Outcomes: Art Therapy Case Vignettes

The following client ‘vignettes’ reference an outcome measure known as the Clinical Outcomes Routine Evaluation Outcome Measure* or CORE-OM for short. In the cases below the ‘measure’ of the client’s difficulties have been taken before therapy began and / or at the first therapy session, at the last session and / or after therapy finished (6 months later where possible).

Only those clients who opted into the evaluation and completed CORE measures before and after therapy and who consented to the use of the information are included.

In regard to the scores:

Subjective Wellbeing

This dimension measures your emotional difficulties, optimism and capacity to manage problems.

The average cut off point for wellbeing scores in clinical and non-clinical population ranges for women is rated at 1.8 or 1.4 for men so any scores moving towards or below this level would be considered improvement towards increased sense of subjective wellbeing. The worst a patient could subjectively rate their wellbeing at is 4.0.

Risk

This dimension measures the degree to which you feel sensitive about the level of distress you can tolerate in life before resorting to risky behavior or actions.

The cut off point for risk scores in the normal non clinical population ranges for women is rated at 0.3 and 0.4 for men so any scores below this would be considered improvement towards less thoughts, feelings or behaviour related to risk. The worst a patient could measure themselves at regarding risk is 4.0.

Overall

This dimension measures a combination of the above plus your capacity to function in daily life and responsibilities as well as manage your problems and symptoms.

The cut off score between clinical and non-clinical results for the overall factors for women is 1.3 and 1.2 for men so any scores below this would be considered improvement. Again the worst a client could rate their overall difficulties is 4.0.

Significant / major change is usually indicated by .5 or greater shifts in the scores.

Outcomes: Art Therapy Case Vignettes

What follows below are 10 case vignettes using a standard evaluation measure for psychological therapy. These cases were taken from the last 5 years. In the last 5 years approximately 45 patients were offered therapy of which 11 patients provided complete sets of data.

Of the remaining clients they either chose not to opt in to the research or did not provide completed sets of data around which to compile a brief study such as those that follow. Two patients dropped out of therapy earlier than planned though no reason could be established about why this happened directly with the client. In all the cases that follow consent was provided to use the statistics whilst ensuring confidentiality remained.

See qualitative comments section for what clients say about art therapy.

A note about the graphs / CORE and how to read the graphs: Read the graph lines from left to right - if they go downward things are improving.

Female
Age 28
Employed part time

Therapy Treatment

  • Individual, weekly art psychotherapy sessions over 18 months (preceded by art psychotherapy trial of 3+1 sessions.) for a combined total of 73 appointments. 10 of the appointments were cancelled by the client with notice (approx 14%).
  • Had received brief ‘targeted’ counselling which did not address the origins of the presenting difficulties. Had begun some individual Cognitive Behavioural Therapy (2007) regarding risk behaviour but ‘did not find that particular approach helpful in working with the problems’ adding it was ‘too prescriptive and outcome driven.’

Presenting Problems

  • Previously diagnosed via Psychiatry services with a Borderline Personality Disorder with previous Psychotic features (no longer manifest at start of therapy).
  • Low mood / depression and paranoia after stopping taking medication. A number of diagnoses had been suggested after various contacts with services over several years including Personality Disorder, Psychosis and anxiety. Difficulties related to childhood issues and a fractious relationship with parents, especially mother. Assaulted by a work colleague.
  • The client described their difficulties in terms of depression and anxiety and when at their worst has been delusional and paranoid. At times found it difficult to leave the house, to be around people and to generally motivate self. Reported a long history of self-harm from the age of 9 years old, difficulty making sense of feelings and inter-personal difficulties.
  • In regard to therapy - wanted a space to explore and work through issues about childhood which they felt contributed to the long standing problems ‘in a safe and objective environment.’ Wanted to be ‘a less difficult person’ and expected that therapy would ‘help to understand things and contextualise them with a view to changing behaviour.’

CORE Score

  • CORE score issues improved from 2.5 in terms of wellbeing to 1.2 at the last therapy session. A significant 13 point improvement.
  • In terms of risk scores fell from 0.3 at pre-assessment to 0.2 at the last session.
  • Overall questions were measured at 2.4 which reduced to 1.2 by the last therapy appointment measure. A significant 12 point improvement.

After therapy finished this client got a new job and had ended a relationship which they had come to see as wrong and re-enacting a problem about their past issues.

See qualitative comments section for what clients say about art therapy.

Co-produced interview recording by this client for their experience of art therapy*

*Not mentioned on the recording (edited out to keep the recording brief) were a series of dreams, the exploration of which the client found very useful in understanding what was in their nature.

Female
Age 40
Working part time
Married with two young children

Therapy Treatment

  • Individual art psychotherapy over 12 months (preceded by art psychotherapy trial of 3+1 sessions.) for a combined total of 51 appointments.
  • 6 of the appointments were cancelled by the client (approx 6%) and mainly due to having no childcare and / or illness.

Presenting Problems

  • Diagnosed with an eating disorder. Difficulties with anxiety, obsessive compulsive disorder and anger.
  • Difficult history with mother and little contact with father after her mother left him when the client was aged six. Deep mistrust of men, avoids love and intimacy or closeness. Minimal availability of soothing and reassurance around in the environment for increasingly destructive thoughts and feelings.
  • Constant upheaval, relocation, moving around, lack of stability. Grievance stored up over many years about her inter-personal relationships and how this is expressed through food.

CORE Score

  • CORE score issues improved from 2.2 in terms of wellbeing to 0.5 at the last therapy session. A significant 17 point improvement.
  • In terms of risk scores began at 0 and rose slightly to 0.2 at the start of therapy and showed the same result at the 5 month review stage during therapy and fell to 0 again at the last session.
  • Overall questions were measured at 1.3 which reduced to 0.5 by the final therapy session which represents a significant shift of 8 increments.

See qualitative comments section for what clients say about art therapy.

Female
Age 34
Working full time
Single with two children

Therapy Treatment

  • 70 sessions of therapy attended (18 months) with a six week break after the death of partner whilst on holiday abroad.

Presenting Problems

  • Problems of ongoing illness with a somatised aspect related to the stressful conditions of a demanding job in Social Care. This role also linked to the client’s own difficult and troubled childhood history marked by abuse and emotional neglect.
  • Persecutory, excessively self-demanding and punitive work ethic and split off internal world.
  • Socially isolated.

CORE Score

  • Therapy began in June 2011. CORE score issues improved from 3.5 in terms of wellbeing to 0.5 at the end of therapy. A significant improvement of 30 increments.
  • In terms of risk the scores improved from 0.5 to 0.2 at the end of therapy.
  • Overall questions were measured at 2.3 which reduced to 0.5 at the end of therapy. A significant improvement of 18 increments.

See qualitative comments section for what clients say about art therapy.

Female
Age 23
Employed full time
Living with partner

Therapy Treatment

Also under Psychiatrist at point of therapy and previously Psychosis Specialist Team

  • Individual art psychotherapy over 14 months (preceeded by art psychotherapy trial of 3+1 sessions.) for a combined total of 56 appointments.
  • 8 appointments cancelled or not attended (approx 7%).
  • Followed up with two, three-month review appointments over seven month period, post-therapy.

Presenting Problems

  • A young woman who had developed Bi-Polar Affective Disorder with periods of hypomania and depression. She was receiving medication treatment and was well stabilised on Lithium. The patient reported not noticing any marked benefit from medication in terms of her depression but had done so regarding the mania.
  • In terms of the family history there was depression on her maternal side of the family. There was some occasions of bullying during her school years but was able to defend herself appropriately and effectively where necessary. She did however report low self-esteem and a negative view of herself from being a teenager. She had occasionally induced vomiting or avoided food having been conscious of her weight since the age of 14.
  • In terms of symptoms of depression she thought this began aged 17 and was prescribed antidepressants which she had a difficult reaction to. Aged 19 she began self-harming as well as having visual and auditory hallucinations. This seemed to coincide with the split from her boyfriend who was frequently violent and controlling towards her. Around that time she received some Cognitive Behavioural Therapy over 12 sessions.

CORE Score

  • CORE score issues improved from 2.8 in terms of wellbeing to 0.8 at the last therapy session and 0.3 at follow up. A significant improvement of 25 increments.
  • In terms of risk scores fell from 1.3 to 0 at the last session being maintained as such through to the six month follow up. A significant improvement of 13 increments.
  • Overall questions were measured at 2.6 which reduced to 0.4 at the last therapy session and measured at 0.5 by the six month follow up post therapy appointment measure. A significant improvement of 21 increments.
  • At the end of therapy this client reported her feelings as not totally resolved but more able to cope with her problems and able to talk about them with her partner and some trusted friends rather than avoid, minimise or split them off. She felt art therapy had helped more than she initially expected and was able to name and recognise her feelings before they grew to catastrophe point. She reports less instances of issues about her body or food and less guilty about things out of her control.
  • At the beginning of therapy they reported massive mood swings; being hyper for days/weeks then low from her pre-teen / early teen years. She wanted to stop obsessing over things and have more control over her mood swings. She thought treatment might help in understanding her own thought processes. Some emotions however continue to take time to process and articulate.

Towards the end of therapy the client had been able to begin driving again having not had any psychotic symptoms for the previous two years. She also began planning to come off medication (having already reduced this) in order to have her first child.

See qualitative comments section for what clients say about art therapy.

Male
Age 36
Working full time

Therapy Treatment

  • Individual art psychotherapy over 12 months (preceded by x4 experiential sessions of art psychotherapy). This was a combined total of 48 appointments.
  • Attended all of the appointments available.

Presenting Problems

  • Difficulties with relationships and specific trauma in childhood.
  • Dependency problems in current relationship and ambivalence.
  • Feelings of shame around intimacy and suppressed anger.
  • Current problems with eating.

CORE Score

  • CORE score issues improved from 1.0 in terms of wellbeing to 0.8 at the follow up measure. A specific life event had occurred midway into therapy where there is a ‘spike’ in the graph.
  • In terms of risk scores were at 0.2, increased slightly to 0.6 during therapy and reduced to 0 by the follow up measure.
  • Overall questions were measured at 1.0 which reduced slightly to 0.8 by the follow up stage.

See qualitative comments section for what clients say about art therapy.

Female
Age 52
Currently off work
Married

Therapy Treatment

  • Individual art psychotherapy of 12 months, preceded by art psychotherapy trial of 3+1 sessions.
  • A phased ending was planned in order to manage attachment and separation issues for a combined total of 55 appointments.
  • 3 of the appointments were cancelled at short notice due to illness.

Presenting Problems

  • Previous depression and subsequent difficult specific incident at work.
  • Some autistic traits which make processing feelings more complicated for the client.
  • Difficult attachments with parents, especially father in childhood due to an issue never fully addressed in the personal family history.

CORE Score

  • CORE score issues improved from 3.0 in terms of wellbeing to 1.8 at the last therapy session. A significant improvement of 12 increments. Then getting worse at follow up March 2015.
  • In terms of risk scores were at 0 at the start of therapy and remained so at the last session but then increased after therapy finished.
  • Overall questions were measured at 1.7 which reduced to 1.5 by the final therapy session.

It is notable that all of the scores get worse at the follow up stage March 2015 which coincides with the time that this client had major surgery on her spine. Despite this she went on to became a co-leader of a local arts project in mental health services – a role which she continued to maintain 18 months later at the time of writing.

See qualitative comments section for what clients say about art therapy.

Co-produced interview recording by this client for their experience of art therapy.

Female
Age 36
Full time mother
Co-habiting
Mother of two young children

Therapy Treatment

  • Individual art psychotherapy of 12 months, preceded by art psychotherapy trial of 3+1 session. Of a total of 45 appointments available the client attended on 42 occasions.
  • There were three cancelled appointments at short notice regarding problems around transport arrangements.

Presenting Problems

  • Attachment difficulties in childhood subsequent to being in foster care from aged 6 months.
  • Ongoing and progressively debilitating physical problems.
  • Depression and anxiety.
  • Specific history / experience of abuse sustained abuse in previous relationship.
  • Difficulties expressing feelings and social isolation.
  • Entrenched pattern of negative self-image.
  • Low sense of own value.

CORE Score

  • CORE score issues improved from 2.8 to 1.0 at the last therapy session. A significant improvement of 18 increments.
  • In terms of risk scores were at 0.8 when first measured and reduced to 0 by the final session. A significant improvement of 8 increments.
  • Overall questions were measured at 2.9 which reduced to 0.9 by the final therapy session which represents a significant shift of 20 increments.

See qualitative comments section for what clients say about art therapy.

Female
Age 53
Working part time
Married

Therapy Treatment

  • Individual art psychotherapy of 12 months, preceded by art psychotherapy trial of 3+1 sessions.
  • A phased ending was discussed in order to manage attachment and separation issues for a planned total of 42 appointments. Of the 40 appointments available the client attended on every occasion.
  • As part of this client’s assessment outcome it was recommended to them by me that they have individual therapy first followed by the possibility of group psychotherapy so that they could continue to work through their difficulties at a more psycho-social and inter-personal level.

Presenting Problems

  • Client struggling with depression and loss of meaning in life, prone to anxiety and feeling pessimistic about their own future.
  • Unhappy marriage and work and feeling generally stuck and unfulfilled.
  • Not liking or having respect for self, isolated from others, finding it difficult to assert self and make choices about their life and avoidance of social situations.
  • Death of mother aged 4 followed by emotional and physical abuse / neglect in parental home by father.
  • Asperger’s syndrome identified as possible underlying factor early in therapy.

CORE Score

  • CORE score issues improved from 2.3 (first therapy session) in terms of wellbeing to 1.5 at the last therapy session. Representing a significant improvement of 8 points.
  • In terms of risk scores were at 0.3 reducing to 0.2 by the last therapy session.
  • Overall questions were measured at 1.6 which reduced to 0.9 by the final therapy session which represents a significant improvement of 7 increments.

 

  • This client had previous support from NHS services beginning in 2000 through to 2003. They received individual Cognitive Behavioural Therapy. Prior to CBT starting they had received 25 sessions of private counselling.
  • There are five evaluation measure scores during this time period. This client in September 2000 (first referred into therapy services but before they met a therapist) rated their wellbeing as 2.8 initially, rising to 3.6 in January 2001, 3.5 in January 2002 (This is when the first therapy session for CBT began), 2.0 in March 2003 (the last therapy session) and 1.3 in September 2003 after therapy finished adding that the therapy they received still ‘helps a little and that they continue to use the techniques.’
  • In terms of risk scores the self-rating was measured at 0.7 at the start and 0 at the last session remaining at 0 in September 2003.
  • Overall scores were first measured at 2.4 and reduced to 1.3 by the last therapy session and reducing again to 1.1 at the follow up point in September 2003.

A six month follow up evaluation is due in the next couple of months at the time of writing.

See qualitative comments section for what clients say about art therapy.

Male
Age 56
Working part time but increasing to full time
Married with a young child

Therapy Treatment

  • Individual art psychotherapy of 18 months. Proceeded by an initial assessment session and art psychotherapy trial / experiential appointments of 3+1 sessions.
  • A phased ending was discussed in order to manage attachment and separation issues for a planned total of 76 appointments. The client attended on 74 occasions. There were two cancellations with notice by the client.

Presenting Problems

  • Severe depression and / or anxiety subsequent to loss of child at birth and subsequent grieving at point of therapy.
  • Long standing problems regarding abusive and neglectful mother and loss of relationship with father in childhood.
  • Subject to bullying at work and discrimination towards problems with dyslexia.
  • Anxiety and stress brought on by financial situation.

CORE Score

  • CORE score issues improved from 2.8 in terms of wellbeing to 1.8 at the last therapy session, improving to 0.5 at the six month follow up stage. A significant improvement of 23 increments.
  • In terms of risk scores were at 0.3 at pre-assessment and reduced to 0 by the final session, increasing slightly to 0.2 at the six-twelve month follow up stage.
  • Overall questions were measured at 2.1 which reduced to 1.1 by the final session, reducing to 0.5 at the follow up stage. This is a significant improvement of 16 increments.

See qualitative comments section for what clients say about art therapy.

Co-produced interview recording by this client for their experience of art therapy

Female
Age 35
Married with three children

Therapy Treatment

  • Individual art psychotherapy over 12 months preceded by 4 experiential sessions. Following a review of progress the client elected to extend the therapy by a further 12 months given the long-standing and complex nature of her difficulties. Of a total of 95 appointments available two were cancelled by the client at short notice mainly due to no childcare arrangements.
  • Wanted help for ‘putting things in the past where it belongs and learning to connect with people on appropriate levels and dealing with intimacy issues.’ Wanted to ‘let go of the past and not feel angry and resentful. Give my husband and children the wife and mum they deserve. Confront or forgive my (parental) family. To have acceptable boundaries with people and stop worrying about people or what they want or being too friendly and not being able to say no.’
  • Previous treatment of 10 weeks ‘self-esteem’ course (several years prior to this episode of therapy).

Presenting Problems

  • Sustained (specific) abuse throughout mid to late childhood (perpetrator successfully convicted several years prior to therapy).
  • Neglect and emotional deprivation in childhood development.
  • Depression and damaged family attachments/relationships.
  • Recent severe stress and anxiety with associated medical condition.
  • No trust in people leads to distancing self and isolation.
  • Minimal self-esteem. Intimacy problems. Anxiety.

CORE Score

  • The CORE plotline graph shows four dates where a measure of the presenting problems was taken. The October 2015 date is the last therapy session. A further outcome measure was completed six months after finishing therapy where the scores notably worsened.
  • The client informed me that things had remained stable after therapy and her life was progressing well. One of her children no longer required counselling, she had got a part time job which she was enjoying but following the need for an operation she was then dismissed by work for ‘refusing to work beyond her contracted hours whilst recovering / sick.’
  • Her partner was then diagnosed with a life threatening illness and she became his full time carer (having planned to go on holiday abroad together for the first time). Notably, despite the difficult events in this client’s life she added that she ‘no longer retired to bed like before, had sought help when she needed it (rather than isolate or void out the problems).’
  • Overall she thought she had got the appropriate support she required which she could access when needed. She agreed that the CORE scores were linked to life events and that although they reflect an appropriate emotional response to things in her life these were not causing her to relapse into her problems in the way they were prior to coming to therapy.

See qualitative comments section for what clients say about art therapy.

*Clinical Outcomes Routine Evaluation Outcome Measure

This is a patient self-report questionnaire designed to be administered before and after therapy. It can also be used during therapy. The patient is asked to respond to 34 questions about how they have been feeling over the last week, using a 5-point scale ranging from 'not at all' to 'most or all of the time'. The 34 items of the measure cover four dimensions. These evaluations refer to subjective wellbeing and specific distressing ideas or thoughts along with an overall rating for dimensions which includes life functioning and problems / symptoms.

The responses are designed to be averaged by the practitioner to produce a mean score to indicate the level of current psychological global distress (from 'healthy' to 'severe'). The questionnaire is repeated after the last session of treatment; comparison of the pre-and post-therapy scores offers a measure of 'outcome' (i.e. whether or not the client's level of distress has changed, and by how much).

CORE is also a nationally recognised measure used across a variety of different kinds of psychological therapies.

CORE does not explain any specific life events at the time the self-rating measure is being completed.

Accreditations

I am a registered art psychotherapist with the British Association of Art Therapists (BAAT) and registered to practice with the Health and Care Professions Council (HCPC).

Art doesn’t have to be pretty. It has to be meaningful.

Duane Hanson

Art is when you hear a knocking from your soul - and you answer.

Terri Guillemets

Creativity is discontent translated into arts.

Eric Hoffer