Date of Submission

2024

Degree Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

Department Chair

Stephanie Felgoise, PhD, ABPP

First Advisor

David Rubenstein

Second Advisor

Leslie Fernandez

Third Advisor

Stephanie Yoder

Abstract

The use of art and drawing has been known to be a well-suited assessment and treatment modality with children, especially children who have been traumatized, due to their hesitancy or inability to verbalize complex emotional thoughts and experiences. The use of projective arts-based assessments can be an effective approach for facilitating engagement, reducing resistance, and offering an alternative for self-expression that can provide insight into a child’s experience that words alone cannot. This study aimed to examine whether specific graphic indicators of the House-Tree-Person (H-T-P) assessment correlated with particular clinical or psychometric criterion according to the Clinician Administered PTSD Scale for DSM-5 – Child/Adolescent Version (CAPS-CA-5). The study also aimed to examine whether themes emerged in regard to drawing characteristics depending on the type of traumatic experience endorsed. The study demonstrated good interrater reliability (κ = .65). It was found that the most common drawing indicators of paper-based drawings, a weak chin, turning paper while drawing, jagged lines, and omission of a chimney were suggestive of feelings of inadequacy, depression, withdrawal, anxiety, and aggression. Consistent with previous literature, characteristics, such as disorganization of body parts, omissions, and ambiguous human figures, were evident in drawings of participants who endorsed experiencing a history of sexual and/or physical abuse. Although there were inherent limitations to the corroboration of drawings being predictive of symptoms of Posttraumatic Stress Disorder (PTSD), it is apparent that the severity of internalizing and externalizing behaviors, such as anxiety, depression, withdrawal, and aggression, may influence the extent of characteristics found in H-T-P drawings. Thus, the findings of this study emphasize that drawings alone cannot be relied upon as a sole diagnostic tool, but rather a less demanding, cost-efficient measure that can provide strong indications for follow-up assessment and treatment interventions, particularly around trauma.

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