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Angie van Broekhuizen

Michael Salamon & Jason Bowers

Digital Design Thesis

24 May 2012

Using Technology in the Art Therapy

Implementing intuitive UI design in an iPad application for today’s art therapist

will improve the collection process and detailed analysis of patient artwork including

traditional art mediums as well as newly adopted techniques. Current technology does

not allow for consolidation of patient artwork and analysis of progress over treatment

periods. Therefore, an application that can collect all patient information and provide

a place for detailed annotation will improve the therapist’s overall process and in turn

accelerate the healing progress of the patient. I had an initial assumption that art

therapists would be less inclined to use technology but only one in seven interviewed

had little knowledge or experience with computer programs and more than half were

owners of an Apple product. Contrary to my perceptions, art therapists are quite inclined

to using technology, possibly because they are in such a young field.

The art therapy profession is less than a hundred years old, therefore research

as well as new technological implementation continues to strengthen the discipline

(AATA 2011). Art therapy has been proven to be effective when used with patients of

various diseases including post-traumatic stress disorder, chronic illness and depression

(Monda 2011). Since being recognized as a profession in the United States in 1960

(AnthroMed), art therapy has been most commonly practiced using common mediums

such as drawing, painting, and sculpting but some therapists are encouraging patients

to use computer programs in addition to the traditional mediums. With computer based

art an issue arises in regards to the ease and ability for a therapist to annotate on a

patient’s video, digitally manipulated photo or sound file.

New technology has great potential, however, even before introducing the new

technology of computer art, various methods are used to organize patient information

and therapist notes. Some therapists use a simple notebook that they keep locked

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in a filing cabinet while others use word processor programs in addition to a digital

camera to keep track of patient artwork digitally. Although there are diverse methods for

accomplishing tasks, the goals of therapists are very similar. An over arching need is to

have this information consolidated and readily accessible for later review with patients

and for in depth analysis after an art therapy session. To my knowledge there has not

been an effective computer program or tablet application that meets all the needs of

these therapists and I have reason to believe that some of it has to do with the legal

implications of keeping these types of patient records digitally.

Patient information confidentiality, in accordance with the American Art Therapy

Association’s Ethical Principles for Art Therapists is an important issue that is currently

being discussed among art therapist professionals (AATA 2011). Regulations protect the

client and client’s artwork as well help the therapist keep client information confidential.

This provides the guidelines for what details need to be discussed with a client about

the implication of sharing their artwork. As a result of these implications a detailed

patient consent form will be necessary to provide further guidance in relation to the

sharing of videos and audio on popular sites like YouTube or Vimeo as well as the

repercussions of sharing that information with their peers and family members. For

clarity I evaluated the newest technology used by medical professionals today.

Medical professionals are quickly adapting to new technology and implementing

the use of electronic health records, also known as “EHRs.” For this reason it is

pertinent that new features are developed for use by therapists. For example, Dr.

Chrono, is an application for the iPad that can be used to collect patient data, schedule

appointments, process billing and send out eRx prescriptions. Although applications like

Dr. Chrono are able to assist a therapist to some extent, they do not have the features

needed to document and expedite patient progress through an art making process. An

ideal application would keep some of the most valuable features from Dr. Chrono and

add a few dynamic features that could be used by the therapist both during a session

and afterwards to supplement analysis. Therefore, my research was conducted in order

to determine the most productive user interface design.

Effective user interfaces are informed by the needs, desires, motivations and

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contexts of the intended user (Cooper, 2007). Within the discipline of art therapy there

are a wide set of skills. Nevertheless, through interviewing and researching, many

similarities began to emerge. My first interview was conducted with Kim Nguyen, MS-

AT who is an art therapist at Aspen Pointe in Colorado Springs and for the Wounded

Warrior Project. In our interview she said, “The art is pointing to where the patients are

emotionally.” Through her analysis and guidance patients are able to create art that

expresses what they cannot express through words. They may even communicate

ideas and emotions that come from their subconscious. One technique is to ask the

patient where he or she is at emotionally on a scale of one to ten. The question could

be based on feelings of anxiety, depression, anger, etc. It all depends on the individual

patient. Patient responses over time could be overlaid on correlating artwork. This would

provide a visual representation of patient progress.

Dr. Michael Franklin from Naropa Institute was able to give even more insight and

some “out of the box” ideas for my application. From our discussion I added the option

of wireless projection from the iPad. This will produce an environment that is more

cohesive to the therapy process instead of having to look at a little iPad screen or small

computer monitor. This additional feature will aid in the process by allowing the patient

to point out specific areas of their artwork. The mere scale of the artwork may also have

the ability to make the patient feel that his or her artwork is more important.

There are also therapists who use art but are not trained as art therapists.

Laura Grotenhuis, MED MS from the Behavioral Health Department at the Northern

Colorado Medical Center (NCMC) in Greeley, said she would benefit from my proposed

application. With eight years of experience using art in therapy within the hospital

system, she had some insight and issues that art therapists did not. Grotenhuis is

required to use an EHR that directly informs the superiors at NCMC. Some of the

information she must provide is helpful such as patient contact information, appointment

scheduling and billing. However, much of the other information seems irrelevant. In

general using the SOAP method, which stands for “Subjective, Objective, Assessment

and Plan,” works for therapy as well as for a broken bone but there are specific therapist

notes that need to be recorded and protected. Some notes must be kept secure

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between patient and therapist only. Although Grotenhuis’ training differed from the

typical art therapist, she was able to provide a link between the electronic health record

and the needs of an art therapist.

During my interviews I found that all therapists were looking for a way to view

artwork over a period of time for comparison and that some were interested in projecting

the artwork from the iPad. Therapy is a process that can take as little as a day or

many years (Franklin). This time frame all depends on the patient, his or her issues,

compounding circumstances and availability for sessions (Nguyen). Imagine, as a

therapist, trying to compare artwork over a year’s time from two sessions per week.

That’s one hundred and four pieces of artwork assuming that you only make one piece

of art per session, an overwhelming task when you consider the comments of the

patient, the thoughts and notes of the therapist and the different mediums used. My

prototype illustrates the concept of making this time line comparison a reality. The time

line view will provide an interactive and consolidated section to be used by the therapist

for analysis and to illustrate growth and changes to their patients.

The methodology behind user experience interactions combined with art

therapy, dictates a more hands on approach. So in order to delve deeper into artwork

analysis, there must be a way to annotate ideas, patient’s comments and therapist

notes directly on or attached to an artwork, video or audio clip. For this reason, two-

dimensional artwork, in Remedy, will accommodate direct annotation by tapping on a

specific element and either recording audio or writing notes on the iPad keyboard. Hot

spots will be created for the therapist to tap and review notes at a later point. Video and

audio files are unique but only add another dimension, the time line. Some common

websites already allow for similar annotations on video and audio clips. We see an

example of this technology represented while watching a YouTube video in which a

note or speaking bubble appear at different times in the video. On a website called

SoundCloud, users are able to make comments at certain times in the audio to tell the

creator what they liked or didn’t like and why. Using this same concept, Remedy will

provide a simple interface for time line annotation on video and audio files. Finally, these

notes will be exported to a pdf report that can be sent to a wireless printer or emailed.

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How can these features be implemented within an iPad application design

to make it useful, convenient and easy to use for therapists? By following the Apple

Human Interface Guidelines (HIG) and using proven techniques by some of the best

user interface designers, I have developed an application that not only follows the

technological rules but provides a simple user interface. The HIG states, “A user

interface that is unattractive, convoluted, or illogical can make even a great application

seem like a chore to use. But a beautiful, intuitive, compelling user interface enhances

an application’s functionality and inspires a positive emotional attachment in users.”

My application concept is both aesthetically designed for the art therapist and made

using intuitive interactions that are not convoluted or unnecessary. Research is vital

for development of an iPad application, however, it is equally important to get user

feedback during the process.

Prototype development provides a way in which to test basic interaction

between user and interface (Unger, 2009). Paper prototypes were used for initial

testing with users of various skill sets. From that point forward I used Adobe programs

to create jpgs for importing into a web prototype application called FieldTestApp. This

application provides a simple interface for evaluation of a user’s expectations and

natural responses. My prototype leads the viewer on a narrative throughout the art

therapy process and stops to explain specific features throughout the experience.

From research to testing and on to development, an iPad application or any interactive

experience must be designed from an informed perspective about the user.

To reiterate, in order to make a successful application the process of researching,

interviewing, wire-framing, prototype development and testing is of utmost importance

(Cooper, 2007). Art therapy will be able to benefit from this type of application because

it is a relatively new discipline. In order to relieve any uncertainty there will be an

intuitive interface structure as informed by the Apple HIG. Further steps will be to find

additional support behind the Remedy application and look into the legal implications for

development of an application for the iPad. With the user at the forefront of research,

design and development, Remedy will improve the art therapist’s workflow and will in-

turn expedite the patient’s healing process.

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WORKS SITED

“Apple Human Interface Guidelines.” Apple HIG. Web. 20 Jan. 2012. <http://developer.

apple.com/library/mac/#documentation/UserExperience/Conceptual/AppleHIGuidelines/

Intro/Intro.html>.

Calisch, Dr. Abby. Telephone interview. 20 Feb. 2012.

Carmi, Giora. E-mail interview. 01 Feb. 2012.

Cooper, Alan, Robert Reimann, Dave Cronin, and Alan Cooper. About Face 3: The

Essentials of Interaction Design. Indianapolis, IN: Wiley Pub., 2007. Print.

Dm3000. “Modern User Experience Tools.” Issuu.com. 11 Oct. 2011. Web. 21 Mar.

2012. <http://issuu.com/dm3000/docs/research>.

Dots2design. “User Experience.” Issuu.com. 03 Sept. 2010. Web. 21 Mar. 2012. <http://

issuu.com/dots2design/docs/usability>.

Elam, Kimberly. Geometry of Design : Studies in Proportion and Composition. New

York: Princeton Architectural, 2001. Print.

“ETHICAL PRINCIPLES FOR ART THERAPISTS.” (2011): 1-10. AMERICAN ART

THERAPY ASSOCIATION. AMERICAN ART THERAPY ASSOCIATION, Inc., 24 May

2011. Web. Mar.-Apr. 2012. <http://www.americanarttherapyassociation.org/upload/

ethicalprinciples.pdf>.

Franklin, Michael. Personal interview. 15 Feb. 2012.

Grotenhuis, Laura. Telephone interview. 09 Feb. 2012.

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WORKS SITED CONT.

Johnson, Jeff. Designing with the Mind in Mind: Simple Guide to Understanding User Interface

Design Rules. Amsterdam: Morgan Kaufmann/Elsevier, 2010. Print.

Krug, Steve. Don’t Make Me Think!: A Common Sense Approach to Web Usability. Berkeley,

Calif: New Riders Pub., 2006. Print.

Monda, Dr. Tony. “The Herald.” The Herald, Zimbabwe’s Largest Daily Newspaper. 04 Nov.

2011. Web. 01 Mar. 2012. <http://www.herald.co.zw/index.php?option=com_content>.

Nguyen, Kim. Telephone interview. 04 Feb. 2012.

Unger, Russ, and Carolyn Chandler. A Project Guide to UX Design: For User Experience

Designers in the Field or in the Making. Berkeley, CA: New Riders, 2009. Print.