriate aggression. Children and adolescents may show either or both forms, as well as no aggressive behavior. Connor (2002) also suggests that there are four subtypes of aggressive behavior: defensive, offensive, relational, and harmful to oneself. Defensive aggression is an angry reaction to real or perceived danger, and arises in response to threats or frustration. It produces intense arousal and is hypervigilant and impulsive. Studies have found that it is associated with peer rejection and exposure to violence. Rather than benefit the aggressor, its intent is to defend against threat, and to harm the source of frustration. It may include depression, social withdrawal, anxiety, fear, or confrontations with others, such as fighting or defying authority. Inappropriate aggressors tend to misinterpret and overreact, blame others, and expose themselves to danger. Their aggressiveness emerges earlier in life, and may result from abuse, harsh parental discipline, or family instability. Offensive aggression is characterized by unprovoked attacks with intent to benefit the aggressor. It is motivated by reward, such as dominance, territory, food, or the acquisition of objects. It tends to arouse little emotion and is reinforced by success and by social role models. Studies have found correlations of aggression with positive expectations and social dominance. Offensive aggressors tend to be callous and unable to empathize. They gang up on victims and use force to have their way. They also tend to hide their aggressiveness and protect themselves from injury. Connor (2002) defines relational aggression as harming a victim’s relations with others. Aggression that is harmful to oneself is suicidal ideation. Fischer and Watson (2002) have identified two characteristics that predict the development of physical violence toward others: harsh physical punishment in the family and inhibited temperament of the child. They distinguish between shyness and inhibited temperament, and suggest two factors that predict aggressiveness in children with inhibited temperaments: fearfulness in general and low self-esteem. Inhibited temperament may appear in infancy as well as in isolated

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and alienated youth, and includes high emotional reactivity. They also suggest that negative self-representation may predict later aggression and violence. They are conducting a longitudinal study of aggressive behavior, tracing the antecedents of teenage aggression that ranges from hostile behavior to physical violence, and have tracked 440 children for 8 years. Trained interviewers go into participants’ homes and conduct a series of 2-hour interviews with the children studied as well as their mothers. Other investigators have found that punitive reactions to youth violence and aggression have had poor results (Christle, Jolivette, & Nelson, 2000). Effective school programs have used preventive strategies instead of waiting for aggressive behaviors to occur and then reacting (Skiba & Peterson, 2000).

DEPRESSION The American Psychiatric Association includes recurrent thoughts of death and suicidal ideation among the symptoms of depressive disorders (Diagnostic Criteria from DSM-IV). As cited in chapter 1 of this volume, several clinicians have observed that negative views of events and oneself are characteristic of depression and that depression can be masked by antisocial behavior. Depression has been found even in young children. In a study of self-reported symptoms Edelsohn, Iaglongo, Wertheimer-Larrson, Crockett, and Kellams (1992) observed that first graders in the highest quartile level of depression remained in the upper quartile at retest. The depressive symptoms they reported were characteristic of adult depression, suggesting that reliable and valid assessment even of young children is possible. Some children become depressed because they tend to be snubbed or ridiculed by peers. The theory of group socialization of development (Harris, 1995) proposes that powerful emotions are generated by intergroup relationships. Regardless of nationality, children’s peer groups create their own culture. Status hierarchies within the group, such as differences in dominance or social power, may have lasting effects on personality. If a child’s behavior does not conform to the group’s norms, he or she risks rejection. For example, shy, inhibited

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behavior is generally acceptable for girls, but not for boys. In most large high schools, adolescents have historically sorted themselves into groups such as the “jocks,” the “brains,” the “burnouts,” and so on. Students who are victimized or rejected by their peers have low status on the popularity hierarchy. Differences in social skills tend to widen over time, and high or low status in the peer group may have effects that persist into adulthood, even though peer groups are less important to adults. The authors cited above did not refer to behaviors such as drawing, but neuroscientists and art therapists have observed the role art can play in understanding cognitive processes and assessing emotional disturbances.

THE ROLE OF ART The visual arts tend to be peripheral in our schools, as though they were irrelevant to the cognitive demands of other subjects in the curriculum. Recently, however, scientists have found similarities between studio art experiences and the function of the human brain. Observations by Neuroscientists and Other Scientists According to Zeki (1999, 2001), the preeminent function of the visual brain is to acquire knowledge about the world, and the brain acquires this knowledge by selecting what is essential and discarding much that is superfluous. The brain is less concerned with particular objects than with generalizing from them in order to obtain knowledge about categories, the constant, essential features of objects or situations. Neurons in the brain’s visual pathways search for constancies in order to solve perceptual problems, just as artists search for the constant, essential features of objects, faces, landscapes, situations, or ideas. Zeki concludes that “in large measure, the function of art and the function of the visual brain are one and the same” (1999, p. 1). Another neuroscientist, Ramachandram (2001), proposes that neural mechanisms and universal laws underlie art experiences,

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“capturing the very essence of something in order to evoke a specific emotion or mood in the viewer’s brain.” The universals cut across cultures, and help explain the effectiveness of an outline drawing. For example, many different brain cells respond to a particular face, each cell responding to a different view of the face. At a subsequent stage, however, a new type of brain cell, a master cell, responds to any view of the face. In the same way, a single line drawing may contain most of the essential information an artist has selected, perceived, and represented about a particular subject, category, or concept. Like these neuroscientists, artists have described their work as a search for essentials. As early as the tenth century, Ching Hao, a painter in China, wrote that the ultimate goal was not to obtain the true likeness of an object or to create beautiful things, but to “fathom the significance of things and try to grasp reality.” He also warned readers that resemblance reproduces the formal aspects of objects, but “neglects their spirit,” whereas “truth shows the spirit and substance in like perfection” (translation by Sakanishi, 1948, pp. 84–92). Scientists in other fields have examined the role of emotions and images in thinking. Joseph LeDoux (1996) noted the similarities between thoughts and feelings. Both involve symbolic representations and may work together rather than separately. Although he doesn’t mention art-making, it too involves symbolic representations, conscious and unconscious thoughts, and feelings. Anotonio Damasio (1994) proposed that human reasoning consists of several brain systems working in concert, that emotions are one component, and that emotions are involved in making decisions. Donald Hoffman (1998) noted that visual intelligence occupies nearly half the brain’s cortex, and like Zeki, finds that vision is not passive perception but an active, intelligent process that is performed the way that scientists develop theories, through experimental evidence. The principal difference is that scientific constructions are performed consciously, whereas visual constructions are often unconscious. Hoffman also observed that we are complex beings with visual, emotional, and rational facets. Understanding how these

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facets interact is a key to understanding who we are as a species and what we might become. Walton discovered the structure of DNA by visualizing the image of a helix. Kekule discovered the benzene ring by visualizing the movement of atoms as a snake grabbing its tail. Einstein noted that visual entities served as elements in his thought, that words did not seem to play any role, and that he sought words laboriously only in the second stage. These scientific observations may explain the successful outcomes of two art projects conducted in New York City schools during the 1970s. Reading Improvement Through Art (Corwin, 1976) used studio art experiences to improve the reading skills of adolescents who had been performing at least two grades below normal. This project provided daily 40-minute studio art classes for 240 teenagers in nine New York City schools for a period of four months. In addition, reading specialists visited the classes twice a week, assisting art teachers in developing related lessons. To determine whether the project was effective, the students who participated were tested before and after each of two 4-month programs. Results indicated that the ninth graders showed more than a year’s growth in reading achievement scores, while the tenth graders showed almost 8 months’ growth. The program was repeated with a second group of ninth, tenth, and eleventh graders, who were pretested in February and posttested in May. Once again, the participants demonstrated significant gains in levels of reading achievement. The gains were not only beyond statistical expectations but also beyond the growth normally expected after a full year program, suggesting that visual art experiences can serve as an important tool for developing the ability to read. The other project, Cognitive Skills Development Through Art Experiences (Silver, 1973), also used studio art experiences to improve the cognitive abilities of children and adolescents who had difficulty producing and/or comprehending words. Some students were emotionally disturbed as well. Sixty-eight students, ages 7 to 15, participated in the study, half attending experimental art classes while the other half who did not attend art classes served as a control group. The 34 children in the experimental group were randomly selected from

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among all students in six classes. They participated in 45-minute art classes twice a week for 11 weeks. Drawing tasks were developed to assess cognitive skills in both groups before and after the art programs. Comparing the scores of 34 students in the experimental group before and after the art program, gains were found at the p .01 level of significance in three cognitive skills: ability to select (ranging from concrete relationships to abstract categories), ability to combine, and ability to represent (creativity). Students in the control group showed no statistically significant gains. Case studies and reviews of the project’s findings were also reviewed in Developing Cognitive and Creative Skills Through Art (Silver, 1978/2000). Subsequently, one of the tasks, Drawing from Imagination, was developed into the DrawA-Story and Silver Drawing Test assignments, described in the following chapter, and used in the studies reported in Part Two. Art Therapy Art therapy is the therapeutic use of making art within a professional relationship, and the process involved in making art is healing and life-enhancing (American Art Therapy Association, 2004). Art experiences can provide an alternative to verbal forms of assessment and treatment. Registered art therapists (ATRs) are mental health professionals with master’s degrees who are trained in both art and therapy, and use art to assess and treat individuals with disabilities in various settings, including schools. Observations by Art Therapists Kaplan (2000) reviewed the findings of other neuroscientists who noted that graphic representation is a complex activity, involving areas of the brain associated with language. For example, Restak (1994) reported that more brain neurons are devoted to vision than the other senses. Kaplan suggests that studio art can facilitate problem-solving abilities, stimulate pleasure and self-esteem, and provide opportunities for successful functioning in children and adults with cognitive impairments.

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Malchiodi (2003) cites studies by scientists who found that drawing involves complex interactions between many parts of the brain, and notes that science will be central to understanding how art therapy works and why it is a powerful therapeutic modality. Riley (2003) observed that offering opportunities to create art to depressed adolescents as a means of communication that can be enjoyed and controlled provides a lens for viewing their perceptions through their own images, as well as a vehicle for treatment and a way to address resistance. In addition, she finds drawing less confrontational, less familiar, and less judgmental than talk, and that adolescent depression is often masked. Teenagers may also be angry or aggressive, as opposed to the lassitude characteristic of depressed adults, and art-making can serve to relieve painful self-deprecation. Wadeson (1980) noted that drawings by patients experiencing depression showed less color, less affect, and less effort than the drawings of nondepressed individuals. In addition, they showed more empty space and more depressive affect, such as drawing about harming others. Gantt and Tabone (2003) observed distinct patterns in the drawings of individuals with depression, indicating that they were closer to the drawings of participants in the control group than drawings by persons with schizophrenia or organic mental disorders. These art therapists found no statistically significant differences between drawings by individuals with depression and participants in the control group in attributes such as integration, logic, realism, and problem solving skills. Drawings by depressed patients differed from the drawings of other patients, showing greater use of logic and more energy, integration, and problem solving to significant degrees, as measured by the Formal Elements Art Therapy Scale (FEATS). On other scales, they were closer to other patient groups in less use of color, less use of space, and fewer details. Ellison (1995) described the behavior and history of a 16-year-old who had been arrested and incarcerated for stabbing another youth with a pencil. His history included a volatile temper and it was feared that he might harm others. His father had disappeared and his mother had been killed in a gang-related incident. During his stay in the facil-

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ity, he was placed on suicide watch, and then was disciplined for angry acting-out. Three weeks after his release, he committed suicide. Art Therapists Who Used the Draw-A-Story (DAS) Assessment Turner (1993) used the DAS with adolescent clients in a psychiatric hospital as one of a five-assessment series to assess possible history of abuse, the extent of abuse, the meaning attached to abuse, and the effects of abuse on her client’s defenses, coping skills, sense of self, relationships, and world view. She found that areas of greatest need may be depicted and described in responses to the drawing task. Cognitive schemas relating to the need may also become apparent. Beliefs concerning attribution of causality, locus of control, concerns about self-protective abilities, trust—mistrust, selfvalue, and community attachments became topics for discussion in the assessment interviews. During discussions, some patients remained metaphorical, whereas others related their responses to events, providing opportunities to address treatment needs, confirm reality, and lay the groundwork for future therapy. Wilson (1990) presented the DAS task to eight depressed, suicidal, and hospitalized adolescents during the first session of a biweekly treatment program, and again 3 months later, to gain insight into changes in their emotional outlook and learn how their sense of self and the environment were evolving. Of 13 respondents, 12 drew pictures about negative or severely frightening events. Only one response was positive. As a member of the clinical treatment team trying to assess a patient’s strengths and weaknesses, Wilson found the task useful for assessing her patients’ emotional states, and how they viewed their situations. She also found that the assessment served to reinforce the findings of other therapists, and in many instances, it contributed information about emotional outlook, depression, and fantasies. Her patients almost always projected themselves into their drawings and stories, offering material about their emotional inner lives. They discussed issues of low self-esteem, concerns about adjustment to disability, and depression over losses.

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Subsequently, Wilson (1993) used the assessment to assess the emotional outlook and skills of outpatients who had sustained brain injuries in accidents, assaults, strokes, and aneurysms. To assess word-finding difficulty, identification skills, and speaking skills, she presented the stimulus drawings mounted on a cardboard background and asked patients to identify the images. To assess ability to establish relationships and to create and organize images, she noted the patients’ ability to combine subjects and show something happening between them. She also examined executive functioning, reasoning, problem-solving abilities, and field-neglect problems, which became evident if the patient drew closer to one side of the page or the other. During the story-writing stage of the task, she observed reading and writing skills. Dunn-Snow (1994) adapted the DAS for use as a therapeutic technique, presenting a case study in which she used the task to determine whether a high school student was depressed. After he responded with self-destructive thoughts, she checked school records and discovered that he had a history of clinical depression, and then used the task to help him resolve feelings about the death of his father. She also used the assessment to evaluate the needs of students who were diagnosed as severely emotionally disturbed but who were still able to attend elementary and secondary schools in a large urban school district. She found it useful in reducing resistance among students who previously had refused to participate, and in working with students who became anxious when asked to do relatively free-choice artwork. She also adapted the assessment for group therapy and to resolve conflicts. In working with fifth grade boys, she used it to provide structure and set limits, inviting each boy to choose a subject then collaborate with others in the group by combining their images into a single drawing with a common theme, title, and story line. She noted that in accomplishing this task, her students followed directions, accepted limits, solved problems, made compromises, and communicated effectively. Coffey (1995) found that male and female patients in the psychiatric units of two hospitals seemed to have different needs, and suggested that gender be considered in planning therapeutic treatment.

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Men seemed more reticent and reluctant to reveal themselves to anyone. Women seemed less apt to recognize their rights or selfworth. They also seemed to fear that moving toward one goal forecloses other goals. Some patients were very agitated, some abused equipment or themselves, and others displayed heavy, pervasive sadness. Coffey also observed that drawing served to establish rapport, disclose areas of patient interests, assess abilities, and observe defense mechanisms. Brandt (1995) investigated the value of visual arts in assessing and treating offenders. She found significant differences between adolescent sex offenders and a normal group of nonoffending adolescents. Her subjects included 14 male sex offenders in a residential facility, ages 12 to18, averaging 16 years. Results indicated that the mean score (average score) of the group of sex offenders (1.89) was significantly lower than the mean score of the normal group (2.73). In other words, the emotional content of the stories drawn by the sex offenders was much more negative than the stories drawn by the normal group, as measured by the DAS scale to a degree that was statistically significant. These findings suggested that offenders are likely to be highly depressed individuals who perceive themselves and their worlds in very negative ways. The following chapter presents a review of the DAS assessment and the studies that examined its reliability and validity.

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3 Draw-A-Story, Screening for Depression

THE ASSESSMENT Draw-A-Story (DAS) is the assessment used in the current studies of aggression and depression reported in this book (Silver 1988b, 2002). It asks respondents to choose two subjects from an array of stimulus drawings, imagine something happening between the subjects they choose, and then show what is happening in drawings of their own. Respondents are encouraged to change the stimulus drawings they choose and add their own subjects and ideas. When they finish drawing, they add stories and, whenever possible, discuss them so that overt and covert meanings can be clarified. This art assessment is concerned with the narrative content of drawings rather than their physical attributes, such as color or line quality, and it includes two sets of stimulus drawings. DAS Form A, shown in Figure 3.1, is provided for pre- and posttesting, and was 19

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Figure 3.1 The Draw-A-Story Assessment; Form A, Stimulus Drawing Task

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used in the studies reported here. Form B is provided for any other purpose and may be found in the DAS manual (Silver, 1988b, 2002). This structured but open-ended task is based on the premise that responses can provide access to fantasies, and visual evidence of subjective feelings that can be assessed by scores on its rating scale. The scale ranges from 1 to 5 points, as shown in Table 3.1. The score of 1 point is used to characterize responses with strongly negative emotional content, such as subjects who are portrayed as sad or in mortal danger, or relationships between subjects that are life threatening. This score is based on observations of depressive illness by the clinicians cited in chapters 1 and 2. The score of 2 is used to characterize moderately negative content, such as subjects who are unfortunate, frustrated, or fearful, or relationships that are stressful or hostile. The intermediate score, 3 points, is used for subjects or relationships that are ambiguous, unclear, neiTable 3.1 Rating Scale for Assessing the Story Content of Responses to DAS Form A 1 point: Strongly negative, for example, a. subjects who are sad, isolated, helpless, suicidal, or in mortal danger b. relationships that are destructive, murderous, or life-threatening 2 points: Moderately negative, for example, a. subjects who are frustrated, fearful, fearsome, or unfortunate b. relationships that are stressful or hostile 3 points: Intermediate level, for example, a. subjects or relationships that are both negative and positive, suggesting ambivalence or conflict b. subjects or relationships that are ambiguous or unclear c. subjects or relationships that are unemotional, neither negative nor positive; no feelings expressed toward the subjects or the relationships portrayed 4 points: Moderately positive, for example, a. subjects who are fortunate but passive b. relationships that are friendly 5 points: Strongly positive, for example, a. subjects who are happy or achieving goals (taking action) b. relationships that are caring or loving

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ther negative nor positive, or both negative and positive, suggesting conflict or ambivalence. The score of 4 is used for moderately positive content, such as fortunate subjects or friendly relationships. The highest score, 5 points, is used to characterize strongly positive content, such as drawings about subjects achieving goals, or relationships that are caring or loving. These scores are based on the observation that respondents tend to associate the stimulus drawings with their own past experiences. They also tend to choose subjects that represent themselves and others in disguise. Some express fears and frustrations directly, others indirectly through symbols and metaphors. Their responses seem to serve different functions, such as reviewing troubling experiences, or fulfilling wishes vicariously. Respondents have ranged in age from 5 years to senior adults. Clinicians and classroom teachers with no special training have administered the task and scored responses. The DAS assessment is not timed. Asked how much time is needed, one of the art therapists who participated in the pilot study replied that DAS takes about 20 minutes to administer and 15 minutes to score. Another replied that scoring takes about 3 minutes, and respondents spend 5 to 10 minutes drawing.

WHY DAS WAS DEVELOPED AND HOW IT EVOLVED When normative data was being collected for the Silver Drawing Test (SDT), some children responded to one of its subtests, Drawing from Imagination, with drawings about suicide or death, raising the question whether responses to the drawing task could serve to identify respondents who might be depressed. The SDT (Silver, 1983, 1990, 1996b, 2002) uses stimulus drawings to elicit responses and includes three subtests: Predictive Drawing, Drawing from Imagination, and Drawing from Observation. Originally, the SDT was designed in the 1970s to bypass words in assessing the cognitive skills of deaf children. The SDT was standardized on approximately 1,400 children, adolescents, and adults in the United States. First published in 1983, it includes studies of reliability and validity, normative data, studies of

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clinical and nonclinical subjects, outcome studies, and studies of age and gender differences in attitudes and cognition. The fourth edition (Silver, 2002) also includes cross-cultural studies by investigators in Australia and Thailand, as well as Brazil and Russia where the SDT has been translated and standardized. Although DAS and the SDT Drawing from Imagination subtest present different arrays of stimulus drawings, their tasks and rating scales are essentially the same. Both use stimulus drawings to elicit response drawings. Both are concerned with the content of drawings rather than physical attributes, and both tend to elicit associations with past experiences. To determine whether they measure the same constructs, both tasks were presented without a time interval to samples of children and adults (Silver, 2002). The samples included 19 children ages 7 to 8 in a public school class in California, and 19 adults in a retirement residence in Florida. Half of each group responded first to the SDT task; the other half responded first to the DAS task. Correlational analysis was used to determine the relationship between test scores. In emotional content, scores of both the DAS and SDT were correlated significantly (r = 0.57, p .0001). Responses for cognitive content also were significant across test scores. The findings suggest that DAS and the SDT assess the same constructs, and lend evidence to the validity of scores across test formats. They also suggest consistency of measurement when the scale is used to rate responses to both instruments.

OVERVIEW OF DAS STUDIES To develop normative data for the DAS, the drawing task was administered to 1,028 children, adolescents, and adults by art therapists in various parts of the country who volunteered their assistance. They include 14 art therapists who administered the task to 446 participants with no known impairments residing in Florida, Kansas, New Jersey, New York, Ohio, Minnesota, and Missouri. They also include 34 art therapists who administered the task to 449

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emotionally disturbed, clinically depressed, delinquent, or learning disabled participants in Arizona, California, Florida, Georgia, New Jersey, New York, Maine, Montana, Pennsylvania, Minnesota, and Oregon. These test booklets have been donated to the archives of the American Art Therapy Association for use in research. The DAS manual includes studies of reliability and validity, as reviewed below.

RELIABILITY Four studies have examined the reliability of the DAS rating scale (Silver, 1993a, 2002). In a study of scorer reliability, three registered art therapists scored (blindly and independently) 20 unidentified responses to DAS Form A. The responses were chosen at random from five clinical and nonclinical groups of children and adolescents. Before scoring, the judges met for about an hour to discuss scoring procedures. Findings indicated that correlations between the scores were highly significant, at the .001 level of probability. Between judges A and B, the correlation coefficient was .806; between judges A and C, .749; and between judges B and C, .816. To determine retest reliability, 24 third graders were presented with the Form A task on two occasions. Twelve of the presumably normal children responded with strongly or moderately negative fantasies. Retested after an interval of approximately one month, 7 received the same scores, 3 had higher scores, and 2 had lower scores (from 2 points to 1 point). When 12 other children were retested after an interval of approximately 2 years, 11 received the same scores they had received previously. These findings suggested that DAS is reliable and that there is a link between depressive illness and strongly negative responses. Although strongly negative responses did not necessarily indicate depression and, conversely, positive responses did not exclude depression, they seemed to indicate that a child or adolescent who scored 1 point may be at risk for depression, and since negative feel-

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ings had persisted over time, they may reflect characteristic attitudes rather than temporary moods. Subsequently, two additional studies examined the test retest reliability of the DAS assessment. In the first, three registered art therapists presented the Form A set of stimulus drawings to children and adults who responded on two occasions. One therapist presented the task twice after a 1-week interval to eight emotionally disturbed children in a New Jersey public elementary school. The second presented the task without a time interval to six emotionally disturbed adolescents, ages 14 to 18, in a summer art therapy program in Florida. The third presented it to 17 men and women in Florida who volunteered to participate anonymously. Significant correlations were found between first and second responses of the 31 subjects (.70262). Correlation for the eight children was .93277; for the adolescents and adults combined, it was .45095, p .05. The fourth study examined retest and scorer reliability of DAS Form B. Thirty-three children, adolescents, and adults responded on two occasions. They included normal subjects as well as subjects previously diagnosed as depressed or emotionally disturbed. Other subjects had attention deficit disorders or learning disabilities. Two judges independently scored the responses, which were identified only by number. First and second drawings were scored on different days. To determine the degree of their agreement in assigning scores, separate interscorer correlations were calculated for the first 33 responses marked A, the 33 second responses marked B, and the combined 66 responses marked A—B. The interscorer correlations were significant. The correlation for A scores was .83943; for B scores, .74054; for combined A and B scores, .80806. These studies suggest that DAS is a reliable measure.

VALIDITY The following studies investigated clinical depression, age and gender differences in attitudes toward self and others, and compared adolescents with and without emotional disturbances.

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Clinical Depression The first study asked whether strongly negative response drawings were linked to clinical depression (Silver, 1988a, b). Participants included 254 children and adolescents between the ages of 8 and 21. Of these, 111 were presumably not depressed, 27 had been diagnosed as clinically depressed, 31 as learning disabled, and 61 as emotionally disturbed with nondepressive psychopathology. In addition, they included 24 nondepressed children who responded to the drawing from imagination task on two occasions. Nineteen art therapists, teachers, and school counselors volunteered to administer the task or score responses. They resided in Arizona, Montana, New Jersey, New York, Oregon, and Pennsylvania. Their names and my appreciation are noted in the acknowledgments to this book. Approximately 56% of the depressed group responded with strongly negative fantasies, scoring 1 point, compared with 11% of the normal group, 21% of those with emotional disturbances, and 32% with learning disabilities. To determine whether the differences were significant, a chisquare analysis found that significantly more participants with depression drew strongly negative fantasies, scoring 1 point more than those who were not depressed (27.63, p .001). The proportion of participants with depression scoring 1 point was also greater than the proportion of participants with emotional disturbances scoring 1 point (10.54, p .01), but was not significantly greater than the proportion of those with learning disabilities scoring 1 point (3.269, p .05). Building on these findings, a second study increased the number of participants to 350 children and adolescents, and again asked whether strongly negative responses to the DAS task were associated with clinical depression (Silver, 1988b, 2002). Participants included 117 presumably normal (i.e., without a diagnosis or disability) children, adolescents, and adults, as well as 35 who had clinical depression, 74 with emotional disturbances with nondepressive psychopathology, 64 with a learning disability, 18 who were deaf or hard of hearing, and 27 senior adults.

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Approximately 63% of the participants with depression responded with strongly negative themes, scoring 1 point, whereas approximately 10% of the nondepressed children and adolescents scored 1 point. Chi-square analysis found the differences significant (x2 = 43.2, p .005). The third study examined age and gender differences in responses to the DAS task by 103 adults and adolescents with and without depression (Silver, 1993a). The depressed group included 47 patients hospitalized for depression in Georgia (18 girls and women, ages 12 to 69, and 23 boys and men, ages 17 to 53). The participants without depression included residents of a nursing home in Pennsylvania and undergraduate university students in Florida (34 women, ages 19 to 72, and 26 men, ages 20 to 77). In addition to the DAS stimulus drawings and rating scale, the study included experimental scales for assessing the use of space and detail (see Figure 8.2) and a self-report, added below the drawing and story as shown in Figure 7.4, were found. Based on an analysis of variance for depression and the use of space and detail, no significant effects emerged for the groups with depression, no difference in the use of space, and only gender differences in the use of detail (F (1,103) = 4.27, p .05). Females used significantly less detail (mean = 1.84) than males (mean = 2.31). These findings suggest that strongly negative responses are associated with childhood and adolescent depression, and that DAS can serve to identify some but not all depressed children and adolescents. Age and Gender Differences in Attitudes Toward Self and Others In this study, DAS responses by 360 subjects were separated into drawings about solitary subjects and drawings about relationships, assigned to age and gender groups, and scored on the rating scale (Silver, 1993a). The study was undertaken because it had been reported that males tend to focus on independence and competition, whereas females tend to focus on relationships and caring for others (Tannen, 1991; Gilligan, Ward, Taylor, & Bardige, 1988). These

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investigators had relied on verbal communication, raising the question whether responses to the DAS task would support the same findings. The participants included children, adolescents, and adults with clinical depression, emotional disturbances, learning disabilities, and presumably unimpaired children, adolescents, and adults. Age and gender groups were then compared. They included 203 females and 157 males in five age groups: children ages 9—12; younger adolescents, ages 13—16; older adolescents, ages 17—19; younger adults, ages 21—64; and adults age 65 or older. The 56 children included 32 girls and 24 boys. Thirty-three had been diagnosed as emotionally disturbed (ED) or learning disabled (LD), 14 were hospitalized with clinical depression, and 9 were presumably normal. The 147 younger adolescents included 71 girls and 76 boys. Thirteen were hospitalized with depression, 78 had been diagnosed with ED or LD and attended special schools, and 56 were unimpaired. The 68 older adolescents included 30 girls and 38 boys: one hospitalized for clinical depression, 27 diagnosed with ED or LD, and 40 unimpaired. The 79 adults included 7 women hospitalized for depression and 53 nondepressed women and 19 nondepressed men. Thirteen art therapists in ten states volunteered to administer the DAS assessment. They resided in Arizona, Florida, Georgia, Maine, Montana, New Jersey, New York, Ohio, Pennsylvania, and Washington. Results In drawing about solitary subjects, no gender differences emerged. Both males and females expressed more negative than positive attitudes toward the subjects they portrayed. Across the female age groups, 41% scored 1 and 2 points, portraying sad—helpless or angry—fearful subjects whereas 28% scored 4 and 5 points, drawing fantasies about passive or active pleasures. Across the male age groups, 49% scored 1 and 2 points, whereas 27% scored 4 and 5 points. The young boys expressed the most negative attitudes; 75% scoring 1 point whereas none of the girls scored 1 point. The older women expressed the most positive attitudes; 41% drew solitary subjects engaged in active pleasures, scoring 5 points, and 12% drew passive pleasures, scoring 4 points.

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In drawing about relationships, however, gender differences emerged. Males tended to be more negative, 72% portrayed assaultive and stressful relationships and scored 1 or 2 points, compared with 34% of the females. More females (29%) than males (9%) drew friendly and caring relationships. More positive relationships appeared in drawings by older women than any other age or gender group: 46% scored 4 and 5 points. Proportionally more women than men portrayed active solitary pleasures (41% women, 20% men). The most negative relationships appeared in drawings by boys (80%), younger adolescents (75%), and older adolescents (67%), whereas female relationships tended to be mixed (34% negative, 29% positive, 37% neutral). Proportionally more adolescent girls than any other female age group drew fantasies about sad, helpless, or isolated solitary subjects and scored 1 point (35% girls ages 13—16; 43% ages 17—19), as well as stressful relationships and scored 2 points (30% ages 13—16, 38% ages 17—19). Observations These findings are inconsistent with the observation that females tend to focus on relationships and responsibility to others, whereas males tend to focus on independence and detachment. More males than females portrayed relationships, and both genders drew relationships more often than they drew solitary subjects. The findings suggest that gender differences are reflected in the emotional content of the relationships portrayed. Males tended to portray negative relationships; females, positive relationships. Unexpectedly, however, differences between age groups emerged in the emotional content of responses to the drawing task. The most negative relationships appeared in drawings by boys (80%), and proportionally more adolescent girls than any other female age group drew sad, helpless, or isolated solitary subjects and scored 1 point, raising the question why tendencies to fantasize about aggression and depression appeared most frequently in these age and gender groups.

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Comparing Adolescents With and Without Emotional Disturbances This study examined responses to DAS Form A by 95 adolescents, ages 13 to 17, diagnosed previously as emotionally disturbed, and 68 presumably nondisturbed adolescents who served as the control group (Silver, 2002). They included four subgroups: 35 girls and 60 boys with ED, 42 girls and 26 boys in the control group. Thirteen art therapists or teachers administered the task to the students with ED in special schools, special classes in public schools, or psychiatric facilities in Florida, Georgia, Nebraska, New York, and Oregon. Six art therapists or teachers administered it to the control group students in four public schools and one private school in Florida, Minnesota, New York, and Ohio. Madeline Altabe performed chisquare analyses to determine the proportions of each group in obtaining certain scores. Significant differences emerged between the emotionally disturbed (ED) group and the “normal” control group. As might be expected, more normal adolescents drew fantasies with positive themes, scoring 4 and 5 points, as shown in Table 3.2. This difference was significant (chi-square (1) = 13.26). The normal girls had the most positive scores (43%) followed by the boys with ED (26%), normal boys (16%), and girls with ED (14%).

Table 3.2 Comparing DAS Scores of 95 Disturbed Adolescents, ages 13–16, with 68 Controls Adolescents 68 control group 95 with ED 42 girls (control) 26 boys (control) 35 girls with ED 60 boys with ED

Mean 2.39 2.25 2.88 1.89 2.43 2.07

1 pt 40% 36% 31% 54% 26% 20%

Scores 2 pts 18% 31% 19% 15% 31% 29%

3 pts 10% 21% 7% 15% 29% 24%

4 pts 15% 3% 17% 12% 3% 6%

5 pts 18% 9% 26% 4% 11% 20%

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31

60

50

40 ED/LD Girls Normal Girls ED/LD Boys Normal Boys

30

20

10

0 1

2

3

4

5

DAS Score

Figure 3.2 Distribution of DAS Scores of Normal and Emotionally Disturbed Adolescents

Among those scoring 5 points, twice as many normal adolescents drew fantasies about caring relationships or effective solitary subjects (18% control group, 9% group with ED), as shown in Figure 3.2. More than six times as many normal girls than normal boys scored 5 points (26% vs. 4%), whereas about twice as many boys than girls in the group with ED scored 5 points (20% vs. 11%). Among those scoring 4 points, five times more of the control group of adolescents than the group with ED drew pictures about friendly relationships or fortunate but passive solitary subjects (15% of the control group, 3% of the group with ED). Even greater differences emerged between the two groups of girls (3% girls with ED, 17% control group). This difference also was statistically significant (chi-square (1) = 9.8). Although more boys from the control group scored 4 points than those from the group with ED, only twice as many did so (12% vs. 6%), which was not significant. In negative responses to the DAS task, the normal boys in the control group had the most negative scores (1 point). This result was sig-

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nificant (chi-square (1) = 4.88). No significant differences were found between the groups of girls who scored 2 points. There were no significant patterns within the groups for a score of 2, 3, or 4 points. The pattern of results for a score of 5 points also was significant (chi-square (1) = 16.72) (girls from the control group being more positive than their counterparts with ED, boys from the control group receiving this score less frequently than their counterparts with ED). Thus it can be said that normal boys had more of the most negative scores and fewer of the most positive scores. Observations and Questions It was unexpected to find no significant difference between the groups in drawing unfortunate subjects and stressful relationships. Why were the presumably normal girls so negative? Were some depressed? Less surprising was the finding that significantly more boys from the presumably “normal” control group drew fantasies about assaultive and murderous relationships than did the boys with ED because similar findings had emerged in a previous study (Silver, 1996b). Nevertheless, it raised the question whether this kind of response may reflect not only fantasies but also potential behavior. It also raised the question whether DAS could be used to identify students at risk for harming others, not only themselves, and led to the pilot study reviewed in the chapter that follows.

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4 The Pilot Study

The pilot study asked whether responses to the DAS task by aggressive children and adolescents have distinctive characteristics that can be quantified and scored, and whether the scores can serve to identify those at risk. Previous studies had found that responses scoring 1 point on the DAS scale can serve to screen for depression, as discussed in chapter 3. The pilot study asked if there were significant differences between the scores of aggressive students and a control group of presumably nonaggressive students.

PROCEDURES Four art therapists in four schools presented the DAS Form A stimulus drawings to 30 aggressive students as well as to 181 students with no histories of aggressive behavior who served as controls (Earwood, Fedorko, Holzman, Montanari, & Silver, 2004). Each therapist selected seven or eight students with histories of aggressive behavior based on teacher reports, school records, or their own

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experiences. After their responses were scored, psychologist Brooke Butler, PhD, analyzed the findings.

SUBJECTS The students ranged in age from 8 to 19 years and attended public elementary or secondary schools in low to high socioeconomic neighborhoods in New Jersey and Florida. The sample of aggressive students included 25 boys and 5 girls. Seven attended a school that does not provide therapeutic programs, whereas 23 attended three schools that provide these programs. Two schools were in upper to middle socioeconomic neighborhoods and two were in low to middle socioeconomic neighborhoods. The sample of nonaggressive students attended regular classes in English or in art, and had received parental permission to participate in the research study.

RESULTS An ANOVA revealed that aggressiveness was significantly related to emotional content scores (F (1, 209) 7.06, p .01). Specifically, aggressive students, when compared to nonaggressive students, exhibited lower, more negative scores on the Emotional Content scale, as shown in Figure 4.1. In other words, the responses of the aggressive students were more negative to a degree that was significant at the .01 level of probability. Another ANOVA revealed that aggressiveness was significantly related to self-image scores (F (1, 209) 3.86, p .05). Specifically, aggressive students, when compared with nonaggressive students, exhibited higher scores on the self-image scale, as shown in Figure 4.2. A chi-square analysis revealed that aggression was significantly related to responses that scored 1 point in emotional content together with 5 points in self-image (x 2 (1) 27.57, p .001). In other words, the aggressive students were significantly more likely than nonaggressive students to draw strongly negative fantasies,

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The Pilot Study

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2.6

3.7 ~ 3.6 Mean SELFIM

Mean EMCONT

2.4 2.2 2.0 1.8

3.5 3.4 3.3 3.2

1.6

3.1 aggressive

nonaggressive

ACG

aggressive

nonaggressive

ACG

Figures 4.1 and 4.2 Relationships of Aggression to Emotional Content and Self-Image

scoring 1 point in Emotional Content, together with strongly positive self-images, scoring 5 points on the Self-Image Scale. Significant gender differences also emerged. A chi-square revealed that gender was significantly related to aggressiveness (x2 (1) 9.66, p .002). Specifically, male students were more likely than female students to be classified as aggressive. In addition, one ANOVA revealed that gender was significantly related to scores in emotional content (F(1,209) 19.68, p .001). Specifically, female students, when compared to male students, exhibited higher scores on the emotional content scale, as shown in Figure 4.3. A second ANOVA revealed a significant interaction between gender and aggressiveness in self-image scores (F(1,207) 5.39, p .02). Specifically, aggressive male students, when compared to aggressive female students, exhibited higher scores on the self-image scale, as shown in Figure 4.4. No significant age differences emerged.

OBSERVATIONS The findings suggested that the DAS assessment showed promise as a way to identify students at risk for aggression. The aggressive stu-

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3.0

4.0

2.8

3.8 3.6 Mean SELFIM

Mean EMCONT

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2.6 2.4 2.2

3.4 3.2 3.0 2.8

2.0

ACG

2.6

1.6 female GENDER

male

aggressive nonaggressive

2.4 female GENDER

male

Figures 4.3 and 4.4 Relationships of Gender to Emotional Content and Self-Image

dents, when compared with the nonaggressive students, expressed strongly negative perceptions of their worlds together with strongly positive perceptions of themselves, drawing fantasies about homicidal and life-threatening situations, and representing themselves as powerful and effective. The aggressive students had significantly lower scores in emotional content and higher scores in self-image than the nonaggressive students, scoring 1 point in emotional content combined with 5 points in self-image. In addition, the pilot study found that five of the 30 aggressive students (17%) drew strongly negative perceptions of themselves as well as their environments, scoring 1 point in both emotional content and self-image, suggesting that they were depressed as well as aggressive, and supporting the findings of the previous DAS studies reviewed in chapter 3. None of the aggressive students expressed moderately negative views of themselves and their worlds, scoring 2 points on both scales. One student had scored 2 points in self-image, but then scored 1 point in emotional content, identifying himself running away from life-threatening danger. Another student scored 2 points in emotional content (hostile relationships) but scored 5 in selfimage.

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Nine students (30%) scored 3 points in emotional content, selfimage, or both. Fifteen (50%) drew wish-fulfilling fantasies, and three of the 15 were moderately positive, scoring 4 points. Twelve of the 15 (40%) represented themselves as powerful and effective, six drawing homicidal fantasies, lethal encounters in which the murderers seem to be themselves. One student represented himself as an exploding volcano; another, as an aggressive mouse. Four portrayed themselves as heroes protecting victims. These findings of the pilot study raised questions with implications for clinicians and educators, and suggested that further investigation would be worthwhile.

QUESTIONS AND IMPLICATIONS Were some of the children and adolescents who responded to the drawing task depressed as well as aggressive? A few students in both aggressive and control groups scored 1 point in both self-image and emotional content. Aggressive behavior has been associated with clinical depression, as discussed in chapter 2, and previous DAS studies have found significant correlations between strongly negative content and clinical depression, as discussed in chapter 3. What is the relationship between aggressive fantasies and aggressive behavior? Six students in the nonaggressive control group also scored 1 point in emotional content together with strongly positive self-images that scored 5 points. Were they aggressive only in fantasy? Was their aggressiveness masked? Overlooked? Under inner control? Can we distinguish between constructive and destructive aggression, fantasies and acting out, bullies and heroes? Do drawings about heroes reflect a desire to protect or an attempt to conceal a desire to punish? Does humor play a role in aggressive behavior? Some students in the aggressive and control groups drew responses that were humorous. According to Vaillard (2002), humor may turn into passiveaggressive behavior or acting out, suggesting that there may be

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differences in the kinds of humor expressed by students in aggressive and nonaggressive groups. Do responses to the drawing task tend to remain stable over time or do they reflect temporary moods? Consistencies may reflect unresolved problems and ongoing concerns, whereas changes may reflect the effectiveness of therapeutic programs. And finally, are the responses characteristic only of students in the United States or are they similar to responses by students in other countries? Part Two addresses these questions and examines more closely responses to the drawing tasks and the individuals who produced them. It also takes closer looks at the experimental and control groups as well as the subgroups that emerged.

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Part II The Current Studies

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5 Rating Scales Used in the Current Studies

This chapter presents the three scales that were used in the current studies to assess responses to the drawing task. They include Emotional Content, Self-Image, and Use of Humor.

EMOTIONAL CONTENT SCALE The scale for assessing the emotional content of responses was not quite the same as the DAS scale presented in chapter 3. It was modified to make more specific the intermediate score of 3 points. Some ambivalent responses have hopeful outcomes whereas others have outcomes that appear hopeless. To include and quantify these differences, the scores of 3.5 and 2.5 points were added; 3.5 to indicate that an ambivalent response seems hopeful, and 2.5 to indicate hopelessness or despair. These additions to the Emotional Content Scale are shown in Table 5.1. 41

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Table 5.1 Scales for Assessing Emotional Content and Self-Images Emotional Content: ___1 point: Strongly negative themes, for example, solitary subjects portrayed as sad, helpless, isolated, suicidal, dead, or in mortal danger Relationships that are destructive, life threatening, lethal, or homicidal. ___2 points: Moderately negative themes, for example, solitary subjects portrayed as frightened, angry, frustrated, dissatisfied, worried, destructive, or unfortunate. Relationships that are stressful, hostile, or unpleasant. ___2.5 points: Ambivalent themes with negative or hopeless outcomes. ___3 points: Neutral themes, for example, ambivalent, both negative and positive. Unemotional, neither negative nor positive. Ambiguous or unclear. ___3.5 points: Ambivalent theme with positive or hopeful outcomes. ___4 points: Moderately positive themes, for example, solitary subjects portrayed as fortunate but passive. Relationships that are friendly or pleasant. ___5 points: Strongly positive themes, for example, solitary subjects portrayed as happy, effective, or achieving goals. Relationships that are caring or loving.

Self-Image: ___1 point: Morbid fantasy, respondent seems to identify with a subject portrayed as sad, helpless, isolated, suicidal, dead, or in mortal danger. ___2 points: Unpleasant fantasy, respondent seems to identify with a subject portrayed as frightened, frustrated, or unfortunate. ___2.5 points: Ambivalent fantasy with negative outcome, respondent seems to identify with subject who is hopeless or likely to fail. ___3 points: Ambivalent, unemotional or ambiguous fantasy, unclear or with invisible narrator. ___3.5 points: Ambivalent fantasy with positive outcome, respondent seems to identify with subject who is hopeful or likely to succeed. ___4 points: Pleasant fantasy, respondent seems to identify with a subject portrayed as fortunate but passive, such as watching television or being rescued. ___5 points: Wish-fulfilling fantasy: respondent seems to identify with a subject represented as happy, loved, powerful, admirable, intimidating, destructive, assaultive, or achieving goals. © 2003 Rawley Silver. Reprinted with permission for personal use

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Rating Scales Used in the Current Studies

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SELF-IMAGE SCALE The current studies also modified the Self-Image Scale of the Silver Drawing Test (SDT) in order to quantify responses to the drawing task. Like the Emotional Content Scale, the Self-Image scale ranges from strongly negative to strongly positive self-images, as shown in Table 5.1. Respondents who seem to identify with subjects portrayed as sad, helpless, isolated, suicidal, dead, or in mortal danger receive the lowest score of 1 point. Respondents who seem to identify with subjects represented as happy, loved, powerful, admirable, intimidating, destructive, assaultive, or achieving goals, receive the highest score, 5 points. Ambiguous, ambivalent, or unemotional self-images score 3 points, and moderately negative (frightened, frustrated, or unfortunate) self-images, and moderately positive (fortunate but passive) self-images score 2 and 4 points respectively. For example, the drawing of a snake catching and eating a mouse scores 1 point in Emotional Content. A respondent who identifies with the snake scores 5 points on the Self-Image scale, whereas a respondent who identifies with the mouse scores 1 point. The additional scores of 2.5 and 3.5 points also were added to the Self-Image scale to represent ambivalent responses with positive or negative outcomes. Validity of the SDT Self-Image Scale To determine the validity of this scale four studies examined selfimages in response to the drawing task. The first study (Silver, 1992) asked whether children tend to identify with the subjects of their drawings by choosing principal subjects the same gender as themselves. To obtain quantified information about the degree to which principal subjects represent self-images, drawings by 261 children were examined, comparing their genders with the gender of the subjects they chose, and taking into account the subjects of their sentences and their use of pronouns.

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Subjects for the study included 145 boys and 116 girls ages 7 to 10, in classes for second, third, and fourth graders in eight public elementary schools in urban and suburban neighborhoods in four states and in Canada. Previously these children had responded to the drawing task in order to contribute to the SDT norms. Results indicated that most of the children drew pictures about subjects the same genders as themselves. Using the chi-square test to determine significance, gender differences were found to be highly significant at the .001 level of probability. These findings supported the premise that children who respond to this task tend to identify themselves with the principal subjects of their drawings. The second study examined age and gender differences in attitudes toward self and others expressed in response to the drawing task (Silver, 1992, 1993a). The subjects included 531 children and adults, 257 male, 274 female, in five age groups: children ages 7 to 10, adolescents ages 13 to 16 and 17 to 19, younger adults ages 20 to 50, and older adults age 65 and older. Responses were divided into two groups, drawings about solitary subjects and drawings about relationships between subjects, then examined for gender differences and similarities. Again, one of the questions asked was whether respondents choose same-gender subjects to a significant degree, supporting the theory that the subjects of drawings reflect self-images. Most respondents chose same-gender subjects, and again a 2 2 chi-square was used to determine whether they drew subjects the same gender as themselves. Respondents who drew human subjects drew same-gender subjects to a highly significant degree (x2 145.839, p .001; φ .657). The tendency to choose same-gender subjects peaked in childhood and reached its lowest level among adults. Among older adults, however, the decline continued among older women, but surprisingly, reversed among older men, most of whom, like the sample of boys, chose male subjects. In addition, the study found that proportionally more women and girls expressed positive attitudes toward solitary subjects, but their drawings about relationships were both positive and negative. These findings too, were significant at the .001 level of probability (x2

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25.32, p .001). On the other hand, males showed higher frequency than females in drawings about assaultive relationships (x2 (1) 9.38, p .01). However, gender and age differences interacted, resulting in a significant age variability in assaultiveness for females, but not males. That is, female assaultiveness appeared to change with age (proportionally more older women expressed aggressive fantasies than any other age or gender group), whereas male assaultiveness remained stable. The converse age and gender interaction was found for caring relationships. Males showed significant age variability, whereas females had similar frequency of caring relationships across age groups (proportionally more younger men fantasized about caring relationships than any other age or gender group). In drawings about stressful relationships (2 points), little difference between genders emerged but proportionally more older men expressed fantasies about stressful relationships than any other age or gender group. The third study examined the self-images incarcerated male adolescents expressed in response to the DAS drawing task (Silver & Ellison, 1995). The study asked three questions: Can art therapists identify self-images blindly without knowing the person who drew them? Do they agree when identifying self-images? Do social workers agree? Ellison, a registered art therapist and educator who worked with adolescents in a residential detention facility, presented the DAS Form B task to 53 boys ages 13—18, and discussed their drawings with them individually. She then sent their evaluations, together with her own, to a psychologist for statistical analysis. Ellison then sent only their response drawing to Silver, who scored the responses blindly, then sent the scores to the psychologist who analyzed the three sets of evaluations. The level of agreement between the adolescents, Ellison, and Silver was viewed as an index of the validity of the self-image measure. Of the 53 juveniles, 39 identified characters in their drawings as themselves. Ellison, who knew their histories and conducted the interviews, accurately matched 76.9% of the respondents. Silver, judging blindly, matched 71.8%. Approximately 3 of 4 respondents

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(71.4%) agreed with the art therapists on the identity of their selfimages. Five disagreed with both art therapists. The art therapists, however, agreed with each other in identifying the self-images of these five students. The interscorer agreement between Ellison and Silver, across 53 respondents, was 94.3%. Although discussion is preferable—and the more discussion, the more accurate interpretations and assessments are likely to be—the findings seem to indicate that discussion can be bypassed, particularly in urgent situations such as the need to identify someone at risk for suicide, when circumstances or time limitations make interviews impossible. In addition, three art therapists and five social workers rated selfimages in 10 of the 53 response drawings selected at random. The average agreement among the social workers was 54.0%, among the art therapists, 78.2%, and among a subgroup of three registered art therapists (ATRs), 93.4%. Overall, the sample of 10 judges agreed 61% of the time. It is hoped that this study can be extended with larger samples of art therapists, social workers, and other mental health professionals. The fourth study asked whether delinquency or gender was related to self-image scores and whether drawings about assaultive relationships or solitary subjects differed, depending on delinquency or gender (Silver, 1996a). The subjects included the same sample of 53 incarcerated adolescents as well as nondelinquent adolescents attending public schools in Ohio, New York, and Florida, a total of 82 boys and 56 girls ages 13 to 17. Their responses were divided into four groups: delinquency, gender, drawings about relationships, and drawings about solitary subjects. Responses were then evaluated on a scale based on attitudes toward the self-images or relationships portrayed. A psychologist, Madeleine Altabe, PhD, analyzed their mean scores. The first analysis asked whether delinquency or gender was related to self-image scores; that is, to fortunate, unfortunate, or aggressive self-images. No significant differences were found. The male mean score was 2.52; the female mean score was 2.92.

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Differences appeared, however, when drawings about assaultive relationships or solitary subjects were examined more closely. Significant gender differences emerged in both solitary and assaultive content, and the finding of assaultive content was reversed for solitary content. Overall, males and females differed in both aggressive content (x2 (1) 11.00, p .01) and solitary content (x2 (1) 6.33, p .05); 31.7% of the males drew pictures about assaultive relationships as compared with 5.4% of the females. In solitary content, however, 37.5% of the females drew pictures about solitary subjects, compared with 15.9% of the males. Solitary content also distinguished between delinquent and control groups: 33.8% of the control subjects drew solitary subjects as compared with 14.1% of the delinquent subjects. These differences reached significance (x2 (1) 9.11, p .01). The difference between male and female delinquents, however, did not reach significance (28.3% of the males drew assaultive relationships). No female delinquents drew assaultive relationships. Although males in the control group differed significantly from females in the control group, delinquent males did not differ significantly from delinquent females. No significant results were found when a group (delinquent vs. control) by gender (male vs. female) 2 2 ANOVA was conducted on the selfimage rating. No differences in gender or delinquency appeared in mean scores. Instead, differences appeared between drawings about solitary subjects and drawings about assaultive relationships. More girls than boys drew pictures about solitary subjects, and regardless of delinquency, more than twice as many girls as boys drew sad, helpless, or endangered solitary subjects, scoring 1 and 2 points (18% girls, 8% boys). Delinquency also made a difference in positive responses scored 4 and 5 points. More than three times as many nondelinquent boys than delinquent adolescents drew fortunate solitary subjects (14% vs. 4%). No delinquent girls but 20% of the nondelinquent girls drew fortunate solitary subjects. The effect was reversed for aggressive content. In drawing fantasies about assaultive relationships, delinquent girls were more like boys regardless of delinquency.

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Surprisingly, more nondelinquent than delinquent boys drew fantasies about assaultive relationships. This unexpected finding raised several questions. Do boys who internalize prohibitions against aggressive behavior tend to fantasize more than those who act out? Does being incarcerated inhibit the expression of aggressive fantasies? What about the fantasies of aggressive students still in elementary and secondary schools? These and other questions led to the pilot study, and subsequently to the current study presented in the chapters that follow. Another unexpected finding indicated that 45.4% of the nondelinquent boys used humor in their assaultive fantasies, whereas no other groups used humor in aggressive fantasies. These and the findings of other studies led to developing a scale for assessing the different forms of humor that have appeared in responses to the drawing task.

SCALE FOR ASSESSING THE USE OF HUMOR Rationale According to Vaillard (1992, 2002), humor serves various functions. It permits us to look directly at what is painful, laugh at our own miseries, vent angry feelings, and loose blunt arrows against others. Under stress, mature humor may turn into passive-aggressive behavior (expressing aggression toward others indirectly) or acting out (expressing unconscious wishes or impulses directly). Ziv (1984) notes that we use humor to face reality, master fears, relieve tension, avoid depression, and deny dangers by making them appear ridiculous. We also use humor to hide aggressive feelings, punish others, and feel superior. Self-disparaging humor permits us to win sympathy and reduce anxiety, sexual humor enables us to deal openly with social taboos, and intellectual humor creates new meanings through absurdity and incongruity. The original scale for assessing humorous responses to the drawing task was a 5-point scale ranging from negative to positive, like the 5-point scales for assessing emotional content and self-image

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Table 5.2 Scale for Assessing the Use of Humor 1 point: Lethal and morbid humor Amused by subject(s) dying painfully or in mortal danger and overtly expressing pain and/or fear, either through words or images. 1.5 points: Lethal but not morbid humor Amused by subject(s) disappearing, dead, or in mortal danger but not expressing pain and/or fear, either through words or images. 2 points: Disparaging humor Amused by a principal subject who is unlike the respondent (such as opposite gender) and unattractive, frustrated, foolish, or unfortunate, but not in mortal danger. 2.5 points: Self-disparaging humor Uses personal pronoun or is amused by a principal subject who is like the respondent as well as unattractive, frustrated, foolish, or unfortunate, but not in mortal danger. 3 points: Ambiguous or ambivalent humor (neutral) Meaning or outcome is both negative and positive, neither negative nor positive, or unclear. 4 points: Resilient humor (more positive than negative) Principal subject(s) overcomes adversity or outcome is hopeful or favorable. 5 points: Playful humor (entirely positive) Kindly, absurd, or play on words, such as rhyme or pun. © 2003 Rawley Silver

(Silver, 2002). It too was modified for the current studies, as shown in Table 5.2. Lethal Humor Drawings that joke about death or annihilation have appeared in two forms. The most negative form, scored 1 point, seems morbid as well as lethal. These drawings suggest that the respondent is amused by fantasies about victims who suffer or plead for help but die nevertheless, and seem to expect that the viewer also will be amused. This form of humor has appeared only in responses by boys and youths. An example is the response titled “Godzilla vs. Mighty Mouse” by a high school student attending regular classes (Figure 5.1).

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Figure 5.1 Lethal and Morbid Humor—“Godzilla vs. Mighty Mouse”

Gallows Humor A second form of lethal humor scores 1.5 points. Even though it jokes about death or annihilation, it tends to dispatch its victims out of sight or without gruesome details, such as the drawing by a young woman, titled “Amy found that James only married her for her trust fund . . .” (Figure 5.2).

Figure 5.2 Gallows Humor—“Amy found that James only married her for her trust fund, and found that he is sleeping with her sister,” by a younger woman.

Disparaging Humor Humorous responses that ridicule subjects but do not harm them also appear in two forms. The first, scored 2 points, disparages subjects other than one’s self, such as “The Scared Dragon” (Figure 5.3).

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Figure 5.3 Disparaging Humor—“The Scared Dragon”

Figure 5.4 Self-Disparaging Humor—“I am a Picses. So where is the other fish?”

Self-Disparaging Humor This format of humor scored 2.5 points, such as the drawing titled, “I am a Picses. So where is the other fish?” by an older woman (Figure 5.4). This form of humor has appeared only in responses by adults.

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Figure 5.5 Ambivalent or Ambiguous Humor—“The Snake and the Mouse”

Ambivalent or Ambiguous Humor Responses that seem unemotional, unclear, or ambiguous receive the intermediate score, 3 points, such as the response titled “The Snake and the Mouse,” by an older man (Figure 5.5). The snake’s embrace could be delicious for the snake but disastrous for the mouse. Resilient Humor Response drawings about victims who joke about their fears or frustrations score 4 points, such as the untitled series of drawings about an encounter between a mouse and a dinosaur (Figure 5.6). Playful Humor This form of humor seems motivated by high spirits and good will, and receives the highest, most positive score, 5 points. It tends to have absurd subjects, witty titles, and little if any emotional involvement, such as “Lyin’ in the livingroom” by a young woman (Figure 5.7).

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Figure 5.6 Resilient Humor—Untitled

Figure 5.7 Playful Humor—“Lyin’ in the livingroom”

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Studies of the Use of Humor Three studies have examined humorous responses to the drawing task. A review of 849 responses by children, adolescents, and adults found that 141 (17%) seemed to express humorous intent (Silver, 1983, 2001). Produced by respondents in five age groups ranging from children to adults, their drawings were divided into five categories of humor: lethal (joking about death or annihilation) disparaging, ambiguous or ambivalent, resilient, and playful. We found that 75% of the humor was negative (43% disparaging and 32% lethal). The second study added responses to the stimulus-drawing task of another assessment (Stimulus Drawings & Techniques [Silver, 1983, 2002]). The subjects included 724 children, adolescents, and adults with no known impairments and 164 with emotional disturbances (Silver, 2002). Eighteen percent of the unimpaired subjects used humor. The findings revealed gender and age differences in the kinds of humor expressed. Analyses of variance found that males produced significantly more humorous responses than females (x2 (1) 37.3, p .01), and more negative humor that females (x2 (4) 7.85, p .10). No females expressed cruelty or portrayed suffering, whereas the males who did so were all adolescents, 3 with emotional disturbances. In the third study, the scale for assessing humor was revised to make it more precise by adding the intermediate scores of 1.5 and 2.5 points (Silver, 2003). To determine the reliability of the revised scale, three art therapists scored two sets of humorous responses to the SDT Drawing from Imagination task. They included Christine Turner, ATR-BC, Victoria Anderson, MA, and myself. We practiced with the first set of responses, discussing our scores via telephone and e-mail. When we seemed to reach agreement, we scored a second set of 12 humorous responses blindly without discussion, and mailed our scores individually to Brooke Butler, PhD, who found a reliability coefficient of .861. This coefficient exceeds the minimum level of acceptability (0.80), and suggests that the Humor Scale is reliable.

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The finding also raised the question whether there is association between aggressive behavior and humorous responses to the drawing task that are both lethal and morbid. If so, drawings that score 1 point on the humor scale also might serve to identify students who may be at risk. In search of answers to this and other questions, the 30 aggressive students were asked to respond to the DAS task. Their responses are reproduced in chapter 6.

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6 Response Drawings and Histories of Aggressive Students Cheryl Earwood, Melinda Fedorko, Eileen Holzman, and Linda Montanari

This chapter presents responses to the DAS task by the sample of 30 children and adolescents who had acted aggressively or violently in their schools. To obtain this sample, four art therapists in four schools selected aggressive students and asked them to respond to the drawing task. In three of the four schools, the students they selected had been participating in special education programs. The response drawings and stories are accompanied by brief histories of the behaviors and relationships of these students with other students or with members of their families. Their responses are presented in groups based on their emotional content scores, beginning with the group that was strongly negative and concluding with those that were moderately positive. No responses by students in the aggressive group were strongly positive. Names have been changed to protect the privacy of these and all other students who participated in this study. 57

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RESPONSES WITH STRONGLY NEGATIVE EMOTIONAL CONTENT Nineteen of the 30 aggressive students drew strongly negative fantasies that scored 1 point on the Emotional Content scale. Their scores on the Self-Image Scale, however, ranged from strongly negative (1point) to strongly positive (5 points). Strongly Negative Self-Images Five of these 19 students drew strongly negative self-images, representing themselves as victims in life-threatening situations, and scoring 1 point on both scales, suggesting that they may have been depressed.

Figure 6.1 “When Dinosaurs Rule America”

Figure 6.1 was created by Jimmy, age 14, who chose four stimulus drawings: the parachutist, dinosaur, castle, and volcano. When he finished drawing, he dictated this story: “The man ejected in the war with the dinosaurs. The monsters are mutated. His goal is to destroy all living mutated organisms. The plane was shot down by the dinosaur’s breath attack. He says he is going to die because the dinosaur is in the castle. He’s calling for backup but it won’t come for a year.” Emotional content: 1 point. Lifethreatening and lethal relationships.

Self-Image: 1 point. Jimmy’s fantasy suggests that the parachutist represents himself. When frustrated, angry, or sad, Jimmy lashes out, places himself in harm’s way, or else withdraws completely. It is not known whether he has experienced abuse. He participates in a program for students with severe emotional problems; his diagnosis is major depression and attention deficit/hyperactivity disorder (ADHD) for which he takes medication daily. Jimmy lives with his biological parents and siblings.

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Figure 6.2 “The mouse was killing people from around the world.”

Joseph, age 10, chose two stimulus drawings, volcano and mouse (Figure 6.2). After drawing, he dictated this story: “A man caught the mouse with a trick and put him in the volcano. When the volcano exploded the mouse came out and fell into the dinosaur’s mouth. The dinosaur didn’t die because it came from the volcano.” Emotional Content: 1 point. Life-threatening relationships. Self-Image: 1 point. Joseph appears to see himself as the mouse. In school, Joseph is aggressive verbally and physically and attends a special program for emotionally disturbed children. His diagnosis is bipolar disorder and ADHD. He lives with his mother, her boyfriend, and many siblings in a chaotic family. It is not known whether he has experienced abuse. His biological father died when he was 7, prior to the onset of his aggressive and defiant behavior. He has also expressed suicidal and homicidal ideation and has been hospitalized several times.

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Figure 6.3 “There was a girl and a snake and the snake was attacking her and she said, ‘Help me!’”

Figure 6.3 was created by Lanette, age 12, who chose the stimulus drawing snake and bride. Her bride has no arms. Emotional Content: 1 point. Life-threatening relationship. Self-Image: 1 point. Lanette seems to represent herself as helpless. Lanette has a strong history of aggression, eating disorder, and auditory hallucinations. She attends the special education classes in her elementary school. She may have experienced abuse as suggested by her multiple responses to the drawing task. They are presented in chapter 7 together with her history. It is important for Lanette to present herself as strong and in control when she is around her peers.

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Figure 6.4 “There was a [“girl” crossed out] balloon and the balloon was cut with a knife and into the sea and was never found. The balloon didn’t know it was cut and so it fell into the water and was never found.”

For Figure 6.4, Victoria, age 17, chose the parachutist and the knife. In her drawing, she transformed the parachutist into a balloon with an empty basket and added wavy lines to represent waves, but no details. Emotional Content: 1 point. Her principal subject is stabbed, helpless, and abandoned. Self-Image: 1 point. Victoria’s girl/balloon/parachutist seems to represent herself. Victoria can be very aggressive, threatening, and cruel to other students. She has a history of abuse but little is known about her family background. Sometimes she seems manic, speaking loudly and ignoring teacher directives; at other times, compliant. She has been suspended for stealing, using profanity toward a teacher, playing with a knife, and defiance.

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Figure 6.5 “The volcano is blowing up the castle.”

Ralph, age 12, chose three stimulus drawings: cowboy, volcano, and castle (Figure 6.5). In his response, his human subjects are small and passive. The figure on the castle roof says, “Oh my.” Emotional Content: 1 point. Life-threatening relationships. Self-Image: 1 point. Ralph identified himself as the person on the roof. Apart from aggressive behavior, little is known about Ralph’s history. His school, in a middle class neighborhood, does not provide programs for students with special needs.

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Moderately Negative Self-Images

Figure 6.6 “A big baby chick is attacking the castle and the warriors are trying to destroy him.”

Colin, age 12, chose the chick and the castle for Figure 6.6. Colin’s chick scowls and is as large as his castle. Six small stick figures on the left are running away while others battle the chick with swords, spears, arrows, and a catapult. Emotional Content: 1 point. Life-threatening relationships. Self-Image: 2 points. Colin identified himself as one of the figures running away. In school, Colin is argumentative, stubborn, and immature, as well as aggressive. He shows little interest in academic work but was pleased when asked to respond to the drawing task. No information about his family or behavior elsewhere was available.

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Ambiguous or Ambivalent Self-Images

Figure 6.7 “The dinosaur is looking for food when all of a sudden, Bomb the Dinosaur is trying to run away from the volcano. But the lava is following him quickly.”

Figure 6.7 was created by Darrell, age 15, who gave his dinosaur a sharp horn, claws, open mouth with sharp teeth, but short legs. Emotional Content: 1 point. Life-threatening relationship. Self-Image: 3 points, ambivalent with outcome unclear. Although Darrell’s dinosaur is powerful, its legs are short and the lava is fast. Will it escape? Darrell has a history of aggression, obesity, hygiene problems, and neurological deficits. This further exacerbates his interpersonal difficulties. He lives with his biological parents and brother. There is frequent stress in the family.

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Figure 6.8 “The snake is going to the top of the volcano and it is about to erupt.”

Ron, age 14, chose the snake and volcano (Figure 6.8). His hasty, imitative drawing suggests guardedness or resistance. Emotional Content: 1 point. Life-threatening relationship. Self-Image: 3 points, unclear. The snake, the volcano, or both could be selfimages. Although Ron has a history of violent behavior, we have seen little of it since he came to this school and began therapy four months ago. He has posttraumatic stress disorder (PTSD) due to physical and sexual abuse. He has attacked people on two occasions. One time he punched a teacher as they were attempting to restrain him. The second incident occurred when another student began “play fighting” with Ron but he felt threatened and put the other student in a chokehold. In therapy, Ron is very guarded, answering questions with one- or two-word replies. He is beginning to open up more, particularly in a small group setting.

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Figure 6.9 “This story is about a mouse that is saying, ‘Help Me’ because the snake is going to eat him.” John, age 14, who chose the mouse, snake, and old tree (Figure 6.9). Although his mouse and tree are imitative, he transformed the snake into a rattlesnake embellished with fangs and other details. He also added leaves on the ground and a mailbox. Emotional Content: 1 point. Life-threatening relationship. Self-Image: 3 points, ambivalent and ambiguous. It is not clear whether John used the mouse, the snake, or both, to represent himself in disguise. John’s behavior in school has been violent, threatening, and withdrawn, suggesting that he may be depressed. It is not known whether he has experienced abuse. Although diagnosed with learning disabilities, John’s response is highly skillful, subtle, and expressive, including fallen leaves, mailbox signal up, and a plea for help. As measured by the three cognitive skills assessed in response to the SDT Drawing from Imagination subtest, Ability to Select, Combine, and Represent (creativity), John’s response receives the highest score, 5 points in each category.

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Powerful and Assaultive Self-Images Ten of the 19 students who drew strongly negative fantasies, scoring 1 point in the Emotional Content, also scored 5 points in Self-Image, representing themselves as powerful, destructive, or intimidating. Five of these students attended a school that has no theraputic or preventive programs: Shaun, Gus, Carl, Toby, and Sam.

Figure 6.10 “I don’t like chickens! The chicken is going to die” Figure 6.10 was created by Shaun, age 12, who chose four stimulus drawings. His chick appears frightened; his smiling mouse holds a knife, as another knife descends on the chick from the parachutist above. Emotional Content: 1 point. Life-threatening relationships. Self-Image: 5 points. Shaun’s use of the pronoun “I” suggests that he is the homicidal mouse. Humor: 1 point. Both lethal and morbid. Shaun was selected for the study because his aggression had caused problems in his school, a suburban school in a middle-class neighborhood. Little is known about Shaun’s family other than that his brother also caused problems in the school.

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Figure 6.11 “Chick: ‘Don’t hurt me, I want to live.’ Knife: ‘Who cares!’”

Gus, age 12, Shaun’s classmate, also chose the chick and the knife (Figure 6.11). Erased but still visible is his title, “Killing is bad!” Emotional Content: 1 point. Assaultive and lethal relationship. Self-Image: 5 points. Since Gus apparently had second thoughts about his title, it is unclear whether he initiated the fantasy or imitated Shaun. Humor: 1 point, lethal and morbid. Gus seems to find his chick’s plea amusing.

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Figure 6.12 “The man is going to die o no”

Figure 6.12 was created by Carl, age 12, who chose the dinosaur and the man smoking a pipe, changing both. Carl’s dinosaur holds the partially devoured man in his toothy mouth. The man looks surprised, and is about to lose his pipe as well as his life. Emotional Content: 1 point. Assaultive and lethal relationship. Self-Image: 5 points. Carl seems to identify with his dinosaur. Humor: 1 point. Lethal and morbid. Carl has poor relationships with his peers. He is limited in academic ability and his behavior in school is very disruptive.

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Figure 6.13 “The knive stabbed the snake. The snake was all bloody. It died in 16 minutes.”

Figure 6.13 was created by Sam, age 12, who chose and imitated the snake and the knife. Emotional Content: 1 point. Assaultive and lethal relationship. Self-Image: 5 points. Sam seems to identify with the anonymous wielder of the knife. Sam is immature as well as aggressive. Although his family relationships seem shaky, he gets along well with his peers.

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Figure 6.14 “Guy saving his girl friend. Evil guys are trying to kill him.”

Toby, age 12, chose the parachutist and knife for Figure 6.14, adding the house and men holding guns. Emotional Content: 1 point. Assaultive and life-threatening relationships. Self-Image: 5 points. Toby seems to represent himself as the romantic and heroic parachutist. Toby is overweight and teased by his peers. He receives therapy (outside of school).

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Figure 6.15 “A boy poisin by a snat from geting bit then he almost died.”

Greg, age 11, chose the boy and the snake, altering both, and adding the pole in Figure 6.15. [A boy was poisoned by a snake. He almost died from being bitten.] Emotional Content: 1 point. Assaultive, life-threatening relationship. Self-Image: 5 points. Greg probably identifies with the snake because he has never been observed in the role of victim with his peers. Greg has a history of experiencing abuse. His is also a bully and very aggressive, constantly teasing or laughing at the others’ misfortunes. Recently, he was suspended for bringing a toy gun to school. When he is on medication, his symptoms decrease and he is able to focus on academic work. Both his parents died several years ago and he lives with his grandmother. He has been in therapy for about one year and is beginning to grieve the death of his mother. He feels safe in therapy and is exploring the reasons for his negative behavior.

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Figure 6.16 “The rat was walking in the snake territory and the snake seen him and eat him.”

Figure 6.16 was created by Larry, age 17, who chose the snake and mouse, altering both. Emotional Content: 1 point. Assaultive and lethal relationship. Self-Image: 5 points. Larry seems to identify with the snake. Larry is in a Special Education class for emotionally handicapped students. He has a history of attacking others as well as experiencing abuse. Both his parents are deceased. Details of his history and additional responses to the drawing task are presented in chapter 7.

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Figure 6.17 “Princess in Danger”

Leroy, age 8, chose four stimulus drawings (Figure 6.17): bride, knife, dinosaur, and parachutist. His bride has no hands to hold the knife (phallus?) and seems to wear trousers. His story (dictated): “Once upon a time the princess was playing with a fake knife. And then the dinosaur came and the princess said, that’s impossible for a dinosaur to come to life, but the knife was real. A guy in a parachute came because he was looking for the dinosaur for a lot of years. The princess got her knife and ran away, then came back and cut off the dinosaur’s head. The end.” Emotional Content: 1 point. Assaultive and life-threatening relationships. Self-Image: 5 points. Leroy’s family history suggests that the parachutist or the princess might be himself or his mother; the dinosaur, his father. Additional response drawing and details of Leroy’s history are presented in chapter 7.

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Figure 6.18 “Shooting Spree”

Jerry, age 17, did not choose a stimulus drawing for Figure 6.18. “The guy shoots the man in the throat, then in the head. He takes a knife and decapitates him. Then he goes after the next guy. These are the only kind of pictures I like to draw. It’s not because I’m crazy or anything. I just find them funny.” Emotional Content: 1 point. Assaultive and lethal relationships. Self-Image: 5 points. Jerry seems to be the man with the gun. Humor: 1 point. Lethal and morbid. Jerry is withdrawn socially. He has been diagnosed with anxiety, ADHD, and learning disability. He is easily frustrated and confused, with pervasive expectation of failure. He had been attending a Special Education program, but abruptly dropped out of school.

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Figure 6.19 “Vocanola urupt—next it will all . . .”

Figure 6.19 was created by Ramon, age 14, who chose the volcano, which he insisted on coloring with crayons, markers, and black paint. Emotional Content: 1 point. Self-Image: 5 points. Ramon may represent himself as the exploding volcano, overlapping the sun. He included a dark sky and clouds above. Ramon has a history of aggressive, volatile behavior. He initiates fights with his classmates who also attack him. He is very isolated, stating that his only friend is his dog. He has received minimal therapy.

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RESPONSES WITH MODERATELY NEGATIVE TO MODERATELY POSITIVE EMOTIONAL CONTENT The only responses by students in the aggressive group that were not strongly negative ranged between moderately negative and moderately positive. The 11 students in the last subgroup scored 2 to 4 points in Emotional Content. Their Self-Images, however, were more positive, ranging from 3 to 5 points. Their responses follow.

Figure 6.20 “Pick on someone your own size!”

Carol, age 17, chose the chick, cat, and mouse (Figure 6.20). Her scowling chick is much larger than her cat, and her mouse is so small that it can be overlooked in her drawing. Story: The cat was chasing the mouse, but the mouse found protection with the giant chick who told the cat to stop picking on the mouse. Emotional Content: 2 points. Hostile relationships. Self-Image: 5 points. Carol’s chick seems to represent herself. Carol has been physically aggressive with members of her family and in school. Diagnosed with ADHD, she takes medication and has been receiving therapy. She is gifted in music and participates in the music program in her school.

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Figure 6.21 “There’s a princess stuck in a castle, but a parachuting cowboy with a knife in his holster is trying to save her.”

For Figure 6.21, Harriet, age 16, chose and altered 11 of the stimulus drawings. Story: “A dinosaur is trying to eat her though, only he’ll have to leave or the lava will kill him—so the cowboy rescues the princess, then the castle burns down in the lava and they all die tragically.” Emotional Content: 2.5 points. Ambivalent with negative outcome. Self-Image: 3 points. Ambivalent, both victim and assailant, princess and volcano, mouse and chicken. Humor: 2 points. Disparaging. Harriet has been diagnosed with ADHD and is in a gifted program in her school. Her aggressiveness has been primarily verbal. As measured by the three cognitive skills assessed by the Drawing from Imagination subtest of the SDT, Harriet’s response receives the highest scores in each of the three categories: Ability to Select, Combine, and Represent (creativity).

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Figure 6.22 “The story is about are you my mother? When the baby bird fall out the tree to go and find his mother and he run into many objects.”

Figure 6.22 was created by Sherrie, 17, who chose the stimulus drawing of two trees. In her response drawing, she included only the old leafless tree, omitting the young, leafy tree nearby, and added the baby bird. Emotional Content: 3 points. Ambiguous. She may have borrowed the phrase, “Are you my mother?” from the title of a book. Self-Image: 3 points, ambiguous or ambivalent. The baby bird might represent Sherrie, her daughter, or both. Sherrie has a history of substance abuse, aggression, and being physically abused. She tends to be passive and minimally verbal both in therapy and in the classroom. She is bipolar and has been psychotic when in the manic phase. At these times, she is hospitalized. Members of her foster family report her to be aggressive and defiant, and note that she has gone after her mother with a knife. Sherrie is the mother of a two-year old daughter. Recently jailed for several weeks, Sherrie has not returned to school. She was incarcerated just before she was to gain custody of her baby.

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Figure 6.23 “That a man likes sports a lot one day he jumped from a coptor he flew to the mountains. Ther was a catle near by he went inside and never came out.”

Joe, 11, chose the parachutist and castle for Figure 6.23, adding his helicopter. Emotional Content: 3 points. Unclear (why did the man never come out?). Self-Image: 3 points. Unclear. The parachutist might be Joe or the faceless man. Joe has a history of aggression, and had been in the Special Education program when it became evident that he had disturbed thoughts and paranoid ideation. When he began art therapy, he shared his idea of getting all the kids in the cafeteria and then taking over the school. He saw himself as both victim and aggressor, retreating into fantasy and fabricating stories. He then became aware of his anger, and as his artwork became less aggressive, it became more concerned with fantasies of escape. After he had received art therapy for several months the family moved away. He always wanted to please his father who seemed strict and remote, and ridiculed him openly. Joe was frequently unhappy, and viewed himself as an outcast. If he felt threatened, he would threaten back verbally but not use physical means or instigate aggression.

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Figure 6.24 “The man is smoking and watching the little rat having fun. Then when he finish smoking he left home.”

Figure 6.24 was created by Harry, 14, who chose and imitated the mouse and man smoking a pipe. Emotional Content: 3 points. Unclear. Self-Image: 4 points. Harry’s little rat seems to represent himself. Harry’s behavior is characterized by verbal and physical aggression, and he attends the Special Education program in his school. He said that his mother beats him but he deserves it when he does stupid things. His response to the drawing task suggests that his father may be absent and that Harry is concerned about his father.

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Figure 6.25 “The Volcano Blast”

Keith, 8, chose and imitated the volcano and dinosaur for Figure 6.25. Story: “Once upon a time it was a dinosaur living by the lava and liked it hot and wanted to get a lot of people killed. He do not like kids or grownups or teenagers. He killed his wife. He put her in the lava. He said, ‘Ahh. No more people.’ Suddenly he had said, ‘No people allowed,’ and a little boy came and he said ‘Hello, welcome to my lava.’ He decided to give him a cookie and be friends. And then they played ‘hot lava.’” Emotional Content: 3.5 points. Ambivalent, both positive and negative, with positive outcome. Self-Image: 3.5 points. Keith seems to identify with the dinosaur that has rejected the people around him. After killing his “wife” (perhaps his sister), he wants to fill the void by welcoming a new friend. Keith has a history of abuse. In school, his behavior is manipulative and impulsive. He is often angry and verbally aggressive toward his peers. He has been in foster care since he was a baby. He has many chronic physical problems and is diagnosed with hyperactivity and developmental delays. He attends a class for severely emotionally disturbed children and has received art therapy for approximately two years.

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Figure 6.26 “Air Force Ejection”

Figure 6.26 was created by Charles, 14, who chose the parachutist, mouse, and castle. The parachutist is large and wears a helmet. Story: “This is a guy from a fighter jet ejecting over enemy territory. Another castle shot his plane down. The mouse is going to become his friend for the next 5 weeks. Later he gets rescued and the mouse becomes his pet.” Emotional Content: 3.5 points. Ambivalent, both positive and negative, positive outcome. Self-Image: 3.5 points. Charles seems to identify with the rescued parachutist. Charles has a history of abuse. His behavior is characterized by angry, aggressive outbursts, paranoid ideation, and poor relationships with his peers. His diagnoses include ADHD, bipolar disorder, and oppositional—defiant disorder. He has been hospitalized for suicidal and homicidal ideation.

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Figure 6.27 “Volcano Monster”

Rico, 9, chose the dinosaur, mouse, parachutist, castle, and volcano for Figure 6.27. His dinosaur is the largest subject in his response drawing, which is embellished with many details. Story: “Once there was a castle next to a volcano. In the volcano lived the enemy of the king. The volcano monster was mad so he started the volcano. One day a tiny mouse and T-Rex came and saw the volcano so the mouse got a hose and T-Rex got a rock and threw it on the volcano monster and broke it. Every one cheered. The end.” Emotional Content: 3.5 points. Ambivalent, both negative and positive, with positive outcome. Self-Image: 5 points. Rico seems to identify with his mouse or T-Rex, assailants who overcome the volcano and are admired by many observers. Rico lives with his mother and siblings and often speaks of missing his father. It is not known whether he has experienced abuse. His current diagnosis is ADHD with hyperactivity and separation anxiety. He often has angry outbursts in the classroom. When frustrated, he becomes angry, and previously had many fears, which seem to be diminishing. He entered the art therapy program 2 years ago when his behavior became aggressive and ADHD interfered with academic progress. Since then, he has participated in small art therapy groups, has taken a leadership position, and proved himself to be very industrious and creative.

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Figure 6.28 “One day there was a princess who lived in a castle.”

George, age 10, chose the bride, castle, and volcano, altering them in his response (Figure 6.28). Story: “There was a volcano and it exploded. She sent her men to stop the volcano from erupting. the volcano erupt. George of the Jungle came and served her and fought a lion for her. They lived happily ever after.” Emotional Content: 3.5 points, ambivalent, both positive and negative, with positive outcome. Self-Image: 5 points, he seems to identify with the hero of this story, and his increasing interest in girls, as a pre-adolescent boy is apparent. George has a history of abuse. He entered the program for severely emotionally disturbed children from a regular program where his behavior was aggressive and defiant. He has been diagnosed with ADHD with hyperactivity. Additional responses to the drawing task and detailed history are presented in chapter 7.

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Figure 6.29 “The cold mouse sees a place to stay for the winter and is immediately filled with joy and hope.”

Figure 6.29 was created by Rex, 17, who chose the stimulus drawing trees and mouse, imitating the trees in his drawing but altering the mouse. His mouse looks at the old tree and smiles, tail up, its paw at its side, suggesting a fist. Emotional Content: 4 points. The mouse is fortunate but passive. Self-Image: 4 points. Rex seems to identify with his mouse, whose hopefulness may reflect a wish-fulfilling fantasy, an effective therapy program, a tongue-in-cheek attempt to please, or all three. It is not known whether Rex has experienced abuse. He once held a class hostage and subsequently has received intensive therapy. He now attends regular school classes as well as a Special Education program.

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Figure 6.30 “A Girl Changing into a Snake”

Ronnie, age 9, chose and altered the bride and snake for Figure 6.30. Story: “Once upon a time there was a girl who changed into a snake because she didn’t want to be a person, because she liked animals. She saw a snake, who was another friend. They both got together.” Emotional Content: 4 points Self-Image: 3 points Ronnie has a history of severe early abuse and abandonment, was born crack cocaine exposed, and has had many foster placements, but recently was adopted into his former foster home. He is extremely moody, volatile when angry, and verbally aggressive. His diagnosis is ADHD and prolonged PTSD. His IQ is in the border range and he has received art therapy for several years.

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SUMMARY These 30 students, offered as brief case studies, were chosen for previously documented aggressive behavior. They exemplify and seem to support the research hypothesis put forward in this book. The scores for Emotional Content were generally on the low end of the scoring scale, significant for strongly negative themes of danger. A majority of these cases also had a score of 3 or higher on the SelfImage scale, suggesting strong self-concepts and feelings of power. These examples seem to provide support for the hypothesis that aggressive individuals have a negative outlook in their environment, while maintaining a strong self-image, the combination of which may very well contribute to their acting out aggression. The responses and histories of these 30 students seem to indicate that DAS is a useful and easy-to-administer tool for screening aggression.

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7 Comparing Aggressive and Control Groups, Subgroups, and Individuals

This chapter compares responses to the drawing task by the samples of aggressive and nonaggressive students. It begins by comparing their Emotional Content and Self-Image scores, and then takes a closer look at the subgroups that emerged. They include students in both groups who scored 1 point on both the Self-Image and Emotional Content scales, suggesting they may be depressed, the subgroup of Depression. The other subgroups were Reactive Aggression and Predatory Aggression, as well as Humorous Responses, Female Responses, and Male Responses.

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COMPARING EMOTIONAL CONTENT AND SELF-IMAGE SCORES In emotional content, the aggressive group was more negative than the nonaggressive control group. More than twice as many students in the aggresive group drew strongly negative fantasies, 63% receiving the most negative score of 1 point compared with 30% of the control group, a significant difference that is statistically at the .01 level of probability. On the other hand, none of the aggressive students who drew strongly positive fantasies scored 5 points, compared with 4% of the controls, and almost twice as many controls drew moderately positive fantasies scoring 4 points, 12% compared with 7% of the aggressive students, as shown in Table 7.1. In self-image, however, it was the other way around. Almost three times as many aggressive students drew strongly positive selfimages, 43% receiving the highest score of 5 points, compared with 15% of the controls, another difference that is significant, at the .05 level of probability, as shown in Table 7.2. More than three times as many nonaggressive students drew fantasies that were ambivalent, ambiguous, or unclear, scoring 3 points, 63% compared with 20% of the aggressive group. Surprisingly, however, more than four times

Table 7.1 Comparing the Emotional Content Scores of Aggressive and Nonaggressive Students Emotional Content 1.0 2.0 2.5 3.0 3.5 4.0 5.0

Aggressive 63% (19) 3% (1) 3% (1) 11% (3) 13% (4) 7% (2) 0% (0)

Nonaggressive 30% (55) 22% (39) 2% (3) 16% (29) 14% (25) 12% (22) 4% (8)

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Table 7.2 Comparing the Self-Image Scores of Aggressive and Nonaggressive Students Self Image 1.0 2.0 3.0 3.5 4.0 5.0

Aggressive 17% (5) 3% (1) 20% (6) 7% (2) 10% (3) 43% (13)

Nonaggressive 4% (9) 7% (12) 63% (114) 2% (3) 9% (16) 15% (27)

as many aggressive students drew strongly negative self-images, scoring 1 point, 17% compared with 4% of the controls, suggesting they may be depressed as well as aggressive.

DEPRESSION Control Group In the nonaggressive control group, eight students drew strongly negative fantasies, scoring 1 point in both emotional content and self-image. None had been identified as depressed, and all were presumably typical students who had expressed interest in joining a research study. They had been attending classes in English or Art in public elementary and secondary schools in Florida. Since their parents had granted permission for them to participate anonymously, it was not possible to alert their parents or refer them for clinical follow-up. Their responses are shown in Figures 7.1 through 7.8.

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Figure 7.1 “Stress messes with everyone. Sometimes it deals with love life, business life, every day life. Most of us are drawn crazy with how our life is, others wanna take drastic measures to just end it, forever,” by a boy, age 17.

Figure 7.2 “The prencess kill’d herself because she is not happy. She killed herself by her favert tress. She used her Dad’s knife to kill her self,” by a girl, age 13.

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Figure 7.3 “The bride is sad. She’s not certain if she wants to let her future husband know her real side. She’s into self-mutilation. The meds don’t do anything. Her scars are still there,” by a girl, age 14.

Figure 7.4 “ ‘Help me! Help somebody help.’ The drawing that you see is a (illegible) running from the lava and asking for help. The poor thing is about to die. So help him,” by a boy, age 17.

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Figure 7.5 “It a Dark Stormy night and a knife is falling from the sky and about to slice the little chick in hafe, But the chick doesn’t know it coming its like fate for the chick’s Death,” by a girl, age 13.

Figure 7.6 “The Bleeding Tree. Once upon a time their was a tree. A very nice tree. Fall came and the leaves started dying. A man came along and notice that the leaves were dying and thought the tree was dying too. He put an end to its misery and stabbed a knife in its back,” by a boy, age 12.

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Figure 7.7 “Once upon a time there was a guy who went skydiving and he lost control and landed in a big volcano and got burned and died. It was very sad,” by a boy, age 12.

Figure 7.8 “The story is about a lonely little baby chick that doesn’t have many friends and is scared of telling people how he feels about them and how he feels about people that bother him (chicken),” by a boy, age 12.

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Aggressive Group Although responses by the five students in the aggressive group who scored 1 point in both Self-Image and Emotional Content were presented in chapter 6, they are revisited here to facilitate comparisons with the control group, and they are reproduced in Figure 7.9. Jimmy, age 14, tends to withdraw or lash out when angry. Diagnosed with major depression and attention deficit/hyperactivity disorder (ADHD), he takes medication daily and lives at home with his biological family. For his first response, he chose four stimulus drawings: the parachutist, castle, dinosaur, and volcano. He did not alter them in his response drawing but added a second volcano, both exploding. Between them, he drew the dinosaur inside the castle, and above, the parachutist saying, “I’m going to die!” (Figure 7.9a). Jimmy’s parachutist seems to represent himself as helpless, hopeless, and doomed, and the person symbolized by a dinosaur in a castle, an overpowering enemy. Victoria, age 17, had been cruel and threatening to other students and had been suspended for stealing, playing with a knife, and defiance. Her history included abuse. Because of her behavior in school, she was referred to the art therapy program where she drew Figure 7.9b, her first response to the drawing task. Choosing the parachutist and the knife, she changed the parachutist into a balloon with an empty basket. Her story began with, “There was a girl,” then she erased “girl” and replaced it with “balloon . . . cut with a knife and into the sea and was never found.” Her girl—balloon seems to symbolize herself, lost, adrift, helpless, and hopeless. Like Jimmy, she seems not only aggressive but also depressed. Joseph, age 10, had bipolar disorder and ADHD. He had expressed suicidal and homicidal fantasies, was aggressive physically as well as verbally in school, and had been placed in its program for emotionally disturbed children. His home life was chaotic with many siblings, his mother, and her boyfriend. His biological father had died when Joseph was seven, before he became aggressive and defiant. Selecting the volcano and the mouse for his drawing, his mouse who

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Figure 7.9 First responses to the DAS task by five students in the aggressive group

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was “killing people from around the world,” is expelled from the volcano into the dinosaur’s mouth (Figure 7.9c). Although Lanette, age 12, was notably aggressive, she liked to have everything under control. For her first response, she chose the princess and the snake, drawing the princess without arms or hands and calling for help as the snake approaches her groin (Figure 7.9d). Her subsequent responses are shown in chapter 8. Ralph, age 12, attended a school that does not provide special programs. In his fantasy about a volcano blowing up the castle, he drew a small stick figure on the castle roof saying, “oh my” (Figure 7.9e). Ralph identified himself as the person on the roof. The responses of these 13 students in both aggressive and nonaggressive groups have much in common even though their behaviors were quite different. They portrayed themselves as victims in mortal danger, scoring 1 point in both Self-Image and Emotional Content, suggesting that all were depressed or reacting to aggression, as discussed later in this chapter. Although students in both aggressive and control groups represented themselves as assailants, scoring 1 point in Emotional Content combined with 5 in Self-Image, two distinctive subgroups emerged: reactive and predatory aggression.

REACTIVE AGGRESSION Reactive or defensive aggression was defined by Connor (2002) as an angry reaction to real or perceived danger, and motivated not by reward but by a need to defend against threat. Its intent is to inflict injury or pain rather than to benefit the aggressor. In the control group of 181 nonaggressive students, none had responded with a drawing that suggested reactive aggression. Consequently, we presented the drawing task to an additional class of 32 fifth graders, ages 10—12, in one of the schools attended by students in both groups. This school was located in a neighborhood where many parents require their children to remain at home in the afternoons and evenings because the neighborhood is so dangerous.

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In this class, 7 of the 14 boys scored 1 point in Emotional Content combined with 5 points in Self-Image, and five of the seven seemed to draw fantasies that suggested reactive aggression, identifying with assailants who were defending themselves from attack or protecting others from life-threatening assaults. To illustrate, an 11-year-old boy chose the stimulus drawing youth, snake, and knife, then drew, “I was sitting down and a snake said I am going to kill you. I said want to bet? then I took out my knife and he ran” (Figure 7.10). In his drawing, he gave the snake sharp teeth, and the youth, bulging muscles and a beard as well as the knife. His use of the pronoun “I” supports the impression that the youth represents himself.

Figure 7.10 “I was sitting down and a snake said I am going to kill you. I said you want to bet? Then I took out my knife and he ran”

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Another boy portrayed his victim reacting with restraint rather aggression (Figure 7.11). A bare-chested, muscular youth, with fists clenched but arms at his sides, glares sideways at a belligerent snake, its teeth bared, their heads almost touching. Although flames erupt from the youth’s head, arms, and legs, he does not fight back. Instead, he portrayed himself as a powerful character in a popular television program, and used his drawing to express intense and conflicting feelings. Both responses suggest they used art experience to transform a frightening and frustrating experience into a wish-fulfilling fantasy. In the aggressive group, the responses of five students suggest reactive aggression. Toby, age 12, chose the parachutist and the knife and identified himself as “Guy saving his girl friend. Evil guys are trying to kill him” (Figure 6.14). According to his history, he is overweight, teased by his peers, and has been receiving clinical

Figure 7.11 “I turned Super Ryan and ignored him, but I said Hi.”

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assistance elsewhere because his school does not provide clinical programs. Jerry, age 17, whose only response was the fantasy, “Shooting Spree” (Figure 6.18), had ADHD and was described as being socially withdrawn and anxious. Greg, Larry, and Leroy (Figures 6.15 to 6.17) responded on several occasions. The consistencies that appeared in their responses, together with their histories, suggest that their aggression was reactive rather than predatory, as discussed in chapter 8.

PREDATORY AGGRESSION In the control group, the responses of 6 of the 181 nonaggressive students (3.3%) suggest predatory aggression. They seem to identify with their assailants and are callous toward their victims, as shown in Figures 7.12 to 7.17.

Figure 7.12 “The snake eats the mouse climbing a tree in the jungle.”

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Figure 7.13 “The cowboy was walkin in the woods and ran into a snake. He blew his head off with his gun.”

Figure 7.14 “Once upon a time when there was this crazy boy with one leg, And a blond hair girl always use to bother him. So one day he went over to her hous and stabed her to death.”

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Figure 7.15 “The guy in the parachute through a knife at the snake and it died and then it scared the cat!”

Figure 7.16 “The cowboy saw the dinosaur trying to eat the parachutist so he got his knife and threw it at the dinosaur called Sam Sam’s cat came and scared the cowboy away. Sam ate the parachute named Andy.”

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Figure 7.17 “A rat just ate a cat well eating a rat, and the snake is going to get big. The escomos are going to have the snake for dinner.”

In the aggressive group, 5 of the 30 students seemed to identify with the assailant in their drawings, making unprovoked attacks on vulnerable victims and suggesting predatory aggression. Four of the five were classmates in a school that does not provide programs for aggressive students. They were asked to respond to the drawing task on several occasions to find out if they showed consistencies in the subjects they chose or the attitudes they expressed toward others and themselves. Shaun, age 12, responded to the drawing task three times at weekly intervals. Each time he chose the stimulus drawing knife, and drew the knife poised above a victim. For two of his drawings, he chose the chick who seems to represent his victim and the mouse who seems to represent himself. In his first response, “I don’t like chickens! The chicken is going to die,” Shaun’s mouse wields a knife and smiles as he confronts the chick, as another knife descends on the chick from above, Figure 7.18a. For his second response, he

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a

b

c

Figure 7.18a, b, and c Shaun’s responses to the drawing task, suggesting predatory aggression

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again chose the knife and added the castle. In his drawing, someone invisible throws a knife, or series of knives, at the parachutist about to land on the castle roof. Shaun’s story: “The castle is under attack, the guy dies,” Figure 7.18b. For his third response, he chose the chick, and again the mouse and knife; as the knife descends on the chick from above, the mouse smiles. Story: “The bird will die,” Figure 7.18c. Gus, age 12, responded to the drawing task on two occasions. He chose the chick and the knife for his first response, Figure 7.19a. His chick says, “Don’t hurt me, I want to live,” and the knife replies, “Who cares!” Although Gus added a title, he changed his mind and erased the words, “Killing is bad,” which remained readable. In his second response, Gus again chose the stimulus drawing knife but, instead of the chick, chose the cat, also a female symbol. Blood drips from his knife as it descends on the cat, Figure 7.19b. Even though Gus did not reveal who threw the knife in both his drawings, they suggest that he identifies with the person who threw it. Carl, age 12, responded to the drawing task a second time the following week. In both his drawings, he claims that his victims are “going to die.” For his first drawing, he chose the dinosaur and the man smoking a pipe (Figure 7.20a). For his second, he chose the cat and the snake, adding an arrow and amplifying the snake (Figure 7.20b). Sam, age 12, showed consistency in being callous toward his victims. In his first response, the descending knife has reached its target, the snake. The person who threw the knife is invisible, like the drawings by Gus and Shaun, but unlike them, Sam described the outcome. The following week, Sam chose the cowboy and mouse. The fifth aggressive student, Ramon, responded only once to the drawing task, and seems to identify with the volcano he chose and revised (Figure 6.19). The responses by these 11 students suggest predatory but covert aggression, identifying with symbolic assailants who attack without provocation. Some also used humor.

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(a) Chick: “Don’t hurt me I want to live”; Knife: “Who cares!”

(b) “Cat gets Killed! Awwwww!” Figure 7.19 Reponses to the drawing task by Gus

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(a) “The man is going to die o no”

(b) “The cat is going to die The snake is going to bite the cat” Figure 7.20 Responses to the drawing task by Carl

THE USE OF HUMOR In the aggressive group, the students who drew humorous responses used negative humor only, mostly lethal and morbid humor, scoring 1 point. Their mean score was 1.6 points on the 5-point humor scale. In the control group, however, humor tended to be positive; their mean score was 3.3 points. In addition, more aggressive than nonaggressive students drew humorous responses. In the sample of aggressive students, 20%

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drew humorous fantasies, compared with 1.6% of the nonaggressive control group. No aggressive student used positive or ambivalent humor. Four used humor that was both lethal and morbid (Shaun, Gus, Sam, and Jerry). Carl’s humor was lethal but not morbid, scoring 1.5 points, and Harriet’s humor was disparaging, scoring 2 points (Figure 6.21).

(a) “The knife stabbed the snake. The snake was all bloody. It died in 16 minutes.”

(b) “The rat is admiring the ranch dude. The ranch dude is gonna shoot the rat. The rat is clueless.” Figure 7.21 Responses to the drawing task by Sam

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In the control group, three students drew humorous responses. One used playful humor, scoring 5 points: A man is looking for a cat that is standing on his head. Two used resilient humor, scoring 4 points. One drew a mouse trying to talk his way out of becoming lunch for a snake: “Don’t you wanna eat the chicken?” (Figure 7.22). The other made a series of drawings about a heroic chicken who warns sleeping people. They escape, the sun returns, and all have babies (Figure 7.23).

Figure 7.22 Positive (resilient) humor by a nonaggressive student. “Don’t you wanna eat the chicken?”

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These findings suggest that there is an association between predatory aggression and humor that is both morbid and lethal. These findings also support a previous study of delinquent and nondelinquent adolescents that found that only the sample of 19 nondelinquent and presumably typical high school students used humor. Their humor was consistently negative, and 9 of the 19 used lethal and morbid humor, scoring 1 point on the humor scale. (Silver, 2000).

Figure 7.23 Positive humor by another nonaggressive student. Untitled.

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MALE RESPONSES Throughout human history and across cultures, males have been hunters and warriors, and as might be expected, males tended to draw fantasies about assaultive relationships, as found not only in the present study but also in previous studies of gender differences in responses to the drawing task (Silver, 1992, 1993b, 1996a). According to Connor (2002), aggression tends to be reinforced among boys because it is generally seen as appropriately masculine, whereas girls experience pressures from parents, teachers, and peers to conform to stereotypes of feminine behavior that tend to suppress aggression. Other investigators have observed that male aggressiveness tends to be physical, overt, and direct, whereas female aggression tends to be indirect, covert, and relational, making it harder to observe and quantify (Bjorkqvist, Osterman, & Kaukianen, 1992). Indirect aggression protects the aggressor from retaliation and induces others to attack victims (Zoccolillo, 1993). In addition, female aggressiveness has been correlated with sexual abuse, delinquency, conduct disorder, family dysfunction, depression, and anxiety. The pilot study of aggressive and nonaggressive children and adolescents found that gender was significantly related to aggressiveness, as reported in chapter 4. In the present study, only boys and adolescents expressed predatory aggression, all were covert, however, and all were in the aggressive group (Carl, Ramon, Shaun, Gus, and Sam). According to Carl, the dinosaur did it. Ramon blamed the volcano. In the drawings by Shaun, Sam, and Gus, the stabbers and knife-throwers were invisible.

FEMALE RESPONSES In the aggressive group, 5 of the 30 students were girls, but 3 of the 5 seemed to represent themselves as victims rather than assailants, using symbols and metaphors to represent themselves and/or their assailants indirectly. Lanette chose the princess–bride and the snake, and drew the princess with no arms and the snake attacking

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her groin (Figure 6.3). Victoria chose the parachutist and the knife, changed the parachute into an empty balloon, crossed out “girl” and wrote, “the balloon was cut with a knife and into the sea and was never found” (Figure 6.4). Both responses are consistent with the observations that female aggressiveness tends to be indirect and correlated with sexual abuse. Sherrie seems to represent herself, her daughter, or both, as a lost baby bird looking for her mother (Figure 6.22). Carol chose and seems to identify with the chick she transformed into a large, scowling hen defending a small mouse (Figure 6.20), expressing reactive aggression. Harriet seems to have four SelfImages, overt (the passive princess “stuck in a castle”) as well as covert (volcano about to explode, cat chasing mouse, and chick killing snake, Figure 6.21). Although responses to the drawing task support the observation that aggression is more prevalent among males, they fail to support the observation that indirect and covert aggression is more prevalent among females. Both genders tended to be indirect and covert, disguising their victims as well as their assailants. In the control group, the female mean score was higher and more positive than the male mean score in both Emotional Content (2.83 female, 2.24 male) and Self-Image (3.44 female, 2.94 male). In Emotional Content, more than twice as many girls drew fantasies with positive Emotional Content (42%, compared with 20% of the boys). Five of the 85 girls but none of the 96 boys scored 5 points in both Emotional Content and Self-Image, and all chose the stimulus-drawing princess and the castle, as in Figures 7.24 to 7.28. Four of the 5 girls mentioned princes or grooms in their stories but failed to include them in their drawings. Also in the control group, 20 of the 85 girls chose and drew both princess and castle (24%), and 15 of the 20 expressed negative Emotional Content. To illustrate, one princess, who lived in a palace, “was so beautiful that no one was allowed to see her so she was always by herself and never got married. She lived sadly ever after by herself” (Figure 7.24, by Sally, age 11).

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Figure 7.24 Sad and Lonely Princess

Figure 7.25 Snake Gets Princess

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Figure 7.26 Volcanoes Explode

Another princess was “running away because of the people who told her what to do. She made a rope down her room when she ran into the forest when a snake gets her. Who will save her now,” by Doris, age 11 (Figure 7.25). In Figure 7.26, the princess “found a chick for a pet. And volcanos exploded when she ran away,” by Mary. Cindy’s princess “came all the way from her castle to save the chick and the mouse by getting eaten by the snake that’s in the biggest tree in the whole friendly kingdom” (Figure 7.27). As discussed previously, another princess was stabbed to death and two committed suicide.

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Figure 7.27 Princess Saves Chick and Mouse

On the other hand, two of the girls in the control group who chose the princess and the castle drew strongly positive fantasies, scoring 5 points in both Emotional Content and Self-Image. Although one princess seemed quite stout, she was described as beautiful, very happy, and romantically involved with a handsome prince (Figure 7.28). The other “got married and is going to go her castle” (Figure 7.29). Seven girls but no boys drew strongly positive fantasies about happy solitary subjects or loving relationships, scoring 5 points in Emotional Content, whereas 18% of the boys compared to 11% of the girls seemed to identify with powerful and effective subjects, scoring 5 points in Self-Image. Substantial gender differences also emerged among those scoring 3.5 and 4 points: 14 boys but only one girl drew ambivalent fantasies with positive outcomes, scoring 3.5 points, and 18% of the girls compared to only 1% of the boys seemed to identify with fortunate but passive subjects or friendly relationships, scoring 4 points.

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Figure 7.28 “She was a beautiful queen and she was very happy and she was with her handsome boyfriend, and she loved him a lot and so do him,” by a girl in the control group.

Figure 7.29 “The princess got married and is going to go her castle,” by a girl in the control group.

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OBSERVATIONS Comparing girls in the aggressive and nonaggressive control groups, the self-image scores of the aggressive girls were lower, more negative; their mean score was 2.6, whereas the mean score of the nonaggressive girls (3.2) was higher, more positive than negative, as shown in Figure 7.30a. Comparing the groups of boys, self-images in the aggressive group were more positive, and their mean score was 3.8, whereas the mean score of the nonaggressive boys was more negative, 3.2. Larger gender differences emerged in the SelfImage mean scores in the aggressive group but not the nonaggressive group, where both genders scored 3.2 points. In Emotional Content, the gender differences were reversed. The boys were much more negative, another difference, as shown in Figure 7.30b. How can these findings be explained? Why did the aggressive girls have more negative self-images than the nonaggressive girls, and the aggressive boys, more positive self-images than the nonaggressive boys? Are the differences biological? Cultural? Studies of cross-cultural differences and similarities are presented in Chapters 9 and 10. In Emotional Content, the nonaggressive group (both boys and girls) was more positive and the aggressive group more negative, as might be expected, but it was surprising to find that eight students in

3.7 ~ 3.6

2.6

Mean SELFIM

Mean EMCONT

2.4 2.2 2.0 1.8

3.5 3.4 3.3 3.2

1.6

3.1 aggressive

ACG

nonaggressive

aggressive

nonaggressive

ACG

Figure 7.30 Gender differences in Self-Image and Emotional Content

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the nonaggressive group scored 1 point in both Emotional Content and Self-Image, suggesting they were depressed. Presumably, they were typical students attending regular classes in their schools who happened to respond to the drawing task because they found it interesting and their parents had agreed to let them participate in the study anonymously. Each drew a solitary subject. Four of their subjects were human, and four were symbols—two chicks, a tree, and either a snake or a worm. Five students chose and drew the knife; two, the volcano. Two of the eight students, a boy and a girl, seemed to draw themselves contemplating suicide. Both chose and drew the stimulus drawing knife with a human subject the same gender as themselves, and both drew solitary subjects in hostile environments. The youth in Figure 7.1 seems to be in a small a room with barred door suggesting a jail cell. The princess who “kill’d herself because she was not happy” stands outside a castle that is surrounded by a moat (Figure 7.2). The girl who drew Figure 7.3 twice drew a large knife and a tearful girl. The boy who drew Figure 7.4, calls for help as he is about to die. Although five times as many students in the aggressive group also scored 1 point on both scales, the patterns that appeared in their responses were similar to those in the control group. Each of the 13 children and adolescents seemed to draw a fantasy about troubling situations, and none drew wish-fulfilling fantasies. Eleven of the 13 drew hostile environments, 9 drew solitary living subjects, 7 appeared helpless, and three were calling for help. Eight appeared hopeless and doomed to die. Six chose and drew the stimulus drawing knife; five chose the volcano; and four chose the castle, perhaps to represent life at home. Differences between the aggressive and nonaggressive groups also emerged. In the aggressive group, no students drew suicidal fantasies, compared with three in the control group; none seemed to represent themselves as sad or fearful, whereas four in the control group drew solitary subjects who were crying, holding handkerchiefs, or exposed to rain. No boys in the aggressive group but two in the control group chose the chick as their only living subjects, per-

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haps the colloquial “chicken” to symbolize fear. Perhaps those in the aggressive group had become aggressive in order to deny or mask anxieties and despair, suggesting that their behaviors reflected reactive, rather than predatory, aggression. The fantasies reproduced here support the findings of the previous DAS studies, and suggest that the 13 respondents in both aggressive and control groups who scored 1 point on both scales were depressed. Those in the aggressive group were receiving therapy and some had been diagnosed previously as clinically depressed. Since those in the control group had responded anonymously, there was no opportunity for follow-up, and presumably their need for clinical evaluation and intervention remained unmet. Two or more responses to the drawing task provide opportunities to clarify intentions, meanings, and emotional states. Changes in their Emotional Content or Self-Image can reflect changes in emotional states or perceptions of self and others. For example, it did not become apparent that a student in the aggressive group, Larry, was depressed until his third response to the drawing task. The sequence of his responses and his history are presented in the following chapter together with the responses and histories of six other children and adolescents whose responses to the drawing task revealed changes or consistencies.

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8 Changes and Consistencies in the Emotional States of Aggressive and/or Depressed Students Melinda Fedorko and Linda Montanari

This chapter presents multiple responses to the drawing task by seven children and adolescents in the aggressive group. It also presents their behaviors over periods of time, as observed by the two art therapists who worked with these students in their schools. The other contributors to chapter 6 did not provide art therapy for the students they tested. Some students chose certain stimulus drawings repeatedly, suggesting that their subjects represented particular individuals or relationships indirectly through symbols. Some students imitated the stimulus drawings they chose, whereas others altered them, intentionally or unintentionally. Some of their responses seem to reflect 121

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consistent emotional states over periods of time, whereas others reflected changes in attitudes toward self and others, as measured by the consistencies and changes in their scores on the rating scales.

LARRY, AGE 17 Larry was a high school student in a low socioeconomic area. In his urban neighborhood many parents do not allow their children to leave home in the afternoons and evenings due to the proliferation of drugs and other dangerous situations. He was in the Special Education class for Emotionally Handicapped children, with only seventeen students in his class. Attendance is poor. The program is self-contained where students remain for most of the day. There are always two teachers or a teacher and an aide. Now in the eleventh grade, Larry was not succeeding academically or behaviorally. He has a history of attacking others, both in and out of school. He does not necessarily have to be angry, but if he feels entitled to something, or someone disrespects him, he will lash out. He will attack adults and other students, both in school and in his community. He creates a fantasy world for himself, and has been arrested for battery, strong-arm robbery, and an assault on one of his teachers. Both his parents are deceased. After his mother died, he lived unsuccessfully with two different aunts. Larry now lives with an uncle and his wife. He gets along well with his uncle, but through discussions in art therapy, he suggests that this aunt behaves erratically and may be severely depressed. Larry reports that he spends as little time as possible at home. As he adjusted to the art therapy program, he began to open up about “being bad” and having no conscience after his mother died. He “got mad at God and stopped listening to the little man inside.” In the sessions, he worked on a paper mache house, painting it with great care. He spent several sessions deciding whether to have a door, and if he should put a lock on it. It seemed as if he was trying to decide whether or not to let me enter his life.

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He responded twice to the DAS task and once to the SDT task, each time drawing fantasies about life-threatening relationships as well as territorial possession. In one of his responses, an aggressive snake guards the turf; in the other, the trespassers die. Larry responded for the first time to the SDT task, choosing two stimulus drawings, the youth and the snake, altering both and adding a sidewalk. His youth wears high boots with cleats and has long curly hair. He stands on the grass, hands on hips, legs apart, facing a tightly coiled snake on the sidewalk. He gave his first drawing the title, “I look at a snake on the sidewalk and it was look at me, and I walk around,” Figure 8.1a. Larry’s use of the pronoun “I” suggests that he sees himself in danger, defiant and powerful, but deferential, scoring 1 point in Emotional Content, 3 points in Self-Image. He responded to the DAS task about 8 weeks later, choosing the snake a second time, and the stimulus drawing mouse. In his drawing, the mouse is disappearing in the snake’s mouth and only its tail and body are visible. Story: “The rat was walking in the snake territory and the snake seen him and eat him,” Figure 8.1b, scoring 1 point in Emotional Content, 5 points in Self-Image. From what is known about Larry, he would not identify with the rat. Larry responded again 3 weeks later, this time choosing the DAS parachutist and the leafy tree, but did not alter them in his drawing or add subjects or details. Story: “The man jumped out of a plane to go to war but he got stuck in a tree. Then he got shot and he dead and then he smellin stinkin,” Figure 8.1c. Emotional Content and Self-Image both scored 1 point, a solitary subject portrayed as helpless, and then dead. Larry seems to identify with his parachutist. Larry’s third and last response suggests that anxiety and feelings of helplessness may underlie his aggressive and violent behavior. His last drawing suggests that he feels hopeless and suicidal. Instead of harming himself, however, he puts himself into very dangerous situations. After participating in the art therapy program 3 to 4 months, Larry was arrested and jailed for dealing drugs at school, and has not returned.

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(a) “I look at a snake on the sidewalk and it was look at me, and I walk around.” Emotional Content: 1 point Self-Image: 3 points.

(b) “The rat was walking in the snake territory and the snake seen him and eat him.” Emotional Content: 1 point Self-Image: 1 point

(c) “The man jumped out of plane to go to war but he got stuck in tree. Then he got shot and he dead and then he smellin stinkin.” Emotional Content: 1 point Self-Image: 1 point

Figure 8.1 Changes in responses to the drawing task by Larry, age 17

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LANETTE, AGE 12 In the fifth grade, Lanette is an elementary student in Larry’s neighborhood. According to previous records, she has been aggressive, has experienced audio-visual hallucinations, and has had an eating disorder. The hallucinations have appeared during her 2 years in the Special Education program. This is her second year in art therapy. Last year, she appeared happy and cooperative, usually taking great care with her artwork. Most of her art pieces reflected positive themes. She likes to have everything under control, and has difficulty letting others know when she is hurting. For example, she was mainstreamed in her first year in our program, but was unable to keep up academically with her classmates. Instead of asking for help, she stopped eating. We returned her to the self-contained class and she was restarted on antidepressants. During the summer, her family reported that she had a poor attitude, was surly and disrespectful. In returning to school in September of that second year, she was negative and resistant to coming to art therapy. She would put little effort into her artwork, and would sometimes ignore the therapist in the session. She seemed to admire thugs and gangs, and even changed the way she walked and dressed. We focused on this change throughout the school year. In one session, I discussed that the symbolism suggests possible sexual abuse. Although she wouldn’t talk, she did become tearful while we continued to work. Then after spring break, she returned and began smiling and talking again, although superficially. When she responded to the drawing task for the first time, Lanette chose two stimulus drawings from the SDT array, the cat and the mouse, but changed them in her drawing (Figure 8.2a). The stimulus drawing cat scowls, and the mouse smiles, standing upright, its tail down. In Lanette’s drawing, however, only the cat smiles. The mouse is now horizontal, its tail up, and between them, she wrote, “men men men.” Lanette’s story: “The cat is cach the rat. The story I’m talking about is a food chain.” Since the relationship seems stressful for the mouse, her drawing scored 2 points in Emotional Content, and since Lanette seems to identify with her mouse, 2 points in Self-Image.

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(a) “The cat is cach the rat. The story I’m talking about is a food chain.”

(b) “A girl and a snake and the snake was attacking her and she said, ‘Help me!’”

(c) “The cat is chasing the rat and the rat ran inside its home. The cat couldn’t get him so he waited outside for the rat but it didn’t come out no more.”

(d) “One day there was a mouse and a refrigerator. He went to go get some food to eat and a man walked into the kitchen and saw the mouse and the mouse ran back into his home. So the man had some people to get all the mices out of his home.”

Figure 8.2 Responses to the DAS and SDT tasks by Lanette, age 12

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In her second response to the DAS task, Lanette chose the girl and the snake. In her drawing, the bride has no arms or hands and the snake’s head is at her groin. As she dictated, “There was a girl and a snake and the snake was attacking her and she said, ‘Help me!’” (Figures 6.3 and 8.2b). This drawing about a life threateningrelationship in which Lanette seems to identify with the victim scored 1 point in both Emotional Content and Self-Image. Both drawings seem to represent sexual abuse indirectly. Responding to the DAS task again 2 months later, Lanette again chose the cat and mouse, but this time her mouse is upright, and her cat no longer smiles. As she dictated, “The cat is chasing the rat and the rat ran inside its home. The cat couldn’t get him so he waited outside for the rat but it didn’t come out no more” (Figure 8.2c). In her drawing, however, the mouse is no closer to home and safety than it is to the cat and danger. Since her drawing seems to contradict her words, it scored 3 points in both Emotional Content and Self-Image. Eighteen months after her first response, she drew her fourth and final response to the drawing task: “One day there was a mouse and a refrigerator. He went to go get some food to eat and a man walked into the kitchen and saw the mouse and the mouse ran back into his home. So the man had some people to get all the mices out of his home” (Figure 8.2d). Near the bottom of her sketch she added, “Thank you for helping me.” It is not clear whether the man is thanking the exterminator for helping him get rid of vermin or whether Lanette is expressing thanks indirectly. Her drawing is no longer about helpless victims, however, but about a subject who solves a problem effectively, with professional assistance, and scores 3.5 point in both Emotional Content and Self-Image.

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VICTORIA, AGE 17 In the eleventh grade, Victoria can be very aggressive, threatening, and cruel to other students. She is writing a journal about the sexual abuse she has experienced, and has allowed male students to read her entries. Sometimes she seems manic, speaking loudly and ignoring teacher directives; at other times, she is compliant. At present, she has been suspended from school for stealing, using profanity toward a teacher, playing with a knife, and defiance. She had been seeing the school’s psychologist individually, but recently attended two group sessions in art therapy, responding to the DAS task the second time after an interval of 1 month. For her first response, she chose the parachutist and knife, then drew, “There was a [“girl” erased] balloon and was cut with a knife and didn’t know it was cut and so it fell into the water and was never found” (Figure 8.3a). Her solitary subject, isolated, helpless,

(a) “There was a [“girl” erased] balloon and was cut with a knife and didn’t know it was cut and so it fell into the water and was never found.” Emotional Content: 1 point Self-Image: 1 point Figure 8.3 Responses to the drawing task by Victoria, age 17

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attacked, and lost, scored 1 point in both Emotional Content and Self-Image. For her second response, three weeks later, she chose the bride and the castle, then drew, “Once upon a time there was a princess who had to marry a prince she did not love. So she ran away and fell in love with another prince. She also started a country where you are free of marriage and she lived happily ever after” (Figure 8.3b). Her ambivalent fantasy with a positive outcome scored 3.5 in Emotional Content, and 5 points in Self-Image. She appears to be attempting to regain control of her life through her fantasy.

(b) “Once upon a time there was a princess who had to marry a prince she did not love. So she ran away and fell in love with another prince. She also started a country where you are free of marriage and she lived happily ever after.” Emotional Content: 3.5 points Self-Image: 5 points Figure 8.3 Responses to the drawing task by Victoria, age 17 (continued)

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GREG, AGE 11 In the fifth grade, Greg is a bully and very aggressive. He is constantly teasing or laughing at the misfortunes of others, and recently was suspended for bringing a toy gun to school. When he is on medication, his symptoms decrease and he is able to do academic work. He has been in therapy for about one year, and is beginning to grieve the death of his mother. His mother’s death was sudden, and both his parents died in the same year. Greg has been living with his grandmother for about 3 years. He feels safe in art therapy and is exploring the reasons for his negative behavior. He recently said, “I wonder why I like to be bad.” Greg responded to the SDT task for the first time when he was 11 years old. After choosing the dog and the cat, he dictated the following story: “The cat is lonely and his head was facing down and then the dog heard the cat and then barked at it. Then the cat got scared. Then the dog started to chase the cat” (Figure 8.4a). Asked how the dog and cat might feel, he replied that the dog was very angry and the cat was very scared and lonely with her head down. His fantasy about a hostile and stressful relationship scores 2 points in Emotional Content, and since he has never been seen in the role of victim with his peers, 5 points in Self-Image. Thirteen months later, Greg again responded to the DAS task. He chose the boy and the snake, then drew, “A boy poisin by a snat from geting bit then he almost died” (Figure 8.4b), scoring 1 point in Emotional Content, and again 5 points in Self-Image. Nine days later, Greg responded to the SDT drawing task again, choosing the snake and the mouse, then drawing Figure 8.4c. “There was once a snake that was hungry. It saw two mices running. Then the snake chace them catch one the mice ran home,” again scoring 1 point in Emotional Content, 5 points in Self-Image.

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(a) “The cat is lonely and his head was facing down and then the dog heard the cat and then barked at it. Then the cat got scared. Then the dog started to chase the cat.”

(b) “A boy poisin by a snat from geting bit then he almost died.”

(c) “There was once a snake that was hungry. It saw two mices running. Then the snake chace them catch one the mice ran home.”

Figure 8.4 Responses to the drawing task by Greg, age 11

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LEROY, AGE 8 Leroy lives with his biological parents. His father is abusive and an alcoholic. Marital problems occur daily and Leroy feels responsible for his mother’s safety and sleeps with her at night. He has average intellectual abilities and is performing at grade level. In the third grade, he has a seizure disorder as well as ADHD. He also exhibited psychotic thought processes when stressed in the past, and is extremely moody, quick to anger, and aggressive, or else withdrawn and sad. He gets along fairly well with his peers, is academically motivated and often insightful about situations, and takes a leadership role. He has been coming to art therapy for approximately 1 year. Leroy’s first drawing was a response to the DAS. After selecting the bride, knife, dinosaur, and parachutist, he drew “Princess in Danger,” Figures 8.5a and 6.17. His princess is about as large as his dinosaur. She smiles and holds a large knife. His dinosaur has no arms, and a small parachutist hovers above both. He dictated the following story: “Once upon a time the princess was playing with a fake knife. And then the dinosaur came and the princess said, that’s impossible for a dinosaur to come to life, but the knife was real. A guy in a parachute came because he was looking for the dinosaur for a lot of years. The princess got her knife and ran away, then came back and cut off the dinosaur’s head. The end.” This response scored 1 point in Emotional Content, 5 points in Self-Image. Leroy’s dinosaur may represent his father, and the princess could represent his mother or himself, or he may be helplessly floating above the scene. Eleven months later, Leroy again responded to the DAS task, choosing the same four stimulus drawings, and adding the volcano and snakes. Now his dinosaur is larger than both volcano and princess. It has arms and claws holding the armless princess who is pleading for help. Once again the parachutist hovers above, but no longer silent, says, “I am going to help you” (Figure 8.5b, titled, “A Spell Caster”). As he dictated, “Once upon a time there was a vol-

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(a) “Princess in Danger.” Emotional Content: 1 point

(b) “A Spell Caster.” Emotional Content: 3.5 points

Self-Image: 5 points.

Self-Image: 5 points

Figure 8.5 Responses to the drawing task by Leroy, age 8

cano and every time it erupted, magic snakes would come out and tell the dinosaur to find a princess or a boy to eat. One boy came with a knife to help the princess but he could not beat the dinosaur. A magic spell caster with a knife came and destroyed the dinosaur and the princess was saved.” Leroy’s second response, an ambivalent theme with a positive outcome, scores 3.5 points in Emotional Content and 5 points in Self-Image. Although he seems to be the same small parachutist hovering above, he now holds a knife. He may also be the “spell caster” with a sword who may save the princess. This second response includes the same subjects and themes, and seems to express persistent attitudes toward himself, the dinosaur, and the princess. On the other hand, the theme of his story has changed. It seems to be a wish-fulfilling fantasy with a hopeful outcome.

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GEORGE, AGE 10 In the fifth grade, George has ADHD. He lives with his mother, stepfather, and two siblings. He entered the program for severely emotionally disturbed children in the first grade. He was placed on Ritalin and began making good progress academically. He continues to be motivated, although his school performance remains 2 years behind grade expectations. Recently, his medication was stopped and his behavior has regressed. He has been impulsive, aggressive, and defiant. He has been receiving art therapy weekly for 3 years. When he was 8 years old, he responded to the SDT task for the first time, selecting the dog, cat, bride, and refrigerator. He drew “The Fox Trying to get to the Refrigerator” (Figure 8.6a), then dictated this story: “The fox wants to get something to eat but the cat

(a)“The Fox Trying to get to the Refrigerator.” Emotional Content: 2 points Self-Image: 2 points. Figure 8.6 Responses to the drawing task by George, age 10

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won’t let it, and it called the girl. And the girl is looking at the fox. She is going to take the fox outside. The fox is the girl’s. The fox is too big.” Two years later, George responded to the DAS task in the fifth grade, choosing the bride again, this time associated with the castle and the volcano, and drawing Figure 8.6b. As he explained, “One day there was a princess who lived in a castle. There was a volcano and it exploded. She sent her men to stop the volcano from erupting. The volcano erupt. George of the Jungle came and served her and fought a lion for her. They lived happily ever after.” George seems to identify with the hero of his story, and his increasing interest in girls, as a preadolescent boy, is apparent. His response to art therapy has been positive. He has engaged himself in several three-dimensional projects, has increasingly utilized his time to process peer conflicts, and has taken a leadership role in a small group of fifth graders transitioning to middle school.

(b) “One day there was a princess who lived in a castle.” Emotional Content: 3.5 points Self-Image: 5 points. Figure 8.6 Responses to the drawing task by George, age 10 (continued)

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JOSEPH, AGE 10 Joseph lives with his mother, her boyfriend, and 11 siblings in a chaotic household. His biological father died when he was 6 years old, prior to the onset of his behavioral problems. He has been a patient in a psychiatric hospital on several occasions. In school, he entered the program for severely emotionally disturbed children in the second grade. His diagnosis is bipolar disorder and ADHD. Noncompliance regarding medication has exacerbated his problems. His behavior has been defiant as well as aggressive and includes suicidal and homicidal ideation. Now in the fifth grade, he functions at the third grade level. Unmotivated academically, he continues to be aggressive verbally and physically. He stutters, has speech and language delays, and has had art therapy once a week for three years. In his first response to the drawing task, Joseph chose two stimulus drawings, the mouse and the volcano, from the DAS array. He drew the mouse exploding from the volcano and falling into the mouth of a dinosaur, and describing the mouse as “killing people from around the world,” then being tricked and put into the volcano, Figures 8.7a and 6.2. The drawing scored 1 point in both Emotional Content and Self-Image. Joseph appears to see himself as the mouse, aggressively defensive and overwhelmed by his environment. This becomes clearer in a drawing done a few weeks later when he feels picked on as a mouse. Aggressive, impulsive tendencies can be seen in his line quality and thematic content. Joseph’s second response, 2 weeks later, reflects his resiliency. In Figure 8.7b, titled “The Mouse who turned into a Dinosaur,” he again chose the mouse, this time associated with the dinosaur. His dictated story: “A little mouse was so tiny and he was getting picked on. He was feeling bad so when he woke up, he was the same size as a giant bird. Ten years later, he was a big, old, giant dinosaur. Then he was still being picked on because he wasn’t one of their kind. They started calling him Long Neck and stuff. Then they asked for the mouse’s help and the mouse said, ‘No, why did you have to pick on me?’ He saw his Mom in trouble, and she said, ‘Go save the world,’ and he said, ‘ok.’ When he saved the

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(a) “The Mouse was Killing people from Around the World.” Emotional Content: 1 point Self-Image: 1 point

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(b) “The Mouse who turned into a Dinosaur.” Emotional Content: 3.5 points Self-Image: 5 points

(c) “The Cool Copter.” Emotional Content: 3.5 points Self-Image: 5 points Figure 8.7 Responses to the drawing task by Joseph, age 10

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world, everyone was happy and they gave him a gold medal and he was happy.” The drawing scored 3.5 points in Emotional Content, and 5 points in Self-Image. Joseph’s last drawing, requested 1 month later, reflects the consistency of his positive emotional state. Choosing the parachutist and volcano and adding his own helicopter, he drew his third fantasy, titled “The Cool Copter” (Figure 8.7c). As he explains, a man is trapped in the volcano. Then Joseph the Action Man gets a call and he ejects out of his building and he grabs the man, using his parachute. Joseph called his chopper to rescue them from landing in the lava. “Joseph the Action Man, if he can’t do it, Nobody can.”

CONCLUDING OBSERVATIONS Larry After participating in the art therapy program for 3 months, Larry was arrested and jailed for selling drugs in school, and did not return. In each of his three responses to the DAS and SDT tasks he scored 1 point in Emotional Content. He viewed his own environment as dangerous, and placed his subjects in danger. Larry’s first response presents a young man who looks at the coiled dangerous snake but chooses to avoid the confrontation, making a secure, strong decision, and scoring 3 points in Self-Image. In his last two responses, we see a decline to 1 point in Larry’s Self-Image. In his second response, it is a rat who is in the snake’s territory, and is helplessly devoured. Larry’s feelings of hopelessness are evident in his final drawing where the man is shot and is “smellin stinkin.” The man hanging from a tree is in stark contrast to the capable young man drawn just nine weeks earlier. Perhaps at this point Larry felt he had little to lose, and made a poor decision to deal drugs in view of the school security camera. Lanette Lanette was an art therapy student for 2 years. Her four responses to the DAS and SDT drawing tasks reflect her therapeutic progress.

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In this series, Lanette has gone from feelings of helplessness to developing ability to seek and accept help from others. Her final response is more elaborate, with two separate drawings used to express her story. Victoria There was only a 3-week interval between her first and second response to the DAS task. Her second drawing reflects a healthier theme, but her castle appears to have aggressive, knife-like features. Victoria’s scores indicate gains in both Emotional Content and SelfImage. Greg Greg’s three drawings received relatively the same scores, despite 2 years of art therapy and group therapy on a weekly basis. In Emotional Content, his subjects are in mortal danger, yielding a score of 1 point each time. Greg identifies with his aggressors who never show empathy or compassion, scoring 5 points in Self-Image. Art therapy helped Greg resolve his grief over the death of his parents, but was unable to alter his anger toward others. He continued bullying his peers throughout the school year. He also developed an interest in art and became more skillful in expressing himself through drawings. Leroy Over a year’s time, Leroy’s choice of the same stimulus drawings seem to express persistent emotional states. The scores on the drawing titled “Princess in Danger” are consistent with the research findings of negative Emotional Content coupled with positive Self-Image and indicate a potential for acting out aggression. In “A Spell Caster,” after 11 months of art therapy during which many aggressive fantasies were expressed and explored through drawing, Leroy’s scores show improved Emotional Content and suggest better capabilities to modulate his chaotic home life.

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Joseph Joseph’s thematic responses reflect recurring issues and fantasies in his life: homicidal—suicidal ideation, antagonistic peer relationships, and rescue fantasies. Joseph’s choice of the volcano over time seems to represent symbolically his pent-up anger over losses and academic failures. Although his scores improved over time, inconsistent medication and the visual indicators present in his drawings, such as impulsivity and varying pressure in line quality, would suggest precarious coping and a poor prognosis. George The scores on George’s DAS samples show growth in both Emotional Content and Self-Image over time. George consistently chose a female subject, perhaps symbolically representing the importance of both his mother and an older sister in his life. The positive outcomes in his stories suggest adaptive coping skills being acquired through art therapy, and the importance of stability in the lives of children who are emotionally challenged.

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9 Cultural Differences and Similarities Alexander Kopytin, Helen Svistovskaya, and Vlada Sventskaya

This chapter presents a study conducted by three mental health professionals in Russia who administered the DAS task and assessed the responses of hospitalized adults who had committed crimes, as well as delinquent adolescents.

FANTASIZING ABOUT VIOLENCE: USING THE DAS TEST IN ASSESSING ADULT PSYCHIATRIC PATIENTS WHO COMMITTED SEVERE CRIMINAL ACTS AND DELINQUENT ADOLESCENTS In the Russian Federation, where art therapy is still a new venue and is unrecognized as a profession, structured therapeutic interventions and assessment procedures, including drawing, are often given preference over nondirective, dynamically-oriented approaches. This paper presents some findings from the study carried out in St. Petersburg, Russia. The goal of the study was to explore diagnostic capacities of the DAS test with regard to emotional and behavioral problems, in particular among delinquent children and juveniles as 141

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well as psychiatric patients who are violent and have committed severe criminal acts. The hypothesis of the study was that drawings and stories created by respondents to the DAS task may reflect their fantasies and attitude toward self and others and may be indicative of certain behavioral patterns associated with destructive and selfdestructive tendencies. Researchers propose that the findings of their study can be used in defining graphic predictors of violence and self-harm, and that the DAS task can be used as a form of intervention, helping to reduce a risk of such behaviors.

INTRODUCTION Drawing tests have been used as a means of assessing cognition and emotions and personality characteristics since the first decades of the twentieth century. For a long time they were the province of psychologists and psychoanalysts, helping them to make a correct diagnosis, evaluate personality characteristics, understand an individual more thoroughly, and see changes in his or her mood or progress. However, while projective tests are still popular, many researchers have questioned their validity and scientific merit. Comparatively recently, new drawing tests and structured assessment procedures begin to be developed by art therapists (Gantt & Tabone, 1998; Kramer & Schehr, 1983; Kwiatkowska, 1978; Ulman & Dachinger, 1975). Though “art-based research” (McNIff, 1998) appears to be promising and attractive to art therapists, “conventional” research methods—in particular, those used by psychologists in their study of reliability and validity of drawing tests—are still considered to be valuable. During the last few years, some assessment and diagnostic procedures that use drawing, particularly those developed by American art therapists (Gantt & Tabone, 1998; Silver, 1996b, 2002) were translated into Russian, and intercultural studies started. Since 1999, cross-cultural normative studies using the SDT (Silver, 1996b) were carried out in the Russian Federation (Kopytin, 2002a; Silver, 2002). The investigators found SDT scores of Russian and American adults to be the same in cognitive subtests, but the scores of the

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Russian children and adolescents were higher than scores of their American counterparts in two of the cognitive subtests. Although researchers found no differences between the sexes in cognitive subtests, considerable gender differences emerged in the emotional content of drawings and in self-images. Later, the SDT was introduced to the centers of psychosocial rehabilitation located in the areas affected by the Chernobyl nuclear accident, in order to evaluate those responses that may be typical for various segments of the affected population and to provide an intervention in dyadic and group situations. As a result, typical responses among children and adolescents living in the affected areas have been found (Kopytin, 2002b). Such responses were characterized by strongly or moderately negative themes—that is, those portraying subjects who are sad, isolated, helpless, suicidal, or in mortal danger; relationships that are destructive or life-threatening; or subjects, who are frustrated, fearful, fearsome, or unfortunate. In 2002, an intercultural study of the diagnostic capacities of the DAS test was initiated. One of the goals of this study was to explore whether the test may be used in identifying those individuals who are at high risk of violence and self-destructive behavior. Though the DAS was initially developed as an instrument of identifying those children and adolescents who are depressed, later studies indicate that the test can be also used to assess the self-image of delinquent adolescents (Silver & Ellison, 1995), to identify adolescents who committed sex offenses (Brandt, 1995), children and adolescents who contemplated or attempted suicide (Wilson, 1990), and for other purposes. The DAS test is based on the premise that strongly negative or morbid responses in the drawing task may reflect depression. It is, however, logical to presume that strongly negative or morbid responses may also reflect other forms of emotional and behavioral problems, including destructive and self-destructive behavior. At the same time it would be a mistake to directly link strongly negative responses to the DAS task with various forms of emotional and

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behavioral problems. Perhaps the difference between fantasizing about violence and acting it out must be taken into account. Responses are scored on the 5-point rating scale shown in Table 9.1. In our study, DAS Forms A and B were used among adult respondents and Form A, with children and juveniles. The subjects of our study included four clinical and two control groups. Three clinical groups consisted of 35 adult psychiatric patients with schizophrenia, 21 patients with personality disorders, and 22 with mental retardation who had committed severe criminal acts: 90% had committed homicide, sexual violence, or injuries that led to death. About 10% had committed theft or robbery. Their control group consisted of 30 adult individuals without any diagnosed psychiatric disorders. All adult respondents in the three clinical and one control group were

Table 9.1 Rating Scale for Assessing the Story Content of Responses to DAS 1 • • 2 • • 3 • • •

4 • • 5 • •

point: strongly negative subjects who are sad, isolated, helpless, suicidal, or in mortal danger relationships that are destructive, murderous, or life-threatening points: moderately negative subjects who are frustrated, fearsome, or unfortunate relationships that are stressful or hostile points: intermediate level subjects or relationships that are both negative and positive, suggesting ambivalence or conflict subjects or relationships that are ambiguous or unclear subjects or relationships that are unemotional, neither negative nor positive; no feelings expressed toward the subjects or relationships portrayed points: moderately positive subjects who are fortunate but passive relationships that are friendly points: strongly positive subjects who are happy or achieving goals (taking action) relationships that are caring or loving

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male. The age of patients ranged from 18 to 57 years; the age of their controls, from 18 to 65 years.

CHILDREN AND ADOLESCENTS IN DELINQUENT AND CONTROL GROUPS This group consisted of 27 delinquent children and adolescents with the diagnosis of social conductive disorder, who were treated at the psychiatric unit during the study, and whose ages varied from 10 to 14 years. There were 6 females and 21 males among them. Many were raised at residential children’s homes. All had demonstrated aggressiveness in one form or another, confirmed by personnel and their case histories. Most were violent towards others, and many took drugs and alcohol. Several respondents had also attempted suicide. Their control group consisted of 25 children and adolescents without a diagnosis of social conductive disorder, who were students in the children’s home. In addition to the Rating Scale for Assessing the Story Content (ranging from 1 to 5 points, as in Figure 3.1 but without the intermediate scores of 2.5 and 3.5 points), we used the SelfImage scale in our study of children and adolescents. After their responses were scored, means and standard deviations were calculated and clinical and control groups compared using t-test criteria. Additionally, histograms of various types of responses in clinical and control groups were compared to provide more accurate analysis of differences. Differences Between Delinquent and Nondelinquent Children and Adolescents

The comparison of mean scores demonstrated statistically significant differences (p 0.01) between delinquent and control groups in the emotional content of drawings (Table 9.2). However, differences between the groups in the Self-Image scale were statistically insignificant. The mean score in the Emotional Content scale was

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considerably higher in the control group than among delinquent children and adolescents, whereas the mean score in the Self-Image scale was slightly higher in the control group than in the delinquent group. More detailed comparison of responses indicates that responses scored with 1 and 2 points were most frequent in the delinquent group, and that the most negative score, 1 point, prevailed. Responses scored with 2 and 3 points in the Emotional Content scale were most frequent among those in the control group, and 3 points was more frequent than 2 points. While responses scored 2 and 3 points in the Self-Image scale appeared with similar frequency in both groups, those scoring 1 points appeared five times as often in the delinquent groups than in the control group. A drawing by a delinquent boy, age 12, who takes toxic substances and has acted violently towards other children, was accompanied by this story: “A mouse walked around and jumped. A snake crawled to her hole and noticed a mouse and wanted to eat her. A mouse went running and a snake followed her. A mouse was running and running. A snake’s eaten her” (Figure 9.1). According to the Bass-Dark Questionnaire, his Index of Aggressiveness is within the normal level (22 points), while Index of Hostility is slightly above it (11 points). Another 12-year-old boy who inhales various toxic substances, including petrol and dye, added the following story to his drawing: “There was a biggest volcano in the mountains and it started to boil. It started to explode and throw big stones. It started to pour lava out Table 9.2 Means and Standard Deviations in the Rating Scale for Assessing the Story Content of Responses and the Self-Image Scale in Groups of Delinquent and Nondelinquent Children and Adolescents

Delinquency (N 27) Nondelinquency N 25)

Story Content M SD 1.87 0.92 2.56 0.82

Self-Image M SD 2.04 1.07 2.56 0.82

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and everything was killed” (Figure 9.2). His mother was imprisoned for selling drugs. With his younger sister he suffered from neglect in his yearly childhood and now is in the children’s home. According to the Bass-Dark Questionnaire, his Index of Aggressiveness is above the normal level (21 points), and his Index of Hostility, considerably above (16 points).

Figure 9.1 “A mouse walked around and jumped. A snake crawled to her hole and noticed a mouse and wanted to eat her. A mouse went running and a snake followed her. A mouse was running and running. A snake’s eaten her,” by a boy age 12.

Figure 9.2 “There was a biggest volcano in the mountains and it started to boil. It started to explode and throw big stones. It started to pour lava out and everything was killed,” by another boy age 12.

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A third boy, age 13, who is violent and often runs away from the children’s home, added this story to his drawing: “Once a boy thrust a knife into his head. He was buried in the coffin,” Figure 9.3. According to the Bass-Dark Questionnaire, his Indexes of Aggressiveness and Hostility are within the normal level. To provide in-depth comparison between groups in terms of different types of responses, we divided them into 21 categories (Table 9.3). As it follows from Table 9.4, the following categories of responses were the most frequent in the clinical group: those portraying dead subjects or subjects in mortal danger (18.52%); those representing destructive, murderous or life-threatening relationships (14.81%);

Figure 9.3 “Once one boy thrust a knife into his head. He was buried in the coffin,” by a boy age 13.

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Table 9.3 Different Categories of Responses According to Criteria of the Rating Scales Categories of responses 1. Sad subjects 2. Isolated, helpless subjects 3. Suicidal subjects 4. Dead subjects or those in mortal danger 5. Destructive, murderous or life-threatening relationships 6. Relationships that are stressful or hostile 7. Fearful subject 8. Fearsome or enraged subject 9. Unattractive subject 10. Frustrated or unfortunate subject 11. Subjects or relationships that are both negative and positive, suggesting ambivalence or conflict 12. Subjects or relationships that are unemotional, neither negative nor positive, no feelings expressed towards the subjects or relationships portrayed 13. Subjects or relationships that are ambiguous or unclear 14. Subjects who are fortunate but passive 15. Friendly relationships 16. Pleasant relationships 17. Subjects portrayed as being rescued 18. Subjects who are happy 19. Subjects who are achieving goals (taking action) 20. Relationships that are loving 21. Relationships that are caring

Points 1

Types of responses Strongly negative themes

2

Moderately negative themes

3

Intermediate level

4

Moderately positive themes

5

Strongly positive themes

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Table 9.4 Appearance of Different Categories of Responses in Clinical and Control Groups Categories of Responses 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.

Clinical Group N 1 2 1 5 4 2 3 1 0 0 2 4 1 0 1 0 0 0 0 0 0

% 3.7 7.4 3.7 18.52 14.81 7.4 11.11 3.7 0 0 7.4 14.81 3.7 0 3.7 0 0 0 0 0 0

Control Group N 0 0 0 1 1 3 2 0 0 2 4 3 5 0 2 0 0 0 0 1 0

% 0 0 0 4 4 12 8 0 0 8 16 20 20 0 8 0 0 0 0 4 0

those portraying subjects or relationships that are unemotional (14.81%) as well as those portraying fearful subjects (11.11%). A little less frequent in this group were responses portraying isolated or helpless subjects (7.4%); relationships that are stressful or hostile (7.4%), as well as those with ambivalent emotional content (7.4%). Even less frequent were responses portraying sad (3.7%), suicidal (3.7%), or fearsome or enraged (3.7%) subjects; those with ambiguous or unclear content (3.7%); as well as those portraying friendly relationships (3.7%).

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As for the controls, most frequent among them were responses with unclear or ambiguous meaning (20%), ambivalent meaning (16%), or those that were unemotional (12%), as well as those portraying relationships that are stressful or hostile (12%). Less popular in this group were responses portraying friendly relationships (8%) and frustrated (8%) or fearful (8%) subjects. Even less frequent were drawings portraying subjects who are in mortal danger (4%) or relationships that are destructive (4%). Other categories of responses were absent in this group. Analyzing different categories of responses, we observed that drawings that portray subjects who are happy or achieving goals were completely absent in both groups, which may reflect a weak self-image of respondents. In rare cases, there were responses portraying friendly relationships in both groups, while relationships that are caring or loving were either completely absent (in the clinical group), or portrayed only by one respondent (in the control group). One of the explanations for this may be that most respondents in both groups were raised in residential homes. Many of them in their childhood suffered from neglect or lack of care and love from their parents. Relationships that are destructive or life-threatening were portrayed by delinquent children and adolescents considerably more frequently than by the nondelinquent group, though most respondents in the clinical group took medication that inhibited their emotional responses and aggressiveness at the moment of study. Our findings in this respect were different from those reported by Silver (Silver, 1996b), who found that proportionally more nondelinquent males than males who are delinquent drew fantasies about assaultive relationships. She presumed that incarceration inhibits the expression of aggressive fantasies. We found that DAS responses among delinquent children and adolescents in our study more acccurately than their self-reports and questionnaires reflected their hostile and aggressive fantasies as well as emotional discomfort, fear, and lack of self-confidence. All this enables us to conclude that the DAS test provides accurate assessment of emotional needs and fantasies of delinquent children and

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adolescents, and helps us to better understand their perception of themselves and others. Using the test may be a valuable means to establish a rapport with those who are unlikely to express their needs verbally, and to provide interventions that reduce a risk of destructive or self-destructive behavior. It was difficult at times to assess adequately the self-image of respondents especially when their responses portrayed relationships between two or more subjects and one of the subjects would be, for instance, portrayed as sad and helpless, whereas another would be portrayed as aggressive or fearsome. An example may be the drawing by a 14-year-old adolescent; his story: “The girl went to a forest to gather mushrooms and was bitten by a snake” (Figure 9.4). This respondent was the only one in the clinical group who acknowledged

Figure 9.4 The girl went to a forest to gather mushrooms and was bitten by a snake.”

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that he was sad while being tested; others, however, claimed to feel happy or okay. His confession that he’s feeling sad makes us presume that he suffers from depression. He may identify himself with either an isolated and helpless girl or an aggressive snake. The latter is more likely, taking into account the close connection between adolescent depression, on one hand, and aggressiveness on the other. Schaffer and Fischer (1981) found that most children and adolescents who made suicidal attempts were delinquent. Examining the connection between adolescent delinquency and aggressiveness and self-destructive behavior, Silver and Ellison (1995) attempted to distinguish adolescents who act out their destructive tendencies toward themselves from those who act out against others. As they discovered, it was practically impossible to differentiate them, because many juveniles tend to deny their depression, acting out their destructive tendencies in their collective antisocial activities. When incarcerated, however, they begin to feel their depression more acutely. They experience fear and anxiety and demonstrate self-destructive tendencies. Silver and Ellison believe that concrete circumstances, as when adolescents take drugs, should be taken into account in order to better estimate the risk of acting out their destructive tendencies toward themselves or others.

ADULT PSYCHIATRIC PATIENTS IN CLINICAL AND CONTROL GROUPS Comparison of means demonstrated significant differences between control and two clinical groups, those of persons with schizophrenia (p 0.01) and patients with personality disorders (p 0.05) in the story content. Differences between participants in the control group and patients with mental retardation were insignificant (Table 9.5). More detailed comparison of responses in four groups through histograms indicated a high percentage of drawings with strongly negative content (scored at 1 point) in groups of patients with schizophrenia and personality disorders. Forty percent of such drawings were in the group of patients with schizophrenia, and about 25% were in the group of patients with personality disorders. A significant

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Table 9.5 Means and Standard Deviations According to Rating Scale for Assessing the Story Content of Responses in the Clinical and Control Groups

Controls Schizophrenia Personality disorders Mental retardation

M 3.133 2.2 2.619 3.09

SD 1.252 1.279 1.43 1.109

percent of drawings in these two groups (about 23% in group of schizophrenics and about 20% in group of patients with personality disorders) showed moderately negative content. At the same time, more responses scoring 3 and 5 points emerged in groups of patients with personality disorders compared with those suffering from schizophrenia. Responses among the mentally retarded were considerably different from those of schizophrenics and psychopaths, and in certain ways, similar to those among controls. Responses scored with 3 points were most frequent in this group and those scored with 4 and 5 points were more frequent than those with negative themes. The following drawings and stories illustrate some of the responses in different clinical groups. The first drawing (Figure 9.5) was made by a 21-year-old patient with schizophrenia, who killed two persons. He added the following story to his drawing: “There was a fish in a shoal. It was young, inexperienced and curious. Once upon a time it was bored to be in a shoal with old fishes and it wished to see the world independently from others and try itself. But soon after it left a shoal it get into trap. Now it is frozen in the depth of a refrigerator and even cannot imagine that it will soon be on a hot frying-pan.” Another response (Figure 9.6) is that of 25-year-old patient with schizophrenia who killed his father. His story is as follows: “Cats are wondering creatures by their nature. It’s a rare place where cats haven’t left their trace. This cat also was moved by mere curiosity and come across a forest meadow. But she didn’t know that the host of this forest meadow was a vigilant serpent. Two animal instincts met, one instinct is to protect one’s territory. Another one is just survival. It’s not difficult to guess, what instinct wins.”

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Figure 9.5 “There was a fish in a shoal. It was young, inexperienced and curious. Once upon a time it was bored to be in a shoal with old fishes and it wished to see the world independently from others and try itself. But soon after it left a shoal it get into trap. Now it is frozen in the depth of a refrigerator and even cannot imagine that it will soon be on a hot frying-pan,” by a 21-year old patient with schizophrenia.

Figure 9.6 “Cats are wondering creatures by their nature. It’s a rare place where cats haven’t left their trace. This cat also was moved by mere curiosity and come across a forest meadow. But she didn’t know that the host of this forest meadow was a vigilant serpent. Two animal instincts met, one instinct is to protect one’s territory. Another one is just survival. It’s not difficult to guess, what instinct wins.”

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The third response (Figure 9.7) is that of a 26-year-old patient with personality disorder, who caused severe injuries to his victim that led to death. He added the following story to his drawing: “There was a chicken who pecked millet. When he grown up and become a cock he irritated people with his cry and get into soup.” An example of responses in the group of mentally retarded may be the following drawing (Figure 9.8), made by a 19-year-old patient who raped a 5-year-old girl. The story with which he added his pic-

Figure 9.7 “There was a chicken who pecked millet. When he grown up and become a cock he irritated people with his cry and get into soup,” by a 26-year-old patient with personality disorder.

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ture is as follows: “A ship drifted in the sea of the unknown country. There were fishes in the sea and it was hot.” It appears to be that drawings in the group of the mentally retarded were less integrated than in two other clinical groups, and this was connected with less coherence in the stories. Items in the drawings were connected simply through their placing close to each other or on a baseline, which was indicative to cognitive deficit. Findings of this study demonstrate that DAS test can be used for screening individuals, in particular those with psychiatric disorders

Figure 9.8 “A ship drifted in the sea of the unknown country. There were fishes in the sea and it was hot,” by a 19-year old patient who had raped a 5-year old girl.

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who are at high risk of committing violence. Absence of significant differences in emotional content of drawings between controls and patients with mental retardation suggest that their criminal acts were committed mostly due to their limited cognitive abilities rather than emotional pathology.

CONCLUSION The findings of our study indicate that the DAS test is a valid instrument for assessing emotional needs and fantasies among adult patients who are inclined to violence as well as among delinquent children and adolescents. Responses to the DAS task also reflect respondents’ attitude toward self and others, and can be used as predictors of destructive and self-destructive behavior, and thereby helping to provide interventions and reduce the risk of self-harm and violence toward others.

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Part III Summary and Implications

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10 Concluding Observations

This chapter begins by reviewing the findings about children and adolescents who may be at risk for harming others, then those at risk for harming themselves. It also reviews the cultural differences and similarities that emerged, as well as the changes and consistencies found in the responses of seven students, and concludes with suggestions for further study.

CHILDREN AND ADOLESCENTS AT RISK FOR HARMING OTHERS The pilot study summarized in chapter 4 found significant correlations between aggressive behavior and scores on two rating scales. The aggressive children and adolescents received lower scores on the Emotional Content scale than those in the control group to a degree significant at the p .01 level of probability. They also received higher scores on the Self-Image scale to a degree significant at the p .05 level, and on the combination of both scores to a

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greater degree, significant at the p .001 level. These findings suggest that responses to the DAS task with strongly negative Emotional Content combined with strongly positive Self-Images can serve as the first of several steps in identifying children and adolescents at risk for harming others. The present study also distinguished between two subgroups of aggressive behavior that seem to differ in motivation and intensity, and call for different treatment. The subgroups include predatory aggression and reactive aggression. Predatory Aggression This subgroup included students who drew fantasies about using force to harm others. They seemed to identify with their assailants and were callous toward their victims, scoring 5 points in Self-Image and 1 point in Emotional Content. All were boys. Five of the 30 aggressive students drew predatory fantasies consistently. Four responded to the drawing task on several occasions, choosing the same or similar stimulus drawings, and scoring 1 point in Emotional Content combined with 5 points in Self-Image. They also showed consistency in concealing the identities of their assailants and victims, choosing symbolic subjects or making their assailants invisible. Gus made the knife his assailant on two occasions. In one drawing, it descends on the chick, and in the other, on the cat, both female symbols. Sam’s knife descends on the snake. Carl chose the snake who devours the cat, and the dinosaur who devours the man smoking a pipe. Shaun chose the knife in each of his three responses to the drawing task, and drew it descending on his victims. The knife-wielder was a cowboy in one drawing, and was invisible in the other two. Ramon chose a single subject, the volcano, perhaps to represent himself (Figures 6.10 to 6.13, and 6.19). In the control group, 3% drew fantasies that suggest predatory aggression, compared with 17% in the aggressive group, their fantasies similar to the fantasies of the aggressive students—knife cut-

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ting a snake into pieces, cowboy stabbing a girl, and predators devouring vicims as in Figures 7.14 to 7.17. Before a student can be identified as at risk for predatory behavior, additional information is needed, and no information about family histories and other relationships of students in the predatory subgroup was available. Nevertheless, additional differences between aggressive and control groups emerged in the use of humor. The Use of Humor in Responses to the Drawing Task In the group of aggressive students, 20% drew humorous responses compared with 1.6% of the nonaggressive group, and their humor tended to be strongly negative; the mean score was 1.6 points. None of these 6 aggressive students used positive or ambivalent humor, and 4 used humor that was both morbid and homicidal, scoring 1 point (Shaun, Gus, Sam, and Jerry). Carl’s humor was lethal but not morbid (1.5 points), and Harriet’s humor was disparaging (2 points). In the control group, the humor tended to be positive, the mean score 3.3 points on the 5-point humor scale. Two students used resilient humor and one used playful humor, scoring 4 and 5 points (Figures 7.21 and 7.22). In both aggressive and control groups, the students who drew predatory fantasies also used morbid and lethal humor. This finding suggests that a relationship exists between humor that is both lethal and morbid, scoring 1 point, and the subgroup of predatory fantasies, scoring 1 point in emotional content and 5 points in selfimage. Lorenz (1963) reminds us that aggression is biological and instinctive in man and beast, and noted the excitedly happy expression of a dog about to catch a hunted rabbit. For some humans as well, hunting is a pleasurable sport. Nevertheless, comparatively few respondents drew humorous responses to the drawing task, and with small samples, the relationship between humorous responses and the subgroup of predatory aggression remains speculative.

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Reactive Aggression This subgroup included children and adolescents who responded to the drawing task with fantasies about reacting aggressively to attacks initiated by others, and like those in the predatory subgroup, scored 1 point in Emotional Content and 5 points in Self-Image. Their responses seem to illustrate Connor’s definition of defensive or reactive aggression: arising in response to frustration, motivated by a need to defend against threat, meant to inflict injury or pain rather than benefit the aggressor, and like offensive aggression, may be appropriate or inappropriate. Lorenz also observed that that the motives of fighters differ from the motives of predators, and various investigators have associated inappropriate defensive aggression with exposure to violence and peer rejection. In the present study, the reactive subgroup of aggressive students included respondents whose histories and drawings suggest defensive, inappropriate, and maladaptive aggression. For example, Toby who drew “Guy saving his girl friend. Evil guys trying to kill him” (Figure 6.14) seems to portray himself as a hero responding to evil assailants. His history indicates that he is overweight and often teased by his peers. Jerry’s drawing suggests predatory aggression at first glance: man shoots others in the throat and head, and then decapitates them (Figure 6.18), and as he explained, “These are the only kind of pictures I like to draw . . . I find them funny.” His history reveals that Jerry has ADHD, learning disabilities, and pervasive expectations of failure, suggesting that his aggressive behavior may be reactive, or both reactive and predatory. Additional students drew ambiguous responses that scored 3 points in Self-Image, such as the drawing of a mouse threatened by a snake by John, who may be the mouse, the snake, or the invisible narrator (Figure 6.9). In the control group, it was surprising to find that none of the of the 181 responses suggested reactive aggression. It also was surprising to find that 7 of the 14 boys in the additional class of fifth graders expressed reactive aggression (no girls did). Since these chil-

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dren had responded anonymously, the only available information about them was that that they had not been aggressive, but that their school was in a particularly dangerous neighborhood. As defined by Connor (2002), reactive aggression is intense, impulsive, and less vulnerable to inner controls, an observation supported by the response of the boy in the control group who drew, “I was sitting down and a snake said I am going to kill you I said want to bet then I took out my knife and he ran” (Figure 7.10). On the other hand, the boy who drew “A snake came up to scare me but I turned Super Saiyen Ryan” (Figure 7.11), suggests that he used drawing to express intense feelings about an encounter with a bully, and to transform a painful experience into a vivid image of conflict, with rage and fear under tight control. Identifying Children and Adolescents at Risk for Harming Others Predatory fantasies alone do not predict predatory behavior, and previous studies also found that adolescents with no histories of aggressive behavior responded to the DAS task with fantasies about assaulting others (Silver, 1996a). Perhaps these fantasies reflect the violence in news reports, movies, and television. Perhaps, too, the experience of drawing a homicidal fantasy may fulfill a wish for “sweet revenge,” to punish someone who violated the respondent’s sense of justice, or ventilate angry feelings vicariously, and keep them under control. Nevertheless, 63% of the aggressive students compared to 30% of the controls scored 1 point in Emotional Content, and 43% of the aggressive students compared to 15% of the controls scored 5 points in Self-Image. These differences were statistically significant (at the .01 and .05 levels respectively), and when the scores of 1 and 5 points were combined, the differences were highly significant at the .001 level. These findings suggest that fantasies expressing callousness toward victims can serve as a first step in identifying some potentially harmful children and adolescents, but that subsequent steps are

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needed: repeating the task another day, acquiring information about family and other relationships, and, when appropriate, providing intervention. Whether predatory aggression is a pervasive instinct or a learned behavior with little emotional involvement motivated by reward, aggressive behavior has been increasing in our schools, and calls for intervention. A combination of preventive programs is more effective than a single intervention, as MacNeil (2002) suggests, and prompt responses to incidents of victimization can drastically reduce the number of incidents. MacNeil also recommends preventive strategies that encourage all members of the school community to work collectively toward a safer environment, rather than strategies that emphasize law enforcement. Schools that institute strong, sustained prevention programs have succeeded in reducing bullying problems. For example, MacNeil suggests interventions that eliminate “by-standing.” Students and teachers who observe bullying behavior without attempting to stop it actually facilitate the problem. For some students, zero-tolerance and sustained prevention programs that encourage active participation by teachers and administrators as well as students have been successful. Other ways of controlling aggression redirect it toward substitute objects, and for some students, athletic competition can be effective in discharging aggression and teaching responsible self-control. The children and adolescents whose aggressive behavior seemed reactive rather than predatory had been participating in special school programs for emotionally disturbed students. Their histories were available, and many revealed abuse and the death of parents, as well as maladaptive behaviors. The positive changes that appeared in the behavior and multiple responses of some of the students, as reported in chapter 6, seem to be related to the clinical interventions they received. Clinical intervention rather than preventive programs would seem appropriate for students whose responses suggest reactive aggression. Talking with a mental health professional can redirect and dissipate angry feelings, or change despair about troubling situations to

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hope, as suggested by the changes that appeared in the responses and behaviors of Lanette, Leroy, George, Victoria, and Joseph. The findings suggest that children or adolescents who score 1 point in Emotional Content and 5 points in Self-Image may be at risk and that further investigation is needed to determine whether it calls for some form of intervention.

CHILDREN AND ADOLESCENTS AT RISK FOR HARMING THEMSELVES The second aim of this book was concerned with identifying students at risk for harming themselves, building on previous studies that found significant correlations between clinical depression and strongly negative responses to the DAS drawing task that scored 1 point, as discussed in chapter 5. In the present study, five times as many children and adolescents in the aggressive group scored 1 point both in Self-Image and Emotional Content, 20% compared with 4% of the control group drawing fantasies about hopelessness or death with bad outcomes for the principal subjects. No child or adolescent in the control group had been recognized as depressed, but four in the aggressive group had been participating in art therapy programs, diagnosed with major depression or emotional disturbances. Two were adolescents (Jimmy, 14, and Victoria, 17) and two were children (Joseph, 10, and Lanette, 12). Jimmy’s diagnoses had included major depression. The art therapist who worked with him noted that he tended to lash out when angry, even when it put him in danger. In responding to the drawing task, he chose four symbolic stimulus drawings: volcano, dinosaur, castle, and parachutist. He copied them without embellishment or changes in his response about an endangered parachutist who says, “I’m going to die!” Although he calls for “back-up . . . it won’t come for a year” (Figure 6.1), suggesting that Jimmy used his drawing to express, indirectly, feelings of hopelessness, helplessness, and impending doom.

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Previously, Joseph had expressed suicidal and homicidal thoughts, and been hospitalized for depression several times. His father had died, and Joseph lived in a chaotic household with his mother, stepfather, and many siblings. Like Jimmy, Joseph chose the volcano and dinosaur, adding the mouse in his drawing. He seems to identify with the helpless and endangered but homicidal mouse who had been “killing people from around the world” before being tricked, caught, and put into a volcano. The exploding volcano throws the mouse into the mouth of a dinosaur (Figure 6.2). Although Larry’s history and first two responses suggested predatory aggression, his third response suggested that he identified with his parachutist who “jumped out of a plane to go to war but got stuck in a tree. Then he got shot and he dead and then he smellin stinkin.” (Figures 8.1a, b, and c). Like Larry, two girls in the aggressive group, Victoria and Lanette, portrayed themselves as helpless victims. In Victoria’s first response, she too chose the stimulus-drawing parachutist but changed it into an empty balloon. Her balloon is stabbed by the knife, lost in the sea, and never found (Figure 6.4). Lanette seemed to use symbols to represent herself as the victim of sexual assault in three of her four responses to the drawing task. In the first, she seems to be the princess with no arms, attacked in the groin by a snake (Figure 6.3); in her second and third drawings, she seems to represent herself as a mouse pursued by a cat (8.2a, b, and c). The fifth student who also scored 1 point on both scales, Ralph had not been recognized as depressed. Instead, he had been selected for the study because he was notably aggressive in his school, which did not provide preventive programs. Ralph seemed to identify with the small, fearful, and endangered victims in both of his responses to the drawing task. In one drawing, the victim stands on the roof of a house, saying, “Oh my!” as rocks approach from an exploding volcano. In the other, the victim stands on the roof of a castle, saying, “O no! here he comes,” as a knife-wielding parachutist descends (Figure 6.5).

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In the control group, eight students also scored 1 point on both scales. Two drew suicidal fantasies, and four drew subjects who are crying, holding handkerchiefs, or standing in the rain. Two girls chose and drew the princess and the knife. One princess stabs herself, the other contemplates self-mutilation. A boy drew a stick figure contemplating the knife. His story: “Most of us are just drawn crazy with how our life is, others wanna take drastic measures to just end it forever” (Figures 7.1 to 7.8). Eight of the 121 students in the control group also seemed to identify with subjects they portrayed as helpless, hopeless, alone, or in mortal danger. There was no opportunity for follow-up because they had responded anonymously. Similar patterns appeared in responses by the 13 students in both groups who scored 1 point on both scales. Twelve of the 13 drew fantasies about life-threatening situations and subjects who were hopeless, helpless, or sad, and 11 of the 13 chose the stimulus drawing knife or the volcano. Differences between groups also appeared. Suicidal fantasies and sad solitary subjects appeared only in responses by students in the control group, perhaps because the aggressive students tended to act out angry feelings and mask anxiety or despair. If so, they seem to belong to the reactive rather than predatory subgroup of aggressive students. These findings support previous findings that the DAS task can serve to identify some but not all children or adolescents at risk for depression and harming themselves, and suggest that every response scoring 1 point in both Emotional Content and Self-Image calls for prompt clinical evaluation.

CONSISTENCIES AND CHANGES IN EMOTIONAL STATES Changes and consistencies appeared in the responses and behaviors of seven of the children and adolescents in the aggressive group, as reported in chapter 6. Larry, age 17, had been abused and

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orphaned when he was a child. He lived in a violent neighborhood and recently had been arrested for strong-arm robbery and for assaulting one of his teachers. During the months between his first and last response to the drawing task, he consistently scored 1 point in Emotional Content but in Self-Image, his score changed from 5 points to 1 point. Larry’s first two responses were fantasies about assaultive relationships and territorial possession. In the first, a youth trespassed into the territory of a snake, and in his second, a “rat was walking in the snake territory and the snake seen him and eat him” (Figures 8.1a and b). In his third and last response, the man jumped from a plane to go to war but was stuck in a tree, and died “smellin stinkin,” scoring 1 point in both Emotional Content and Self-Image, and suggesting that Larry was depressed as well as volatile. Soon after, he was arrested, imprisoned for dealing drugs, and had not returned to school, concluding his experience with art therapy after about 3 months. Greg’s history also reveals physical abuse and the death of both parents. His art therapist describes him as a bully, constantly teasing or laughing at the misfortunes of others. Age 11, he has been in art therapy for about 1 year and was beginning to grieve the death of his mother. In his first response to the drawing task, he seems to be the angry dog barking at a frightened cat; in his second, the snake biting and almost killing a boy; and in his third and last, the snake swallowing a mouse. His scores in Emotional Content dropped from 2 to 1 point while his Self-Image scores remained at 5 points, consistently representing himself as an assailant, at first frightening, then biting, and finally destroying his three helpless victims. His three fantasies, drawn on three occasions during the school year, seem to increase in anger and intensity, suggesting that his drawings reflect both predatory and reactive aggression. Lanette’s responses, strongly negative at first, gradually became positive, her scores in both Emotional Content and Self-Image changing from the low of 1 point to a high of 3.5 points, suggesting ambivalence with a hopeful outcome. Lanette lived in Larry’s dangerous neighborhood. Her art therapist observed that she found it

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difficult to let others know when she was hurting, liked to have everything under control, had a history of aggression, and may have experienced abuse. In Lanette’s first three responses to the drawing task, she seems to represent herself as a victim of sexual abuse, consistently and symbolically. In the first, a princess with no arms or hands to protect her groin from a snake is calling for help, scoring 1 point both in Emotional Content and Self-Image (Figure 8.2b). In her last response, 18 months later, she is thanking an exterminator for helping her get rid of pests, scoring 3.5 points in both Emotional Content and Self-Image (Figure 8.2d). It is unclear whether Lanette was expressing gratitude to her art therapist or someone else symbolized by the exterminator in her drawing, but the changes from strongly negative to moderately positive suggest beneficial changes in feelings about herself and her relationships with others, perhaps the result of healing art experiences and experiences with her art therapist. Leroy’s history indicated that his father was abusive and an alcoholic. For his first response, he chose the knife and bride, then drew a princess or prince “in danger,” who flees from the dinosaur but returns to cut off its head (Figure 8.5a). Eleven months later, he chose the same subjects, but this time, the dinosaur has seized the armless princess who calls for help. In both drawings, a small parachutist hovers above; mute in his first drawing, but in his second, proclaims, “I am going to help you.” Instead, she is saved by a magic spell-caster. It is tempting to speculate that the princess represents his mother; the dinosaur, his father; and the parachutist and magic spell-caster, his real and his wished-for self. The consistencies in Leroy’s drawings suggest intense and persistent feelings of anger, fear, and the desire to protect his mother and himself. Nevertheless, his score in Emotional Content changed from 1 point to 3.5 points (ambivalent with hopeful outcome), while his Self-Image remained consistent, a wish-fulfilling 5 points. At age 8, George had a history of abuse, ADHD, and aggressive behavior, and was attending his school’s program for severely emotionally disturbed children. In his first response he seemed to portray

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himself as a hungry and frustrated fox, scoring 2 points in both Emotional Content and Self-Image. Two years later, he seemed to portray himself as an exploding volcano as well as a hero who rescues a princess who resembles the rejecting girl in his first drawing. He fights a lion for the princess and lives with her happily ever after, scoring 3.5 points in Emotional Content and 5 points in Self-Image (Figures 8.6a, b). Victoria, age 17, had been threatening and cruel to other students and was suspended from school for stealing and other deviant behavior. Subsequently, she had been seeing the school’s psychologist, and recently participated in two art therapy programs. Her two responses to the drawing task after an interval of 1 month revealed changes in both Self-Image and Emotional Content. For her first, she chose the parachutist but drew an empty balloon, which is cut with a knife, falls into the sea, and is never found, scoring 1 point in both Emotional Content and Self-Image. She seems to see herself as helpless, lost, and abandoned; like an empty balloon drifting over the sea. For her second response, she chose the princess. In her fantasy, the princess runs away, falls in love, creates a free country, and lives happily ever after, scoring 3.5 points in Emotional Content, and 5 points in Self-Image. She seems to see herself as a princess who is effective, successful, and beloved—a victim who triumphs over adversity (Figures 8.3a and b). Joseph’s history included the death of his father prior to the onset of his behavioral problems, and a chaotic home-life. He had been hospitalized several times for suicidal and homicidal ideation. His diagnoses included bipolar disorder and ADD, speech and language delays, and defiance as well as aggressiveness. Now age 10, he had been in the school’s special program for severely emotionally disturbed children for 3 years, and has been receiving art therapy. In his first response, he seemed to represent himself as a mouse threatened by a volcano and a dinosaur, scoring 1 point in both Emotional Content and Self-Image. In his last, he is a helicopter pilot who saves a man who is trapped in a volcano, scoring 3.5 points in Emotional Content and 5 points in Self-Image (Figures 8.7a and c).

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Although there may be other causes for the positive changes in attitudes toward self and others that appeared in the responses of these students after intervals of time, the changes suggest that they were associated with healing art experiences, and that the experiences contributed to their gains in subjective well-being by providing opportunities to express pain or fear in an empathetic professional relationship. It is always difficult to distinguish the precise effects of therapy from other factors, but higher posttest scores on the Emotional Content and Self-Image scales suggest that the changes were a consequence of art therapy rather than coincidental. On the other hand, consistencies in the choice of stimulus drawings, symbols, self-images, and relationships between the subjects portrayed can illuminate anxieties and coping strategies. Consistencies across multiple responses after intervals of time also contribute to the reliability of the DAS assessment. Presenting the drawing task again another day can clarify the question whether a strongly negative fantasy reflects a passing mood or persistent emotional state, and provides empirical evidence through higher, more positive scores that a therapeutic or preventive program has been effective.

GENDER DIFFERENCES AND SIMILARITIES Across cultures and throughout history, males have been hunters and warriors, and previous studies of responses to the drawing task found gender to be related to aggressiveness, as reported in chapters 2 and 4. The findings of the present study support the previous findings. Boys were significantly more likely to be classified as aggressive than the girls, and in the aggressive group, boys had significantly higher Self-Image scores than girls. In the aggressive group, girls had significantly higher, more positive scores in Emotional Content, whereas boys had significantly higher scores in Self-Image. No girls expressed predatory aggression, but five girls in the aggressive group expressed reactive aggression. They included Victoria and Lanette, whose responses suggest

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they also were depressed, scoring 1 point in both Self-Image and Emotional Content, as discussed in chapter 5. They also included Sherrie and Harriet, whose Self-Images were unclear or ambivalent, and Carol whose Self-Image was positive. Carol and Harriet portrayed themselves as aggressors indirectly. Carol’s angry and protective hen seems to represent herself as well as the little mouse between her feet. Harriet’s drawing seems to include four Self-Images: princess, volcano, cat, and chick. Lanette, Sherrie, and Victoria seem to represent themselves as victims. In the control group also, the female mean score was higher than the male mean score in Emotional Content, and more than twice as many girls received positive scores (42% girls, 20% boys), as reported in chapter 4. In addition, five girls but no boys scored 5 points not only in Emotional Content but also in Self-Image. Twenty of the 85 girls (24%) selected the stimulus-drawing princess and the castle, drawing fantasies that included both in their drawings. They tended to identify with their princesses, some of whom appeared happy, others sad or suicidal. Additional gender differences emerged: Boys tended to draw fantasies about making things happen, but girls fantasized about things happening to them. Only 1% of the boys drew passive or moderately positive Self-Images, scoring 4 points, compared with 18% of the girls, and no boys but 7 girls drew strongly positive fantasies about happy solitary subjects or loving relationships. Responses to the drawing task support the observations by various investigators that female aggressiveness is associated with sexual abuse, conduct disorder, and depression, but fail to support the observations that male aggressiveness tends to be overt and direct whereas female aggressiveness tends to be covert and indirect. Both genders tended to be indirect and covert. Boys as well as girls expressed aggression indirectly in responding to the drawing task, as reported in chapter 4. Only Jerry revealed that he was the aggressor, whereas 12 of the 25 boys in the aggressive group fantasized about assaulting others but disguised their assailants by making them invisible, or representing them as snakes, volcanoes, or dinosaurs.

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They also tended to disguise their victims as chicks, mice, and cats, all feminine symbols. The findings suggest that the innate or biological differences characteristic of male and female behavior are also evident in responses to the drawing task.

CULTURAL DIFFERENCES AND SIMILARITIES Previous Studies Investigators in Brazil, Thailand, Australia, and Russia have undertaken cross-cultural studies of responses to the SDT Drawing from Imagination task by children, adolescents, and adults, as reviewed in Silver (2001, 2002). The studies examined age, gender, and cultural differences in Emotional Content and Self-Images scores, cognitive skills, and the outcomes of therapeutic programs. In Brazil, the SDT was standardized on 1,995 children and adults by Allessandrini, et al. (1998) who confirmed the dependence of cognitive score on age and level of education in both countries. Although the trend of mean scores was similar, the American scores were consistently higher. They found similar emotional content in the responses of sixth graders, twelfth graders, and college students in both countries. Among Brazilian respondents, no significant gender differences emerged. In Thailand, a graduate student at Burapha University used the SDT to assess the effects of an art therapy program on male adolescents in a detention facility (Dhanachitsiriphong, 1999). The adolescents selected for the program had drawn the most negative fantasies in responding to the drawing task, ranking below the 25th percentile in Emotional Content, suggesting they might be depressed. They also ranked above the 75th percentile in cognitive content, suggesting that they also were the most intelligent. The strongly negative fantasies in responses to the drawing task in Thailand were similar to the strongly negative fantasies in responses by adolescents in the United States and elsewhere. A study of delinquent and incarcerated adolescents in

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the United States found that they, too, tended to draw sad rather than aggressive fantasies (Silver, 1996a). The Russian investigators translated and standardized the SDT based on samples of 702 children, adolescents, and adults residing in various parts of the Russian Federation and Estonia (Kopytin, 2002). As found in the United States and Brazilian studies, the cognitive scores of the Russian respondents increased with age, reaching their highest level among adults. Although no differences between the scores of American and Russian adults were found, the scores of Russian children and adolescents were higher than their American counterparts in some test scores, but lower in others. In addition, Russian females had higher, more positive scores than Russian males in both Emotional Content and Self-Image, whereas males had lower, more negative scores, opposite the findings about American males and females. The Present Study The three Russian clinicians who contributed the report in chapter 7 administered the DAS task to delinquent children and adolescents with social conduct disorder as well as adult psychiatric patients with histories of violent behavior. The 27 children and adolescents had demonstrated aggressive behavior, as noted in their case histories and by the personnel who worked with them. They ranged in age from 10 to 14 and included six girls and 21 boys. Many had been raised in residential homes for children because they had been abandoned or taken from their parents. Several had attempted suicide. For their control group, the Russian investigators also presented the task to 25 nondelinquent children and adolescents who were living in a residential home. Before reviewing the numerical and statistical differences and similarities that emerged between cultures, consider the differences and similarities that emerged in the drawings themselves. The Russian investigators included four response drawings to illustrate their findings, and each drawing seems to have an American counterpart.

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Note the similarities between two of the Russian responses and two of the American responses in Figures 10.1 to 10.4. Figure 10.1 was the fantasy of an aggressive American adolescent, Larry, who has been arrested for battery and for assaulting others. Figure 10.2 was the fantasy of a delinquent Russian adolescent who takes toxic drugs and has acted violently toward others. Both selected the snake and the mouse, both drew mice trespassing on snake territory, both drew fantasies about snakes devouring mice. Russian story: “A mouse

Figure 10.1 By an American aggressive adolescent

Figure 10.2 By a Russian delinquent adolescent

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walked around . . . a snake noticed . . . and wanted to eat her. A mouse went running and a snake followed her. A mouse was running and running. A snake’s eaten her.” Larry’s story: “The rat was walking in the snake territory and the snake seen him and eat him.” Both adolescents seem callous toward their helpless and doomed mice and both seem to identify with their intimidating, and destructive snakes. In another pair of responses, Figure 10.3 was drawn by a delinquent Russian adolescent who chose the stimulus drawing girl in

Figure 10.3 By a Russian delinquent adolescent

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association with the snake; and Figure 10.4, by Greg, a school bully, who chose the stimulus drawing boy in association with the snake. Both drew their snakes biting or about to bite their passive victims. The Russian snake bites the leg of a girl who “went into the forest to gather mushrooms and was bitten by a snake.” Greg’s snake climbs a pole and bites the neck of a boy wearing glasses and sitting on the ground clasping his knees. His story, “A boy poisin by a snak from getting bit then he almost died.” All four fantasies suggest predatory aggression.

Figure 10.4 By an American aggressive adolescent

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Figure 10.5 Response from the American control group

For comparison, consider the response of a male adolescent in the American control group of nonaggressive students, who also selected the snake and the mouse, but in his drawing, added two ways for the mouse to escape, a dark hole and the downspout and gutter of a nearby house (Figure 10.5). Story: “The snake is going to eat the mouse but the mouse runs into the gutter.” This respondent seems to express empathy with the mouse, and a desire to provide assistance. In another pair of drawings, Figures 10.6 and 10.7, a delinquent Russian boy, age 12, selected a single stimulus drawing, the volcano, then drew it exploding. His story: “There was a biggest volcano in the mountains and it started to boil. It started to explode and throw big stones. It started to pour lava out and everything was killed”

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Figure 10.6 From a Russian delinquent

Figure 10.7 From an American aggressive

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(Figure 10.6). Ramon, too, selected only one stimulus drawing, the volcano, then drew and painted it exploding (Figure 10.7). Ramon’s two-word story: “volcano urupt.” Both seemed to identify with their powerful, destructive, and solitary subjects. The fourth pair of Russian and American respondents also selected the same two stimulus drawings, the boy and the knife. In the Russian drawing, a coffin has been added and the knife appears to stab the boy’s head. Story: “Once a boy thrust a knife into his head. He was buried in the coffin,” (Figure 10.8), scoring 1 point in

Figure 10.8 From a Russian delinquent

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both Self-Image and Emotional Content, a suicidal drawing that suggests clinical depression. An American adolescent in the control group also selected the boy and the knife and added a table, chair, and door. The knife lies on the table and the boy is writing letters. Story: “stresses messes with everyone. Sometimes it deals with love life, business life, every day life. Most of us are drawn crazy with how our life is, others wanna take drastic measures to just end it forever,” a suicidal drawing that suggests clinical depression (Figure 10.9).

Figure 10.9 American but not aggressive

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OBSERVATIONS In Self-Image scores, highly significant cultural differences emerged. The American students exhibited higher scores on the Self-Image scale when compared with their Russian counterparts. An ANOVA revealed a significant effect of nationality on Self-Image scores (F(1,261) 19.06, p .001). The American aggressive students portrayed strongly positive Self-Images to a highly significant degree, more positive than the American control group, as noted previously. The mean score of the Russian control group was higher than the mean score of the Russian delinquent group in Self-Image, 2.56 points compared to 2.04 points for the delinquent group. In Emotional Content, however, no significant differences were detected with respect to the effect of nationality on Emotional Content scores (F(1,261) .655, p .42). The mean score of the American aggressive group was the lowest of all four groups in Emotional Content, highest in Self-Image. The mean score of the Russian control group was 2.56 points in Emotional Content, higher than the mean score of the Russian delinquent group, 1.87 points.

Cultural Differences It was surprising to find that the Russian groups not only had significantly lower Self-Image scores than the American groups, but also that the Self-Image scores of the delinquent Russian adolescents tended to be strongly negative, unlike their American counterparts, which tended to be strongly positive. The finding suggests that respondents in the Russian delinquent group tended to be depressed as well as delinquent, unlike most respondents in the American aggressive group (although 5 of the 30 Americans also seemed depressed, scoring 1 point on both scales). How can these differences be explained? It may be that the differences reflect the national differences found in cross-cultural studies of the nature of happiness. Bok (2003) observed that people in Latin American countries report being happier on average than

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those in other societies, whereas the reverse was found in Korea, China, and Japan, as well as people in countries recently under communist rule, who reported considerably lower levels of satisfaction than those in neighboring countries. Responses to the question, “All things considered, how satisfied or dissatisfied are you with your life as a whole now?” were measured on a scale ranging from 1 to 10. The mean score of the Russian respondents (4.2) was considerably lower than the mean score of the American respondents (7.4 [Veenhoven, 2002]). In the present study of aggression and depression, the finding that the mean score of the American control group was higher than the mean score of the Russian control group seems to support the cultural differences between American and Russian groups in responses to the Enjoyment of Life scale. Another possible explanation is that the differences between SelfImage scores of American and Russian children and adolescents reflect differences between living in a single family home and going to public school, compared to living in institutions; and for those in the Russian delinquent group, being confined in a psychiatric hospital where they were tested. Further, they were treated only with psychotropic drugs and did not receive psychotherapy. A previous of study of American adolescents who were both delinquent and incarcerated found that they, too, tended to draw sad rather than aggressive fantasies (Silver, 1996a). A third possibility, that the differences may be semantic, could explain the identical Emotional Content and Self-Image histograms in Figure 9.5, and the apparent discrepancies that appear between Figures 9.4 and Figure 9.5. The meaning of the 5-point score on the Self-Image scale might have changed if the words “intimidating, destructive, and assaultive” had preceded “happy, loved, and powerful,” or if it had not been necessary to translate them into another language, and thereby affecting the research results. Differences Between Clinical and Control Groups Comparing American aggressive and control groups, an ANOVA found that the aggressive students had significantly lower scores in Emotional

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Content (F(1,209) 7.06, p .01) and significantly higher scores in Self-Image (F(1,209) 3.86, p .002). In other words, aggressiveness was significantly related to scores on both scales. In addition, a chi-square revealed that aggressive students were significantly more likely than nonaggressive students to score 1 point in Emotional Content combined with 5 points in Self-Image at the .001 level of probability. These aggressive American children and adolescents expressed significantly more negative perceptions of their situations and their relationships with others than those in the control group (p .01): 63% compared to 30% of the controls. In addition, most had histories of abuse, the death of one or both parents, or dysfunctional families, and some lived in neighborhoods so dangerous that many parents require their children to stay home in the afternoons and evenings, as discussed previously. Although none of the American aggressive students drew fantasies with strongly positive Emotional Content, scoring 5 points, 4% of those in the control group drew strongly positive fantasies, such as caring or loving relationships, and 5 girls and one boy scored 5 points on both scales. Also in the control group, 12% drew moderately positive fantasies, such as friendly relationships or fortunate solitary subjects, compared with 7% of the aggressive students. On the other hand, more than three times as many aggressive American students (43%) drew strongly positive Self-Images, compared with 14% of the American control group, receiving significantly more positive Self-Image scores. Comparing Russian clinical and control groups, those in the control group lived in residential homes for children, and unlike the delinquent group, had not been diagnosed with “social clinical disorder.” Their mean score was significantly higher than the mean score of the delinquent group, both in Self-Image and Emotional Content (see chapter 7). Unlike the American control group, only 1 in the Russian control group (0.04%) scored 5 point in Emotional Content, compared with 4% of the American controls, presuming that living in a home for

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orphaned or abandoned children was more satisfactory than being confined in a mental hospital. In addition, no significant difference between the Self-Image scores of the Russian delinquent and control groups emerged, suggesting that those in the delinquent group were depressed as well as aggressive. Cross-Cultural Similarities The finding of no significant difference between American aggressive and Russian delinquent groups in Emotional Content scores may reflect the abandonment and dysfunctional family life experienced by respondents in both countries. No child or adolescent in either country scored 5 points on either scale. Similarities also appeared in the proportions of children and adolescents who scored 1 point in both Emotional Content and SelfImage, suggesting that they were depressed. Five in the Russian clinical group (19%) and one in the control group (4%) scored 1 point on both scales. In the United States, five in the aggressive group (17%) and eight in the control group (4%) also scored 1 point on both scales. In addition, both control groups expressed more positive feelings than the clinical groups, receiving higher scores in both Emotional Content and Self-Image. The four drawings by children and adolescents in the delinquent Russian group that illustrate the report in chapter 9 seemed to have counterparts in the four drawings by aggressive American students, and no one in either group scored 5 points in Emotional Content. In addition, most of those in the American control group, like their Russian counterparts, had histories of parental neglect or abandonment. These cross-cultural similarities support the findings that children and adolescents who score 1 point in Emotional Content combined with 5 points in Self-Image may be at risk for harming others, and that those who score 1 point on both scales may be at risk for harming themselves. They also suggest that the DAS task or the SDT

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drawing from imagination task can serve as a first step in identifying students at risk. Subsequent procedures are needed, however, to clarify and amplify the identification of students at risk. Five such procedures are suggested. Follow-up Procedures to Facilitate Identifying Students at Risk 1. Collect information about the student’s family history and relationships at home and with peers and teachers in school, as well as normal and atypical development and behavior. 2. Administer DAS Form B on two or more occasions, reserving Form A for post-testing at the end of the program. 3. Keep responses on file to review and compare with subsequent responses. 4. Discuss responses individually and privately with the students who drew them, whenever possible, to clarify intended and unintended meanings. 5. Score each response for Emotional Content, Self-Image, and when appropriate, The Use of Humor, and examine for consistencies as well as changes.

SUGGESTIONS FOR FURTHER STUDY The findings of the studies raise questions that suggest further investigation would be worthwhile. What distinguishes aggressive fantasies from aggressive behavior? Why did some students who fantasized about harming others behave aggressively whereas others did not? Like the present study, previous studies found that male adolescents with no histories of aggressive or delinquent behavior drew predatory fantasies (Silver, 1996a). Were they inhibited by inner controls, social mores, or fear of being caught? Masked? Repressed? Sublimated or vented by art experiences? Normal?

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Why were female scores lower in Self-Image than the male scores in both aggressive and nonaggressive groups, but higher in Emotional Content? What is the relationship between scores on the humor scale and behavior, both aggressive nonaggressive? Do the responses of children and adolescents in other cultures tend to resemble or differ from those observed in the United States or Russia? The fantasies expressed through responses to the drawing task are not predictors of behavior, but symbolic representations that can provide access to wishes and fears. Although it is not possible to generalize from the responses of these samples of individuals and groups, the findings seem to indicate that the drawing task can serve as the first of a series of steps for identifying children and adolescents at risk for harming others or themselves.

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Silver, R. (1990). Silver Drawing Test of Cognition and Emotion (Rev. ed.). Mamaroneck, NY: Ablin Press. Silver, R. (1992). Gender differences in drawings: A study of self-images, autonomous subjects and relationships. Art Therapy, Journal of the American Art Therapy Association, 9(2), 85—92. Silver, R. (1993a). Draw a Story: Screening for depression and age and gender differences. New York: Trillium. Silver, R. (1993b). Age and gender differences expressed through drawings: A study of attitudes toward self and others. Art Therapy, Journal of the American Art Therapy Association, 10(3), 159—168. Silver, R. (1996a). Sex differences in solitary and assaultive fantasies of delinquent and non-delinquent adolescents. Adolescence, 31(123), 543—552. Silver, R. (1996b). Silver Drawing Test of Cognition and Emotion (Rev. ed.). Mamaroneck, NY: Ablin Press. Silver, R. (1997). Stimulus drawings & techniques in therapy, development, and assessment (5th ed.). Sarasota, FL: Ablin Press. Silver, R. (2000). Developing cognitive and creative skills through art: Programs for children with communication disorders (4th ed.). Lincoln, NE: iuniverse.com. (Author’s Guild backinprint.com edition; Original work published 1978) Silver, R. (2001). Art as language: Access to thoughts and feelings through stimulus drawings. New York: Brunner-Routledge; UK: Taylor & Francis. Silver, R. (2002). Three art assessments: The Silver Drawing Test, Draw a Story, and stimulus drawings and techniques. New York: BrunnerRoutledge; UK: Taylor & Francis. Silver, R. (2003). Humorous responses to a drawing task, ranging from lethal to playful. Washington, DC: U.S. Department of Education. (ERIC Document Reproduction Service No. ED 474679, CG032289). Silver, R., and Ellison, J. (1995). Identifying and assessing self-images in drawings by delinquent adolescents. The Arts in Psychotherapy, 22, 339—352. Skiba, R. J., & Peterson, R. L. (2000). School discipline at a crossroads. Exceptional Children, 66, 335—347. Turner, C. (1993, November). The Draw a Story in assessment of abuse. Preconference course presentation at the 1993 Conference of the American Art Therapy Association, Atlanta, GA. Ulman, E., and Dachinger, P. (1975). Art therapy: In theory and practice. New York: Schocker Books. Vaillant, G. (2002). Aging well. New York: Little, Brown and Co. Veenhoven, R. (2000/2002). Freedom and happiness: A comparative study in forty-four nations in the early 1990s. In E. Diener & E. Suh (Eds.), Culture and subjective well-being. Cambridge, MA: MIT Press. Wadeson, H. (1980). Art psychotherapy. New York: Wiley.

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Index

A

Attention deficient disorder (ADD), 172 Attention deficit/hyperactivity disorder (ADHD), 58–59, 75, 77–78, 83–85, 87, 96, 101, 132, 134, 136, 164, 171

Ability to Select, Combine, and Represent, 66, 78 Abuse, 58–60, 65–66, 72–73, 79, 82, 84, 86–87, 96, 112–113, 132, 166, 169–171, 186 assessment, 15 sexual, 125, 127–128, 168, 171, 174 Adult psychiatric patients, in clinical and control groups, 153–158 Age differences, 27–29, 35 Aggression harmful to oneself, defined, 8 previous studies of, 7–9 problems of, 3–4 Ambiguous responses, 164 Ambivalent themes, 133 Anger, suppression of, 4 ANOVA, 34–35, 184–185 Antisocial behavior, 4, 9 Anxiety, 75 Appropriate aggression, 7–8, 164 Art therapists, 10, 22–23, 25, 28, 30, 45–46, 55, 57, 121, 125, 142, 170–171. See also Registered art therapists (ATRs) pilot study and, 33 Art, function of, 10 Assaults, 16, 29, 32, 45–46, 47, 122, 170, 177 Athletic competition, 166

B Bass-Dark Questionnaire Index of Aggressiveness, 146–148 Index of Hostility, 146–148 Bipolar disorder, 59, 79, 83, 96, 136, 172 Brain-injured patients, assessment of, 16 Bullying behavior, 3, 72, 130, 165–166, 170, 179 pilot study and, 37 By-standing, elimination of through interventions, 166

C Categories, brain function and, 10 Chi-square analyses, 26–27, 30–32, 44, 186 pilot study and, 34–35 Children and adolescents at risk for harming others, 161–164 identification of, 165–166 Children and adolescents at risk for harming themselves, 167–169 Clinical depression, 25–27 197


198

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Clinical intervention, as opposed to preventive programs, 166 Cognitive content, 23 Cognitive schemas, 15 Cognitive Skills Development Through Art Experiences, 12, 13 Conscious thoughts, 11 Constructive aggression, pilot study and, 37 Covert aggression, 106, 112, 174 gender and, 113 Criminal acts, severe, 141–142, 144 Cultural differences and similarities present study, 162, 175–188 previous studies, 161–162, 175–176

D Damasio, Anotonio, 11 Dangerous neighborhoods, 165 Death with bad outcomes for principal subjects, 4 Defensive aggression, defined, 8 Defiance, 61, 96, 128, 134, 136 Delinquents, 111–112, 141–142, 175 cross-cultural studies and, 184–187 responses contrasted with those of nondelinquents, 145–153 Depressed students' responses aggressive group, 96–98 control group, 91–95 Depression previous studies of, 9–10 problems of, 4 Depressive disorders among students, 4 symptoms of, 9 Destructive aggression, pilot study and, 37 Destructive behavior, 142–143, 152–153 responses as predictors of, 158 Detention facilities, 45, 175 Draw-A-Story (DAS), 15 assessment, reliability of, 173

comparison with SDT, 23 depression and, 143 development of, 13 reason for, 22–23 duration of, 22 evolution of, 22–23 explained, 19–22 Form A, 19–20, 30, 144, 188 pilot study and, 33 reliability of, 24–25 Form B, 21, 45, 144, 188 reliability of, 25 manual, 21, 24 as a means of intervention, 142, 152, 158, 166–167 rating scale, 21–22 reliability of, 24–25 for assessing story content, 144–145, 154 Russian patients and, 143 studies, overview of, 23–24 as a therapeutic technique, 16 validity of, 25–32 Drawing from Imagination task, 13 Drawing tests history of, 142 validity of, 142 Drawing, talk and, 14 Drawings by depressed patients, 14 Drugs abuse of, 79 dealing of, 123, 138, 170 proliferation of, 122 use of, 145–146, 153, 177

E Eating disorders, 60, 125 Emotional content, 23, 29 scale explained, 41– 42 pilot study and, 34–37, 161–162


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Index moderately negative to moderately positive, 77–87 scores of aggressive and nonaggressive students, 90–91 strongly negative, 58–76 Emotional disturbances in adolescents, 30–32 Emotional states, consistencies and changes in, 169–173 Emotionally disturbed (ED), 28 Enjoyment of Life scale, 185 Experimental scales, 27 Explosions, 4

F Fantasies ambivalent, 116, 129 assaultive, 151, 165, 170 expressing callousness toward victims, 165–166 expression of, 4 about using force to harm others, 162 homicidal, 96, 165 about hopelessness or death, 167 hostile, 151 humorous, 109 positive, 116 predatory, 162–163, 165 of rescue, 140 sad, 185 suicidal, 96, 119, 169 about territorial possession, 170 violent, 141–142, 144 wish-fulfilling, 37, 100, 119, 133, 171 Female responses to the drawing task, 112–117 Feminine behavior, stereotypes of, 112 Fighting instinct, 7 Formal Elements Art Therapy Scale (FEATS), 14

199

G Gender therapeutic treatment and, 16–17 differences, 27–29, 143, 173–175 in responses to the drawing task, 112–113, 116, 118 pilot study and, 35–36 similarities, 173–175 George of the Jungle, 85, 135 Godzilla, 50–51 Graphic predictors of violence, 142 Graphic representation as a complex activity, 13 Group socialization of development, theory of, 9–10 Guardedness, expression of, 65

H Hallucinations audio-visual, 125 auditory, 60 Heroes, pilot study and, 37 Homicidal ideation, 59, 83, 136, 140, 168, 172 Homicide, 3–4, 32, 67, 144 pilot study and, 36–37 Hostage situations, 86 Hostile relationships, pilot study and, 36 Human brain, function of, 10 Human reasoning, 11 Humor pilot study and, 37–38 assessment scale age and, 54 gender and, 54 rationale, 48–55 reliability of, 55 ambivalent or ambiguous, 52–54, 109, 163 disparaging, 51–52, 109, 163


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Humor (continued) gallows, 50–52 homicidal, 163 intellectual, 49 lethal, 50–51, 55, 108–109, 111, 163 morbid, 50, 55, 108–109, 111, 163 negative, 55, 108 playful, 53–54, 110, 163 positive, 108–109, 163 resilient, 53–54, 163 self-disparaging, 49, 51–52 sexual, 49 studies of, 54–55 Humorous responses to the drawing task, 106–111 Hunting as a pleasurable sport, 7, 163 Hygiene problems, 64 Hyperactivity, 82, 84

I Impulsiveness, 134, 136, 140, 165 Inappropriate aggression, 7, 164 Indirect aggressiveness, 174 Inhibited temperament, 8–9 Injuries to students, 3 Intercultural studies, 142–143 Intergroup relationships, 9

L Learning disabilities, 66, 75 Learning disabled (LD), 28

M Maladaptive aggression, 164 Male responses to the drawing task, 112 Masculine behavior, stereotypes of, 112 Mental retardation, 144, 153–154, 156–158 Metaphors, 22

Mice, pilot study and, 37 Mighty Mouse, 50, 51

N Narrative content of drawings, 19 Negative self-representation, 9 Negative views, 4 of events, 9 of oneself, 9 Neural mechanisms, 10 Neuroscientists, 10–11, 13 Normative data, 22–23

O Obesity, 64 Offensive aggression, 8 Oppositional–defiant disorder, 83 Organic mental disorders, 14 Outline drawing, effectiveness of, 11 Overt aggression, 113

P Paranoid ideation, 80, 83 Passive-aggressive behavior, 48 pilot study and, 37 Personality disorders, 144, 153–154, 156 Physical punishment, 8 Physical violence, predictive characteristics of, 8 Pilot study conclusions, 161–162 observations, 35 procedures, 33–34 questions and implications, 37–38 results, 34–37 subjects, 34 Posttraumatic stress disorder (PTSD), 65, 87 Predatory aggression, 101–104, 106–107, 112, 120, 162–163


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Index Preventive strategies, effectiveness of, 9 Profanity, 61, 128 Psychopaths, 154

R Rape, 156 Reactive aggression, 99–101, 120, 164–165 defined, 98 Reading Improvement Through Art, 12 Registered art therapists (ATRs), 13, 46. See also Art therapists Relational aggression, 8 Resemblance, 11 Resistance, 65, 125 Response drawings, images in arrows, 63, 106 babies, 110, 113 balloons, 61, 96, 97, 113, 128, 168, 172 birds, 79, 113, 136–137 blood, 106, 109 brides, 60, 74, 85, 87, 92–93, 126–127, 129, 132–135, 163, 171 castles, 58, 62– 63, 78, 80, 83–85, 92, 95–98, 105–106, 113–117, 119, 129, 135, 139, 167–168, 174 catapults, 63 cats, 77, 103–104, 106–108, 110, 113, 125–127, 130–131, 134, 154–155, 162, 168, 170, 174–175 chairs, 183 chickens, 67, 156 chicks, 63, 67–68, 77, 94–95, 104–107, 110–111, 113, 115–116, 119–120, 162, 174–175 clouds, 76, 111, 117, 181 coffins, 148, 182 cowboys, 62, 78, 102–103, 106, 109, 162–163

201 dark skies, 76, 181 dinosaurs, 53–54, 58–59, 64, 69, 74, 78, 82, 84, 96–98, 103, 106, 108, 112, 132–133, 136–137, 162, 167–168, 171–172, 174 dogs, 130–131, 134, 170 doors, 183 dragons, 51–52 escape avenues, 180 eskimos, 104 exterminators, 126–127, 171 fallen leaves, 66 fish, 51–52, 154–155, 157 food chain, 125 food, 126–127, 156 foxes, 134–135, 172 frying-pans (hot), 154–155 guns, 71, 75, 101–102, 109, 164 helicopters, 80, 137–138, 172 hens, 113, 174 heroes, 71, 85, 100, 110, 137–138, 140, 164, 172 houses, 71, 111, 168 jail cells, 119 knives, 61, 67–68, 70–71, 74–75, 78, 92–94, 96–97, 99–100, 102–109, 112–113, 119, 128, 132–133, 139, 148, 162, 165, 168–169, 171–172, 182–183 letters, 183 lions, 135, 172 magic, 171 mailboxes, 66 meadows, 154–155 men smoking pipes, 69, 81, 106, 108, 162 mice, 43, 50, 52–54, 59, 66–67, 73, 77, 81, 83–84, 86, 96–97, 101, 104–105, 110, 113, 115–116, 123–127, 130–131, 136–137, 146–147, 164, 168, 170, 172, 174–175, 177–178, 180 moats, 119


202

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Response drawings, images in (continued) monsters, 50, 58, 84 mountains, 146–147, 180–181 mushrooms, 152, 178–179 parachutists, 58, 67, 71, 74, 78, 80, 83–84, 95–97, 100, 105–106, 113, 123–124, 128, 132–133, 137–138, 167–168, 170–172 poles, 72, 179 princesses, 74, 78, 85, 92, 97–98, 112–115, 116–117, 119, 129, 132–133, 135, 139, 168–169, 171–172, 174 rats, 73, 81, 104, 109, 123–127, 138, 170, 178 refrigerators, 126–127, 134, 154–155 sidewalks, 123–124 snakes, 43, 52, 54, 60, 65–66, 70, 72–73, 87, 93, 97–104, 106, 108–110, 112–115, 119, 123–127, 130–133, 138, 146–147, 152–155, 162–165, 168, 170–171, 174, 177–180 spears, 63 stabbings, 61 sun, 76, 93, 95, 110–111, 117, 181 ships, 157 swords, 63 tables, 183 trees, 66, 79, 86, 92, 94, 101, 103, 110–111, 115, 117, 119, 123–124, 138, 152, 154–155, 168, 170, 178–179 volcanoes, 58–59, 62, 64–65, 76, 82, 84–85, 93, 95–98, 106, 111–113, 115, 119, 132–133, 135–138, 140, 146–147, 162, 167–169, 172, 174, 180–182 warriors, 63 water, 61, 96–97, 113, 128, 157, 168, 172 worms, 119

youth, 99–100, 123–124, 130–131, 152–153, 163, 178–179, 182 Responses categories of, 149–150 distinctive characteristics of, 33 Robbery, 144, 170 Role of art, previous studies of, 10 art therapists who used the DAS assessment, 15–17 observations by art therapists, 13–15 by scientists, 10–13

S Schizophrenia, 14, 144, 153–154 Seizure disorders, 132 Self-destructive behavior, 142–143, 152–153 responses as predictors of, 158 Self-destructive thoughts, 16 Self-Image ambiguous or ambivalent, 64–65, 66 moderately negative, 63 positive, 77 powerful and assaultive, 67–76 scale, 146 pilot study and, 34–37, 161–162 strongly negative, 58–62 scores of aggressive and nonaggressive students, 90–91 Separation anxiety, 84 Sex offenders, 17 Sexual violence, 144 Self-mutilation, 93 Silver Drawing Test (SDT), 13 age and, 44–45 Drawing from Imagination subtest, 22–23, 55, 66, 78 cross-cultural studies and, 175–176 validity of, 26 self-image scale, 42–48 assaultive content and, 47–48


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Index delinquency and, 46–48 discussion and, 46 gender and, 43–48 relationships and, 44, 46 solitary subjects and, 44, 46–47 deaf children and, 22 Predictive Drawing subtest, 22 Russian patients and, 142–143 Social clinical disorder, 186 Social conductive disorder, 145, 176 Social workers, 45, 46 Socioeconomic neighborhoods, 34 Solitary subjects, 27–29, 31 Special education programs, 57, 60, 73, 75, 80–81, 86, 122, 125 Stabbings, 4, 14 Status hierarchies within peer groups, 9, 10 Stimulus drawings, 19, 22–23, 25, 27 alteration of, 66, 96, 121, 123, 125, 168 imitation of, 65–66, 70, 81, 121 pilot study and, 33 Students at risk, identification of, 188 Subtypes of aggressive behavior, 8 Suicidal ideation, 8, 9, 59, 83, 123, 136, 140, 143, 150, 168, 172, 176, 183 Suicide, 4, 15, 22, 145 deliquency and, 153 Sustained prevention programs, 166 Symbols, 11, 22, 121, 125, 162, 167–168, 173, 175

203

T Teachers, 26, 30 Teenage aggression, antecedents of, 9 Temporary moods, pilot study and, 38 Theft, 61, 96, 128, 172, 144 Therapeutic programs, effectiveness of, 38

U Universal laws, 10–11

V Violence in the media, 165 Violent behavior efforts to prevent, 3–4 on the rise, 3 Visual art as a tool for reading development, 12 Visual arts and offender treatment, 17 Visual brain, function of, 10 Visual entities as elements in thought, 12 Visual intelligence, 11 Volcanoes, pilot study and, 37

Z Zero-tolerance programs, 166


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Aggression and Depression Assessed Through Art: Using Draw a Story to Identify Children and Adolescents at Risk

Depression in Children and Adolescents

Handbook of Depression in Children and Adolescents

The Silver Drawing Test and Draw a Story: Assessing Depression, Aggression, and Cognitive Skills

Adolescents at Risk: Prevalence and Prevention

PTSD in Children and Adolescents

Schizophrenia in Children and Adolescents

Autism, Art, and Children: The Stories We Draw

Depression and Attempted Suicide in Adolescents

A Clinical Guide to Sleep Disorders in Children and Adolescents

Treating Child and Adolescent Aggression Through Bibliotherapy

CBT WITH DEPRESSED ADOLESCENTS (Cbt With Children, Adolescents and Families)

Handbook of Depression in Adolescents

Sports Injuries in Children and Adolescents

Children and adolescents with mental health problems

Anxiety Disorders in Children and Adolescents

Personality Disorders in Children and Adolescents

Individual Differences in Children and Adolescents

Risk Factors in Depression

Risk Management: Value at Risk and Beyond

Chronic Disorders in Children and Adolescents

Chronic Disorders in Children and Adolescents

Cognative Therapy with Children and Adolescents

Anxiety Disorders in Children and Adolescents

Normal and Abnormal Fear and Anxiety in Children and Adolescents

Depression in Children

Measuring Suicidal Behavior and Risk in Children and Adolescents (Measurement and Instrumentation in Psychology)

Counselling Children, Adolescents and Families: A Strengths-Based Approach

Clinical Interviews for Children and Adolescents: Assessment to Intervention

A Question of Technique: Independent Psychoanalytic Approaches with Children and Adolescents (Independent Psychoanalytic Approaches With Children and Adolescents)

Aggression and Depression Assessed Through Art: Using Draw a Story to Identify Children and Adolescents at Risk

Depression in Children and Adolescents

Handbook of Depression in Children and Adolescents

The Silver Drawing Test and Draw a Story: Assessing Depression, Aggression, and Cognitive Skills

Adolescents at Risk: Prevalence and Prevention

PTSD in Children and Adolescents

Schizophrenia in Children and Adolescents

Autism, Art, and Children: The Stories We Draw

Depression and Attempted Suicide in Adolescents

A Clinical Guide to Sleep Disorders in Children and Adolescents

Treating Child and Adolescent Aggression Through Bibliotherapy

CBT WITH DEPRESSED ADOLESCENTS (Cbt With Children, Adolescents and Families)

Handbook of Depression in Adolescents

Sports Injuries in Children and Adolescents

Children and adolescents with mental health problems

Anxiety Disorders in Children and Adolescents

Personality Disorders in Children and Adolescents

Individual Differences in Children and Adolescents

Risk Factors in Depression

Risk Management: Value at Risk and Beyond

Chronic Disorders in Children and Adolescents

Chronic Disorders in Children and Adolescents

Cognative Therapy with Children and Adolescents

Anxiety Disorders in Children and Adolescents

Normal and Abnormal Fear and Anxiety in Children and Adolescents

Depression in Children

Measuring Suicidal Behavior and Risk in Children and Adolescents (Measurement and Instrumentation in Psychology)

Counselling Children, Adolescents and Families: A Strengths-Based Approach

Clinical Interviews for Children and Adolescents: Assessment to Intervention

A Question of Technique: Independent Psychoanalytic Approaches with Children and Adolescents (Independent Psychoanalytic Approaches With Children and Adolescents)

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