Abstract The Person Picking an Apple from a Tree (PPAT) drawing ...

Abstract
The Person Picking an Apple from a Tree (PPAT) drawing and Formal Elements Art
Therapy Scale (FEATS) (Gantt & Tabone, 1998) had not been studied for a profile of
characteristics unique to individuals with Borderline Personality Disorder (BPD). There is limited
quantitative research designed to identify frequent formal art elements in artwork of patients with
BPD with the exception of a study by Mills (1989) who used the Diagnostic Drawing Series
(DDS) to identify items in the assessment that were found in patients with BPD. Two
quantitative studies established the occurrence of Axis I disorders in patients diagnosed with
BPD, specifically mood disorders and major depressive disorder. In an anecdotal report based
on her work with patients with BPD, Silverman (1991) observed black holes, strong outlines,
and disorganization. In their anecdotal report, Cole and Robbins (1994) observed concrete and
pictorial images that were repetitive, two-dimensional, dull in color, lacked organization, and
included universal signs. Mills’ (1989) findings were strong enough to warrant another look at
what formal art elements were characteristic of patients diagnosed with BPD. Results might be
beneficial to the field of art therapy by providing art therapists with additional information
regarding diagnosis, patient’s mental status, or patient’s response to treatment.
Participants were five outpatient psychiatric patients diagnosed with Axis I Major
Depression or Depressive Disorder Not Otherwise Specified, both previously treated, and Axis II
Borderline Personality Disorder (BPD). Participants each completed a drawing of a Person
Picking an Apple from a Tree (PPAT). The Formal Elements Art Therapy Scale (FEATS) (Gantt
& Tabone, 1998) was used to rate the PPATs and identify frequent formal art elements.
The Pearson r was used to calculate inter-rater reliability for each of the 14 FEATS
derived from two raters’ scores. For scales with acceptable inter-rater reliability (r=0.70), the
mean score for each participant was determined. Finally, a frequency count of the resulting
means was conducted to identify frequent formal art elements. A 60% or higher reoccurrence of
the mean score was required to identify the frequent formal art element for each scale with
acceptable inter-rater reliability.
Of the 14 scales, six resulted in acceptable inter-rater reliability and a 60% or higher
reoccurrence of the same mean score across participants. These scales were: Space (r=0.866,
p=0.0288, 60% reoccurrence of score 3.75); Integration (r=1, p=NaN, 60% reoccurrence of
score 4.5); Logic (r=NaN, p=NaN, 100% reoccurrence of score 5); Line Quality (r=NaN, p=NaN,
60% reoccurrence of score 4); Rotation (r=1, p=NaN, 80% reoccurrence of score 5); and
Perseveration (r=NaN, p=NaN, 60% reoccurrence of score 5).
In sum, the PPATs of these five BPD patients were characterized by (1) using 50% to
75% of the paper for the drawing, (2) a visual relationship between at least three elements to a
well integrated, well balanced composition, (3) no bizarre or illogical elements, (4) lines that are
under control, (5) no rotation, and (6) no perseveration. It was concluded the FEATS could be
used to establish a profile of characteristics typical of these five diagnosed participants with
BPD.
This information is applicable to clinical practice of art therapy because it provides
additional information regarding diagnosis, the patient’s mental status, or the patient’s response
to treatment. Having patients with BPD draw PPAT drawings throughout their treatment might
be useful to identify regression or progression in treatment.

References
Cole, M. D., & Robbins, A. (1994). Diagnostic indicators in the artwork of borderline and
dissociative patients. In A. Robbins, (Ed.), A multi-modal approach to creative art
therapy (pp. 124-140). Bristol, PA: Jessica Kingsley.
Gantt, L., & Tabone, C. (1998). Formal Elements Art Therapy Scale: The rating manual.
Morgantown, WV: Gargoyle Press.
Mills, A. (1989). A statistical study of the formal aspects of the Diagnostic Drawing Series of
borderline personality disordered patients, and its context in contemporary art therapy.
Unpublished master’s thesis, Concordia University, Montreal, Quebec, Canada.
Silverman, D. (1991). Art psychotherapy: An approach to borderline adults. In H. B. Landgarten,
& D. Lubbers, (Eds.), Adult art psychotherapy: Issues and applications (pp. 83-110).
Philadelphia: Brunner/Mazel.