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THE ART THERAPISTS’ PRIMER
Image by Michele Jenco.
ABOUT THE EDITOR
Ellen G. Horovitz, Ph.D., ATR-BC, LCAT, ERYT 500, C-IAYT is

Professor Emerita and former director/founder of the graduate Art
Therapy program at Nazareth College. I have 40 years of experience
with myriad patient populations (aged 3–96) as a licensed art thera-
pist, psychotherapist, registered yoga teacher, and a certified yoga
therapist (iayt.org). Ellen has over 40 years of experience with myriad
patient populations, specializes in family art therapy and yoga thera-
py, and has researched, published and presented internationally.
Doctor Horovitz is the author of numerous articles, book chapters and
the following books: Spiritual Art Therapy: An Alternate Path; A Leap of
Faith: The Call to Art; Art Therapy As Witness: A Sacred Guide and Visually
Speaking: Art Therapy and the Deaf; Digital Image Transfer: Creating Art
With Your Photography and co-editor of the Yoga Therapy: Theory and
Practice and Head and HeART: Yoga Therapy and Art Therapy Interventions
for Mental Health Professionals. She is past President-Elect of the
American Art Therapy Association (AATA) and served on its board
for over 12 years. Doctor Horovitz incorporates yoga therapy and art
therapy with her patients in private practice and is the COO of Open
Sky Yoga Therapy Training at Open Sky Yoga Center in Rochester,
NY.
Published and Distributed Throughout the World by
CHARLES C THOMAS • PUBLISHER, LTD.

2600 South First Street
Springfield, Illinois 62704
This book is protected by copyright. No part of

it may be reproduced in any manner without written
permission from the publisher. All rights reserved.
© 2020 by CHARLES C THOMAS • PUBLISHER, LTD.
ISBN 978-0-398-09338-9 (paper)

ISBN 978-0-398-09339-6 (ebook)
First Edition, 2009

Second Editon, 2014
Third Edition, 2020
Library of Congress Catalog Card Number: 2020017592 (print)

2020017593 (ebook)
Cover art courtesy of Michele Jenco
With THOMAS BOOKS careful attention is given to all details of manufacturing

and design. It is the Publisher’s desire to present books that are satisfactory as to their
physical qualities and artistic possibilities and appropriate for their particular use.
THOMAS BOOKS will be true to those laws of quality that assure a good name
and good will.
Printed in the United States of America

MM-C-1
Library of Congress Cataloging-in-Publication Data

Names: Horovitz, Ellen G, editor.
Title: The art therapists’ primer : a clinical guide to writing assess-
ments, diagnosis, and treatment / edited by Ellen G. Horovitz,
PH.D., ATR-BC, LCAT, ERYT 500, C-IAYT.
Description: Third edition. | Springfield, Illinois : Charles C Thomas,
Publisher, Ltd., 2020. | Includes bibliographical references and
index.
Identifiers: LCCN 2020017592 (print) | LCCN 2020017593 (ebook) |
ISBN 9780398093389 (paperback) | ISBN 9780398093396 (ebook)
Subjects: LCSH: Art therapy.
Classification: LCC RC489.A7 A766 2020 (print) | LCC RC489.A7
(ebook) | DDC 616.89/1656—dc23
LC record available at https://lccn.loc.gov/2020017592
LC ebook record available at https://lccn.loc.gov/2020017593
For my husband, Eugene (Jay) V. Marino, Jr. and my children,
Kaitlyn, Bryan, Nick and Paolo, whose assessment of me is unending.
E.G.H.
ABOUT THE CONTRIBUTORS
James Albertson, MS received his Masters of Science in Creative Arts

Therapy from Nazareth College of Rochester in May, 2008. James was the
recipient of the 2008 Alumni Award at Nazareth College of Rochester.
James facilitated art therapy workshops at the Annual World Children’s Art
Festival in Washington, D.C. and participated in an international internship
experience conducting art therapy in Tanzania, East Africa. Prior to his en-
rollment in the Creative Arts Therapy program at Nazareth College, James
served as a United States Peace Corps Volunteer in Niger, West Africa and
subsequently, provided extensive consulting services for the Carter Center,
Inc. in Ghana and Mali. He is currently employed by the Carter Institute
and is working as a primary therapist in Sudan, Africa.
Jacob M. Atkinson, MS has worked as an Art Therapist/Clinical Case Man-

ager for the Center for Psychosocial Development in Anchorage, Alaska. He
graduated with his Masters of Science in Creative Art Therapies at Nazareth
College in Rochester, New York. Jacob completed his undergraduate work
at Utah State University, where he received his Bachelor of Fine Arts with
an emphasis in printmaking. Jacob also co-authored a chapter with Dr. Ellen
Horovitz in her book (2007) Visually Speaking: Art Therapy and the Deaf.
Jocelyn J. Berg received her Bachelor of Science from SUNY Geneseo with
Speech Pathology/Communicative Disorders as her major and Studio Art as
a minor. She took time off from school to work as a Level III certified
Teacher’s Assistant in a ninth through twelfth grade 12:1:1 Special Education
classroom for seven years. After having the opportunity to work with her stu-
dents on creative projects in individual and group settings, she chose to re-
turn to school and entered Nazareth College’s Graduate Creative Art Ther-
apy Program. She is currently working with emotionally disturbed at-risk
adolescents in the Rochester area. She hopes to eventually work with the
Developmentally Disabled population with a focus on individuals with
Autism Spectrum Disorders. She earned her Masters Degree in May, 2015.
vii
viii The Art Therapists’ Primer
Donna J. Betts, Ph.D., ATR-BC was Assistant Professor of Art Therapy at

the George Washington University and President-Elect of the American Art
Therapy Association. She has researched, published and presented interna-
tionally on a variety of topics, including assessment and research. In 2006,
Dr. Betts published her seminal article, Art Therapy Assessments and Rating
Instruments: Do They Measure Up? She is also the Editor of the Charles C
Thomas publication, Creative Art Therapies Approaches in Adoption and Foster
Care: Contemporary Strategies for Working with Individuals and Families, and
Director of the International Art Therapy Research Database,www.artthera-
pyresearch.com.
Aimee Beyette, MS completed her Master of Science in Creative Arts

Therapy from Nazareth College of Rochester in May, 2015. She received a
Bachelor of Arts in Studio Art from William Smith College in May, 2010.
After attaining her B.A., Aimee interned with an art therapist at the Albright
Knox Art Gallery and attained an Arts in Healthcare certificate from Univer-
sity at Buffalo. She worked as an assistant kindergarten teacher, life skills spe-
cialist, after school art instructor, and summer camp art director. Aimee also
sells commissioned artwork. Her current clinical experiences involve work-
ing with a grieving family, seniors with Alzheimers, and inner-city school
children. Aimee hopes to provide art therapy services to the medical field
and elderly.
Shawna Boynton, MS received her Master of Science in Creative Arts

Therapies from Nazareth College and her Bachelor of Fine Arts from the
Rochester Institute of Technology. She is currently working with people with
disabilities in the Rochester area in the therapeutic, vocational, recreational,
and residential realms. She bases much of her practice in mindfulness psy-
chology and, in her free time teaches courses that intertwine meditation and
creative arts.
Sarah L. (Eksten) Brasse, MS, ATR received her Master of Science in

Creative Arts Therapy from Nazareth College in May, 2008. She also com-
pleted her undergraduate in Psychology at Nazareth College of Rochester.
Sarah has vast experience working with children described as “at-risk,” chil-
dren and adults diagnosed with psychiatric disorders, children with Autism,
the developmentally delayed population, and those that have experienced
trauma. Currently she works as the Autism Skill Building Program Coor-
dinator for CDS Monarch’s Family Support Services designing, managing,
and implementing an after-school program to help individuals on the Autism
spectrum increase their skill development within a play therapy setting. She
also is the Art Therapist for the Warrior Salute Program providing individ-
About the Contributors ix
ual and group art psychotherapy to veterans with TBI, PTSD, and addic-
tions, as a means of addressing relationship issues, coping skills, behavioral
management, personal growth and skill building. Sarah co-edited the first
edition of The Art Therapist’s Primer: A Clinical Guide to Writing Assessments,
Diagnosis, and Treatment, and is a member of the American Art Therapy
Association and Treasurer for the Western New York Art Therapy Associa-
tion.
Day Butcher, MS received her Master of Science in Art Therapy from

Nazareth College of Rochester in May, 2008. Ms. Butcher graduated from
Roberts Wesleyan College, Rochester, New York with a Bachelor of Science
in Art Education in May, 2003. Currently she is working on a Doctorate in
Education in Counseling from the University of Rochester. Although she has
worked with a variety of populations using art therapy, her passion lies in
working with individuals with Autism Spectrum Disorder. She is the Art
Therapy Department Chair at Spectrum Creative Arts in Rochester, NY.
Marcia Sue Cohen-Liebman, PhD, ATR-BC, LPC is a Forensic Art

Therapist. Her specialization in the realm of Forensic Art Therapy emanat-
ed from her work as a child forensic interviewer. Marcia’s work extended the
modality beyond diagnosis/evaluation and treatment/intervention into the
realm of investigation. Marcia has written extensively on Forensic Art Therapy
and related topics. She developed a course for graduate level students on
Forensic Art Therapy while an adjunct Assistant Clinical Professor at Drexel
University where she taught from 1998-2017. Marcia provides consultation
for forensic cases as well as guidance for art therapists engaged in judicial
proceedings.
Caitlin Farmer Cassella, MS completed her master’s in the Creative Arts

Therapy program at Nazareth College of Rochester in May, 2015. She com-
pleted her undergraduate with a double major in Studio Arts and Creative
Writing at the University of Rochester with an emphasis on printmaking and
visual storytelling.
Erin Dougherty, MS received her Master of Science in Art Therapy from

Nazareth College of Rochester in May, 2015. For her undergraduate work,
she has a certificate of completion for Communication Design from Pratt
Munson-Williams-Proctor and a BS in Art Therapy from Springfield College.
Her clinical experience includes internship work with multiple populations
such as inpatient substance abusers, underprivileged children and adoles-
cents, children with various developmental disabilities, children on the
autism spectrum, and adults with traumatic brain injuries.
x The Art Therapists’ Primer
Amy Miller Hoag, MS completed her master’s in the Creative Arts

Therapy program at Nazareth College of Rochester, New York in May, 2014.
She completed her undergraduate work at Stephen F. Austin State University
of Nacogdoches, Texas in 1986 earning a Bachelor of Arts in Business
Communications and minor in art and taught photography techniques. After
a career of incorporating art and business, she pursued her dream of using
art to help others heal and prosper. Using clinical art therapy to treat the
effects of trauma with emotionally disturbed children at Crestwood-Hillside
of Rochester, NY, she became grounded in the neuroscience research of Dr.
Bruce Perry as evidence of the efficacy of art therapy as a treatment modal-
ity for trauma. She pursued CASAC licensure to combine with ATR licen-
sure to work in the field of addictions. She developed a creative arts program
for young children of families affected by addiction to be used as an adjunct
to family therapy. She is a member of the American Art Therapy Association
and the Western New York Art Therapy Association.
Ellen G. Horovitz, Ph.D., ATR-BC, LCAT, ERYT 500, C-IAYT is Profes-

sor Emerita and founder of the Graduate Art Therapy and the Art Therapy
Clinic at Nazareth College of Rochester. She has had over 40 years of expe-
rience with myriad patient populations, specializes in family art therapy and
yoga therapy, and has researched, published and presented internationally.
Dr. Horovitz is the author of numerous articles, book chapters and the fol-
lowing books: Spiritual Art Therapy: An Alternate Path; A Leap of Faith: The Call
to Art; Art Therapy As Witness: A Sacred Guide and Visually Speaking: Art Therapy
and the Deaf; Digital Image Transfer: Creating Art With Your Photography; Yoga
Therapy: Theory and Practice and Head and HeART: and Yoga Therapy and Art
Therapy Interventions for Mental Health Professionals. Dr. Horovitz is in private
practice (http://www.yogartherapy.com), incorporates yoga therapy and art
therapy with her patients and is the COO for Open Sky Yoga Therapy
Training at Open Sky Yoga Center in Rochester, NY.
Benjamin Keipper, MS received his Bachelor of Arts Degree in Art Studio

at the State University of New York at Geneseo where he focused on water-
color painting and figure drawing. He received his Master of Science Degree
in Creative Arts Therapy from Nazareth College of Rochester where he was
inducted into the honor society of Phi Kappa Phi. In his training, he worked
with adult and elderly veterans at the Department of Veterans Affairs
Medical Center in Canandaigua, New York as well as with children at
Crestwood Children’s Center in Rochester, New York, part of the Hillside
Family of Agencies. He currently works with people of all ages as an Art
Therapist at Hochstein School of Music and Dance in Rochester, New York.
About the Contributors xi
Michael E. Martin, MS received his Master of Science in Creative Arts

Therapy from Nazareth College of Rochester in May, 2014 where he was
inducted into the Honor Society of Phi Kappa Phi. Michael received his
Bachelor of Fine Arts from Rochester Institute of Technology in Professional
Photographic Illustration with a concentration in Advertising Photography
and worked in the field of Graphic Design and Photography in Ithaca, New
York prior to returning to school. As an art therapy student, Michael worked
with incarcerated individuals in a substance abuse program at Monroe
County Correctional Facility and with United States Military Veterans with
PTSD and/or Traumatic Brain Injuries at the Warrior Salute Program in
Webster, New York. Michael plans to eventually continue his education in
pursuit of his Ph.D. in Clinical Psychology in hopes of one day establishing
a holistic healing and creative arts therapy clinic in the Finger Lakes Region
of New York.
Kathryn McCarthy, MA, MS completed her Master of Science in the

Creative Arts Therapy program at Nazareth College of Rochester in May,
2014 and her Bachelor degree in Anthropology and Fine Art from the State
University of New York at New Paltz in 1996. She also received her Master’s
Degree in Art Education from Brooklyn College in 2007. She is presently
teaching art at Colden Elementary School. Kathryn was a recipient of the
Horovitz Scholarship in 2013. Prior to her enrollment in the Creative Arts
Therapy program, Kathryn taught art in Brooklyn, where she was a very
active member of the American Social History Project. This organization
fused literature, arts activities and history through alliances with galleries
such as the New Museum. Kathryn has led numerous workshops incorpo-
rating art and self-awareness at the Jung Center in Buffalo and Be Healthy
Institute in Hamburg.
Cara Monachino, MS completed her graduate training at Nazareth College

of Rochester in the Creative Arts Therapy program in May, 2015. She grad-
uated with honors from the State University of New York at Fredonia in May
of 2013 with a Bachelor of Arts in Psychology, and minors in Visual Arts and
Sociology. There, she was involved in four honor societies, as well as a mem-
ber of several campus-run organizations. While completing her degree, Cara
experienced working with adolescents as a School Counseling Intern and
with adults with developmental disabilities as an Artistic Student Intern. Her
current clinical experiences involve working as a Intern with refugee chil-
dren, as well as with adults who have physical, mental, and developmental
disabilities.
xii The Art Therapists’ Primer
Erin Popcun, MS completed her graduate training at Nazareth College of

Rochester in the Creative Arts Therapy program in May, 2015. She received
a Bachelor of Science in Interdisciplinary Arts For Children from State
University of New York, College at Brockport in May, 2012. Erin’s work has
been exhibited in a local recycled art show and she has had work published
in Cabbages & Kings (2007–2008), a literary and arts magazine for student
artists and writers. Erin is a veteran of the United States Navy. After serving
her country, she began work with the Developmentally Delayed and hopes
to continue to work with this population as an Art Therapist, supporting
their needs and fostering growth. Her current clinical experience includes
work with Veterans suffering from PTSD and Traumatic Brain Injuries.
Julie Riley, MS received her Master of Science in Creative Arts Therapy

from Nazareth College of Rochester in May, 2008. She also earned a BFA
(2004) in Visual Media from Rochester Institute of Technology. Julie also
explored her interest in cross-cultural trends by co-leading art therapy pro-
grams at the International Child Art Foundation’s World Child Art Festival
in 2007 and participating in an international internship in Tanzania, Africa
in August, 2007 working with adolescent detainees. Currently, she is estab-
lishing an art therapy career in Houston, Texas.
Stella A. Stepney, MS, ATR- BC, LCAT is a Registered and Board

Certified Art Therapist. She is licensed by New York State as a Creative Arts
Therapist and holds a New York State Teaching Certification in Art
Education. Ms. Stepney has worked professionally in the field of Art Ther-
apy as a clinician, educator, and independent practitioner. As a published
author, her literary contributions to the field of art therapy include Art
Therapy with Students at Risk: Introducing Art Therapy into an Alternative Learning
Environment for Adolescents (2001) and Art Therapy with Students at Risk:
Fostering Resilience and Growth Through Self-Expression (2010). Ms. Stepney is a
member of the adjunct faculty of Saint-Mary-of-the Woods College in Terre
Haute, IN. She has served the American Art Therapy Association (AATA)
as Chair of the Multicultural Committee, a member of the Education
Program Approval Board and as a Director on the Board of Directors. Ms.
Stepney is a member of the American Counseling Association, the for
Creativity in Counseling, and the Association for Multicultural Counseling
and Development. Ms. Stepney is recognized in Aetna’s 2013 African
American History Calendar, Complementary and Alternative Medicine:
Celebrating African Americans Practicing Physical and Alternative Healing, for her
work in the field of Art Therapy.
About the Contributors xiii
Michele (Shelley) Takei, Ph.D. has a doctorate in Transpersonal

Psychology and Women’s Studies. She teaches at Atlantic University where
she specializes in feminine psychology and spirituality. Shelley is the owner
of the MARI (Mandala Assessment Research Instrument,) and is involved in
teaching, training and administering the MARI throughout the world.
Shelley has been a counselor for more than 25 years specializing in Trans-
personal Psychology and women’s issues. Her private practice, Creative Re-
sources Center, is located in Raleigh, near Wake Med.
Sally Taylor, MS completed her graduate training at Nazareth College of

Rochester in the Creative Arts Therapy program in May 2015. She received
a Bachelor of Science in Human Development and Psychology from SUNY
Empire State and attended the Alfred University School of Art and Design
for ceramics and photography. Sally has worked for nine years as a preschool
teaching assistant supporting children with special needs and behavioral
issues; she is also an independent artist based in Wyoming County, New
York. Her work has been shown at Livingston Arts and the Arts Council for
Wyoming County. She hopes to implement art therapy with preschool chil-
dren and adolescents.
Chelsey Vano, MS received her Master of Science in Creative Arts Therapy

from Nazareth College of Rochester in May, 2014. Chelsey earned her
Bachelor of Science in Biomedical Photographic Communications from
Rochester Institute of Technology in 2011, with a minor in Psychology and
a concentration in Multimedia. While receiving clinical training, Chelsey
worked with inmates at Monroe County Correctional Facility and incarcer-
ated juveniles at Monroe County Children’s Detention Center. Chelsey
hopes to continue working with incarcerated individuals with a variety of
mental health needs.
Kelsey H. Wall, MS received her Master of Science in Creative Arts

Therapy from Nazareth College of Rochester in May, 2014. Kelsey com-
pleted her undergraduate degree in Fine Arts Studio from Rochester
Institute of Technology, with a focus in printmaking and sculpture.
Profoundly deaf, fluent in sign language and verbal communication, Kelsey
successfully works with both hearing and deaf clients. Her graduate clinical
experiences were with children and adults within the Greater Rochester
community and in Buffalo, NY. Kelsey is currently an intern at the
Advocacy Services for Abused Deaf Victims and Rochester Institute of
Technology. She hopes to establish an art therapy career in providing visual
expression as a means of communication and healing for developmentally
disabled or deaf and hard-of-hearing individuals.
PREFACE ON HOW TO USE THIS BOOK
Y ou know how you get software and bundled in it is this small text file
that says something like “Read This First”? Well, that’s what I am hop-
ing you will do before heading straight into the chapters. The reason is three-
fold: (1) if you are an educator you will want to know how to use this man-
ual as a teaching tool; (2) it will save you some time in case you are an expe-
rienced clinician and merely want to flip around to gather what is pertinent
to your practice; and (3) if you are new to the field (a student or even a sea-
soned graduate), it will afford you the armament to write up clinically-based
reports that include assessments, objectives, modalities, goals, summaries,
and termination reports. As well, the Appendices provide you with a wealth
of information and forms to use in your practice.
But bear with me for a moment, because the history of this book’s birth
represents a little over 40 years of my life as an educator. Around the early
‘90s, I developed a required textbook (which was published by Nazareth
College in Rochester, NY) so that students would have a manual for my
Assessment, Diagnosis and Counseling yearlong class. As luck would have
it, one day I found myself sitting on a tram next to my (now deceased ) and
dear colleague, Dr. Rawley Silver, HLM, ATR-BC, on the way to an Ameri-
can Art Therapy Association (AATA) conference. Rawley was flipping
through my treatise called the Art Therapy Program Textbook (Horovitz, 1995),
which every incoming student received and was required to read before
entering Day 1 of classes. Suddenly, she turned to me and adamantly de-
manded, “You must make this available for purchase! Everyone in the field
would benefit. Do it!!” (Mind you, this approximately 200-page text, aptly
called the “Bible” by my students, was not for sale to anyone outside of my
art therapy program.) But a strange thing happened: my students kept grad-
uating and getting work, and more often than not as primary therapists. I
slowly figured out that this was due not only to the medically-based training
that the students received but more importantly, because they were able to
transliterate their findings to a medical, educational, and/or clinical team. The
“Bible” (Art Therapy Program Textbook) had secured them with the necessary
armament to communicate their findings in a cogent manner. They could
xv
xvi The Art Therapists’ Primer
walk the walk but more significantly, they could talk the talk. So, I knew that
Rawley was right: it was time to share my main cooking ingredient (informed
treatment) with others.
After 40 some-odd years of educating, I asked my students who had
turned in A or A+ papers if they wanted to publish their samples in this
(now) publicly available opus. It was a win-win for everyone. My students
got published (some even before graduating) and art therapists would be
able to use my formula to cultivate a clinical recipe guaranteed to offer them
acceptance in a scientific community, thus elevating the Art Therapy field.
In a nutshell, that’s the game plan in this book. All chapters of assess-
ments walk the reader through the history of the actual assessment tool and
how to administer it. Those chapters offer several case samples for the read-
er to purview so that he or she might be able to glean not only how to
administer the test, but also how one should write-up the results for dissem-
ination to other clinicians.
So now let me tell you how it’s organized:
This third edition has been completely revamped and divided into five
sections:
• Section I: Introduction to the Third Edition: Quantifying Qualitative

Assessments (which contains a chapter on gathering client informa-
tion, constructing genograms, releases, and ethical considerations), a
chapter on the application of quantifying four nonstandardized assess-
ments, (which sets the cornerstone for the second section, should the
reader want to standardize any qualitative assessments for research
and/or forensic purposes) and Stepney’s chapter on multicultural
issues in assessment, documentation, and treatment, which is manda-
tory in considering the assessment of the whole person including cul-
tural and ethical considerations.
• Section II: Qualitative Instruments includes chapters on the Art
Therapy Dream Assessment (ATDA), Belief Art Therapy Assessment
(BATA), Cognitive Art Therapy Assessment (CATA), the House Tree
Person Test (HTP) and the Kinetic Family Drawing (KFD) as well as
a new chapter on the Mandala Assessment Research Instrument
(MARI) written by Shelley Takei.
• Section III: Standardized Instruments contains sample chapters of
normed batteries such as the Bender Gestalt II (BG II), Person Picking
An Apple from a Tree (PPAT), Silver Drawing Test (SDT), and the
Face Stimulus Assessment (FSA), revised by Donna Betts and normed
to the Formal Elements Scale as outlined by Gannt and Tabone (1998).
• Section IV: Combining Multiple Assessments contains a comparative
look at conducting batteries on several individual clients as well as a
Preface on How to Use this Book xvii
multigenerational family assessment. Contributions include assessing

a refugee in resettlement (James Albertson); a three-generation famil-
ial assessment (Shawna Boynton); assessment of a Deaf woman
(Kelsey Wall) and an assessment of a schizophrenic man (Chelsey
Vano). This new edition now sports a chapter contribution by myself
and Dr. Marcia Sue Cohen-Liebman, long considered an expert in the
area of sexual abuse and an expert witness in the court systems.
• Section V: Conclusion contains a chapter on treatment objectives and
modalities, internet referrals, a few case samples, and termination
summaries and referrals.
• Appendices: Finally, the reader will find all the appendix forms at the
back of the book. These forms along with three movies on conduct-
ing the CATA, ATDA and BATA are available separately on the pub-
lisher’s web site at www.ccthomas.com.
In conclusion, while all the assessments that are currently available to art
therapy practitioners are not covered in this treatise, what is offered is a sys-
tematic review of the assessments outlined above. These assessments were
chosen because of their ease in administration as well as the information pro-
cured for the practitioner. The SDT, Bender-Gestalt II, and FEATS have
been empirically tested. The SDT and BGII can be used for pretest and
posttest purposes. The CATA was chosen specifically since it is guised as an
open-ended, nondirective battery, thus eliminating stress (Horovitz & Schulze,
2007; 2008). As well, the CATA can also be used for pretest and posttest pur-
poses and has been submitted for empirical testing as part of an NIH-fund-
ed pilot study.
Additionally, the practitioner is offered sample formats, legends and
abbreviations of clinical and psychiatric terms, guidelines for recordable sig-
nificant events, instructions on writing-up objectives, modalities, and treat-
ment goals as well as training on composing progress versus process notes.
It is hoped that this book will serve as a companion guide for every art
therapist in creating clinical reports on patients to aid their trajectory
towards wellness, recovery and, above all, health.
E.G.H.
References
Gantt, L., & Tabone, C. (1998). The Formal Elements Art Therapy: The rating manual.
Morgantown, WV: Gargoyle Press.
Horovitz, E. G. & Schulze, W. D. (2007). American Art Therapy Association 38th
Annual Conference, Albuquerque, NM; Art Therapy & Stroke: New research on
mood and stress reduction, November 17, 2007.
xviii The Art Therapists’ Primer
Horovitz, E. G. & Schulze, W. D. (2008). Society for the Arts in Healthcare, 19th
annual conference Philadelphia, PA; Art Therapy & Stroke: New research on mood
and stress reduction, April 18, 2008.
ACKNOWLEDGMENTS
My mother taught me to always make my bed, say thank you

and to write thank you notes acknowledging the kindness
by others. Thanks for teaching me so well, Mom.
B ooks take time and constant seasoning until they are baked, just like a
good meal. But this treatise has been a wholly different order since the
concoction being stirred was not only my words and work, but also that of
my colleagues and (past) students who contributed to the chapters herein.
For it is my students that I wish to thank and acknowledge. As Jacob Bronoski
said, It is important that students bring a certain ragamuffin barefoot irreverence to
their studies. They are here . . . to question it.
Yet, categorically, I need to thank some very important people who con-
tinue to sustain me and have been in my life for the long haul: my immedi-
ate family and friends: My husband, Eugene (Jay) V. Marino, Jr., my sister,
Dr. Nancy Bachrach, my brother, Dr. Len Horovitz, my brother-in-law (now
deceased), Orin Wechsberg, my sister-in-law, Valerie Saalbach, my mother,
Maida Horovitz, my children: Kaitlyn Leah Darby, Bryan James Darby,
Nick (Schnickolas) Marino, and “The Paolo” Marino, my cheering squad
and closest friends, Karen Armstrong, Janet Rock, and Dr. Jessie Drew-
Cates. I also need to acknowledge my closest and most admired art therapy
friends: Dr. Irene Rosner David (my Rendala), Dr. Donna Betts (my Don-
nala), Dr. Bruce Moon, Cathy Moon, (my dancing partner on the AATA
floor), Dr. Michael Franklin, Dr. David Gussak, Dr. Patricia Isis, Dr. Judy
Rubin, Dr. Rawley Silver, Dr. Lori Wilson, Elizabeth Stone, the late Don
Jones, the late Bob Ault, and my wonderful mentor, the late Edith Kramer.
While I could list all of the students and past students who have contributed
to these pages, the reader can find their names in the Contributor’s Section
but Michael Martin, my past graduate assistant and an author herein, has
been of particular support; so Michael, thank you for making it to the “fin-
ish line.”
It goes without saying that I am extremely indebted to Michael Thomas,
publisher of Charles C Thomas, who has patiently awaited this new third
xix
xx The Art Therapists’ Primer
edition and has been with me since 1992 when my first manuscript was
accepted. Thank you, Michael, for believing in me and offering me the abil-
ity to share my work with others.
I also wish to thank Chrissie Probert Jones of Doodle Stitch and Loie
West, Ph.D. and Tom West of Genogram Analytics for their generous dona-
tion to my work and research through their in-kind donation of products.
And I wish to thank Brendan O’Shea for allowing me to beta-test the
BetterMind app, which has over 47 psychological assessments that can be
sent to my patients even before they enter my office. In more than one
instance, this has been a lifesaver and will be referenced in numerous cases
throughout this book.
Finally, I wish to thank my patients, whose stories and hearts I have held
and entwined with mine, as we worked towards a trajectory of wellness.
Thank you for giving meaning to my life.
E.G.H.
CONTENTS
Page
Preface on How to Use this Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
List of Illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxv
Chapter
SECTION I: INTRODUCTION TO THE THIRD EDITION:

QUANTIFYING QUALITATIVE ASSESSMENTS
1. THE EFFICACY OF ASSESSMENTS IN ART THERAPY . . . . . 5

Michael E. Martin and Ellen G. Horovitz
2. GATHERING PATIENT INFORMATION, CONSTRUCTING

A GENOGRAM, ETHICAL CONSIDERATIONS, AND
RELEASES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Ellen G. Horovitz
3. THE APPLICATION OF QUANTIFYING FOUR

NONSTANDARDIZED ASSESSMENTS . . . . . . . . . . . . . . . . . . . 45
Michael E. Martin
4. MULTICULTURAL ISSUES IN ASSESSMENT,

DOCUMENTATION AND TREATMENT . . . . . . . . . . . . . . . . . 66
Stella A. Stepney
SECTION II: QUALITATIVE INSTRUMENTS
5. ART THERAPY DREAM ASSESSMENT (ATDA) . . . . . . . . . . . 79

Ellen G. Horovitz and Contributors
6. BELIEF ART THERAPY ASSESSMENT (BATA) . . . . . . . . . . . . 94

xxi
xxii The Art Therapists’ Primer
7. COGNITIVE ART THERAPY ASSESSMENT (CATA) . . . . . . 114

8. HOUSE-TREE-PERSON ASSESSMENT (HTP) . . . . . . . . . . . . . 126

9. KINETIC FAMILY DRAWING ASSESSMENT (KFD) . . . . . . . 141

10. MARI (MANDALA ASSESSMENT RESEARCH

INSTRUMENT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Shelley Takei
SECTION III: STANDARDIZED INSTRUMENTS
11. BENDER GESTALT II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

12. PERSON PICKING AN APPLE FROM A TREE

ASSESSMENT (PPAT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
13. SILVER DRAWING TEST ASSESSMENT (SDT) . . . . . . . . . . . 207

14. FACE STIMULUS ASSESSSMENT (FSA) . . . . . . . . . . . . . . . . . 215

Donna Betts and Contributors
SECTION IV: COMBINING MULTIPLE ASSESSMENTS
15. FROM AFRICA TO AMERICA: ART ASSESSMENTS

WITH A REFUGEE IN RESETTLEMENT . . . . . . . . . . . . . . . . 225
James Albertson
16. THREE GENERATIONS OF ART: A FAMILIAL

ASSESSMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
Shawna Boynton
17. ASSESSMENT OF A 29-YEAR-OLD DEAF WOMAN . . . . . . . 261

Kelsey Wall
Contents xxiii
18. ASSESSMENT OF A SCHIZOPHRENIC MAN . . . . . . . . . . . . 271

Chelsey Vano
19. A De NOVO CASE: EFFICACY, TELEHEALTH, AND

SUPERVISION WITHIN A LEGAL CONFINE . . . . . . . . . . . . 280
Ellen G Horovitz and Marcia Sue Cohen-Liebman
SECTION V: CONCLUSION
20. TREATMENT OBJECTIVES, MODALITIES AND

TERMINATION SUMMARIES . . . . . . . . . . . . . . . . . . . . . . . . . 307
Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Name Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
ILLUSTRATIONS
Figures Page
Figure 1.0. Original image created from Paper53 App by

Horovitz; left lower image taken into PS Express
App and changed to Spring filter; right lower image
manipulated further with Film Edges adjustment . . . . . . 11
Figure 1.1. Final image output (top) from previous app (PS
Express) is saved to camera roll on smartphone; next
it is manipulated in TTV app (another smartphone
app), using various filters and is now ready to be sent
out to the Instagram community . . . . . . . . . . . . . . . . . . . 12
Figure 2.0. Genogram Analytic Sample . . . . . . . . . . . . . . . . . . . . . . . 23
Figure 2.1. IP System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Figure 2.2. Pam—Genogram and Nodal Events . . . . . . . . . . . . . . . . . 26
Figure 2.3. DASS-21 graph of patient . . . . . . . . . . . . . . . . . . . . . . . . . 29
Figure 3.0. ATDA Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Figure 3.1. BATA Response: Directive (left) and Directive 2
(right) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Figure 3.2. CATA Drawing Subtest (left); Painting Subtest
(right) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Figure 3.3. Road Drawing Response . . . . . . . . . . . . . . . . . . . . . . . . . 60
Figure 3.4. Adapted Content Tally Sheet (Scored for Figure
3.3.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Figure 3.5. Adapted Content Tally Sheet—Front (see Appendix G
for reproduction) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Figure 3.6. Adapted Content Tally Sheet—Back (see Appendix G
for reproduction) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Figure 5.0. Blank Sample—Doodle pillowcase . . . . . . . . . . . . . . . . . . 81
Figure 5.1. Sample—Doodle pillowcase . . . . . . . . . . . . . . . . . . . . . . . 81
Figure 5.2. K’s genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Figure 5.3. K’s ATDA response and DASS-2 results . . . . . . . . . . . . . . 86
Figure 5.4. Elizabeth’s genogram and timeline . . . . . . . . . . . . . . . . . . 88
Figure 5.5. Elizabeth’s ATDA Art Response . . . . . . . . . . . . . . . . . . . . 90
xxv
xxvi The Art Therapists’ Primer
Figure 6.0. Maggie’s genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Figure 6.1. BATA Directive 1 by Maggie . . . . . . . . . . . . . . . . . . . . . 103
Figure 6.2. BATA Directive 2 by Maggie . . . . . . . . . . . . . . . . . . . . . 105
Figure 6.3. Amelia’s genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Figure 6.4. BATA First directive response . . . . . . . . . . . . . . . . . . . . 110
Figure 6.5. BATA Second directive . . . . . . . . . . . . . . . . . . . . . . . . . 111
Figure 7.0. S’s Genogram and timeline . . . . . . . . . . . . . . . . . . . . . . 122
Figure 7.1. S’s CATA response (Paint subtest—upper left; Drawing
Subtest—upper right; Clay Subtest—bottom center) . . . . . . . 123
Figure 8.0. Diane’s Genogram and Timeline . . . . . . . . . . . . . . . . . . 129
Figure 8.1. Diane’s HTP Achromatic House (upper) and
Chromatic House (lower) . . . . . . . . . . . . . . . . . . . . . . . . 130
Figure 8.2. Diane’s HTP Achromatic Tree and Chromatic Tree . . . 131
Figure 8.3. Diane’s HTP Achromatic Person and Chromatic
Person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Figure 8.4. Joyce’s Genogram and Timeline . . . . . . . . . . . . . . . . . . 133
Figure 8.5. Joyce’s House, Tree, Person response—achromatic
version only (from left to right) . . . . . . . . . . . . . . . . . . . . . 134
Figure 8.6. Horizontal Placement of the Whole Sheet to place
over any horizontal subtest . . . . . . . . . . . . . . . . . . . . . . . 138
Figure 8.7. Vertical Placement of the Whole . . . . . . . . . . . . . . . . . . 139
Figure 9.0. Nathan’s Genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Figure 9.1. Nathan’s KFD Response . . . . . . . . . . . . . . . . . . . . . . . . . 144
Figure 9.2. Nathan’s Analysis Sheet . . . . . . . . . . . . . . . . . . . . . . . . . 145
Figure 9.3. KFD grid analysis sheet—this can be printed out on
a transparency and thrown atop of the KFD result . . . . 147
Figure 9.4. Morgan’s Genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Figure 9.5. Morgan KFD (front) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Figure 9.6. Morgan KFD (back) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Figure 9.7. Elizabeth’s Genogram and Timeline . . . . . . . . . . . . . . . 154
Figure 9.8. Elizabeth’s KFD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Figure 10.0. Mari—The Great Round . . . . . . . . . . . . . . . . . . . . . . . . . 161
Figure 10.1. Mari Grand Round Board with samples of cards
symbol and color selected images at Stage 0,
Stage 4, Stage 8, and Stage 11 . . . . . . . . . . . . . . . . . . . . 162
Figure 10.2. Mandala Sample Stage 0 . . . . . . . . . . . . . . . . . . . . . . . . 164
Figure 10.3. Mandala Sample at Stage 8 . . . . . . . . . . . . . . . . . . . . . . 165
Figure 11.0. Corrine’s Genogram and Timeline . . . . . . . . . . . . . . . . . 180
Figure 11.1. Corrine’s Bender Gestalt II Copy Test attempts for
cards 5–16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Figure 11.2. Corrine’s Bender Gestalt II Recall Test results . . . . . . . . 184
Figure 11.3. Bender Gestalt II Perception Response . . . . . . . . . . . . . 184
Illustrations xxvii
Figure 11.4. Bender Gestalt II Motor Test . . . . . . . . . . . . . . . . . . . . . 185

Figure 11.5. Elizabeth’s Genogram and Timeline . . . . . . . . . . . . . . . 187
Figure 11.6. Elizabeth’s Bender-Gestalt II Copy and Recall Test . . . . 188
Figure 11.7. Motor Test and Perception Test. (Editor’s Note: ovals
were digitally placed over Elizabeth’s demarcation by
editor to indicate her choices, which were made with
dashes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
Figure 12.0. CR’s Genogram and Timeline . . . . . . . . . . . . . . . . . . . . 197
Figure 12.1. CR—PPAT response . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Figure 12.2. E’s Genogram and Timeline . . . . . . . . . . . . . . . . . . . . . . 201
Figure 12.3. E’s PPAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Figure 13.0. S’s Genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Figure 13.1. SDT—Predictive Drawing (upper left); Drawing from
Observation (upper right); Drawing from Imagination
(middle bottom) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Figure 13.2. Pam’s Genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Figure 13.3. Pam’s SDT responses . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Figure 14.0. Pam’s Genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Figure 14.1. Pam’s FSA Picture 1, 2 and 3 . . . . . . . . . . . . . . . . . . . . . 218
Figure 15.0. Alexander’s Genogram and Timeline . . . . . . . . . . . . . . 226
Figure 15.1. Alexander’s CATA Pencil and Paint Subtest . . . . . . . . . 229
Figure 15.2. CATA Clay Subtest (left and right) . . . . . . . . . . . . . . . . . 231
Figure 15.3. HTP Achromatic House (left), Tree (middle), Person
(right) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Figure 15.4. SDT results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Figure 15.5. KFD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Figure 15.6. Alexander’s PPAT Response . . . . . . . . . . . . . . . . . . . . . . 237
Figure 15.7. Alexander’s BATA Response . . . . . . . . . . . . . . . . . . . . . 239
Figure 15.8. Map of Alexander’s Homeland . . . . . . . . . . . . . . . . . . . 240
Figure 16.0. Ruby, Marshall and Aldo Genogram and Timeline . . . . 244
Figure 16.1. Ruby’s PPAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248
Figure 16.2. Marshall’s PPAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
Figure 16.3. Aldo’s PPAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
Figure 16.4. Ruby’s FSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Figure 16.5. Marshall’s FSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Figure 16.6. Aldo’s FSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Figure 16.5. Ruby’s BG II—Copy, Backside of Paper and Recall . . . . 256
Figure 16.8. Marshall’s BG II—Copy (BG #1) and Recall (BG #2) . . 257
Figure 16.9. Aldo’s BG II—Copy, Copy (backside of paper) and
Recall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Figure 17.0. BW’s Genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
Figure 17.1. CATA Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
xxviii The Art Therapists’ Primer
Figure 17.2. PPAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265

Figure 17.3. KFD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Figure 17.4. KFD Grid Overlay and Horizontal Overlay (Overlays
are in Appendix J and H) . . . . . . . . . . . . . . . . . . . . . . . 268
Figure 17.5. KFD Analysis Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Figure 18.0. Max’s Genogram and Timeline . . . . . . . . . . . . . . . . . . . 271
Figure 18.1. Max’s KFD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Figure 18.2. Max’s HTP Achromatic (upper center—house; bottom
left—tree; bottom right—person) . . . . . . . . . . . . . . . . . . . . . . 274
Figure 18.3. Max’s HTP Chromatic (upper left—house; bottom
left—tree; bottom middle—tree backside; upper right—
person; bottom right—person backside) . . . . . . . . . . . . . . . . . 275
Figure 18.4. Max’s FSA (responses: upper left # 1; upper right #2;
bottom center #3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Figure 19.0. A’s Genogram (conducted on Genogram Analytics
app) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Figure 19.1. A’s KFD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Figure 19.2. A in his banket . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Figure 19.3. A’s clay mug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Figure 19.4. Spence Children’s Anxiety Scale—Child (SCAS-Child)
resutls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Figure 19.5. DASS-21 results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Figure 19.6. Anubis image created by “A” . . . . . . . . . . . . . . . . . . . . . 290
Figure 19.7. Bender Gestalt II Side 1 of the Copy Test . . . . . . . . . . . 291
Figure 19.8. Side 2: Backside of paper of the Copy Test (Bender
Gestalt II) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Figure 19.9. Anubis in clay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Figure 19.10. “A’s” forgiveness card for mother: the building on the
lower right represents the trailer that “A” and “C” lived
in when they resided with the mother . . . . . . . . . . . . . . 296
Figure 19.11. “A” and stepfather’s superheroes . . . . . . . . . . . . . . . . . . . 299
Figure 19.12. Work by “C,” stepmother, and “s” respectively (left
to right) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Figure 20.0. Nora’s Genogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Figure 20.1. Nora’s KFD response and detail (bottom) . . . . . . . . . . . . 312
Figure 20.2. Scout’s Genogram and Timeline . . . . . . . . . . . . . . . . . . 315
Figure 20.3. Scout’s Pillows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Figure 20.4. MK’s Genogram and referral information . . . . . . . . . . . 320
Figure 20.5. MK’s “Thinking Cap” . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
Figure 20.6. MK’s Narrative Story Scene . . . . . . . . . . . . . . . . . . . . . . 323
Illustrations xxix
Table
Table 1.0. The Horovitz Adapted Formal Elements Chart for
Nonstandardized Assessments . . . . . . . . . . . . . . . . . . . . . 16
Table 3.0. Horovitz’s Adapted Formal Chart for Nonstandardized
Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Table 19.0. Spence’s Children Anxiety Scale (Self-report) results . . . 283
THE ART THERAPISTS’ PRIMER
Section I
INTRODUCTION TO THE THIRD

EDITION: QUANTIFYING QUALITATIVE
ASSESSMENTS
Chapter 1
THE EFFICACY OF ASSESSMENTS

IN ART THERAPY
MICHAEL E. MARTIN AND ELLEN G. HOROVITZ
There is curiously little art concerning the efficacy of reason—

perhaps simply because reason is not noticeably efficacious.
—Nicholas Mosley
INTRODUCTION
A s in any medical profession, the use of assessments is crucial in art ther-

apy in order for the therapist to understand the patient’s psychosocial,
psychological, cognitive/developmental, physiological/genetic, cultural, emo-
tional, and spiritual state. Armed with this information, the clinician can
then track the patient’s progress over time and throughout the entire thera-
peutic process. The field of art therapy offers many different assessments in
order to accomplish this, ranging from highly directive and standardized as-
sessments to projective drawings and even free association drawing. While
this book provides an overview of some of the more widely used assess-
ments, it cannot cover them all. To wit, this third edition will not only review
the efficacy behind said assessments (and discuss the reliability and validity
of assessments where applicable), but also offer vignettes and case samples
for each battery that is covered. Then the reader will be prepared to conduct
theses batteries with his/her/their patient. (N.B.: In this book, Horovitz refers to
the word “patient(s)” herein since it has a distinct connection to the Latin “pati” for
“suffering,” meaning “the one who suffers.” Though “patients” can be much more than
“customers” in terms of a word choice, “patients” are generally connected to legal and/
or business contexts, which is not the scope of this work.)
5
6 The Art Therapists’ Primer
Additionally, while a summation of these assessments is covered herein,

it is by no means a substitute for the original publications. Therefore, it is
advised that the reader refer to the original publications of all assessments
herein in order to have a formal working knowledge of their constructs and
administration.)
Over the years, since Horovitz (1988, 1994, 1999, 2002, 2004, 2005,
2006, 2007, 2208a, 2008b, 2009; 2014) published her widely-used assess-
ments—Cognitive Art Therapy Assessment (CATA), Belief Art Therapy
Assessment (BATA), and the Art Therapy Dream Assessment (ATDA)–many
inquiries have come forward about tying such instruments to a quantitative,
efficacy-based platform. While Horovitz has responded to these queries by
writing (via personal electronic communications) that the aforementioned
batteries can be normed according to Gannt and Tabone (1998); Lowenfeld
and Brittain (1980); Piaget (Piaget, J. & Inhelder, B. (1967); Horovitz, 2014;
Fowler (1980) and/ or Kohlberg (1974), in this 3rd edition, Horovitz goes
one step further by suggesting that for validation, these aforementioned bat-
teries (and indeed any other projective instruments (such as the HTP, KFD, and
the like) be tied not only to the developmental, spiritual, and/or moral stages
(as cited above—see Appendix for developmental stages comparison chart)
but also to an altered version of the Formal Elements Art Therapy Scale
(FEATS) as designed by Gannt and Tabone (1998). (Indeed, in Chapter 14,
Donna Betts ties the Face Stimulus Assessment (FSA) to specific sections of
the FEATS.) Moreover, in Chapter 3, Michael Martin structures how to do
such an analysis with the ATDA, BATA, CATA and the Hanes Road
Drawing assessment. The reader is urged to apply this directly to any pro-
jective, qualitative or nonstandardized battery. As well, it is the opinion of
the editor, that any projective (read: subjective) assessment can be rated with
the FEATS as Gussak so aptly noted in his latest book (2013).
In addition to looking at the various assessments both for qualitative and
quantitative analysis, in this revised edition, a new instrument has been
included, the Mandala Art Research Instrument (MARI). Since Shelly Takei
(author of that chapter) trained Horovitz well after the first edition had been
published, it was regrettable that this extraordinary instrument was not cov-
ered. Hopefully, Takei’s chapter will whet the appetite of art therapists yet to
be trained in that system and urge them to seek out training as MARI prac-
titioners.
Moreover, Stella Stepney’s contribution in Chapter 4, Multicultural Is-
sues in Assessment, Documentation and Treatment is a very important new
addition. Here, Stepney outlines the necessity of assessing a person(s) from
a multicultural perspective and underscores best practices in operating from
this platform.
The Efficacy of Assessments in Art Therapy 7
One of the largest changes in this book is the standardization of

genogram information using Genogram Analytics software (designed by
Loie West, Ph.D. and Tom West). Standardizing genogram information is as
necessary to the validation of every instrument as is diagnosis and treatment;
standardizing genogram and timeline information allows for multiple disci-
plines to understand and value inherent information that can be used in
interdisciplinary format. The art therapist should consider any factors that
may influence the outcomes of the assessment, such as culture, race, gender,
age, religion, sexual orientation, education, and disability (AATA, 2009, sec
3.5). Genogram Analytics software takes such information into account and
creates a visual schematic that allows the practitioner to consider the
“whole” patient as opposed to the identified patient (I.P.). Indeed, the pa-
tient’s strengths and weaknesses can be “seen” from a generational perspec-
tive where transitional conflicts may have been handed down from genera-
tion-to-generation; having this visual map can serve to elucidate familial
information. Within this chapter, Horovitz also discusses informed consent,
ethical considerations and release forms. Here, she provides a variety of
forms and letters that will aid the art therapist in public or private practice.
In Chapter 2 of this book, Horovitz will discuss how she has been employ-
ing the Better Mind App (which she beta-tested with the developer before
its release. This will also be referenced in Chapter 19 which she co-authors
with Dr. Marcia Sue Cohen-Liebman,
Indeed, the structure of the book has been completely revamped and
divided into five sections: Section I: Introduction to the Third Edition:
Quantifying Qualitative Assessments contains (a) this chapter, (b) a chapter
on gathering patient information, constructing genograms, releases, and eth-
ical considerations, (c) a chapter on the application of quantifying four non-
standardized assessments (setting the cornerstone for standardizing any qual-
itative assessments for research and/or forensic purposes (Gussak, 2013), and
(d) Stepney’s chapter on multicultural issues in assessment, documentation
and treatment as mandatory in considering the assessment of the whole per-
son including cultural and ethical considerations.
Section II: Qualitative Instruments includes chapters on (a) the Art
Therapy Dream Assessment (ATDA), (b) Belief Art Therapy Assessment
(BATA), (c) Cognitive Art Therapy Assessment (CATA), (d) the House Tree
Person Test (HTP), (e) Kinetic Family Drawing (KFD) as well as (f) the
Mandala Assessment Research Instrument (MARI) written by Shelley Takei.
Section III: Standardized Instruments contains sample chapters of
normed batteries such as (a) the Bender Gestalt II (BG II), (b) Person Picking
An Apple from a Tree (PPAT), (c) Silver Drawing Test (SDT), and (d) Face
Stimulus Assessment (FSA) revised by Donna Betts and normed to the
Formal Elements Scale as outlined by Gannt and Tabone (1998).
Section IV: Combining Multiple Assessments contains a comparative

look at conducting batteries on several individual patients as well a multi-
generational family assessment. Contributions include (a) assessing a refugee
in resettlement (James Albertson), (b) a three-generation familial assessment
(Shawna Boynton), (c) assessment of a deaf woman (Kelsey Wall), (d) an as-
sessment of a schizophrenic man (Chelsey Vano) and (e) a new chapter
which discusses treatment, telehealth and the legal system co-authored by
Horovitz and Dr Marcia Sue Cohen-Liebman.
Finally, Section V: Conclusion contains a chapter by Horovitz on treat-
ment objectives and modalities, termination summaries and referrals.
A download is available with numerous charts (referred in the body of the
book) on the publisher’s website (www.ccthomas.com) where these materials
can be downloaded for a modest fee. These can be used for assessing instru-
ments covered within this book, and a plethora of forms are included to be
used in best practice and treatment. There are also three movies on con-
ducting the ATDA, BATA, and CATA (the ABC’s of Horovitz’s assessments).
As all health fields move toward evidence-based practice, looking at as-
sessments for both their inherent qualitative and quantitative value is neces-
sary. The American Art Therapy Association (AATA) expresses that assess-
ments should be used by an art therapist to better understand and serve the
needs of his or her patient and one should only use assessments within a pro-
fessional relationship (AATA, 2009, sec 3.0). An art therapist should be
familiar with all aspects of the assessment, including reliability, validity, stan-
dardization, error of measurement, and the proper application and adminis-
tration of the assessment prior to its use with a patient (AATA, 2017, sec 3.0).
The aim of this book is to provide the reader with a stepping-stone to do
such work.
As with any medical assessment, the art therapist should obtain informed
consent from the patient regarding the purpose for the assessment (AATA,
2017, sec 3.4). (Templates of release forms and informed consent forms are
provided in Chapter 2 of this book as well as in the available download of
on the publisher’s website. As well, should a patient have difficulty under-
standing the language of the assessment or the procedural directives in-
volved, a qualified interpreter should be used to assist the patient prior to
administering the assessment and/or reduce the language to the develop-
mental or cognitive level of the patient (AATA, 2017, sec 3.4). Finally, all art-
work and related data from the assessments should be kept confidential in
accordance with the art therapist’s professional setting as well as the guide-
lines of the American Art Therapy Association (AATA, 2017, sec 3.6). Vari-
ous forms for conducting such work will be found in Chapter 2 and
Appendix B, C, & D. These forms may be photocopied with the permission
of this author.
Definitions
So, what exactly is art therapy and why conduct art therapy assess-
ments? Art therapy is a mental health profession in which patients create art-
work in order to explore their feelings, express emotions surrounding con-
flicts, stress and traumas, foster self-awareness, manage dysfunctional behav-
iors and addictions, develop social skills, develop healthy coping strategies
and express one’s emotions surrounding anxiety (Nainis, Paice, Ratner,
Wirth, Lai & Shott, 2006). In addition, art therapy helps the patient increase
self-esteem in order to restore his or her level of functioning and sense of
personal well-being (http://www.arttherapy.org).
Art therapy adheres to the belief that people possess the ability to
express themselves creatively and that the process involved in creating the
artwork can be more important than the product itself (AATA, 2013; Malchi-
odi, 2012). Art therapists know from their own life experiences that art ther-
apy works (Slayton, D’Archer & Kaplan, 2010). In short, art therapy is used
to aide patients with their psychosocial, psychological, cultural, emotional,
behavioral, (Reynolds, Nabors, Quinlan, 2000) cognitive and spiritual devel-
opment (Horovitz-Darby, 1988, 1994; Horovitz, 1999, 2004, 2005, 2006,
2007, 2008a, 2008b and 2014) through a nonverbal means of communica-
tion and/or via symbolic speech (Naumburg, 1987; Rubin, 2001).
Pizzaro (2004) states that one advantage that art therapy holds over ver-
bal therapies is that the artwork itself does not require literacy or verbal flu-
ency; yet it still conveys emotion, relates stories and stimulates verbal expres-
sion and communication, making it extremely beneficial for patients who
otherwise lack the skills to communicate effectively.
Art: Past, Present and Future

Throughout history, art has been used as a method of self-expression,
connecting people to their feelings, bodily states and bringing their uncon-
scious thoughts into conscious awareness (Brooke, 2004). Brooke (2004)
explains that the evidence of self-expression can still be seen through the
remains of pottery, cave drawings, masks, and other archeological remnants
of the past. The use of art continues to remain as a means of self-expression,
much the same way as it was millennia ago (Brooke, 2004; Dissanyake,
1992). Cave drawings served as a vehicle for communication, and in fact
may have been one of humankind’s earliest attempts at self-expression, pic-
torial, symbolic language and actual historical recording (Stokstad, 1995;
www.wikipedia.com, 2013). Although the mediums have changed, humans
have innate drives to create as it serves as a way to make sense of the world
around them (Brooke, 2004, Dissanyake, 1992).
In the words of Dissanayake (1992):
making important activities special has been basic and fundamental to human
evolution and existence, and . . . while making special is not strictly speak-
ing in all cases art, it is true that art is always an instance of making special.
To understand art in the broadest sense, then, as a human proclivity, is to
trace its origin to making special, and I will argue that making special was
often inseparable from and intrinsically necessary to the control of the
material conditions of subsistence that allowed humans to survive. (p. 92)
With the current technological advancements and ease of access to graph-

ics and photography programs, any individual with a smartphone, tablet or
laptop can now create remarkable artwork with the touch of a button (see
Figures 1.0 and 1.1). Horovitz demonstrates how easy it is to take an image
created on her tablet (iPad, using Paper 53 app), then sent to her iPhone and
then moving it into several possible scenarios with frame changes (see oval
arrows) using PS Express, a smartphone app. In fact, the final image (in
Figure 1.1) can be taken into yet another application, in this case, Ttv (Figure
1. 1), to create yet another version of this original sketch. (The same thing
can be done with any digital image.) And if you want to take that same
image into software programs as Horovitz (2011) outlines in her text, Digital
Image Transfer: Creating Art with Your Photography, the possibilities are endless.
But, to what end? While these programs might be appealing for a variety of
reasons, such as using such software in restrictive medical environments
when conducting medical art therapy, the loss of honing fine and gross
motor skills when working with materials such as real pencils, paint, cameras
and indeed 3-dimensional materials are lost in this capacity. Still, one needs
to add this to the arsenal that is out there. Horovitz recently started using the
application, Paper 53, along with a stylus and her iPad tablet (soon to be
available in other platforms) in order to navigate medical situations that
restrict such media. Examples of where this technological tool could be em-
ployed are chemotherapy units, dialysis units, and post-operative units (ICU).
In fact, the artwork distilled from such sessions can be output into a Mole-
skine© journal. Another less expensive option, would be to create a screen-
shot from the image (which yields about 1 megabyte of information) and
printing the result onto 2 and 3-dimensional surfaces.
Indeed, there is even an art therapy app, which the art therapy assess-
ment Facebook™ community is pooh-poohing. To read more about the app,
I would refer the reader to Malchiodi’s recent blog in Psychology Today (http:
//www.psychologytoday.com/blog/the-healing-arts/201202/art-therapy
-theres-app-1). Ultimately, such choices lie with the art therapist. There are
good reasons for embracing both old and new technologies. But these writ-
ers urge the reader to be mindful of the reason that art therapy emerged in
the first place. One can only imagine how Horovitz’s mentor, the great Edith
Kramer, would frown upon such electronic outlets. Here, Dissanyake’s trea-
tise (1992) makes more and more sense. Technology both advances and dis-
tances us from our roots. And therein lies the rub.
Figure 1.0. Top—Original image created from Paper53 App by Horovitz; left lower
image taken into PS Express App and changed to Spring filter; right lower image manip-
ulated further with Film Edges adjustment.
Figure 1.1. Final image output (top) from previous app (PS Express) is saved to camera
roll on smartphone; next it is manipulated in TTV app (another smartphone app, using
various filters and is now ready to be sent out to the Instagram community.
Art-Based Assessments
In sum, the purpose behind art-therapy-based assessments is to assess a
patient’s current level of functioning, strengths and presenting problem(s). The
assessment results enable the therapist to formulate treatment goals, objectives,
and track the patient’s progress in therapy (Betts, 2005). There is a distinction
between an art-based assessment and using art within a psychological evalua-
tion in regard to the process of administering the assessment as well as its pur-
pose (Malchiodi, 2012). According to Malchiodi (2012), the main purpose of
an art therapy assessment is to gather information in order to create a treat-
ment plan for the patient, not to diagnose the patient, since art-based assess-
ments alone are not empirically based tools for psychological evaluations.
In regard to the process of assessing a patient, the art therapist typically
asks him/her/they to complete a series of drawings, paintings and sculptures
in order to build a body of work. This body of work ranges from highly
directive and structured assessments to free drawing wherein the patient is
given a choice of medium without a directive (Horovitz, 2002; Kramer, 1971;
Malchiodi, 2012). The patient’s body of work allows the art therapist to
assess overall functioning, ability to control the medium, developmental
level, communication patterns and/or abstract thinking (Horovitz & Eksten,
2009; Malchiodi, 2012). If the artwork indicates pathological concerns, a
treatment plan may be modified with appropriate goals and interventions
(Horovitz & Eksten, 2009; Malchiodi, 2012).
To reiterate: art therapists use multiple types of art-based assessments:
standardized, those with specific directives, and projective batteries, which
are open-ended and may be rated subjectively. However, as previously stat-
ed, any projective test can be modified and tied to the Formal Elements Art
Therapy Scale (FEATS-Gantt & Tabone, 1998) and/or the cognitive, spiritu-
al or moral stages of development, provided at the end of this chapter (in chart
form) and the Appendix A (Hammer, 1958; Piaget & Inhelder, 1969; Kohl-
berg, 1984; Lowenfeld & Brittain, 1987; Fowler, 1995; Oster & Crone, 2004;
Horovitz & Eksten, 2009; Horovitz, 2014). Both standardized and projective
instruments may be utilized for myriad reasons but may be administered
while the patient builds his/her/their body of work. Thus, the standardized
assessments (be they tied to norms or developmental levels) tend to be the
assessments that are typically used in order to measure specific progress per-
taining to a patient’s goals, and pretest/ posttest measures (Horovitz & Ek-
sten, 2009; Horovitz, 2014; Malchiodi, 2012; Silver, 2007).
Standardized Assessments
Malchiodi (2012), Silver (2007) and others explain that standardized as-
sessments provide consistent results in their use of directive, materials, and
time constraints. Silver (2007) purports that standardized assessments are

also scored and evaluated by an art therapist following specific guidelines
that have been tested for validity and reliability. The art therapist, however,
should be aware that some standardized assessment materials or procedures
may not have been tested for validity and reliability (Malchiodi, 2012).
Malchiodi (2012) reported that four art-based assessments have been
standardized: the Diagnostic Drawing Series (DDS); the Silver Drawing Test
(SDT) and Draw a Story (DAS)), the Formal Elements Art Therapy Scale
(FEATS): “Draw a Person Picking an Apple From a Tree” (PPAT); and the
Levick Emotional and Cognitive Art Therapy Assessment (LECATA). How-
ever, projective tests, such as the House-Tree Person (HTP), Kinetic Family
Drawing (KFD), Cognitive Art Therapy Assessment (CATA), Belief Art
Therapy Assessment (BATA), Art Therapy Dream Assessment (ATDA), and
others, could be held to the same standards (Horovitz, 2013). For brevity, the
only standardized assessments that will be discussed in this book will be the
Bender Gestalt II (BG II), the Silver Drawing Test (SDT), and the Person
Picking an Apple from a Tree (PPAT).
To Use Assessments or Not

Although some art therapists do not use assessments with their patients
since many lack in reliability and validity testing (Brooke, 2004), it is these
writers’ opinion that a patient should be given multiple art-based assessments
in order to allow the administrant to search for underlying themes that may
not be present in a single battery. Indeed, Gussak (2013) published the use
of both conducting assessments as well as reviewing artwork for forensic pur-
poses in his recent book; here the art became the defendant in deciding the
ultimate fate of a man who had murdered his child. Since art therapists are
tasked with evaluating a patient’s current level of functioning in psychoso-
cial, psychological, emotional, genetic, physiological, cultural, cognitive,
spiritual, moral and behavioral fronts, as well as assigned with formulating
treatment goals and objectives, it seems necessary that art-based assessments
should be administered (Betts, 2006; Horovitz & Eksten, 2009; Horovitz,
2014; Malchiodi, 2012).
Conversely, Bruce Moon (1990) asserts that, “Those who force visual
symbols into verbal constructs may be guilty of imagicide, i.e., the murderous
destruction of an image” (p. 28). While these authors do not agree with Dr.
Moon’s position, one must include his philosophy in order to allow the read-
er to decide his/her/their operational stance on the use of assessments. In
fact, the Art Therapy Dream Assessment (Horovitz, 1999, see Chapter 2) re-
sulted from her work with both Bruce Moon (Moon, 1998) and that of Clark
Moustakis, (Moustakis, 1994). Furthermore, Dr. Moon’s Existential Art Ther-
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WATER SUPPLY
It would seem to be unnecessary to repeat the axiom, “No water,

no plant or animal life,” but so many buildings, both public and
private, are located and constructed before the problem of supplying
an ample, perennial supply of potable water is solved, that it seems
necessary to briefly treat this subject.
Several public institutions with which I have been familiar have
erected expensive structures before supplying water for them. Three
and sometimes five separate attempts were made to furnish water
for the use of the plant, none of which were entirely successful.
The amount of water needed and the conditions under which it
must be secured are so variable that few specific directions can be
given. One simple, certain and cheap way of securing water for the
barn is usually neglected. In some sections of the South, by reason
of peculiar geological formations, the practice of constructing pools
or storage reservoirs has become common. A slight depression or
draw or swale is selected and dammed by using the earth from the
bottom of the proposed pool and from the higher land adjoining. No
stone or wood is necessary to support the dam. The only precaution
necessary is to have a broad base (see Fig. 7), and to provide
sufficiently large outflows or spillways, one on either end of the dam,
that the pool may never rise higher than within two feet from the top
of the dam. The surface soil, if it contains much vegetable matter,
should be scraped off a strip three to four feet wide and as long as
the dam, and the depression filled with earth—clay is best—that
contains little or no organic matter. If the bottom of the dam where it
meets the normal earth is constructed with sods, or other material
which will decay, in time the water will find its way through the
porous earth.
The pools of the South, to which reference has been made,
sometimes have an extreme depth of 12 to 15 feet, and may cover a
fraction of an acre or several acres. I have known one of these pools
to furnish water for a hundred head of cattle during a long continued
drought. It is difficult to explain why more pools, lakes and fish ponds
are not constructed. Possibly the reasons are that there is a
prejudice against them, and well there may be, since they are
usually so shallow that the water becomes impure, and since it is not
generally realized that a substantial dam can be erected by the use
of earth alone. If it is thought advisable not to allow the animals to go
to the pool, it may be fenced, since it is not expensive to lay a pipe in
the dam, when it is being constructed, on a level with the bottom of
the pool, the outer end of the pipe being furnished with a ball and
cock to regulate the flow of water into the trough.
Usually it is not advisable to build cisterns for storing water for
barn use, since they are too expensive if built as large as needed. A
cow requires from forty to eighty pounds of water daily in the
summer. If sixty pounds be taken as the average, it will be seen that
it would require a cistern of three hundred and fifty barrels capacity
to supply a herd of fifty animals for one month. In some cases the
water of a stream or well may be so highly charged with the products
of magnesian limestone as to produce goitre, in which case soft
water should be supplied for the horses.
Streams or springs are often available for summer, but they
seldom supply ideal water conditions in winter. Young animals, and
especially cows in milk, should not be required to drink water at a
low temperature or be forced to travel long distances for it in cold
weather. The only really satisfactory method of supplying the
domestic animals with water is to bring it into the barn, and if the
water in the pipes is not under pressure, a small storage tank may
be placed in a mow and surrounded by straw. Such storage tank
may be built, if small, out of rough 2-inch plank, spiked together, or, if
large, of 2- by 4-inch scantling, spiked flatwise one upon the other; in
both cases the tank is lined with galvanized iron. All barns provided
with steam boilers should also be provided with a few small steam
pipes leading to the water boxes, that the drinking water of the
animals may be raised in winter to 98° Fahr.
Animals do not relish lukewarm water in the winter, but they really
enjoy hot water. The economy and safety of using hot drinking water
will justify the expense of providing it. This is especially true in the
winter dairy and when horses have severe winter work. An
overheated, tired horse may drink all the hot water he desires
without danger. Water taken into the stomach at 40° Fahr. must
absorb heat enough from the system to raise it to about 99°. To do
this food must be burned, as literally as coal is burned in the boiler to
heat water. It requires more units of heat to raise a pound of water
one degree in temperature than any other substance except two or
three of the gases.
There are now so many styles of really good air motors or wind
mills, that water from wells may be pumped at a minimum cost into
storage tanks. There is no longer any excuse for pumping water by
hand for any considerable number of animals, nor for compelling
them to seek water in cold weather at some distant stream. As has
been said, there are many ways of securing a supply of water for the
barn. The details of accomplishing the results desired are many, but
the result should always be the same: an abundant supply of water
within the barn under more or less pressure. If this is not secured the
plans of a barn, as a whole, are unsatisfactory.
CHAPTER XVI
BUILDING THE BARN—THE BASEMENT
Squaring the foundation site is a simple operation, yet few are able
to perform it, and it is seldom that a surveyor is at hand. Buildings
are so generally placed with their fronts parallel to the highway or the
private way, that the road may be assumed to be the base line. Four
stakes set in the middle of the road, as shown in Fig. 96, establish
the base line, from which is measured the distance from the road at
which it is desired to place the building. The stakes A and B should
be placed farther apart than the width of the front of the building;
they are connected by a line which is parallel to the road and forms
the permanent base line. Next the stakes C and D are placed, and
also connected by a line. With a 10-foot pole, six feet are measured
off on either line, beginning at the intersection of the lines, and eight
feet on the other line. If the line C to D is at right angles to the line
AB, the 10-foot measure will just reach from 6 to 8, since 6 multiplied
by 6, plus 8 multiplied by 8, equals 100, and the square root of 100 is
10. Should the 10-foot measure be longer than from 6 to 8, the stake
D is moved to the left until the pole reaches from 6 to 8; if the
measure is too short to reach from 6 to 8, the stake is moved to the
right. All of these measurements should be gone over two or three
times, as in moving the stake the lines may stretch or shrink. Either a
pin or a pencil mark may be used to indicate the measurements on
the lines at 6 and 8.
Fig. 96. Locating the barn.
If the building is to be 26 feet deep, that distance is measured on

the line CD and the same distance from the line AB. Stakes are then
driven and a line drawn from E to F, and in like manner a line is
drawn from G to H. The work is verified by squaring the last angle as
in the first case. The eight dots represent stakes driven in even with
the surface of the ground, at just 10 feet from the corners. Since it
will be necessary to remove the lines before the horse scraper can
be used in excavating, and as the construction stakes at the corners
will be disturbed, the short stakes become necessary that the lines
may be restored as the work proceeds and the excavation kept
square and true. It will be seen that a line drawn from A to B will
restore the base line, and in like manner the other lines may be
quickly reproduced. It will be necessary, too, to restore these lines
before the foundation wall is begun. By “plumbing” downward from
the restored lines, other lines may be placed in the bottom of the
excavation, which will be duplicates of those first drawn.
Fig. 97. The original incline or slope is too steep.
Fig. 98. The original slope is not steep enough.

EXCAVATION
Barns are now usually built with a basement story. This implies
that the building is to be placed on more or less sloping ground, in
which case the removal of some earth will be necessary. The
basement story should extend well above ground, to economize
construction and to secure dry walls and floors. It is a great mistake
to place animals in cellars. The dotted line in Fig. 97 shows an
incline rather too steep; and in Fig. 98 one that is not steep enough.
It is better to place the barn where wanted, even if the incline has to
be changed, than to place it in an unhandy position that the best
slope may be secured. It is not difficult to construct a basement barn
on level or nearly level land. In the latter case, all of the basement
walls may be of wood, since provision can be made for a driveway to
the second floor by means of a retaining wall built some ten or
twelve feet from the barn; the space between the wall and the barn
may be bridged (Fig. 99). Cast-off steel or iron rails form durable and
excellent sleepers for such a bridge, the plank being kept in place by
spiking two-inch pieces, one on either end on top of the bridge plank.
In case no retaining wall is built, and the earth lies immediately
against the basement wall (Fig. 100), dampness may be largely
prevented from reaching the stable and the animals by building a
second wall across the side or end of the barn, inclosing a space or
room for roots immediately under the driveway. The floor over this
root-cellar should be deafened to prevent frost entering from above
(Fig. 101). The second wall will remain comparatively dry, since no
damp earth rests against it. This location of the root-cellar makes it
convenient for unloading the roots through trap doors in the floor,
which are kept partly open for a time after the roots have been put in,
to prevent them from heating.
Fig. 99. Bridge into the barn.
Fig. 100. An embankment entrance, with retaining walls holding the corners.
Fig. 101. Deafening or packing the floor, to keep out cold.
WALLS
The foundation walls for barns need not necessarily extend below
frost, if the earth is as dry as it should be; for a slight settling of the
building does not result in injury, as in the plastered house. All that is
necessary is to make the walls broad and strong and to have them
well drained.
Fig. 102. Good and faulty construction in a wall.
Masons understand the necessity of bonding stone walls, and

know how to perform the work; but too often they are careless, and
therefore need to be supervised. In Fig. 102, a well bonded wall is
shown at the left end, and one imperfectly bonded at the other. If the
wall should chance to pull endwise a crack would appear to the right
of the dotted line, since in the seven layers shown there is but one
stone, A, that has sufficient contact to bond the two stones upon
which it rests. The wall should also have its face and back side tied
together or bonded, or it may split apart near the middle. Two walls,
one of which is properly bonded, the other is not, are shown in Fig.
103. One layer only of stone can be shown in the diagram, but it will
readily be seen that if the course which is placed on the one shown
is laid like it,—that is, if the faulty bonding near the back side be
continued for several courses—the wall will pull apart. The small,
narrow stones have been placed at the back side of the wall, and the
good stones in the front of the wall; this is all very well, but some
long stones should reach from the back side of the wall to near the
face, if the bond is made good. No stone should reach entirely
through the wall, since in cold weather the frost will follow through
such stones from face to rear.
Fig. 103. Poorly and properly bonded.
There is no economy in using mortar which is poorly mixed or that

which contains too much sand and too little lime or cement. If the
lime or cement, that is, the binding material, does not come into
immediate contact with every particle of sand, then the mortar will be
weak. If not enough of the cement or lime is used, the bond will also
be weak. For stone walls not more than four parts of sand to one of
cement or lime should be used. If the sand be sharp and clean a
much stronger mortar is secured than when it is composed in part of
rotten sand mixed with vegetable matter. If the materials are good
and they are mixed in the right proportion, still good mortar will not
be secured unless they be thoroughly mixed. The best masons use
the least mortar, while poor masons are wasteful of it.
The prices given below are not applicable to the whole United
States, but they may serve to decide the relative proportions of sand
and lime which should be used, and the kind of lime which can be
used most economically. Water lime retails at about eighty cents per
barrel, and three parts of sand and one of lime, if the latter is fresh,
should make a strong mortar. Water lime deteriorates rapidly with
age, while the higher priced cements deteriorate quite slowly. Stone
lime should be fresh and in no case air-slaked. It costs about one
dollar a barrel and may be mixed three of sand to one of lime.
Rosendale cement costs about $1.25 per barrel, and may be mixed
four to one. Portland cement costs about $3 per barrel, and if used
instead of the cheaper materials named above, may be mixed five to
one. It should always be used for pointing walls and in the
construction of cemented floors, in which case it should be mixed
two or three to one. All this presupposes that the mortar is so
thoroughly mixed that a lime film will surround every particle of sand.
The cement and water lime is mixed with the sand before it is wet,
and this dry mixing should be most thorough, as the strength of the
mortar is largely dependent on the uniform incorporation of the
cement with the sand. This mixing can be much more perfectly done
when the material is dry than after it is wet. Other precautions are
necessary. The mortar should contain the minimum of water which
will permit it to work freely, and when the mortar is used it should be
solidified, that is, pushed together by means of a trowel or by the
material which is laid upon it. In case of cement or grout floors, the
material should be pounded thoroughly. The object of all this is to
compel each particle of sand to firmly touch other particles. The
tendency to “water-log” mortar, to save labor in spreading it, is too
common.
If, from any cause, the basement walls must be largely of stone,
the tendency for them to gather moisture may be somewhat
overcome by plastering them with cement mortar, or studding may
be placed against the walls upon which unmatched boards may be
nailed (Fig. 104). The warm air of the stable cannot then reach the
relatively cold walls, and little condensation will appear on the
boards, since they are always more nearly the temperature of the
stable than are the stone.
Wooden basement walls are preferable in all ways to those
constructed of stone, grout or brick, wherever the earth does not rest
against them. An excellent method of constructing the walls of the
basement story is shown in a section of the first story, Fig. 104. The
studding should be 2 × 6 inches, with short pieces of 2 × 4 placed
edgewise between them to serve as outside nailing girts.
Fig. 104. Lining the basement wall.
A broad, steep water-table is placed just above the upper end of

the studding to receive the boarding above the basement and to
improve the outside appearance of the building. After the outside
boarding of the basement and the window frames are placed, the
inside of the wall is boarded horizontally with unmatched seasoned
lumber, and as the boards are being put on, the hollow wall space is
filled with short straw or straw and chaff. This construction has
proved to be the most satisfactory of any tried. The wall is cheap,
durable, dry, excludes the cold, and still allows a little fresh air to
enter the stables gradually. Objection has been made to this
construction on the ground that it harbors mice and rats. After having
used buildings with walls of this character for a quarter of a century, I
must say that the objection is not well taken.
FLOORS
The floor of the first story should be partly of wood and partly of
cement or of brick.
All voidings of the animals should be removed from the stable at
least once a day. Allowing the manure to drop through gratings, with
the view of letting it remain there more than one day, is decidedly
wrong, and any arrangement which does not admit of the thorough
cleaning and airing of the stable daily is objectionable. Nor is the
practice of washing out the stables economical, since it necessitates
great waste of manure or too great expense in caring for and
removing the diluted excreta. If the floors and stable be well cleaned
with shovel and broom, and dusted with gypsum, dry earth, sawdust,
or chaffy material, good sanitary conditions will be secured easily
and cheaply. While the stables are being cleaned and treated they
should also be aired. The animals meantime should be allowed to
stretch their limbs, by which it is not meant that they should be
hooking one another around a muddy barnyard, or running foot
races up and down the lane. On the one hand, it may be all well
enough for those who sell animals at fabulous prices and have long
bank accounts, to procure water-proof blankets for them, and to
accompany them on their regular daily “constitutional.” The other
extreme is where the animals are fastened by the head or neck by
contrivances not always comfortable, and left standing for six months
without being removed from their stall. Is there not a happy medium
between these two extremes?
Top left rooms: 4′ × 10′ and 10′ × 11′.
Midway width: 10′.
Over-all width: 32′.
Bottom left room: 10′ × 11′.
Width of stalls: 3′ 6″.
Over-all length: 80′.
Room central bottom: 3′ × 6′.
Fig. 105. Basement cattle stable.

At the right is a cross-section of the stable, showing the convex cement midway.
Animals are more comfortable on a wooden floor than on one built

of either brick, cement, or asphalt. Notwithstanding this, most of the
floor of the basement should be constructed of more durable
material than wood. If the animals are kept fully bedded, as they
usually are not, then it would be best to discard wooden floors
entirely. Fig. 105 shows a basement floor designed for cattle. The
part where the animals stand is of wood, the balance of hard or
pavement brick set edgewise on a bed of sand. The cement or grout
floor may be substituted for the brick if desired. If the cracks between
the bricks in the floor are filled with thin cement mortar, the floor
becomes water-tight, though this is not necessary except in the
gutters. The ground underneath the wooden floor should be leveled
and pounded, and covered with a thin layer of salt to preserve the
wood. The plank which forms the side of the drip should be of oak or
some other durable wood. The 2 × 4 pieces to which the floor is
nailed when first built, need not be replaced when they rot, since the
dirt underneath will be smooth and hard. The large nails which fasten
the floor to the oak piece at the rear and the mangers combined will
suffice to keep the floor plank in place; the only object in placing the
nailing pieces at first is to facilitate construction. The plank of the
floor should be of some uniform standard width, as 8, 10, or 12
inches wide, that repairs may be made quickly when the floor gives
way.
STALLS
When a dairy of some size is kept, the cows may be arranged in

double rows. Fifty cows could be crowded into a barn 80 × 32 feet.
But fifty cows of 800 pounds each weigh 40,000 pounds; and if the
stable is ten feet from the top of the lower floor to the bottom of the
upper floor, it would contain only 25,600 cubic feet of air space. This
is manifestly too little, as 1 cubic foot of air space should be allowed
for each pound of live animal. Many stables, in fact most stables,
provide but one-half of a cubic foot of air space for each pound of
live animal kept in them; in such case it is impossible to keep the air
approximately pure or the stable decently sweet. To realize what this
means, suppose a bedchamber be constructed for a man weighing
160 pounds. If one foot of air space be provided for each pound of
live weight, the chamber might be built 4 feet wide, 7 feet long and 6
feet high. This would give 168 cubic feet of air space. If the
bedchamber be made proportionally as large as are most cow
stables, its dimensions would be 3 feet wide, 6¹⁄₂ feet long and 4¹⁄₂
feet high. To insure good air in such a sleeping room one side of it
would have to be knocked out.
If one or two box-stalls and one feed-bin are provided in an 80 ×
32-foot barn, with 12-foot ceilings (Fig. 105), and room for a hallway,
3 feet wide, be left at one end of the building, it will then
accommodate thirty-nine animals. Each one would have 800 cubic
feet of air space, the required amount. The first story of most cow
stables is about seven feet. It is seen how easily the stable may be
overcrowded. A high story gives opportunity for long windows and for
placing them well up from the floor, and for good ventilation. If the
ceiling is to be reduced in height, which it well may be, the building
should be proportionately longer.
A section of a part of the inside of the wall with swing windows is
shown in Fig. 106. The windows should be of one sash and hung
near the middle, as shown, by means of a piece of iron ³⁄₈ of an inch
in diameter and 4 inches long. A hole for the reception of the iron,

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ABOUT THE EDITOR

Ellen G. Horovitz, Ph.D., ATR-BC, LCAT, ERYT 500, C-IAYT is

CHARLES C THOMAS • PUBLISHER, LTD.

This book is protected by copyright. No part of

© 2020 by CHARLES C THOMAS • PUBLISHER, LTD.

ISBN 978-0-398-09338-9 (paper)

First Edition, 2009

Library of Congress Catalog Card Number: 2020017592 (print)

Cover art courtesy of Michele Jenco

With THOMAS BOOKS careful attention is given to all details of manufacturing

Printed in the United States of America

Library of Congress Cataloging-in-Publication Data

James Albertson, MS received his Masters of Science in Creative Arts

Jacob M. Atkinson, MS has worked as an Art Therapist/Clinical Case Man-

Donna J. Betts, Ph.D., ATR-BC was Assistant Professor of Art Therapy at

Aimee Beyette, MS completed her Master of Science in Creative Arts

Shawna Boynton, MS received her Master of Science in Creative Arts

Sarah L. (Eksten) Brasse, MS, ATR received her Master of Science in

Day Butcher, MS received her Master of Science in Art Therapy from

Marcia Sue Cohen-Liebman, PhD, ATR-BC, LPC is a Forensic Art

Caitlin Farmer Cassella, MS completed her master’s in the Creative Arts

Erin Dougherty, MS received her Master of Science in Art Therapy from

Amy Miller Hoag, MS completed her master’s in the Creative Arts

Ellen G. Horovitz, Ph.D., ATR-BC, LCAT, ERYT 500, C-IAYT is Profes-

Benjamin Keipper, MS received his Bachelor of Arts Degree in Art Studio

Michael E. Martin, MS received his Master of Science in Creative Arts

Kathryn McCarthy, MA, MS completed her Master of Science in the

Cara Monachino, MS completed her graduate training at Nazareth College

Erin Popcun, MS completed her graduate training at Nazareth College of

Julie Riley, MS received her Master of Science in Creative Arts Therapy

Stella A. Stepney, MS, ATR- BC, LCAT is a Registered and Board

Michele (Shelley) Takei, Ph.D. has a doctorate in Transpersonal

Sally Taylor, MS completed her graduate training at Nazareth College of

Chelsey Vano, MS received her Master of Science in Creative Arts Therapy

Kelsey H. Wall, MS received her Master of Science in Creative Arts

• Section I: Introduction to the Third Edition: Quantifying Qualitative

multigenerational family assessment. Contributions include assessing

My mother taught me to always make my bed, say thank you

SECTION I: INTRODUCTION TO THE THIRD EDITION:

1. THE EFFICACY OF ASSESSMENTS IN ART THERAPY . . . . . 5

2. GATHERING PATIENT INFORMATION, CONSTRUCTING

3. THE APPLICATION OF QUANTIFYING FOUR

4. MULTICULTURAL ISSUES IN ASSESSMENT,

SECTION II: QUALITATIVE INSTRUMENTS

5. ART THERAPY DREAM ASSESSMENT (ATDA) . . . . . . . . . . . 79

6. BELIEF ART THERAPY ASSESSMENT (BATA) . . . . . . . . . . . . 94

7. COGNITIVE ART THERAPY ASSESSMENT (CATA) . . . . . . 114

8. HOUSE-TREE-PERSON ASSESSMENT (HTP) . . . . . . . . . . . . . 126

9. KINETIC FAMILY DRAWING ASSESSMENT (KFD) . . . . . . . 141