Family art therapy

1. Introduction

Version followed: Hanna Yaxa Kwiatkowska's Family Art Evaluation (FAE, six tasks) and family art therapy as developed at the US National Institute of Mental Health (NIMH) from 1958 and published in Family Therapy and Evaluation Through Art (1978). That book is not drawn on; the procedure is reconstructed from secondary accounts that cite it, with setup details taken from the Brazilian adaptation Arte-Diagnóstico Familiar (ADF; Magalhães, Machado, de Mello and Féres-Carneiro, 2026), which follows Kwiatkowska's sequence. Where these accounts differ, the difference is named. [uncertain: no primary Kwiatkowska text is drawn on]

What it is. Kwiatkowska was a Polish-born sculptor and psychologist. She worked as an art therapist at St Elizabeths Hospital from 1955 and joined Lyman C. Wynne's Section on Family Studies at NIMH in 1958, where she worked with families of people with schizophrenia [source: GoodTherapy biography]. She described the method as having begun almost by accident: relatives visiting during sessions saw the patient's art and joined in [source: GoodTherapy]. Her work produced three formats: (a) a structured family art evaluation protocol, (b) family art sessions used alongside verbal family therapy, and (c) family art therapy as the primary treatment [source: VT dissertation ch. 2, p. 9]. It is a psychodynamic, family-systems use of art therapy, not a separate school with its own institute.

How change happens. A family has a shared history, its own ways of thinking, alliances and defences, which an unrelated group lacks [source: GoodTherapy]. When the family makes art together, these patterns show up in what they draw and in how they behave while drawing. Patterns that can be seen can be worked on by the family as a unit, rather than by blaming one member [source: GoodTherapy; Nieduziak 2021, pp. 155, 159]. The finished pictures stay available, so therapist and family can return to them and work through what Kwiatkowska called "distortion, denial, or resistance" (quoted in Nieduziak 2021, p. 167).

2. Framework

Kwiatkowska's published structure is an assessment session followed by open-ended family art therapy. She did not publish numbered treatment phases; Phases 0, 2 and the movement criteria below are [synthesis] built around her assessment and therapy formats.

Phase	Goal	Format and length	Move on when
0. Referral and preparation [synthesis]	Agree why art is being added; check who will attend; screen for acute risk	Contact with the referring family therapist and the family	Whole family (or every available member) agrees to attend
1. Family Art Evaluation	Observe how each member sees the family, and how the family works together under rising structure and stress	One session of 1 to 2 hours with all available members; six tasks in fixed order [source: Nieduziak 2021, p. 159; Del Dosso 2016, pp. 11-12; Magalhães et al. 2026, p. 6]	All six tasks done, or stopped for safety
2. Review and feedback	Turn observations into working hypotheses; share what the family can bear	Team review of art and notes; in the ADF version, one or two feedback sessions (devolução) with the family [source: Magalhães et al. 2026, pp. 8, 15]	Family and team agree a focus and a format
3. Family art therapy	Use joint art-making and review of pictures to change patterns of communication, alliance and defence	Long-term or intermittent, depending on the family's response and the wider programme [source: Nieduziak 2021, p. 159]; either alongside verbal family therapy or as the main treatment [source: VT dissertation, p. 9]	[synthesis] Agreed goals met, or the family can use verbal sessions without the art bridge

Session frequency and total course length for Phase 3 were not found in any source opened [uncertain]. A later inpatient model (Nielsen et al., described in Nieduziak 2021, pp. 159-160) used 3 to 12 one-hour sessions about three times a week; that is a different programme, not Kwiatkowska's.

Who is in the room. The art therapist runs the evaluation. In Kwiatkowska's set-up the family's primary therapist (psychiatrist or social worker) attends as participant-observer and records observations for later use in therapy [source: Nieduziak 2021, p. 159; Del Dosso 2016, pp. 11-12]. In the ADF version, the therapist is a non-participant observer during the tasks and takes an active role only in feedback [source: Magalhães et al. 2026, p. 7].

Indications reported. Families of hospitalised adolescents and young adults with schizophrenia or other severe psychoses (the original population); Kwiatkowska also described work with a "hysterical family" [source: Nieduziak 2021, pp. 159, 162]. Later users apply the evaluation to see whether a child's acting out reflects wider family difficulty (Klorer 2000, cited in Del Dosso 2016, p. 13) and to families after trauma or loss [source: Magalhães et al. 2026]. A 1971 study by Mosher and Kwiatkowska applied the evaluation to families with schizophrenic twins [source: GoodTherapy; Magalhães et al. 2026, reference list]. Kwiatkowska wrote a chapter on indications and contraindications for family art therapy and evaluation [source: GoodTherapy, publication list], but its content was not found [uncertain].

Professional frame. Both secondary sources stress that the clinician needs art therapy training, partly because family dynamics come up quickly and the therapist must have interventions ready [source: ebrary chapter "Assessment of Families through Art"; Shalmon et al. 2012, pp. 43-44]. In practice this means a qualified art therapist (UK: HCPC-registered art therapist, usually a BAAT member; US: AATA member with Art Therapy Credentials Board credential ATR or ATR-BC, plus state licence where required) working with, or also trained as, a family therapist. Credential rules are not drawn on here [uncertain]. A psychotherapist without art therapy training should not run the FAE as a formal assessment; they can co-work it with an art therapist or use simple drawing tasks within their own competence, without the interpretive claims [synthesis].

3. Guiding principles

The family, not the identified patient, is the unit. In practice: invite every available member and frame tasks as "learning how your family works", never as testing the patient [source: GoodTherapy; Nieduziak 2021, p. 159].
Process is as informative as product. In practice: record who starts, who helps whom, who adjusts the children's easels, who talks over whom, not only what is drawn [source: VT dissertation, p. 9; Del Dosso 2016, p. 13].
Fixed sequence, rising structure. In practice: run the six tasks in order. The ADF authors say following the set sequence is essential ("Seguir a sequência determinada é fundamental") because each task builds feeling that the next one works with [source: Magalhães et al. 2026, p. 6].
Minimal, neutral instructions. In practice: do not answer "who should I include?"; say there is no right or wrong way; reassure people that no artistic skill is needed [source: Del Dosso 2016, p. 12].
Everyone can see everyone. In practice: easels in a semicircle, each person's work visible to all, free comment allowed [source: Magalhães et al. 2026, p. 6].
Hold interpretation back. In practice: during assessment, ask the family what the pictures mean before offering any reading; interpretations at this stage are premature [source: Kwiatkowska as reported by Shalmon et al. 2012, p. 37].
Readings are hypotheses, not findings. In practice: size, order, placement and omissions of figures are not experimentally validated; check each idea against what the family says and their history [source: Shalmon et al. 2012, p. 37; Del Dosso 2016, p. 13, citing Feder and Feder; Magalhães et al. 2026, p. 7].
Triangulate three streams. In practice: weigh graphic content, verbal exchanges and non-verbal interaction together, letting each confirm or question the others [source: Magalhães et al. 2026, p. 7].
Symbolism matters (psychodynamic stance). In practice: listen for family stories carried in images, including very primitive forms [source: Nieduziak 2021, pp. 155, 159].
Spontaneity and creativity are goals in themselves. In practice: protect free-choice time and play; do not turn every picture into a problem [source: GoodTherapy].
Pictures are kept and revisited. In practice: date, title and store all work; bring earlier pictures back in later sessions [source: Nieduziak 2021, p. 167].
Pace feedback to what the family can bear. In practice: let the family reflect first, then share only what they can take in [source: Magalhães et al. 2026, p. 8, citing Ocampo et al.].
Work with the family's own therapist. In practice: the evaluation feeds the ongoing family therapy; agree in advance who records and who gives feedback [source: Nieduziak 2021, p. 159; Del Dosso 2016, p. 12].
Safety and safeguarding come before procedure. In practice: stop or change the session if anyone is at risk; follow child-protection duties [synthesis].

4. Intervention inventory

Part A covers the six Family Art Evaluation tasks and the procedures around them. Part B covers Kwiatkowska's ongoing family art therapy. Part C lists later family art techniques by other authors, kept apart so they are not credited to Kwiatkowska. Example language is illustrative unless quoted with a citation. Instruction wording quoted from Del Dosso (2016) is her report of the FAE; its match to the 1978 book is [uncertain].

Part A. Family Art Evaluation (one session)

A0. Room, materials and set-up

Purpose: give every member the same tools and a shared view, so differences come from the family rather than the set-up.
Steps:
1. Gather all available members of the nuclear family in one session of 1 to 2 hours [source: Nieduziak 2021, p. 159; Del Dosso 2016, p. 12].
2. Materials, by version: semi-hard, square-edged pastels and white paper (FAE as reported by Del Dosso 2016, p. 12); one box of wax crayons per person and white A3 sheets (ADF, Magalhães et al. 2026, p. 6). The joint scribble uses one 18 x 24 inch sheet (ebrary chapter). Exact paper sizes for the other tasks were not confirmed for the original [uncertain].
3. Set one easel per person in a semicircle so all can see each other's work, and put a fresh sheet up for each task (ADF, p. 6). Lower the easels for children [synthesis].
4. Seat the observing therapist where they can see faces and hands without joining in (ADF, p. 7; Del Dosso, p. 12).
5. Safety [synthesis]: pastel and chalk dust can irritate airways, so choose low-dust pastels for people with asthma and do not use fixative spray in the room; check easels are stable around small children; check for allergies to wax or latex.
Example language (illustrative): "Today we'd like to see how your family works together through some pictures. Nobody needs to be good at art. There are six short drawings, and we'll talk a little after each."
Watch for: who sits next to whom, who sets up the children's easels, and who asks the first question [source: Del Dosso 2016, p. 13].

A1. Task 1: Free picture

Purpose: a warm-up that shows each person's spontaneous concerns and the family's first tensions before any structure is added [source: Magalhães et al. 2026, p. 6].
Steps:
1. Each person works on their own sheet.
2. Give the instruction to draw "a picture of whatever comes to mind" and say nothing elaborate is expected [source: Del Dosso 2016, p. 12]. The ADF version gives no specific theme at all (p. 6).
3. When everyone has finished, run the inquiry (A7).
Example language (illustrative): "Draw anything you like. It can be simple."
Watch for: refusals, copying, people who wait to see what others do, and themes that repeat across members. Keep the picture for comparison with Task 6 [source: Magalhães et al. 2026, p. 8].

A2. Task 2: Picture of your family

Purpose: shows how each member sees the family's structure, roles and relationships, and often starts discussion on its own [source: Shalmon et al. 2012, p. 37; Magalhães et al. 2026, p. 6].
Steps:
1. New sheet for each person.
2. Ask each person to draw the family, every member including themselves, as whole figures; Del Dosso reports the instruction as including "draw the whole person" (p. 12). In the ADF version each figure is labelled (p. 6).
3. If someone asks who to include, do not decide for them; say there is no right or wrong way [source: Del Dosso 2016, p. 12].
4. Inquiry (A7).
Example language (illustrative): "However you see your family is fine. You decide who goes in."
Watch for: order in which figures are drawn, relative size and position, who is left out or added (dead relatives, grandparents, pets), who is drawn with extra detail [source: Shalmon et al. 2012, p. 37]. In the ADF case, a son drew only his grandparents, and a mother drew all figures without mouths (Magalhães et al. 2026, p. 12). Treat all of these as questions to ask, not conclusions.

A3. Task 3: Abstract family portrait

Purpose: shows each person's level of abstraction and symbolic thinking, and lets feelings about each member come out without drawing people [source: Magalhães et al. 2026, p. 6].
Steps:
1. New sheet. Ask for "an abstract family portrait" [source: Del Dosso 2016, p. 12]. In the ADF version: no human figures or faces; show what you think or feel about each member (p. 6).
2. Here, unlike Task 2, answer clarifying questions about what "abstract" means [source: Del Dosso 2016, p. 12].
3. Inquiry (A7): ask which shape or colour stands for whom.
Example language (illustrative): "Instead of drawing people, use colours, shapes or lines to show what each person in the family is like, or how you feel about them."
Watch for: people who cannot leave concrete figures (note it, do not push); symbols that others in the family recognise or dispute. ADF case symbols included a chameleon for one parent and a ball with a hole (Magalhães et al. 2026, pp. 12-13).

A4. Task 4: Picture started from a scribble (individual)

Purpose: loosens control and invites more spontaneous, less defended imagery. Nieduziak links the two scribble tasks to Winnicott's child-therapy techniques [source: Nieduziak 2021, p. 159; Magalhães et al. 2026, p. 6].
Steps (ADF detail, p. 6):
1. Ask everyone to relax hands and arms and make large scribbling movements in the air.
2. With eyes closed, each person makes a free scribble on their sheet.
3. Eyes open: each looks at their scribble from all sides, finds an image in it, and develops it into a picture.
4. Inquiry (A7), including a title if offered.
Example language (illustrative): "Shake out your arms. Now draw big loose lines in the air. Next, close your eyes and let your hand scribble on the paper. Then open your eyes, turn the page around, and look for something hiding in the lines."
Watch for: anxiety about closing eyes (allow eyes open, see Section 5); images that link to family events. In the ADF case, a father's scribble picture was read as forming letters of a dead son's name (Magalhães et al. 2026, p. 13).

A5. Task 5: Joint family scribble

Purpose: the main interaction sample. It shows power, boundaries, roles, unity or disunity, alliances, and each member's engagement; the ADF authors describe it as the point of highest group anxiety [source: ebrary chapter; Del Dosso 2016, p. 13; Magalhães et al. 2026, pp. 5-6].
Steps:
1. Each person makes a scribble as in Task 4 (ADF, p. 6).
2. The family together chooses one scribble [source: Magalhães et al. 2026, p. 6]. The ebrary account places the joint work on a single 18 x 24 inch sheet; whether members scribble on the shared sheet or choose among individual sheets differs between accounts [uncertain].
3. The family completes the chosen scribble into one picture together.
4. They agree a title and everyone signs [source: Magalhães et al. 2026, p. 6].
5. Do not direct the process; observe and record.
Example language (illustrative): "Now, as a family, choose one of these scribbles and turn it into one picture together. When you're done, agree a title and all sign it."
Watch for: whose scribble is chosen and how; who decides; who is ignored; who works on their own corner; who adds to or overrides others. ADF case: one parent began a sun without asking others, the son added rays, the other parent added a face, and the first parent objected (p. 14). These sequences are the material for later work.

A6. Task 6: Final free picture

Purpose: shows how the family and each member recover after the stress of the joint task [source: Del Dosso 2016, p. 13; Magalhães et al. 2026, pp. 6-7].
Steps: same instruction as Task 1, new sheet, followed by inquiry.
Example language (illustrative): "Last one: again, anything you like."
Watch for: compare with Task 1 for each person. More constricted or more open? New themes? In the ADF case, a son's final picture included a bus to the clinic and two unknown figures the authors suggest were the therapists (p. 15).

A7. Inquiry after each task

Purpose: gets each person's own meaning, which the guidance says must come before any interpretation [source: Magalhães et al. 2026, p. 7; Shalmon et al. 2012, p. 37].
Steps:
1. After each task, invite each member to describe their picture; others may comment freely (ADF, p. 7).
2. Ask open, descriptive questions; do not interpret during the evaluation.
3. Record titles, explanations and reactions word for word where possible.
Example language (illustrative): "Tell us about your picture." "Who is this?" "What do others notice?"
Watch for: one member speaking for others; mocking; disagreements about what a picture shows. These are data.

A8. Observation and recording

Purpose: produce a usable record for the family therapy.
Steps:
1. The observer records three streams: graphic content, what is said, and non-verbal interaction [source: Magalhães et al. 2026, p. 7].
2. Note formal qualities. The ADF authors list categories from Mosher and Kwiatkowska (1971): integration, intelligibility, colour, body schema and plasticity, always read against family history and associations (p. 7). Kwiatkowska also created a scoring system that, according to Del Dosso (2016, p. 13), other therapists have rarely used. Its items were not found [uncertain].
3. Note sequences across tasks: who changes, who holds firm.
4. Label, date and keep all pictures [source: Nieduziak 2021, p. 167].
Watch for: confirmation bias. Write observations first, hypotheses separately [synthesis].
Validity limits: meanings of size, placement and omission are not experimentally validated [source: Shalmon et al. 2012, p. 37]. No reliability or validity data for the FAE are given in the sources [uncertain]. The FAE is not a diagnostic test of abuse or disorder.

A9. Feedback session (devolução; ADF adaptation)

Purpose: return findings in a form the family can use to agree a shared focus [source: Magalhães et al. 2026, pp. 8, 15-17].
Steps:
1. Lay the pictures out in order.
2. Let the family reflect first; ask what they see when they look at them all together.
3. Compare the first and last free pictures with them.
4. Offer a small number of hypotheses, sized to what the family can bear (citing Ocampo et al., p. 8).
5. Agree a focus for therapy. The ADF case used two feedback sessions (p. 15).
Example language (illustrative): "Looking at all your pictures side by side, what stands out to you? ... One thing we noticed is that the family picture came together quickly once Tom started. What do you make of that?"
Watch for: the family moving from complaining about one member to a shared concern. The ADF authors report this as the change they saw (pp. 16-17).
Note: the feedback session is documented for the ADF; whether Kwiatkowska held a separate feedback meeting was not found [uncertain].

Part B. Kwiatkowska's family art therapy (ongoing sessions)

The sources describe the aims and stance of her ongoing therapy but not a session-by-session protocol. The steps below put the reported elements into a usable order; the ordering and wording are [synthesis].

B1. Open family art session

Purpose: encourage spontaneous expression, imagination and creativity in the whole family, and move attention off the identified patient [source: GoodTherapy; Nieduziak 2021, p. 159].
Steps [synthesis]: (1) set out the same materials as the evaluation; (2) invite free or loosely themed drawing, individually or together; (3) each member shows and describes their work; (4) the therapist links what is seen in the art and in the process to the family's current concerns, after members have given their own meaning.
Example language (illustrative): "Let's start with everyone drawing whatever is on your mind this week, then we'll look at them together."
Watch for: whether members begin to comment on each other's pictures with curiosity rather than blame, which suggests the family is starting to work as a unit.

B2. Revisiting earlier pictures

Purpose: earlier artworks bring back intense memories and can be reviewed with the family to work through "distortion, denial, or resistance" (Kwiatkowska, quoted in Nieduziak 2021, p. 167).
Steps [synthesis]: (1) bring out a dated picture that relates to the current topic, for example the evaluation family portrait; (2) ask the maker and the others what they see now; (3) compare it with a new picture on the same theme; (4) name differences without judging them.
Example language (illustrative): "This is the family picture you drew in our first meeting. Looking at it now, what do you notice?"
Watch for: a member who denies what they drew. The picture is on the table, so explore it gently rather than argue.

B3. Working with symbolism (psychodynamic stance)

Purpose: her programme was analytical and aimed to ease the controlling role of the superego and to understand symbols, even in very primitive visual forms, that often carry family stories [source: Nieduziak 2021, pp. 155, 159].
Steps [synthesis]: (1) ask what the image or colour brings to mind for the maker; (2) ask other members what it brings up for them; (3) offer a tentative link to family history only when associations support it; (4) leave it as a question if the family does not take it up.
Example language (illustrative): "You've drawn that hill three times now. Does it remind anyone of something?"
Watch for: interpretation that runs ahead of the family; shame in members with psychosis whose images are disorganised. Do not interpret psychotic content as a hidden message from the family [synthesis].

B4. Large-surface joint work and family portraits

Purpose: large surfaces suit joint family work, including family portraits; Kwiatkowska (1978) and Rubin (2005) both recommend them, and Rubin fixes a large sheet to a wall, which lowers stress [source: Nieduziak 2021, p. 161].
Steps [synthesis]: (1) fix a long sheet to the wall or lay it on a table; (2) give a theme (for example, the family together) or none; (3) let members choose where to work; (4) review the finished picture as in A7.
Example language (illustrative): "Here's one big sheet for all of you. Make one family picture together."
Watch for: territory (who stays in their own corner), crossings into others' areas, and who fills the centre. Shalmon et al. (2012, p. 38) give a mural example in which two children competed for the mother while the father drew alone in a corner.

B5. Art as an adjunct to verbal family therapy

Purpose: one of Kwiatkowska's three formats was family art sessions used alongside verbal family therapy, as well as art therapy as the main treatment [source: VT dissertation, p. 9].
Steps [synthesis]: (1) agree with the verbal family therapist what the art sessions will focus on; (2) share pictures and observations with consent; (3) meet regularly as a team; (4) decide together when to stop the art sessions.
Watch for: splitting, where the family brings one story to the art sessions and another to the verbal sessions.

Part C. Later family art techniques by other authors (not Kwiatkowska's)

These came after Kwiatkowska. They are included because practitioners commonly combine them with her approach. Each is credited to the author who described it.

C1. Landgarten's family art assessment

Purpose: assesses ego strengths and weaknesses, roles and behaviour patterns, communication, power and control, and interaction style [source: ebrary chapter, citing Landgarten 1987].
Steps: three tasks: (1) a non-verbal team art task, (2) a non-verbal family art task, (3) a verbal family art task [source: ebrary chapter]. In Del Dosso's account each member used a distinct marker colour so contributions could be traced; team tasks were dropped because only three members attended (Del Dosso 2016, p. 31). How teams are formed and timed was not found [uncertain].
Example language (illustrative): "For this one, please don't talk at all. Make one picture together using only your own colour."
Watch for: who leads without words, and how this changes once talking is allowed.

C2. Relationship drawing exchange (Shalmon et al.)

Purpose: brings out misperceptions and projections between two people [source: Shalmon et al. 2012, p. 38].
Steps: each person draws their relationship; then each interprets the other's drawing; then the makers say what they meant. Recommended for couples as well as parent and child.
Example language (illustrative): "Draw how things are between you two. Then you'll each guess what the other's picture says before they tell you."
Watch for: surprises. In their example a mother learned her son saw himself as the family's "black cloud" (p. 38).

C3. Draw the family, then cut yourself out (Shalmon et al.)

Purpose: helps a client think about their role and how the family might work without them; used to reframe a client as a possible scapegoat holding the family steady [source: Shalmon et al. 2012, pp. 38-39].
Steps: draw the family including yourself; cut out your own figure; consider how the others would relate and what you might do outside the family frame.
Example language (illustrative): "If you step out of this picture, what happens between the people who are left?"
Watch for: distress about exclusion or abandonment; use with care where there is suicidal thinking, and check risk if the client imagines the family "better off" without them [synthesis]. Scissors: supervise with children [synthesis].

C4. Side-by-side genograms (Shalmon et al.)

Purpose: partners compare intergenerational patterns affecting the couple [source: Shalmon et al. 2012, p. 39].
Steps: each partner draws their family tree on adjoining paper; they look for repeating patterns and discuss them.
Watch for: one partner's history taking over the session.

C5. Plasticine relationship map (Shalmon et al.)

Purpose: makes closeness and distance physical; helped a couple step out of a pursue-withdraw cycle [source: Shalmon et al. 2012, p. 39].
Steps: each partner shapes a figure for themselves and places it on a surface that stands for the relationship ("make a map of your relationship"); they move the figures closer and further apart, notice discomfort, and speak as their figures.
Example language (illustrative): "Move your figure to where it feels right. Now a bit closer. What does it want to say?"
Watch for: the moment one partner wants more distance; slow down there.

C6. Subsystem tasks (Shalmon et al.)

Purpose: structural work, for example strengthening the parental subsystem [source: Shalmon et al. 2012, pp. 39-40].
Steps: give parents one page and children another on the same theme (for example a holiday); or ask the parents to lead an art task for the family.
Watch for: whether parents can agree and lead together, and whether children accept their lead.

C7. Draw the problem (narrative; Shalmon et al.)

Purpose: externalises the problem so the family can look at its influence together [source: Shalmon et al. 2012, pp. 40-41].
Steps: ask the client or family to draw the problem as a thing or creature; name it; explore when it is strong or weak; revisit the drawings over time, and share them as a final "performance" of the new story.
Example language (illustrative): "If this worry were a creature, what would it look like?"
Watch for: blame shifting back onto a person; keep the problem as the problem.

C8. Dyadic parent-child art (Shalmon et al.)

Purpose: observe and support the parent-child relationship with minimal verbal interpretation [source: Shalmon et al. 2012, p. 42].
Steps: parent and child make art together on one surface; the therapist observes engagement, use of space, and whether the parent takes over the child's work.
Watch for: a parent redoing the child's work without being asked, as in their example (p. 42). Coach gently in later sessions [synthesis].

C9. Other named variants (described briefly in Nieduziak 2021)

Joint Family Holiday Drawing (Jordan): family draws a holiday together, non-verbally, to assess relationships and roles (p. 164).
ADHD family tasks (Safran): joint tasks such as drawing a family trip, used to observe dynamics and practise assertiveness (p. 161).
Three-stage model for families of autistic children (Gabriels and Gaffey): open task, then added rules and tools, then an interview about behaviour (pp. 161-162).
Parent-child workshops (Plante and Bernèche): nine evening workshops for single-parent pairs using doodling together, body outlines, plaster masks, clay and cardboard building, aimed at the bond rather than insight (pp. 164-165). Plaster masks on faces need consent and skin and breathing safety checks [synthesis].
Gavron's Joint Painting Procedure assesses parent-child interaction (ebrary chapter); its steps were not found [uncertain].

5. Handling problems

The sources say little about problem handling. Each item names any source; everything else is [synthesis].

The whole family will not come. The FAE needs every member, and families are often reluctant to attend together [source: ebrary chapter]. Response [synthesis]: explain to each absent member, ideally by phone, that you want their view of the family, not to judge anyone; offer a time that suits working parents; if someone still refuses, run the evaluation with those present, record who is missing, and treat the absence as information. Drop tasks that need numbers, as Del Dosso did with Landgarten's team task when only three attended (Del Dosso 2016, p. 31).
"I can't draw" and fear of judgement. Adults often avoid art because they feel awkward, fear being judged on skill, or see no point in it; the clinician should expect this and work with it [source: Shalmon et al. 2012, p. 43]. Response: say again that no skill is needed (Del Dosso 2016, p. 12); model stick figures; allow shapes, words or colour only; for Task 2, accept stick figures. Never praise or criticise skill [synthesis].
A member refuses a task. [synthesis] Accept the refusal, note it, and offer to let them watch or do a simpler version; return to them in the inquiry ("What was it like to watch?"). Do not force participation, especially for adolescents.
Anxiety about closing the eyes in the scribble tasks. [synthesis] Offer eyes open, looking away, or a softened gaze; ask before the task and say it is optional for anyone with trauma history or psychosis.
Things come up fast. Family dynamics can surface quickly in the FAE, so the therapist needs interventions ready [source: ebrary chapter]. Response [synthesis]: agree a stop rule with the co-therapist beforehand; if a fight starts, pause the task, name the pattern in neutral terms, and either set a ground rule (for example, no touching others' work without asking) or move to the inquiry early.
One member dominates the joint scribble. [synthesis] Do not intervene during the evaluation (it is the data). In therapy, set structure: turn-taking, a colour per person (as in Del Dosso's account, p. 31), or a rule that each person must add to the picture before anyone adds twice. Then review the picture together.
A parent takes over the child's work. Seen in dyadic work [source: Shalmon et al. 2012, p. 42]. Response [synthesis]: in assessment, note it; in therapy, give each their own sheet first, then a shared sheet with a clear boundary, and coach the parent to ask before adding.
The identified patient is blamed. [synthesis] Return to the family frame: "These pictures are about all of you." Use the abstract portrait and joint scribble to show patterns that involve everyone. In the ADF case the young adult son was read as carrying the family's distress for everyone (Magalhães et al. 2026, pp. 15-16).
Denial of what a picture shows. Kwiatkowska saw kept artworks as a way to work through distortion, denial or resistance (quoted in Nieduziak 2021, p. 167). Response [synthesis]: do not insist; keep the picture and return to it later (B2).
Feedback too painful (grief, family secret, marital conflict). Share only what the family can bear and let them speak first [source: Magalhães et al. 2026, p. 8]. Response [synthesis]: split feedback over two sessions as in the ADF case (p. 15); see the couple separately before discussing marital material in front of children.
Poor attendance and dropout. The ADF case had many absences and delays across eight sessions (Magalhães et al. 2026, p. 9). Response [synthesis]: keep sessions predictable, contact absent members directly, and use the pictures already made to show the family what they have built.
Rupture with the therapist. [synthesis] Families may feel exposed or judged by the pictures. Name it directly, own any interpretation that went too far, and give control back by asking the family what they want to do with the artwork (keep, take home, put away).
Psychosis in a family member. The method was developed with families of people with schizophrenia [source: Nieduziak 2021, p. 159]. Response [synthesis]: keep sessions shorter if the patient tires or becomes agitated; do not read disorganised imagery as family symbolism; coordinate with the psychiatric team; stop if the person becomes acutely distressed or unsafe.
Disclosure of abuse or domestic violence. In Del Dosso's study, domestic violence came to light in a separate session with the mother after a family art assessment, and a clinician described ongoing checks for possible sexual abuse [source: Del Dosso 2016, pp. 27, 30-35]. Response [synthesis]: if a child or adult discloses harm, or what you see raises concern, follow your local child-protection and adult-safeguarding procedures and mandatory-reporting duties; do not question the child in front of the alleged abuser; offer separate sessions; reconsider whether joint sessions are safe. Never treat a drawing on its own as evidence of abuse; record what was said and done, not your reading of the image.
Requests to use the pictures in custody or court. No source opened addressed this [uncertain]. Response [synthesis]: the FAE has no published validity for forensic use; decline to give opinions on parenting or abuse based on artwork; refer to forensic assessment.
Children: consent, assent and adaptations. [synthesis] Get parental consent and the child's own assent; explain to children in plain words that they can stop; lower easels and give chunkier materials to young children; keep sessions short; allow movement breaks. Ask consent before keeping or sharing any child's artwork, as Del Dosso's participants gave written consent for use of their artwork (p. 4).
Suicide or self-harm themes in images. [synthesis] Treat images or titles suggesting self-harm as a cue to ask directly, in private, using your service's standard risk assessment. Do not rely on the drawing alone, and do not wait for the next session.
Cultural differences. [synthesis] Ideas of who counts as family, eye contact and who speaks first vary. Let the family define its members (Task 2 already does), and ask about meanings rather than applying Western symbol readings.
Physical safety. [synthesis] Pastel and chalk dust (asthma), no fixative sprays indoors, stable easels, supervised scissors, latex or wax allergies, and wiping hands before food.

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