Facilitative Drawings With Children Versus Human Figure Drawings

LETTERS TO THE EDITOR To the Editor: In the recent article Human Figure Drawings as a Measure of Children's Emotional Status, Skybo et al. (2007) provide a comprehensive review of human figure drawings (HFDs) as a measure of children's emotional status. However, as Skybo begins her discussion about using HFDs in practice and research, she states “HFDs provide a greater quantity and more descriptive information than verbal interviews” (p. 26). This is incorrect and, as stated, is very misleading. Wesson and Salmon (2001), whose study she cites, did not use HFDs. They used facilitative drawings, drawings used to facilitate conversation or dialogue during an interview, which is a very different technique. The HFD is a very specific and very useful adjunctive assessment tool, but there are no studies, to my knowledge, that demonstrate that HFDs provide a greater quantity and more descriptive information than verbal interviews, which is what Skybo states. There are only studies that show that facilitative drawings demonstrate this. I believe this is a very important distinction. Facilitative drawing techniques provide children the opportunity to draw as part of an interview process. The act of drawing moderates their narrative skill, providing children the opportunity to organize and tell their stories using retrieval cues that are internal, rather than externally generated. Although there is extensive research on the projective value of children's drawings, especially HFDs, it is critical not to abandon a child's accompanying narrative or voice in favor of adult expert interpretation. Children's drawings should facilitate rather than replace communication with children—a point I tried to emphasize in an article published earlier in this journal (Driessnack, 2005). Again, I believe that the article provides an excellent review of HFDs but may be misleading to some readers on this one, very critical point. Martha Driessnack, PhD, ARNP Post Doctoral Research Fellow College of Nursing, The University of Iowa Iowa City, IA E-mail: [email protected] REFERENCES Driessnack, M. (2005). Children's drawings as facilitators of communication: A meta-analysis. Journal of Pediatric Nursing, 20, 415−423.

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Wesson, M., & Salmon, K. (2001). Drawing and showing: Helping children to report emotionally laden events. Applied Cognitve Psychology, 15, 301−320.

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Reply: We would like to thank Dr. Driessnack for her interest in our article (Skybo, Ryan-Wenger, & Su, 2007) and continued campaign to have children's voices heard. Dr. Driessnack is correct in that Wesson and Salmon (2001) did not use human figure drawings (HFDs) to help children tell about an emotionally laden event. Rather, they used facilitative drawings by asking the children to draw “everything that you remember about this time when you were happy (or sad, or scared)” (p. 305). Nevertheless, the point of Wesson and Salmon's work is that children who drew and were interviewed reported more information and included more descriptive items than those children who were only interviewed. It is important that children have an opportunity to express themselves through drawings regardless of type. As discussed in our article, content analysis of HFDs can be obtained in a variety of ways, one of which is interactive, that is, children are asked for their own interpretation of their drawing (Is the person someone you know? What is the person thinking?). When used as a projective technique, drawings are nonverbal communications that reveal “the artist's self-concept, anxieties, attitudes and conflicts” (Ryan-Wenger, 2002, p. 144). A systematic analysis of projective HFDs involves identification of specific parts in the HFD (emotional indicators) for which research has shown their presence is highly correlated with emotional health disturbances (Kopptiz, 1968). The method of analysis is the researcher's or clinician's choice. We did not recommend that the child's narrative or voice be abandoned in favor of the adult expert interpretation. We reiterate Dr. Ryan-Wenger's response to your letter to the editor on the same topic in 2002: In practice, “… a child's narrative regarding his or her drawing is a component of the interview process” (p. 156). Because research has shown that drawings may also “represent emotions or thoughts that children may be unable or unwilling to verbalize” (p. 156; see, e.g., Salmon, Roncolato, & Gleitzman, 2003), there is merit in independently analyzing

Journal of Pediatric Nursing, Vol 22, No 6 (December), 2007