Art Therapy Assessments

Art-based assessment instruments are used by many art therapists to determine a client's level of functioning; formulate treatment objectives; assess a client's strengths; gain a deeper understanding of a client's presenting problems; and evaluate client progress (Betts, 2006).

Art therapists are often expected to use assessment tools for client evaluation. Art therapists most often use instruments that are known in the field as art-based assessments or art therapy assessments. These two terms are used interchangeably throughout this manuscript, as are the words assessment, instrument, test, and tool (Betts, 2006).

As a reminder, assessments and rating scales are imperfect. It is stated across the clinical board, however, that standardized methods of measurement are essential to the progression of research as well as client health.

“It is the consensus of most mental health professionals, agency administrators, and insurance companies that regardless of the formality or structure, assessment—and reassessment at appropriate times—constitutes the core of good practice” (Gantt, 2004, p. 18). Furthermore, funding for research, treatment, or programming is only provided to those who demonstrate the efficacy of treatments or interventions. Standardized assessments are fundamental to all disciplines that deal with intervention and change, including the field of art therapy (Betts, 2006).

In this portion of the guide, I discuss commonly utilizedArt Therapy assessments, key domains of assessment in Art Therapy, and resources for these assessments.

Commonly Utilized Art Therapy Assessments

  1. Projective Drawing Assessments

    Open-ended, symbolic, meaning emerges through projection

    • House-Tree-Person (HTP) - The client draws a house, tree, and person: often used to explore self-image, family dynamics, and environment/attachments to home life.

    • Draw-A-Person (DAP) - Evaluates aspects of self-image, development, and functioning.

    • Draw-A-Person-In-The-Rain (DAP-R) - Focuses on coping skills and resilience under stressors.

    • Goodenough-Harris Drawing Test - The test evaluates cognitive development and, to a lesser extent, emotional adjustment by analyzing the accuracy, detail, and complexity of a human figure drawing.

    • Kinetic Family Drawing - The client draws their family doing something together; This can provide insights into roles, relationships, and attachments.

    • Tree Drawing Test (Baum Test) - A Useful Aid to Diagnose Cognitive Impairment

    Clinical focus:
    Self-image, ego development, emotional functioning, internalized experience

    Structured Art Therapy Assessments

    Standardized prompts, consistent administration, research-supported

    • Diagnostic Drawing Series (DDS) - help increase insight and awareness of the issues, help improve the patient’s judgment, cope with stress, work through events that have been traumatic, and embrace creativity to become familiar with the art of self-expression.

    • Formal Elements Art Therapy Scale (FEATS) - FEATS focuses on how people draw, or the process of drawing, rather than the resulting content of the drawing.

    • Person Picking an Apple from a Tree (PPAT) - Its straightforward nature helps clients project their inner feelings, relationships, and self-perceptions onto paper, providing valuable diagnostic and therapeutic insights.

    • Silver Drawing Test (SDT) - bypasses the spoken or written word through drawings to assess cognitive, developmental and emotional functioning

    • Road Drawing Test - In drawing a road, it allows individuals to explore different aspects of their lives while engaging in a creative process through the use of symbolic metaphor.

    Clinical focus:
    Mood, cognition, coping, organization, psychological functioning

    Trauma-Focused & Attachment-Informed Assessments

    Emphasize safety, containment, implicit memory, and relational security

    • Bird’s Nest Drawing (BND) - helps identify a person’s attachment style and may provide insight into the person’s past attachments.

    • Mandala Assessment Research Instrument (MARI) - It is a comprehensive system that uses symbols, known as mandalas, to reveal the inner truth and reality of the subject as it is – not what the ego filters of consciousness would want it to be.

    • Safe Place Drawing - This exercise involves creating a drawing of a place where you feel safe, calm, and at peace.

    • Bridge Drawing - Bridge Drawing is a projective assessment that may provide insight into a person’s functioning, perception of his/her environment as a stable place, and perception of movement or stagnancy.

    • Container Drawing - One goal of the American psychologist or psychotherapist, in case conceptualization, is to identify the nature and strength of a person's “ego container,” particularly which parts may be weaker than other parts, in order to give attention to which exact functions of self need support. From a strengths-based perspective, celebrating which parts of self are intact or stronger can help to restore positive self image.

    Clinical focus:
    Safety, regulation, attachment, resilience, trauma integration

    Self, Identity & Relationship Assessments

    Explore interpersonal roles, attachment patterns, and relational perception

    • Kinetic Family Drawing (KFD) - A projective assessment technique developed by Burns and Kaufman in 1970 to evaluate a child's self-concept and perception of family relationships.

    • Family Drawing Test - The assessment is made according to some indicators that suggest certain patterns of attachment (e.g., lack of color or distance between family members suggests an avoidant attachment, and unusually small figures or exaggeration of body parts suggests an ambivalent attachment.)

    • Relational Map Drawing -

    • Genogram Art Assessment -

    • Self-Portrait Assessment -

    Clinical focus:
    Attachment, roles, boundaries, identity development

    Emotional, Cognitive & Executive Functioning Assessments

    Assess processing, planning, affect regulation, and problem-solving

    • Silver Drawing Test (SDT)

    • PPAT

    • Road Drawing Test

    • Draw a Problem / Draw a Solution

    Clinical focus:
    Executive function, coping strategies, emotional regulation

    Narrative & Projective Storytelling Assessments

    Integrate visual expression with meaning-making and verbal narrative

    • Draw-A-Story (DAS)

    • Comic Strip Narrative Assessment

    • Life Story Drawing

    • Six-Part Story Method (art adaptation)

    Clinical focus:
    Identity, internal conflicts, themes, meaning-making

    Qualitative, Humanistic & Strength-Based Assessments

    Non-pathologizing, reflective, client-centered

    • Art-Based Self-Assessment

    • Goal-Oriented Art Assessment

    • Emotion Color Mapping

    • Strengths Shield Drawing

    Clinical focus:
    Insight, empowerment, therapeutic progress

    Important Notes to Keep in Mind

    • Art therapy assessments are exploratory, not diagnostic

    • Ethical use requires:

      • Cultural humility

      • Client-led meaning

      • Developmental awareness

      • Relational context

    • Many assessments are used informally to guide treatment rather than score outcomes

    • Interpretation should privilege process over product

Key Domains of Assessment in Art Therapy

  1. Process how the art was created

    • How did the client engage in art creation? Did the client dive in, hesitate to start, or avoid materials all together?

    • What was the client’s energy/movement like? Was their application of materials forceful, light, controlled, or chaotic?

    • What were the choices that the client made? Were art materials chosen deliberately, impulsively, or not at all?

    • How was the clients flow vs/ resistance? was the client absorbed or frustrated/blocked by the process of creativity?

  2. Use of creative materials

    • Reminder: Specific art materials (clay, paint, pencil/resistive, fluid) fit into the different ETC levels (sensory, affective, etc.).

    • Did the client explore any sensory (kinesthetic) qualities such as scribbling or smudging the art?

    • Were art materials controlled by the client, such as fine lines, neat coloring, or uncontrolled, such as spills or tearing?

    • Was the client comfortable with mixing media materials or did they stick to one only?

  3. Formal Elements (Visual qualities)

    • Line work: Were the lines jagged, soft, repetitive, ridged, etc.?

    • Color: Were their use of colors muted, bright, symbolic, or have emotional overtones?

    • What was their use of space and composition? was it crowded, isolated, centered, balanced, or fragmented?

    • What did the client’s form/structure consist of? Realistic vs abstract or organized vs. chaotic?

  4. Content (What they depicted)

    • Did the client utilize symbols, metaphors, or themes such as (houses, trees, figures, paths)?

    • Is there a presence or absence of people, themselves, or specific relationships in their artwork?

    • Is there a use of a narrative, fantasy, or abstract imagery in their artwork?

    • Are there reoccurring motifs across various sessions?

  5. Clients Personal Meaning Making

    • What does the client mention about their artwork?

    • Does the Client identify with any aspects of their image or not, and why?

    • Does their artwork reflect current concerns, emotions, or internal conflicts that the client is going through?

    • Reminder: The client’s interpretation often differs from the therapist’s initial impressions, which means that the client’s perspective ALWAYS takes priority.

Approaches and Tools for Assessment

  • Phenomenological Approach: Describing the artwork without judgment, focusing on “what is” (e.g., “I notice the figure is in the corner of the page, tell me about that?”

  • Formal Analysis Tools: Specific rating scales that Art Therapists (or those who are trained to administer them) can utilize with clients for structured evaluation), such as the FEATS (Formal Elements Art Therapy Scale).

  • Projective Drawing Tests: These are standardized assessments (e.g., House-Tree-Person, Kinetic Family Drawing). These are utilized cautiously, and interpretation must consider the client’s context. The point is not over-pathologizing the client or searching for diagnoses.

  • ETC (Expressive Therapies Continuum) Framework: This places the client’s engagement within the continuum, focusing on the different levels of art creation such as (sensory, affective, cognitive, symbolic, etc.).

Ethical Principals in Art Assessment

  • Avoid over interpreting the client’s artwork. Artwork does not have universal meaning (e.g., black does not always mean “depression” or “evil”).

  • Make the art process client centered. The Client’s explanation and interpretation of their artwork is the most important part of the experience. You will learn the most by listening and focusing on their experience instead of your own.

  • Cultural sensitivity is one of the main things to keep in mind during assessment as well as being a competent counselor. Symbols/colors/forms can hold various meanings across cultures.

  • Avoid imposing your own interpretations of the artwork. Do not “read into” the client’s use of colors, shapes, lines, etc., as universal meanings.

  • Respect your client when they don't want to talk about their artwork or experience. Pushing this can damage rapport building, thus leaving you to repair the relationship.

  • Always link your directives or assessments back to the client’s treatment plan goals (e.g., emotional regulation, self expression, insight, building self-esteem, identity exploration, etc.).

  • Reminder: focus on the PROCESS OVER THE PRODUCT. Assessment is the same. What are you noticing about their EXPERIENCE as they traverse the assessment?

Healing happens during the process of art creation, NOT only the end result.

Resources/Websites for Art Therapy Assessments

Betts, D. J. (2006). Art therapy assessments and rating instruments: Do they measure up? The Arts in Psychotherapy, 33(5), 422–434. https://doi.org/10.1016/j.aip.2006.08.001

Donna Betts, PhD, ATR-BC, FSAScot. (2025, January 20). Assessment in Art Therapy. Donnabettsphd.wordpress.com. https://donnabettsphd.wordpress.com/2025/01/20/assessment-in-art-therapy/

https://www.feats.pro/

https://en.wikipedia.org/wiki/House-Tree-Person_test

https://en.wikipedia.org/wiki/Kinetic_family_drawing

https://en.wikipedia.org/wiki/Draw-a-Person_test

https://pubmed.ncbi.nlm.nih.gov/?term=person+picking+an+apple+from+a+tree+art+therapy

https://www.diagnosticdrawingseries

https://www.mandalaproject.org/

https://www.routledge.com/Silver-Drawing-Test-and-Draw-A-Story/Silver/p/book/9780415957670

https://www.wpspublish.com/draw-a-story-das

https://stephanielbrooke.com/tools.html

https://stephanielbrooke.com/tools.html

https://stephanielbrooke.com/tools.html

https://stephanielbrooke.com/tools.html

https://en.wikipedia.org/wiki/Bridge_drawing

https://stephanielbrooke.com/tools.html

https://stephanielbrooke.com/tools.html

https://arttherapy.org

Assessments, Questionnaires & Checklists

Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)

Patient Health Questionnaire-9 (PHQ-9) (Depression)

Patient Health Questionnaire-2 (PHQ-2) (Depression)

GAD-2 (Anxiety)

McLean Screening Instrument for BPD (MSI-BPD) (NovoPsych.com)

Pediatric Symptom Checklist

Mood Disorder Questionnaire (MDQ) (NovoPsych.com)

Attachment Style Questionnaire – Short Form (ASQ-SF) (NovoPsych.com)

PTSD Checklist for DSM-5 (PCL-5) (NovoPsych.com)

State Difficulties in Emotion Regulation Scale (S-DERS) (NovoPsych.com)

Phobic Stimuli Response Scale (PSRS) (NovoPsych.com)

Strengths and Stressors (SAS) (NovoPsych.com)

You can find more assessments at these sites:

NovoPsych.com

Emotional Check-ins

An emotional check-in is a brief process used in therapy, education, groups, or personal reflection to help a person identify, name, and acknowledge their current emotional state. It may seem simple, but it serves several important psychological and therapeutic functions.

1. Builds Emotional Awareness

Emotional check-ins help clients notice and label their feelings, which is a core component of emotional intelligence.

When individuals regularly pause to ask “What am I feeling right now?”, they strengthen:

  • emotional vocabulary

  • self-reflection

  • awareness of internal states

In therapies such as Dialectical Behavior Therapy, recognizing emotions is the first step toward regulating them.

2. Supports Emotional Regulation

Once a feeling is identified, it becomes easier to manage.

For example:

  • “I feel overwhelmed” → take a grounding break

  • “I feel anxious” → use breathing or mindfulness

  • “I feel angry” → pause before reacting

Research shows that naming emotions can reduce their intensity (“name it to tame it”).

3. Improves Communication and Trust

In groups, classrooms, or therapy sessions, check-ins:

  • create psychological safety

  • normalize emotional expression

  • help clinicians understand clients’ needs

This helps prevent misunderstandings and strengthens therapeutic rapport and alliance.

4. Helps Therapists or Facilitators Gauge Readiness

In therapeutic settings like Art Therapy, an emotional check-in helps the therapist determine:

  • The client’s current mood

  • The client’s level of distress

  • Emotional capacity for the session

  • Possible context for current mood

  • Talking point to break the ice

This can influence the type of intervention used as well (e.g., grounding vs. deeper processing).

5. Prevents Emotional Build-Up

Unchecked emotions can accumulate and eventually lead to:

  • Emotional overwhelm

  • Burnout

  • Reactive behavior

  • Outbursts

Regular check-ins allow emotions to be processed in small, manageable moments.

6. Strengthens Mind-Body Connection

Emotions often appear in the body (tight chest, stomach tension, fatigue).
Check-ins help people notice physical cues connected to emotional states, which supports mindfulness practices.

Example Emotional Check-In Questions

A check-in can be very simple:

  • “What emotion am I feeling right now?”

  • “If my mood was a color, what would it be?”

  • “Where do you feel this emotion in my body?”

  • “What might this feeling need from you?”

  • “What number (1–10) is the intensity of your mood right now?”

In art therapy, check-ins might include:

  • Choosing a color that represents a feeling

  • Drawing a quick emotional symbol

  • Selecting an emotion card

In trauma-informed or art therapy settings, emotional check-ins are especially important because they:

  • Help clients stay within their window of tolerance

  • Build safety before deeper emotional work

  • Support grounding and stabilization.

5 Easy Emotional Check-Ins - Club Experience Blog (A Youth Development Resource From Boys & Girls Clubs of America)

Three Powerful Art Therapy Ice-breakers to Start Any Conversation - Emojar - Blog by: Dr. Ria Das | Art-based Therapist | Counselling Psychologist