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Draw-a-Person-in-the-Rain as an assessment of stress and coping resources

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The Arts in Psychotherapy 37 (2010) 233–239

Contents lists available at ScienceDirect

The Arts in Psychotherapy

Draw-a-Person-in-the-Rain as an assessment of stress

and coping resources
Lisa R. Willis, LPC, MA a,∗ , Stephen P. Joy, PhD b , Donna H. Kaiser, PhD, ATR-BC b
a
Clinical Liaison at Rushford Center, Meriden, CT, United States
b
Albertus Magnus College, New Haven, CT, United States

a r t i c l e i n f o a b s t r a c t

Keywords: This study examined the relationships between the Draw-a-Person-in-the-Rain (DAPR) and the Cop-
Draw-a-Person-in-the-Rain ing Resource Inventory for Stress (CRIS) and the Perceived Stress Scale (PSS-10). Participants were 40
Stress clients with psychiatric diagnoses and co-occurring substance use disorders. Three raters used revised
Coping
DAPR rating scales to score the drawings for stress and protection indicators. Intraclass correlation coef-
ficients demonstrated satisfactory inter-rater reliability for both scales, Perceived Protection (r = .89) and
Perceived Stress (r = .88). The number of DAPR protection indicators correlated positively with the CRIS
Self-Directedness scale (r = .43, p < .01); there also were trends towards significant correlations with the
Confidence scale (r = .31, p < .10) and the Mental Tension Control subscale (r = .30, p < .10). The DAPR stress
indicators did not correlate with either self-report measure; however, the DAPR protection indicators and
the PSS-10 did show a trend toward a significant correlation (r = .29, p < .10).
© 2010 Elsevier Inc. All rights reserved.

Clients often enter mental health treatment programs with
acute symptoms because they lack healthy coping skills or the
ability to identify coping resources. Aldwin and Sutton (1996)
found that coping resources allow a person to perceive positive
outcomes instead of feeling hopeless. Moos and Schaefer (cited
in Aldwin & Sutton, 1996) suggested that the ability to cope with
stress increases feelings of mastery and self-esteem, improves
close relationships, values, and reality testing. Lack of healthy
coping resources promotes the use of escapism as a coping tool
and increases feelings of depression. Learning to identify stress
triggers and coping resources, and improving coping skills increase
the client’s ability to maintain higher levels of functioning and
mental health.
The ability to assess a person’s perceived coping resources
and their stress is helpful in several ways. According to Matheny,
Aycock, Curlette, and Junker (1993), focusing on coping resources
and access to coping tools, rather than assessing for coping
responses or the reaction to stress, is a better predictor of a
person’s ability to cope with a stressful situation by identify-
ing “the factors in place before stressors occur.” Clinicians need
tools that will allow for a quick assessment (Rossi, 1997) as
they observe, listen to, and talk to clients, assessing any change
in their mental health to determine their abilities to cope in
order to stabilize the client and prevent decompensation. Clin-
∗ Corresponding author.
E-mail address: lisarwillis@gmail.com (L.R. Willis).
icians must contend with limits to the amount of time clients
may spend in treatment while trying to provide the best level of
care.
The Coping Resource Inventory for Stress (CRIS; Matheny et al.,
1993) was designed to assess a person’s ability to access resources
for coping with stress. The authors maintained that stress results
from an imbalance between perceived demands and available
resources. The CRIS is a 15-scale inventory, each scale consisting
of 20 or more items. The authors assert that the CRIS scales have
high internal consistency, test–retest reliability, and moderate to
low intercorrelations, offering stable measures of subconstructs.
Matheny et al. (1993) created a shorter version of the CRIS using 6
of the 15 scales (Social Support, Social Ease, Problem Solving, Self-
Directedness, Confidence, and Acceptance). Research supported the
construct validity of five of the CRIS scales as well as its divergent
validity. The CRIS reflects the imbalance between perceived coping
resources and stress.
Cohen and Williamson (1988) explored the influence of per-
ceived stress on pathology and on functioning when stress is
diffuse. The authors noted that changes in coping resources influ-
ence appraised stress. The Perceived Stress Scale (PSS), created by
Cohen, Kamarack, and Mermelstein (1983), is useful in measuring
the current level of perceived stress in a person’s life.
Self-report measures are limited in that they reflect only con-
scious, verbalized expressions of self. Machover (1949) proposed
projective drawing tests as a means for uncovering preconscious
or unconscious material that a client may not be able to access
verbally. Hammer (1958) agreed that drawings are a means of

0197-4556/$ – see front matter © 2010 Elsevier Inc. All rights reserved.
doi:10.1016/j.aip.2010.04.009
 Author's personal copy
234 L.R. Willis et al. / The Arts in Psychotherapy 37 (2010) 233–239
expressing people’s unconscious or reluctant view of the self as
one is, or as one would like to be. Frank (1948, cited in Aiken, 1999)
asserted that projective tests could reveal conscious and uncon-
scious conflicts, desires, fears, and needs of a person, as well as his
or her overall way of perceiving and responding to the world. Criti-
cisms of drawing assessments point to the need to develop reliable
scoring systems and conduct adequate validity studies of projec-
tive measures. Aiken (1999) also alluded to the frequent criticism
of projective tests as suffering from poor reliability, poorly designed
validity studies and results that do not hold up to cross validation.
There is also, he suggested, a tendency on the part of those adminis-
tering these tests to focus on findings that are consistent with their
own expectations, while discounting negative findings.
Hammer (1958) discussed the importance of research to explore
any limitations of projective drawings and further validate their sig-
nificance as diagnostic instruments. His 1958 book also contains the
first published reference to the Draw-a-Person-in-the-Rain (DAPR).
Verinis, Lichtenberg, and Henrich (1974) used the DAPR in the only
published empirical study to date; these authors asserted that the
DAPR may be useful in determining the most appropriate treatment
approach for clients who suffer from persistent mental illness. They
also speculated that the elements of the drawing, the rain and the
defenses against the rain, related to the amount of stress a per-
son experiences, and his or her defenses for coping with stress,
respectively. They attempted to demonstrate the benefit of a stan-
dardized approach for measuring a projective drawing by depicting
a person in a stressful situation. They did not, however, develop
an actual rating scale for the drawings, relying instead on clinical
judgment.
In the first of their three studies, Verinis et al. (1974) found
that it was possible to predict broad diagnostic category (neurotic,
character-disordered, and psychotic/borderline psychotic) for ado-
lescents in treatment. The second study of hospitalized adolescents
had less significant results—there was no correlation between rat-
ings based on the drawings and scores on personality inventories.
Data collected from the last study was from a sample of non-patient
adolescents and was intended to determine whether any significant
differences existed along racial or sexual lines. The researchers did
not find any significance in the sex of the figure drawn relative
to the sex of the participant. They did find significant differences
between races, with the drawings of the black adolescents demon-
strating a greater tendency to be placed in the psychotic/borderline
psychotic category (Verinis et al., 1974).
Other (unpublished) studies have related the Draw-a-Person-
in-the-Rain to stress-related symptoms. Carney (1992) studied
depression in an adolescent population (N = 121), testing the rela-
tionship between the lack of protection indicators in the DAPR and
increased levels of depression. Carney concluded that an increase in
a depressive emotional state, expressed through insufficient pro-
tection from the rain in drawings, might reflect a breakdown in
the ability to cope with stressors. Results from her study supported
the validity and reliability of the DAPR as a measure of stress and
depression in adolescents.
Rossi (1997) argued that projective tests are useful in assess-
ing and moving beyond defenses in order to collect non-verbal
information that may give insight into a client’s ego functioning,
including the presence or lack of tools for coping in stressful sit-
uations. Rossi’s study included clients (N = 13) from a short-term
mental health agency and she concluded that the DAPR was effec-
tive as a measure of a client’s subjective stress level. However, the
study demonstrated only a weak correlation between the DAPR and
the client’s perception of his/her ability to problem solve.
Krom (2002) used the DAPR to study indicators of stress and
coping among hospice nurses (N = 35) using two rating scales: one
scored the number of protective indicators (coping resources), and
the second scale scored the size and density of the rain (perceived
stress). She concluded that a balance between the protective indi-
cators and perceived stress indicators was demonstrative of the
ability to cope. Results provided preliminary support for the validity
of the DAPR as a measure for assessing coping and stress; how-
ever, only one rater was used to score the drawings. Other students
extended this research to other populations.
Russo (2007) tested the Draw-a-Person-in-the-Rain (DAPR)
with the Psychological Stress Measure (PSM-9) in a sample of ele-
mentary school professionals (N = 35), demonstrating a marginally
significant negative correlation between the two measures. Russo
(2007) indicated problems with the DAPR scales because of prob-
lems with the scales from Krom’s study. The three raters expressed
confusion about scoring potentially important indicators that were
not included in the scale, such as puddles, clouds, or the person
smiling as if enjoying the rain. Likewise, Proto (2007) expressed
rating concerns in her study of the DAPR in a sample of prosecuting
attorneys (N = 24). Inter-rater reliability was poor, and she ques-
tioned whether the inclusion of unused protection items (such as a
tree or an umbrella not used for protection against the rain) should
be considered as evidence of personal resources for dealing with
stress.
Both Russo (2007) and Proto (2007) concluded the DAPR scales
needed to be improved, especially due to the poor inter-rater reli-
ability of the stress scale. There were also other aspects of the
drawings collected that they speculated were important. For exam-
ple, in some cases the rain was drawn as scribbles or dashes, neither
of which matched any of the examples in the scoring guide. Also,
the size of the rain relative to the figure could indicate greater or
lesser degrees of stress. There also was no measure to account for
puddles or clouds in the drawings, which could also possibly indi-
cate perceived stress. Protection indicators such as buildings and
unused rain gear created another challenge for the raters. It is also
possible that some indicators could be used in ways that would alter
their meaning. Figures drawn inside of buildings, for example, could
indicate avoidance of a situation or resourcefulness. Similarly, an
umbrella that was available, but left unused, might indicate either
an inability to make use of available resources or that the figure no
longer needs protection.
Hammer (1958) discussed aspects of the DAPR that are relevant
to improving the validity of the DAPR scales. He highlighted sym-
bols of withdrawal, unused protection items, and facial expressions.
One subject drew a figure with an umbrella pulled down to the
point that it covered the eyes as if to use the protection item to hide
from a difficult situation instead of actively dealing with the rain.
Hammer compared the subject’s drawing to traditional symbols of
withdrawal such as a turtle hiding in its shell, an ostrich burying
its head in the sand, or a person hiding in a cave. He also described
a drawing of a figure exposed to a few sprinkles of rain with an
unopened umbrella in his hand. A third figure was drawn standing,
a smile on his face, with a dark cloud overhead and rain falling only
on him. Hammer concluded, after interviewing the individuals that
their drawings reflected a cheerful attitude after moving out of a
difficult situation.
The use of a drawing assessment like the DAPR has the poten-
tial to aid clinicians in determining whether a client possesses
coping resources sufficient to move to a higher level of treatment
without fear of a relapse. The present study used the information
reviewed above to revise Krom’s (2002) scales and tested rela-
tionships between the DAPR and the Coping Resource Inventory
Scale (CRIS) and the Perceived Stress Scale (PSS). Testing the inter-
rater reliability of the revised scales would improve the validity of
the DAPR to determine the ability to cope with perceived stress.
We tested whether the number of protective items in the drawing
would be indicative of the client’s ability to access coping resources,
while the number of stress indicators would be indicative of per-
ceived stress.
 Author's personal copy

L.R. Willis et al. / The Arts in Psychotherapy 37 (2010) 233–239 235

Methods Table 1
DAPR inter-rater reliability analysis.

Participants Rater 1 Rater 2 Rater 3 Mean SD

Protection
Volunteers were recruited from a partial hospitalization and Rater 1 .76 .70 2.30 1.09
intensive outpatient programs at a private psychiatric facility. The Rater 2 .77 2.72 1.09
sample included 40 participants (21 males and 19 females) with Rater 3 2.78 1.33
a variety of disorders and comorbid substance abuse symptoms Mean r = .74
diagnoses. Those with severe neurological impairment or cogni- Intraclass correlation coefficient = .89
tive functioning in the mentally retarded range were excluded. The
ages ranged from 18 to 56 years (M = 40.49, SD = 11.37) and the Stressors
Rater 1 .79 .66 3.08 1.23
ethnic breakdown was 30 Caucasians, 3 African Americans, 6 Latin
Rater 2 .71 2.65 1.00
Americans, and 1 designated as other. Rater 3 2.90 1.93

Mean r = .71
Instruments Intraclass correlation coefficient = .88

All participants completed the Draw-a-Person-in-the-Rain. The

DAPR theoretically creates a situation for projecting a symbolic
image of oneself in a stressful environment (Hammer, 1958). A
revised version of Krom’s (2002) rating scales was used. The first
scale hypothetically measures coping resources and rates various
forms of protection against the rain: a hat, a coat, shoes or boots,
an umbrella, a tree providing shelter, a roof or awning providing
shelter, and a smile. Raters may also add points for other indica-
tors judged to be protective in nature. Points were not awarded for
forms of protection not actually in use (e.g., a folded umbrella). The
second scale hypothetically measures stress and includes features
of the rain itself: large raindrops, dense rain, diagonal rain, rain
focused solely on the human figure, puddles, and clouds. As with the
protection scale, the rater may exercise discretion and award points
for other indicators judged to increase the stressfulness of the rain.
In addition to the two scores, a Coping Balance index is derived by
subtracting the number of stress indicators from the number of pro-
tective indicators. In theory, a person with more coping resources
could manage higher levels of stress without being overwhelmed.
The Coping Resource Inventory for Stress (CRIS; Matheny et al.,
1993) is a 15-scale self-report with each scale consisting of at least
20 items. This study used the recently released six-scale short form
of the test (Matheny, 2007). The scales are Self-Directedness (SDI),
Confidence (CN), Social Support (SS), Physical Health (PH), Tension
Control (TC), and Structuring (ST). Internal consistency (coefficient
alpha) ranged from .88 to .94, and test–retest reliability ranged from
.72 to .89.
Previous validity studies correlated CRIS scores with measures
of illness, emotional distress, personality type, drug dependency,
occupational choice, acculturation, and life satisfaction. Matheny
et al. (1993) hypothesized that there would be significant cor-
relations between the CRIS scales and other measures of similar
constructs, while the CRIS should relate negatively with measures
of psychopathology, as it is designed to measure health. In gen-
eral, results have been supportive. For example, the Interpersonal
Behavior Survey-General Assertive Subtest correlated with the CRIS
Self-Directedness scale at r = .70, the Social Support Questionnaire-
Satisfaction Subtest (SSQ) correlated with the CRIS Social Support
scale at r = .48, and the Beck Depression Inventory (BDI) corre-
lated negatively with the CRIS Social Support (r = −.62), Confidence
(r = −.62), and Tension Control (r = −.59) scales (Matheny et al.,
1993). The authors concluded that the CRIS is a promising instru-
ment for identifying strengths and weaknesses in the ability to
employ coping resources although they did note limitations related
to the exclusive use of other self-report measures as validity cri-
teria and the homogeneous sample of college students that was
used. One hypothesis of this study is that the number of protective
indicators on the DAPR should correlate positively with the CRIS.
All participants also completed the Perceived Stress Scale (PSS-
10), which served as a measure of the overall perception of stress.
Cohen et al. (1983) reported that the PSS-10 has adequate internal
reliability (˛ = .78) and construct validity (demonstrated by cor-
relations with self-reported health and health services utilization
measures, and health behavior measures). The second hypothesis
is that the PSS-10 should correlate positively with the DAPR indica-
tors for stress and negatively with the DAPR indicators for coping.
One would also expect a negative correlation between the PSS and
the CRIS Short Form, demonstrating that increased subjective stress
is related to poor coping.
Procedure
Participants were recruited from treatment groups, and those
who volunteered completed informed consent forms. They were
then given 10 min to “draw a person in the rain as best you can,”
using an 8 1/2 × 11 in. sheet of paper and a number 2 pencil with
eraser. Next, they completed the CRIS Short Form and the PSS-10.
Three graduate art therapy student served as raters. They were
trained to use the revised scales using sample drawings of rain. The
manual included a guide depicting the various types and intensity
of rain.
Results
Inter-rater reliability for the raters was computed using intr-
aclass correlation coefficients. Satisfactory inter-rater reliability
for both the Protection (r = .89) and the Stress (r = .88) Scales
was achieved. The mean inter-rater correlations for the protec-
tion score (r = .74) and stress score (r = .71) were also satisfactory
(Table 1). The mean protection score for the first rater was 2.30
(SD = 1.09); for the second rater, 2.72 (SD = 1.09), and for the third
rater, 2.78 (SD = 1.33). The mean stress scores for the raters were
3.08 (SD = 1.23) for rater #1, 2.65 (SD = 1.00) for rater #2, and 2.90
(SD = .93) for rater #3.
Mean scores for each DAPR measure averaged across the raters
demonstrated the effectiveness of assessing coping and stress. The
mean protection score was 2.60 (SD = 1.07), with a range of 0–5
protective items. The mean stressor score was 2.88 (SD = .95) with a
range of 0–4.07 stress items. The very low correlation between pro-
tection and stress indicators (r = .06) indicates that they are indeed
measuring distinct constructs.
The PSS-10 uses a 5-point Likert-type scale ranging from 0
(never) to 4 (very often). Scores can range from 0 (low perceived
stress) to 40 (high perceived stress). Using the 14-item version of
the PSS, Cohen et al. (1983) reported mean scores of 19.6 for a sam-
ple of non-patients and 29.1 for a sample of outpatients. Pro-rating
from 14 items to 10 items, these would correspond with PSS-10
scores of 14.00 and 20.8, respectively. The present sample obtained
a relatively high mean score of 24.7 (SD = 6.4), with a range of 12–39.
 Author's personal copy

236 L.R. Willis et al. / The Arts in Psychotherapy 37 (2010) 233–239

Table 2 did not differ to a statistically significant degree: t(38) = 0.91. The
Descriptive statistics and reliability of the CRIS.
mean DAPR stress indicator score for depressed clients was 2.95
Scale Coefficient Mean Standard (SD = 1.08); that for non-depressed clients was 2.83 (SD = 0.94). This
alpha deviation difference, too, was statistically insignificant: t(38) = 0.30.
Confidence (overall) .85 61.14 17.34 The number of protective indicators among patients diagnosed
Confidence/situational control .82 58.17 21.30 with psychotic disorders (mean = 2.85, SD = 0.83) did not differ sig-
Confidence/emotional control .60 64.00 18.78 nificantly from that among patients without psychotic symptoms
Social Support (overall) .85 47.31 19.02 (mean = 2.51, SD = 1.14): t(38) = 0.91. The number of DAPR stress
Social Support/family .86 40.83 26.72 indicators among patients with psychotic symptoms (mean = 2.39,
Social Support/friends .87 52.12 21.12
SD = 1.08), was significantly lower than that among non-psychotic
Tension Control (overall) .80 52.52 13.20 patients: t(38) = 2.05 (p = 0.05).
Tension Control/physical .85 50.58 22.30 The number of DAPR protection indicators among patients diag-
Tension Control/mental .78 53.49 14.75
nosed with cocaine abuse or dependence (mean = 1.85, SD = 1.14)
Structuring (overall) .84 51.31 19.87 was significantly lower than that among patients not diag-
Structuring/making plans .77 51.90 21.81 nosed with cocaine abuse or dependence (mean = 2.89, SD = 0.90):
Structuring/carrying out plans .68 50.75 20.27
t(38) = 3.02 (p = 0.004). The mean stress score for cocaine abusers
Physical Health (overall) .88 51.50 22.55 was 2.45 (SD = 1.18), while that for non-cocaine abusers was 3.03
Physical Health/wellness .84 49.60 25.44
(SD = 0.82); this difference, too, approached statistical significance:
Physical Health/energy .83 53.70 25.01
t(38) = 1.77 (p = 0.085). Cocaine abusers, in short, depicted lower
Self-Directedness (overall) .83 53.13 18.77 levels of both stress and coping in their drawings.
Self-Directedness/asserting .74 51.69 20.46
In order to evaluate whether the differences between cocaine
Self-Directedness/trusting .84 54.84 22.59
abusers and non-cocaine-abusers were specific to cocaine or
reflected a more general effect of substance abuse, a final set of
Internal consistency coefficients for the CRIS (Table 2) demon- analyses compared clients who abused alcohol, but not cocaine,
strate high reliability for all six scales. The ratings for the six overall with the rest of the participants. These groups did not differ signif-
categories are as follows: Confidence (˛ = .85), Social Support icantly in either the number of protection indicator or the number
(˛ = .85), Tension Control (˛ = .80), Structuring (r = .84), Physical of stress indicator [t(38) = −1.46]. The mean protection score for
Health (˛ = .88), and Self-Directedness (˛ = .83). clients diagnosed with alcohol abuse but not with cocaine abuse
Correlational analysis (Table 3) demonstrated significant cor- was 2.83 (SD = 0.83), while that for the rest of the clients was 2.52
relations between the DAPR protection indicators and the CRIS (SD = 1.13). These were not significantly different [t(38) = 0.80]. The
Self-Directedness scale (r = .43, p < .01) as well as a marginally sig- mean number of stress indicators for alcohol abusers who did not
nificant correlation with the Confidence scale (r = .31, p < .10) and abuse cocaine was 2.50 (SD = 0.76). Mean stress indicator score for
with the Mental Control subscale of the Tension Control scale the rest of the sample was 3.00 (SD = 0.99).
(r = .30, p < .10). There was no significant correlation between the
DAPR Stress Indicators and the PSS-10. There was an unexpected,
though marginal, positive correlation between the DAPR Protection Discussion
indicators and the PSS-10 (r = .29, p < .10). As predicted, the study
did not show any significant correlation between the DAPR stress The aims of this study were to test the reliability of the revised
indicators and the CRIS except for a marginally significant corre- rating scales for the Draw-a-Person-in-the-Rain (DAPR) and to test
lation with the CRIS Physical Health scale (r = .29, p < .10). Results their validity using the CRIS and PSS-10 as criterion measures. This
also showed unexpected significant positive correlations between was intended to build the case for the construct validity of this
the PSS-10 and all of the CRIS scales. projective measure of coping resources and perceived stress level.
Comparisons were made of the drawings from all the partici- Established construct validity allows clinicians to be more confi-
pants falling into the following categories: depressed (N = 14) vs. dent that they are assessing coping and stress accurately. Results
non-depressed (N = 26), psychotic symptoms (N = 11) vs. no psy- were encouraging, though not always consistent with expectations.
chotic symptoms (N = 29), cocaine abusers (N = 11) vs. non-cocaine Our modifications of Krom’s DAPR rating scales improved the
abusers (N = 29), and those who abused alcohol (but not cocaine: inter-rater reliability of the stress scale to a satisfactory level (.88).
N = 10) vs. the rest of the participants (N = 30). The modifications included the addition of a smile as a protective
Clients diagnosed with depressive disorders showed a mean item, the addition of puddles and clouds as stress items, and addi-
of 2.81 protection indicators (SD = 1.08); those without a diagno- tional illustrations of different types of rain. In addition, raters were
sis of Depression showed a mean of 2.49 (SD = 0.99), results that instructed not to score any drawn protective items that were not
actually in use.
Table 3
The CRIS Self-Directedness scale correlated significantly with
Correlational analysis of the DAPR, the PSS-10, and the CRIS. the number of DAPR protective indicators (p < .01), while the CRIS
Confidence scale and Tension Control “Mental” subscale correlated
Scale Protection Stressors Balance [PSS-10]
with the DAPR at the p < .10 level. The CRIS Self-Directedness scale
PSS-10 .29+ .01 .21 measures the extent to which people rely on their own judgment
CRIS and their ability to assert themselves in interpersonal relationships
Confidence .31+ .04 .21 .58** (Matheny et al., 1993). This correlation suggests that participants
Support .22 −.10 .24 .38** who incorporate more protection items in their drawings tend
Tension Control .19 .16 .03 .31+
to be better able to assert themselves and make decisions. The
Structuring .12 .23 −.06 .51**
Physical Health .26 .29+ −.01 .58** Confidence scale measures the ability to gain mastery over one’s
Self-Directedness .43** −.10 .40** .36* emotions and environment in order to achieve personal goals. This
*
p < .05.
demonstrates that more self-confident people tend to include more
**
p < .01. protection items in their drawings. Tension Control refers to the
+
p < .10. ability to lower arousal through relaxation and thought control. One
 Author's personal copy
L.R. Willis et al. / The Arts in Psychotherapy 37 (2010) 233–239
Fig. 1. Drawing by a 53-year-old female diagnosed with Major Depressive Disorder.
may conclude that those who depict themselves as better defended
against the rain also perceive themselves as better able to manage
mental tension.
The three other CRIS scales (Social Support, Structuring, and
Physical Health) did not correlate with the number of DAPR protec-
tive indicators. Social Support refers to a person having a network
of caring people. Structuring refers to the ability to organize and
manage resources. Physical Health refers to one’s overall health
condition. The DAPR does not appear to be sensitive to these aspects
of coping.
Figs. 1–5 show examples of DAPRs by the participants. The
person who produced Fig. 1 obtained a very high score of 39 on
the PSS-10 and scored at the 79th percentile on the CRIS Self-
Directedness scale and the 90th percentile on the CRIS Confidence
scale. The scores for the drawing indicated average protection and
slightly less than average stress. This person, diagnosed with Major
Depressive Disorder, appears to be able to assert interpersonally
and to have skills to achieve personal goals.
The participant who produced Fig. 2 scored 19 on the PSS-10, at
the 73rd percentile on the CRIS Self-Directedness scale, and at the
81st percentile on the CRIS Confidence scale. Scores for the draw-
ing indicated average protection and average stress. This individual
was diagnosed with Bipolar Disorder, current episode Depressed,
and appears to have low perceived stress, to feel able to assert his
or her will, and to feel able to achieve personal goals.
The client who produced Fig. 3 scored 12 on the PSS-10, at
the 13th percentile on the CRIS Self-Directedness scale, and at the
12.5th percentile on the CRIS Confidence scale. Scores for the draw-
ing indicated low protection and low stress, highly consistent with
self-report results. This person, who had a diagnosis of Bipolar Dis-
237
Fig. 2. Drawing by a 55-year-old female diagnosed with Bipolar Disorder, current
episode Depressed.
order, Severe, with Psychotic features, appears to have moderate
to low perceived stress, but feels unable to assert in interpersonal
relationships or to achieve personal goals. One may conjecture that
the low level of perceived stress results from the client’s reliance
upon reality-distorting defenses.
The client who produced Fig. 4 scored 24 on the PSS-10, at the
6th percentile on the CRIS Self-Directedness scale, and at the 70th
percentile on the CRIS Confidence scale. Scores for the drawing
indicate low protection and medium stress. This person, who had
diagnoses of Depressive Disorder NOS and Alcohol Dependence,
appears to experience moderate perceived stress and to feel unable
to assert in interpersonal relationships, but able to achieve personal
goals.
The individual who produced Fig. 5 scored 21 on the PSS-10,
at the 15th percentile on the CRIS Self-Directedness scale, and at
the 20th percentile on the CRIS Confidence scale. Scores for the
drawing indicate low protection and medium stress. This person,
with a diagnosis of Opioid Dependence, appears to have moder-
ate perceived stress, and to feel unable to assert in interpersonal
relationships or to achieve personal goals.
The drawings produced by participants with depressive
disorders did not differ from those produced by other psychi-
atric patients. The DAPR may not be differentially sensitive to
depression-specific symptoms, at least, not as presently scored.
This does not mean that the DAPR would not differentiate depres-
sion from good mental health; the comparison group in this study
was other patients with psychiatric diagnoses.
Participants with psychotic disorders did not differ from other
patients in their depiction of protection against the rain, but they
did portray fewer signs of stress in their DAPR protocols. The cop-
ing mechanisms or defenses reflected in these drawings may well
include some that are characteristic of psychotic individuals (e.g.,
 Author's personal copy

238 L.R. Willis et al. / The Arts in Psychotherapy 37 (2010) 233–239

Fig. 3. Drawing by a 47-year-old male diagnosed with Bipolar Disorder, mixed,

severe, with psychotic features, Alcohol Dependence, and Polysubstance Depen- Fig. 5. Drawing by a 26-year-old male diagnosed with Opioid dependence.
dence.

grandiose delusions and other reality-distorting defenses), which,

Fig. 4. Drawing by a 47-year-old male diagnosed with Depressive Disorder and
Alcohol Dependence.
while maladaptive in many ways, nonetheless help the individual
to maintain a personally satisfactory adjustment—just as higher
level defenses do for other people. It also indicates that the psy-
chotic clients were experiencing lower levels of stress than were
the other clients, perhaps due to their use of reality-distorting
defenses. This suggests that a positive balance between coping and
stress indicators on the DAPR need not always reflect good external
adjustment. Patients with obvious psychopathology and life prob-
lems who produce low-stress DAPR protocols are liable to screen
out awareness of their problems (e.g., to exhibit poor insight).
Participants with a history of cocaine use included fewer protec-
tion items and depicted less stress in their drawings than did other
psychiatric patients. This suggests that these patients are unable
to identify or access coping resources and rely on cocaine to com-
pensate for this deficit, using drug-induced energy and euphoria to
inhibit feelings of stress.
Participants with a history of only alcohol abuse (not cocaine
abuse) did not differ significantly from other patients in their
depiction of protection or stress items. If anything, their drawings
suggest slightly (but not significantly) higher levels of coping and
slightly lower levels of stress. This suggests that the findings with
respect to cocaine abusers are specific to cocaine, not applicable
to patients with other forms of substance abuse. Further research
is needed to explore the differences in DAPR protocols between
patients who abuse only alcohol and those who abuse cocaine. Pro-
visionally, it appears that patients who abuse only alcohol have
access to more coping resources (as measured by the DAPR) than
do those who abuse cocaine.
 Author's personal copy
L.R. Willis et al. / The Arts in Psychotherapy 37 (2010) 233–239
Self-reported levels of stress (PSS-10 scores) did not correlate
with the number of DAPR stress indicators, so despite the improved
reliability of this revised DAPR scale, evidence for its validity was
lacking. The PSS-10 did, however, correlate marginally but posi-
tively with the number of DAPR protective indicators. This was
unexpected, but would seem to indicate that patients experienc-
ing higher levels of subjective stress were activating their defenses
in order to cope with that stress.
One distinct limitation of the DAPR as a clinical tool at the
present time is the absence of normative standards. Other open
questions are the extent to which the DAPR may be sensitive to
change over time (e.g., in response to treatment) and the impact
of allowing participants the option of selecting colored drawing
materials.
We are encouraged by the results of this study in that the revised
scales improved inter-rater reliability and the DAPR protection
scale was moderately related to the self-reported ability to cope.
The stress scale, however did not demonstrate a relationship to our
self-report stress measure. The DAPR appears to be a promising
projective instrument, but both its scoring and the interpretation
of those scores need to be subjected to considerably more investi-
gation.
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