DIAGNOSTIC DRAWING SERIES
A Standardized Three-picture Art Interview
Assessment of Adults through Art


 30 Years of Research. Proven Validity and Reliability.

About The Diagnostic Drawing Series

(see also www.diagnosticdrawingseries.com)

A THREE-FOLD MISSION

•    Design a standardized art-based assessment tool to meet the needs of professional art therapists in a variety of settings.

•    Develop a research base that supports the tool as well as the clinicians who use it.

•    Introduce a clearly-defined common language for describing therapeutic artwork.

The Diagnostic Drawing Series
(DDS) is a three-picture art interview developed in 1982 by art therapists Barry M. Cohen and Barbara Lesowitz. The DDS Rating Guide (Cohen, 1986/1994) provides clearly defined and illustrated criteria that highlight the structure, not the content, of the drawings. The DDS is not tied to any particular psychological or theoretical model.


First presented in 1983 as a pilot study at the annual American Art Therapy Association conference, the DDS was granted the Research Award by the association that same year for its multicenter collaborative design. The DDS was the first art therapy assessment for adults to be systematically correlated with the nomenclature of the Diagnostic and Statistical Manual of Mental Disorders (DSM) through research. It can be administered individually and in groups with psychiatric and medical populations and has been deemed acceptable in reviews by JCAHO.


The DDS is one of the best-known and more commonly taught art therapy assessments (Hall & Knapp, 1993; Mills & Goodwin, 1991; Mills, 1995; Smitheman-Brown, 1998). It first entered the published literature in 1985, when the Handbook was made widely available and the test itself was profiled in the American Psychological Association’s Monitor. An overview by Cohen in a European psychological journal appeared in 1986, and the first DDS research results were presented in the expressive therapies literature in 1988 (Cohen, Hammer, & Singer). The DDS was featured on National Public Radio’s “All Things Considered” in 1984 and illustrated in two college psychology textbooks in 1987. Approximately 35 DDS studies have been completed to date; most norm different DSM diagnostic groups (see DDS Resource List, Mills, 2000).


MATERIALS, TASKS, ADMINISTRATION, RATING


The Series is made with a 12-color pack of square, soft chalk pastels (Alphacolor brand in North America; Faber Castell elsewhere).  DDSs are drawn on 18"x 24" (45 x 60cm outside the USA), 70 lb. white drawing paper that has a slight tooth, or texture. These artist-quality materials are readily available and are appropriate to the drawing tasks. Complete directions for administering the DDS are described in the DDS Handbook (Cohen, 1985).


The DDS is designed to be administered to people 13 years and older in one 50 minute session; most people finish it in 20 minutes, however, leaving time for discussion with the artist. Administered on a table top, each of the three pictures in a Series has its own piece of paper and specific directive. The pictures must be made in the following order, and the directions may not be paraphrased or changed.


• "Make a picture using these materials" is the directive for the first picture. This is the unstructured task of the Series, and is often referred to as the Free Picture. In this drawing, we typically see a manifestation of the client’s defense system.


• The directive for the second picture is "Draw a picture of a tree.” The tree picture is the structured task of the Series. Thus, the DDS incorporates a well-known projective drawing task that connects it to decades of earlier research.


• The third picture is referred to as the Feeling Picture because its directive is to "Make a picture of how you're feeling, using lines, shapes, and colors." A semi-structured task, it asks the client to communicate about her affective state directly, as well as to represent it in abstract form.


Each of the three pictures in the Series can be rated using the DDS Rating Guide for the presence of a total of 23 criteria. These descriptive, primarily structural, criteria, defined in the Rating Guide (Cohen, 1986/1994), lead the rater toward an empirical (rather than intuitive) graphic profile of the art.


DDSs can be collected individually and in groups, and can be administered to a client repeatedly over time. The varied task structure of a DDS elicits valuable content, structural, and process information that—together—can inform clinicians as to the strengths and psychopathology of the subject. It also provides a rich source of material for treatment planning.


Who may administer the DDS?

The DDS was designed by art therapists for use by art therapists.  However, the DDS may be administered by any mental health professional or trainee who has read the Handbook and is prepared to follow its protocol.


Who may rate and interpret the findings?

It is possible for individuals to train themselves to rate and render interpretations accurately by painstaking study of the Rating Guide and the existing research on the DDS. However, participation in a two-day training on the DDS taught by an approved DDS trainer is highly recommended due to the practical difficulties posed by self-study.  


How can one get trained in the use of the DDS?

Introductory training sessions usually last approximately six hours; advanced level training includes up to six additional hours of material. Participants, whether they are graduate students or seasoned mental health professionals, have preferred the two-day format because it enables them to practice rating, and to competently synthesize their observation skills with DDS research data and clinical scenarios.


RELIABILITY AND VALIDITY STUDIES


Numerous reliability and validity tests of the DDS were reviewed in 1993 by Mills, Cohen, and Meneses.  Five investigations of the validity of the DDS were discussed, and they suggest “high validity with reference to the particular use for which the test is being considered” (p. 85).  The tests were made on the general psychiatric population, both child and adult.  Three interrater reliability studies were reviewed that suggested the Rating Guide had “high reliability with reference to these applications” (p. 86).  Evidence continues to accrue that the DDS and the DDS Rating Guide are reliable and valid instruments for use in clinical assessment and research.  


NORMATIVE STUDIES


DDSs have been collected and grouped according to the DSM diagnoses of subjects and studied for statistically significant graphic profiles which the members hold in common, and which reliably distinguish among the diagnostic groups.  The list of normative studies and replication follows;  samples consisted of adult subjects unless otherwise specified.


Non-hospitalized (Controls)

children & adolescents (Leavitt, 1988; Neale, 1994; Shlagman, 1996)
adults (Cohen, Hammer, & Singer, 1988; Morris, 1995)
seniors (Couch, 1992)

Schizophrenia (Cohen, Hammer, & Singer, 1988; Mills & Yamashita, 1996; Morris, 1995; Ricca, 1992)

Mood disorders
Major depressive disorder
children & adolescents (Leavitt, 1988)
adults (Cohen, Hammer, & Singer, 1988; Morris, 1995)
Dysthymic disorder (Cohen, Hammer, & Singer, 1988)
Bipolar disorder (McHugh, 1997)

Dissociative disorders
Dissociative identity disorder (Fowler & Ardon, 2000; Heitmajer & Cohen, 1993; Kress, 1992;
Mills & Cohen, 1993; Morris, 1995; Ricca, 1992)
Dissociative disorder not otherwise specified (Fowler & Ardon, 2000)

Eating disorders (Kessler, 1994)

Borderline personality disorder (Mills, 1988)

Posttraumatic stress disorder (Des Marais & Barnes, 1993)

Dementia (Couch, 1994)

Adjustment disorder
children (Neale, 1994)

Conduct disorder (Neale, 1994)

NON-DSM RESEARCH BASE


Other groups that have been studied include:

•    Child witnesses to domestic violence
•    Children with documented sexual abuse histories     
•    Women with disturbed body images
•    Chemically dependent adults
•    People who have suffered head injuries
•    Survivors of the atomic bomb at Hiroshima
•    Siblings of hearing-impaired children
•    Military personnel with Gulf War Syndrome
•    Men incarcerated for murder

Other DDS studies include:

•    Outcome study with adolescents and the MMPI-A
•    Color use in the DDS
•    Tree drawings of people with histories of severe trauma
•    Trees as the subject of the first picture in the Series


CROSS-CULTURAL AND MULTICULTURAL STUDIES


Because contributions of drawings to the DDS Archive have come from many psychiatric centers and from art therapists across the United States, a broad range of race and ethnicity is represented among the artists.


DDS studies have been conducted in Japan, Canada, and the Netherlands. A recent study (and complete ePacket translation) has been completed in Latvia. Foreign language translations of the basic DDS protocol are available in Dutch, French, German, Spanish, and Japanese. Translations into other languages are welcome.


THE DDS ARCHIVE


The original DDS Archive is housed in Alexandria, Virginia, a few miles from Washington, DC’s Reagan National Airport. The Archive includes approximately 1500 Series made by Controls and patients representing 30 clinical diagnoses (about 4500 pictures). It also contains Drawing Analysis Forms for most of the collection, and unpublished papers by DDS researchers.  The DDS Archive is always interested in receiving carefully collected samples of five DDSs or more. See clearinghouse address below for details.


A DDS Archive has also been established in the Netherlands for the convenience of European researchers. Correspondence for the Dutch Archive can be directed to the central clearinghouse in the United States and will be forwarded.


Both DDS Archives are available to students, clinicians, and researchers by appointment.


ANNUAL RESEARCH AWARD


To apply for the DDS Research Award of $300, interested parties should send a letter describing their study and how much of it has been completed, along with relevant supporting materials. Applications must be received prior to October 15. Preference is given to studies that are already underway.


TRAINING OPPORTUNITIES AND CONSULTATION


The cost of an introductory day-long training is usually priced at approximately $300, depending on sponsorship and the size of the class.  All materials necessary to begin working with the DDS are distributed to attendees at trainings.

DDS trainings are offered by DDS originator Barry M. Cohen and teaching associates Anne Mills and Kathryn Johnson. To arrange a training, contact Barry M. Cohen of the DDS Project at <landmarc@cox.net>. Sponsoring organizations are often able to raise money with trainings that are also open to counselors, social workers, psychologists, and psychiatrists.


DDS telephone consultation is also available by appointment.

TO ORDER A DDS e-PACKET

DDS e-Packet include the DDS Handbook, Administration Guidelines, the DDS Rating Guide, and other resources for collecting and rating DDSs for clinical use and research. However, e-Packets do not teach how to "read" a DDS. To learn to use the DDS as an aid in 
differential diagnosis, it is necessary to take a weekend training. 

DDS e-Packet orders can be made directly through the <www.diagnosticdrawingseries.com> website, or via email at landmarc@cox.net. Payment via Paypal is preferred.  At $20/ea, orders for DDS e-Packets support the annual DDS Research Award as well as DDS Archive-related expenses. Educational discount licenses (for classes of 10 or more students) can also be arranged.

TRANSLATORS WELCOME

We are always looking for volunteers to help us with foreign language translation of the basic DDS directions.


REFERENCES

For a complete listing of all DDS related publications and studies, please see the DDS Resource List at www.diagnosticdrawingseries.com.







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