A Structured Observation Framework for Evaluating Clients’ Inner Change During and After Art Therapy

Figures & data

Figure 1 The Five Themes with Subthemes

Table 1. Observational Framework of Developmental Inner Change

Therapeutic Alliance
Sub-theme	First Observation	Developmental Stage 1	Developmental Stage 2	Developmental Stage 3
Attachment secure, insecure-ambivalent, insecure avoidant or insecure-disorganized	………………. ………………. ……………….	Unsure in the contact Example: Pays attention to the reactions of the therapist. Tests the trustworthiness of the therapist. Date … … …	Contact making Example: Shows interest in the therapist. Discusses what is happening in the therapy room and dares to express dissent. Date … … …	Attached to the therapist Example: Shows joy, playfulness, and engagement. Gives an impression of confidence. Date … … …
Trust in the therapist and situation	………………. ………………. ……………….	Carefully begins to build a relationship Example: Asks for advice. Shares parts of her/his life. Seeks affirmation. Shows some controlling behavior. Date … … …	Showing incipient trust Example: Is active and sometimes spontaneous. Shares parts of her/his private life. Date… … …	Exhibiting trust Example: Is calmer and more relaxed. Is more proactive and interactive. Shares difficult emotional experiences. Date … … …

Table

Creating
Sub-theme	First Observation	Developmental Stage 1	Developmental Stage 2	Developmental Stage 3
Experimentation Playfulness, creativity	………………. ………………. ……………….	Investigating Example: Tries different materials, tools, colors, and shades. Tests forms and movements. Discovers possibilities and limitations. Date … … …	Risk-taking Examples: Challenging oneself and usual patterns. Changes choice of material, technique, and symbolic language. Date … … …	Changing creation Example: Enjoys sensory experiences. Changes the image, cuts out, paints over, adds, removes. Playful and spontaneous creation. Date … … …
Exploration Explores the content of the image	………………. ………………. ……………….	Interested in the content of the image Example: Discovers that the image has a personal content and meaning. Is surprised by own images. Date … … …	Beginning of reflecting Example: Shows signs of reflective distance. Is attracted to the symbolic language. Date … … …	Shows reflective distance Example: Associates freely. Is amused by exploring the image. Can see her/himself from the outside and others from their inside (Mentalization). Date … … …

Table 1. Continued

Affect-Awareness
Sub-theme	First Observation	Developmental Stage 1	Developmental Stage 2	Developmental Stage 3
Bodily expression of feelings Nonverbal expressions in image	………………. ………………. ……………….	Access to affects Example: Shows awareness of bodily reactions and behaviors during creation. Sometimes exhibits discomfort. Date … … …	Tolerance of emotions and feelings Examples: Shows tolerance of affects. Continues creation despite evoked affects. Seems to understand them as emotions and feelings. Date … … …	Non-verbal expressions Example: Creates freely, evokes affects and shares emotions and feelings in the image. Reflects on these experiences. Date … … …
Verbal expressions of feelings Identifying and describing feelings	………………. ………………. ……………….	Pays attention to emotions and feelings Example: Observes emotions and feelings, identifies them, and can see them in the image. Date … … …	Reflects on emotions and feelings Example: Interprets and understands feelings aroused during the image-creation process. Starts to put words to them. Talks about different feelings. Date … … …	Handles strong emotions and feelings Example: Is able to harbor strong emotions. Understands the importance of communicating emotions and feelings. Reflects freely on feelings in the past and present. Seems revitalized. Date … … …

Table

Self-Awareness
Sub-theme	First Observation	Developmental Stage 1	Developmental Stage 2	Developmental Stage 3
Insight In-depth knowledge of own inner life	………………. ………………. ……………….	Surprise Example: Becomes surprised that the image reveals unknown material. Unexpected emotional memories appear in the image. Date … … …	Insight Examples: Starts to understand the image’s mirroring of the inner life, relationships, and life situations. Expresses self-empathy. Date … … …	Recognizes connections between image and inner life Example: Consciously uses the image to express emotions and feelings. Improved awareness of inner processes and impact on own external life and behaviors. Date … … …
Sub-theme	First Observation	Developmental Stage 1	Developmental Stage 2	Developmental Stage 3
Self-image A more realistic image of oneself	………………. ………………. ……………….	Reframing oneself Example: Begins to use other words when describing her/himself. Can see opportunities to make positive changes in her/himself. Date … … …	Accepting oneself Example: Expresses change in self-image. Can identify resources in her/himself. Can see both strengths and weaknesses. Date … … …	Improved self-image Example: Shows understanding and tolerance of her/himself. Affirms the meaning of own art creation. Can joke about her/himself. Date … … …
Wider perspective Changing perspective on own life in the past, present, and future	………………. ………………. ……………….	Attentive to changes Example: Can feel and see changes appearing and see them confirmed in the image. Starts to become aware of reasons for own behavior. Date … … …	Reshaping the image Example: Creates change through reformulating the image using color and shape. Revaluates and expresses understanding of why changes are necessary. Date … … …	Changed behavior Example: Sees new perspectives in the image and different aspects of her/himself. Transfers the content of the therapy process to everyday life. Date … … …

Table

Ego-Strength
Sub-theme	First Observation	Developmental Stage 1	Developmental Stage 2	Developmental Stage 3
Authenticity Changes toward an authentic self	………………. ………………. ……………….	Reflective Example: Starts to reflect on the images and on several sides of her/himself. Seeks confirmation of own personality in the images. Date … … …	Coherence Example: Increased coherence of image and narratives. The image is more integrated, colors and elements are associated. Date … … …	Openness Example: Expresses honesty and genuineness. Has confidence in her/his own personality, values, and spirit. Recognizes her/himself in the image. Date … … …
Autonomy, e.g., independence Trust in oneself, acting from own values and interests	………………. ………………. ……………….	Responsibility for own process Example: Less reserved. Talks about choices of art materials and the emerging image. Is sensitive to own feelings and to the art process. Date … … …	Interested in other’s opinion Example: Explores own values and opinions. Open to the therapist´s comments. Date … … …	Hopes for the future Example: Expresses faith in the future. Trust’s own ability has the strength to make decisions. Sees new opportunities. Is revitalized, and harmonious. Date … … …