VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 1
Visual Impairment and Artistic Media Preferences
Kelly McEwen, BA
A Thesis Submitted in Partial
Fulfillment of the Requirement
for the Master of Arts in Art Therapy Degree
Department of Art Therapy in the Graduate Program
Saint Mary-of-the-Woods College
Saint Mary-of-the-Woods, Indiana
May, 2020
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 2
ABSTRACT
This heuristic study investigated the artistic media preferences of the visually impaired researcher in order to enhance the availability and fit of art therapy service provision for the population of individuals with visual impairment. The participant engaged in art interaction with materials ranging from fluid to resistive, recorded written responses regarding thoughts and feelings associated with using each material, and completed pretest- and post- Impact to Self-
Worth assessment. Thematic analysis was used to determine common themes. The findings suggested that the participant preferred to use art materials between the spectrum of fluid and resistive media. Overarching themes included (a) control, (b) freedom, (c) challenges, (d) relaxation and anxiety reduction, (e) creativity and self-expression, (f) self-worth, and (g) response to art materials.
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 3
TABLE OF CONTENTS
ABSTRACT ...... 2
LIST OF FIGURES ...... 5
I. INTRODUCTION ...... 6 Problem Statement ...... 6 Research Questions ...... 7 Basic Assumptions ...... 7 Statement of Purpose ...... 8 Definition of Terms ...... 8 Justification of the Study ...... 10
II. REVIEW OF LITERATURE ...... 11 Visual Impairment ...... 11 Demographics and Prevalence ...... 11 Challenges of the Visually Impaired ...... 13 Workplace Factors ...... 13 Social Exclusion or Isolation ...... 15 Depression and/or Anxiety ...... 18 ADHD Link ...... 20 Current Treatment Methods ...... 20 Cognitive Development ...... 21 Motor Development ...... 21 Tactile Aids and Tool Utility ...... 22 Consideration of Individual Strengths and Differences ...... 22 Visual Type ...... 23 Haptic Type ...... 23 Media Properties and Use in Art Therapy ...... 24 Art Therapy and Visual Impairment ...... 26 Greif/Emotional Conflicts ...... 26 Identity/Self-Image ...... 27 Control/Freedom ...... 27 Social Engagement ...... 28 Media Preferences ...... 29 Summary ...... 29
III. METHODOLOGY ...... 30 Participants ...... 30 Research Design ...... 30 Research Instruments ...... 31 Art Directives ...... 31 Art Interaction Survey ...... 31 Data Collection ...... 33 Data Analysis ...... 33
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Qualitative Data Analysis ...... 33 Phase 1, Familiarization with the Data ...... 33 Phase 2, Generating Initial Codes ...... 34 Phase 3, Searching for Themes ...... 34 Phase 4, Reviewing the Data Sets ...... 34 Phase 5, Defining and Naming Themes ...... 34 Phase 6, Reporting the Final Analysis ...... 34 Ethical Implications ...... 36 Researcher Bias ...... 36
IV. RESULTS ...... 38 Control ...... 38 Freedom ...... 41 Challenges ...... 42 Relaxation and Anxiety Reduction ...... 43 Creativity and Self-Expression ...... 43 Self-Worth ...... 44 Response to Art Materials ...... 45 Fluid Media ...... 46 Mid-Spectrum Media ...... 47 Resistive Media ...... 49
V. DISCUSSION ...... 52 Discussion ...... 52 Control ...... 53 Freedom ...... 54 Anxiety and Anxiety Reduction ...... 55 Self-Worth ...... 55 Challenges ...... 56 Response to Art Materials ...... 57 Limitations ...... 58 Recommendations ...... 58 Conclusion ...... 59
REFERENCES ...... 60
APPENDICES ...... 74 APPENDIX A: Prevalence of VI Between Age Ranges ...... 74 APPENDIX B: Causes of VI ...... 75 APPENDIX C: Educational Attainment of Individuals with VI ...... 76 APPENDIX D: Art Process and Interaction Videos ...... 77 APPENDIX E: Feelings of Self-Worth Measure ...... 78 APPENDIX F: Feelings of Self-Worth Data Charts ...... 80 APPENDIX G: Thematic Analysis Charts ...... 83
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LIST OF FIGURES
Figure 1. Thematic Analysis Chart ...... 34 Figure 2. Fluid Acrylic and Oil Pastel Resist ...... 44 Figure 3. Gouache and Colored Pencil Resist ...... 45 Figure 4. Marker Mandala ...... 46 Figure 5. In Progress Charcoal Rendering ...... 47 Figure 6. Magazine Collage ...... 48 Figure 7. Colored Pencil Drawing ...... 49
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CHAPTER I
Introduction
The World Health Organization (2012) reported that visual impairment was a medical issue that impacted many individuals globally. This sensory deficit impacted individuals from all age ranges, sexes, cultures, and so on (Erikson, Lee & Von Schrader, 2017). Visual impairment
(VI) had been present at birth or acquired over time. While the physical impact of visual impairment was widely understood, the psychological implications of visual impairment were less/er known by the general public. Art therapy had shown some success in previous research
(Cohen, 1987; Rubin, 1975), however much of this research was dated. The current study sought to analyze the artistic media preferences and feelings associated with art interaction of an individual with VI, through the lens of the visually impaired researcher. Lastly, it aimed to assess the impact of art interaction on the participant’s feelings of self-worth.
Problem Statement
According to WHO (2012), Visual Impairment (VI), affected 2.2 billion individuals globally. VI included cataracts, corneal opacity, glaucoma, phthisis, motor development, and optic atrophy (Negral, Minassian & Sayek, 1996). Visual impairment was also frequently characterized by its developmental and physical symptomology including motor development
(Sretennović & Nedović, 2019), spatial orientation (Tulumović, Omerćehalić, & Husić Duzić,
2019), and academic performance (De Verdier & Ek, 2014; Zebehazy, Zigmond & Zimmerman,
2012). Current research had also assessed the psychological impact of visual impairment and comorbid diagnoses. This included social isolation or loneliness (Brunes, Hansen & Heir, 2019;
Kasiram & Subrayen, 2013), depression (Nispen, Vreeken, Comijs, Deeg & Rens, 2016;
Papadopoulos, Papakonstantinou, Montgomery & Solomou, 2014), and anxiety (Latham,
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 7
Baranian, Timmis & Pardhan, 2015; Papadopoulos et al., 2014). According to Ueda and Tsuda
(2013), experiencing grief was also identified as a factor that accompanied visual impairment, especially when the impairment was acquired rather than present at birth. However, much of the current research had shifted focus toward the medical and mental pathology of individuals with
VI, rather than holistic and creative treatment approaches (Heyl & Hintermair, 2015; Morash &
McKerracher, 2017; Reimer, Cox, Boonstra, & Nijhuis van der Sanden, 2015). Unfortunately, there had been minimal research available regarding art therapy with individuals with VI in recent years.
Research Questions
This study investigated the artistic media preferences of the visually impaired researcher ranging from fluid materials to resistive materials. Additionally, this study aimed to assess how interacting with various art materials influences self-worth of the participant through analysis of pretest-posttest self-worth measures, before and after art interaction. This study was guided by the following questions:
1. What art materials does the visually impaired participant prefer?
2. What feelings are evoked for the visually impaired participant through creative art
making experiences?
3. How do different art materials impact the visually impaired researcher’s feelings of
self-worth?
Basic Assumptions
It was assumed that the participant would answer survey questions truthfully. Another basic assumption was that the survey was accessible to individuals with VI through the use of video and auditory media to communicate informed consent, study purpose, and instructions to
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 8 complete the survey. It was assumed that although this study analyzed data within the context of the participant’s experience, the research could be applied to a broader population of individuals with VI. This was demonstrated through the mirroring of themes between the current study and previous research (Bathelt, de Hann, & Dale, 2019 Cohen, 1987; Rubin, 1975).
Statement of Purpose
The purpose of this study was to expand current research on the application of art therapy services to individuals with VI. Another purpose of this study was to gain a better understanding of the artistic media preferences of individuals with VI, in addition to thoughts and feelings experienced by individuals who were visually impaired while working with various art materials.
The results of this study may be used to provide information on the best material and directive options within the field of art therapy for individuals with VI. Additionally, the results may be used to add current data to research surrounding art therapy with the visually impaired.
Definition of Terms
Visual impairment. According to Project Informing and Designing Education for All
Learners (IDEAL) visual impairment was defined as any visual condition that hindered an individual’s ability to complete everyday tasks (ProjectIDEAL, n.d). The World Health
Organization (WHO; 2012) categorized visual impairment as either distance or near presenting vision impairment. Visual impairment severity was based on an individual’s level of visual acuity.
Acquired visual impairment. Acquired visual impairment was defined as VI that occured after birth and included the loss of visual acuity after having normal vision. This was also referred to as adventitious visual loss, which was sometimes the result of a hereditary condition or visual trauma (ProjectIDEAL, n.d.).
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Low vision. The American Foundation for the Blind (AFB, n.d.) stated that low vision is referred to a functional definition of poor sight unable to be corrected with treatment options such as glasses, contacts, medicine, or surgery. The term was often associated with an individual’s hinderance to complete daily tasks as a result of low visual acuity (AFB, n.d.).
Legal blindness. Legal blindness was referred to as a legal term used to denote a person’s eligibility to receive services such as rehabilitation, schooling, vocational training, disability benefits, low vision devices, and tax exemption programs. The term legal blindness did not provide a functional definition of low vision (AFB, n.d.).
Keratoconus. The American Optometric Association defined keratoconus as a disease that resulted in the typically round cornea of the eye becoming thin and cone shaped. The atypical shape of the cornea caused visual distortion due to the inability for light to focus on the retina correctly (American Optometric Association, n.d.).
Fluid media. Fluid media refers to art materials that have minimal inherent structure and flow freely and easily while used in the process of creation (Hinz, 2009). These materials include various types of paint such as watercolor, acrylic, and finger paint.
Mid-spectrum media. Hinz (2009) stated that mid-spectrum media encompasses art materials with structure that falls somewhere on the spectrum between fluid and resistive. These materials have more structure than fluid media, however they can be easily with added pressure.
Examples of these materials include chalk pastels, oil pastels, markers, water-based or modeling clay, and crayons.
Resistive media. Resistive media refers to artistic materials that hold their own inherent structure and require pressure to be utilized (Hinz, 2009). Resistive media includes materials and
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 10 processes such as plasticine clay, wood or stone sculpture, pencils, pens, colored pencils, and collage.
Justification of the Study
As someone with VI, and who experienced associated psychological symptomology, the researcher was aware of the need for therapeutic services that were informed on the condition and accompanying stressors. The researcher believed from experience that art therapy could be beneficial in mitigating psychological distress resulting from VI. This study sought to advance the body of research regarding artistic media preferences and differential mental and emotional responses between materials with individuals who have acquired VI.
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CHAPTER II
Literature Review
Challenges for individuals with visual impairment included both the physical impairment of low sight and a wide range of social, mental, and developmental difficulties. A review of past and present literature suggested that prevalent issues among visually impaired individuals included the availability of workplace accommodation, job security, social exclusion or isolation, depression, anxiety, and the possible link between VI and Attention-Deficit/Hyperactivity
Disorder (ADHD; McEwen, 2018). This review of the literature explored the demographic data surrounding VI, challenges individuals with VI frequently encounter, current topics of research regarding VI, and the use of art therapy with visually impaired individuals.
Visual Impairment
According to WHO (2012), approximately 2.2 billion people were impacted by visual impairment globally, many of which had not received proper treatment. The National Federation of the Blind (NFB, 2019) stated that because there were no generally accepted definitions for the terms “visual impairment” or “low vision,” statistics could only estimate the prevalence and demographics of visual impairment. The following statistics were based on individual reports of visual impairment; therefore, it was important to note that the number of individuals with VI was likely to be higher than the number of those who report having VI.
Demographics and prevalence. Erikson et al. (2017) reported that 3,118,647 individuals within the United States had a visual impairment, which was an estimated 2.3% of the U.S. population. However, the NFB (2019) estimated that 7,675,600 individuals of all ages, ethnicity, and genders reported having visual impairment which was also estimated to be 2.4% of the United States population. According to Erikson et al. (2017) the prevalence of individuals
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 12 with VI within the U.S. was similar between the population of men and women. A sample of
1,604,382 women within the U.S. reported having a visual impairment which was an estimated
2.5% of non-institutionalized females within the United States. According to the NFB (2019), roughly 2.65% of men reported having a visual impairment. In contrast, Erikson et al. (2017) reported 1,514,265 males with visual impairment which was an estimated 2.2% of the male population.
Erickson et al. (2017) reported that within the U.S., white individuals had an estimated
2.3% prevalence of VI, Black/African American individuals had a 3.0% prevalence of VI,
Hispanic individuals had a 2.1% prevalence of VI, Asian individuals had a 1.4% prevalence of
VI, American Indian or Alaskan Native individuals had a 4.0% prevalence of VI, and individuals who identify as another race or ethnicity had a 2.1% prevalence. Which suggested a minor increase from 2016 (AFB, n.d.)
According to Erikson et al. (2017), individuals under the age of 4 years old within the
U.S. had an estimated 0.4% prevalence of VI. As of 2017 Erikson et al. (2017) estimated that ages between 5-15 had a 0.9% prevalence of VI, individuals 16-20 had 1.1% prevalence, 21-65 had 2.0% prevalence, individuals older than 65 had 6.3% prevalence, and individuals older than
75 had an estimated 9.3% prevalence of VI (Appendix A).
The primary cause of visual impairment can vary greatly between demographic groups.
According to the American Academy of Ophthalmology (AAO; n.d.) the following were the primary causes of visual impairment between White individuals, Black individuals, and Hispanic individuals. White individuals within the U.S. most often became visually impaired with cataracts at 42.2%, followed by age-related macular degeneration 2.8%, other 22.7%, diabetic retinopathy 4.7%, and glaucoma 2.3%. Cataracts were also the most prevalent cause of visual
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 13 impairment among Black/African American individuals in the United States at 41.7%, followed by other 27.0%, diabetic retinopathy 12.2%, glaucoma 11.3%, and age-related macular degeneration 7.8% (American Academy of Ophthalmology, n.d.; Appendix B).
Of non-institutionalized individuals with visual impairment aged 21-64 residing in the
United States an estimated 21.5% received less than a high school diploma, 31.9% received a high school diploma or equivalent, 30.7% completed some college or an associate’s degree, and
15.9% completed a bachelor’s degree or higher (Erikson et al., 2017; Appendix C). Of non- institutionalized individuals with VI, aged 21-64 years old and working full time, the median annual earnings was estimated to be roughly $39,700. Within the same population it was estimated that the median household income was roughly $43,500 (Erikson et al., 2017). Other research suggested that socioeconomic challenges could also negatively impact individuals with visual impairment, including both access to health care and certain cultural factors that acted as mediating factors between socioeconomic status and VI (Yan, Chen & Yan, 2019). Habsyiyah,
Yeni, Arianwan and gondhowiardjo (2015) stated that there was a higher prevalence of VI within the populous of individuals with lower income. Lastly, Biesland and Mersland (2014) reported that individuals with VI, in general, had lower income statuses in comparison with the average individual with other disabilities. Chou, Beckless, Zhang and Saaddine (2015) reported that socioeconomic status was inversely associated with sensory impairment among working
Americans. According to Erikson et al. (2017), an estimated 27% of non-institutionalized individuals age 21-64 with visual impairment lived below the poverty line in the United States.
Challenges of the Visually Impaired
Workplace factors. According to Erikson et al. (2017), among the population of visually impaired males and females between the ages of 18 and 64 years old, regardless of
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 14 ethnicity, had an estimated 44% employment rate. An estimated 8.7% of non-institutionalized individuals aged 21-64 with visual impairment were not working but were actively looking for work. Among non-institutionalized individuals aged 21-64 with a visual impairment an estimated
30% were employed full-time (Erikson et al., 2017).
Since the amendment of the Americans with Disabilities act in 2008, there was an 8% decrease in workplace acquisition discrimination as of 2017 (Victor, Thacker, Gary, Pawluk, &
Copolillo, 2017). However, job retention discrimination increased to 5% and job satisfaction discrimination increased by 3.6%. Individuals with visual impairment reported feeling a wide range of acceptance, discomfort, and dismissal within the workplace (Dong, Warner, Mamboleo,
Guerette, & Zalles, 2017; Mojon-Azzi, Sousa-Poza, & Mojon, 2010; Papakonstantinos &
Papadopoulos, 2010).
Workplace accommodation. Despite the decrease in workplace discrimination barriers in workplace accommodation negatively impacted both the job satisfaction and employment acquisition of visually impaired individuals. According to Silverman, Mendez and Bell (2019), individuals with VI stated that they had rejected job offers due to transportation barriers and inaccessibility. Other difficulties were presented in job acquisition, for example, individuals with
VI also reported spending a long time on the job market and a low ratio of interview offers to applications (Silverman et al., 2019). Conversely, the researchers also stated that visually impaired individuals that were employed reported job satisfaction, competitive wages, and benefits.
Dong et al. (2017) stated that lack of knowledge toward the Americans with Disabilities
Act (ADA) and accommodations on the part of visually impaired individuals and respective employers, served as a barrier to workplace accommodation. Additionally, the perception of
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 15 accommodation for individuals with VI as a financial burden to a company could have been a factor in both the likelihood of individuals to ask for accommodation and the provision of it by employers (Dong et al., 2017; Mojon-Azzi et al., 2010). Dong et al. (2017) identified fear of job loss acted as a barrier to individuals with VI inquiring about workplace accommodations.
According to Mojon-Azzi et al. (2010) individuals with more severe visual impairments had a higher rate of reporting low job security.
Silverman et al. (2019) stated that individuals with VI reported encountering discrimination during the interview process while applying for employment. Individuals with VI experienced inadequate support, minimal opportunity for freedom and growth, and did not receive recognition for workplace contributions (Mojon-Azzi et al., 2010; Papakonstantinou &
Papadopoulos, 2010). However, Papakonstantinou and Papadopoulos (2010) also presented various examples of positive social support that individuals with VI experienced in the workplace.
Social exclusion or isolation. Another difficulty that individuals with VI faced was social exclusion or isolation, which resulted from transportation limitations (Naraine & Lindsay,
2011), lack of social knowledge (Hopps , Pépin, Arseneau, Fréchette, & Bégin, 2001; Ishtiaq,
Chaudhary, Rana, & Jamil, 2016), lack of autonomy (Jessup et al., 2017), decreased engagement in social activities (Jessup, Bundy, Broom, & Hancock, 2017; Jin et al., 2019), and negative social interactions (Brunes et al., 2019; Kasrim & Subrayen, 2014; Stanimirović, Jablan,
&Stojković, 2017). In contrast, some research argued that loneliness was not impacted by the severity of an individual’s visual impairment (Hopps et al., 2001). Jessup et al. (2017) also stated that a majority of students with visual impairment reported feeling included overall. However, students with additional disabilities in particular report feelings of loneliness. Additionally,
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Stanimirović et al. (2017) concluded that a majority of adolescents living with VI reported positive feelings of happiness and minimal feelings of loneliness. Their study suggested that only
15% reported feelings of extreme loneliness. This being said, Stanimirović et al. (2017) noted that participants may have censored their answers to present themselves in a positive light, especially when discussing topics, such as loneliness, that had negative associations.
Transportation limitations. Naraine and Lindsay (2011) discussed interview answers from visually impaired individuals about experiences with social exclusion in the workplace.
Their findings suggested that individuals with VI felt excluded from social work outings due to lack of transportation and the challenges of other transportation means. Examples of this included not being able to find work colleagues or the appropriate location if obtaining a ride from a taxi or other transportation service (Naraine & Linday, 2011). Crudden (1999) indicated that over half of participants in a study of barriers to employment among the visually impaired, reported difficulty in accessing transportation as a major barrier to finding employment. Cmar,
McDonnall, and Crudden (2018) suggested that self-efficacy and confidence in navigating transportation was high among employed individuals with VI. Silverman et al. (2019) also highlighted transportation limitations as a major barrier to employment, as well as a factor to an individual with VI’s avoidance of applying. According to Silverman et al. (2019), transportation limitations included the lack of public transport, inefficient fixed-route public transport, unavailability of public transport during certain days or times, and the high cost of other options such as personal drivers or ridesharing.
Lack of social knowledge. Hopps et al. (2001) stated that loneliness was negatively associated with social skills, suggesting that the more social skills and individual with VI had, the less likely they were to report feelings of loneliness. According to Ishtiaq et al. (2016),
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 17 students with VI faced more challenges with social interaction than their sighted peers.
Additionally, visually impaired individuals who were not blind were more likely to present with lower social skills and practical knowledge compared to blind and sighted individuals (Ishtiaq et al., 2016).
Lack of autonomy. Individuals with VI encountered issues with feeling a loss of autonomy which could enhance negative feelings and a sense of isolation or exclusion.
Papadopoulos, Paralikas, Barouti, and Cronopoulou (2014a) found that individuals with VI who were capable self-sufficiency were less likely to express depressive symptoms. Kasiram and
Subrayen (2013) documented that individuals with VI experienced challenges with autonomy in both their home and work experiences. Individuals reported having autonomy withheld from them by others at home and school, disallowing their decision making or participation, usually resulting from thinking that the visually impaired individual was incapable (Kasiram &
Subrayen, 2013). Lastly, individuals with VI reported more positively regarding feelings of loneliness when they were able to engage in activities that involved more autonomy in school
(Jessup et al., 2017).
Decreased social engagement. Jessup et al. (2017) suggested that individuals with VI felt the loneliest when they were participating in idle activities at school and not participating with others. Individuals were generally unable to participate in certain activities due to lack of accommodation or accessibility (Jessup et al., 2017). Jessup et al. also stated that individuals with VI often participated in solitary activities at home, which may have been amplified by the use of digital technology. Some individuals with VI, especially older individuals, may have chosen not to participate in social activities. Jin et al. (2019) indicated that older individuals with
VI, glaucoma in particular, demonstrated reduced interaction in social settings such as in sports,
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 18 with friends or family, and charity work. Crudden, Cmar, and McDonnall (2017) also discussed stress associated with transportation, which was a factor in an individual’s lack of participation.
Negative social interactions. Stanimirović et al. (2017) suggested that stereotypes and stigmatization of disability and visual impairment may have been a factor in lower psychosocial functioning and the likelihood of reporting feelings of loneliness and isolation. Brunes et al.
(2019) revealed that feelings of loneliness among the visually impaired were strongly associated with experiencing bullying or abuse. Kasiram and Subrayen (2013) stated that a large number of individuals with VI experienced abuse of power and negative social interactions from family, school members, and other community members. This abuse of power was found to sometimes manifest as the aforementioned withholding of autonomy from visually impaired individuals
(Kasiram & Subrayen, 2013).
Depression and/or anxiety. Two of the most commonly discussed mental health concerns associated with VI were depression and anxiety. However, it was important to note that confounding factors may have been present in the causation of depressive and anxious symptomology (Court, McLean, Guthrie, Mercer, & Smith, 2014; Ogunsemi, Bodunde, Afe, &
Abasiubong, 2016; van Nispen, Vreeken, Comijs, Deeg, & Van Rens, 2015). Ogunsemi et al.
(2016) stated that the relationship between mood disorders and general functioning may be bidirectional.
van Nispen et al. (2015) stated that when compared to normally sighted individuals, individuals with VI, even if the impairment was mild, had a higher prevalence of depression.
Ishtiaq et al. (2016) indicated that a majority of individuals with VI reported depressive symptoms. Singla (2018) asserted that chronic health problems and the presence of functional impairments were risk factors of depression. Shakel et al. (2019) revealed that individuals with
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VI reported more depressive symptoms and higher levels of fatigue than normally sighted individuals.
Anxiety. Ogunsemi et al. (2016) suggested that individuals with VI were at higher risk for psychological morbidity, including the prevalence of anxiety among the population. Visual impairment may also have exacerbated preexisting mental health conditions (Ogunsemi et al.,
2016). Anxiety and stress may have revolved around difficulties in transportation, challenges in completing certain tasks, social challenges, or in expressing experiences with VI.
Crudden et al. (2017) highlighted stress and anxiety that individuals with VI had regarding transportation. Individuals with visual impairment experienced stress navigating unfamiliar areas. This resulted in heightened cognitive requirements for individuals with VI especially, which may be a factor in increased stress (Crudden et al., 2017). Additionally,
Crudden et al. (2017) posited that individuals with VI who experienced transportation stress may have been more likely to engage in avoidance coping behaviors.
Visagie, Loxton, Stallard, and Silverman (2017) proffered that anxiety among individuals with VI manifested into themes of performance concerns, social concerns, socio-evaluative concerns, and concerns related to injury. Performance and social concerns involved apprehensions on the part of visually impaired individuals in completing school tasks or engaging in social activities due to physical limitations (Visagie et al., 2017). Socio-evaluative concerns referred to the anxieties of visually impaired individuals surrounding the comparison of themselves to others (Visagie et al., 2017). Lastly, Visagie et al. stated that while less frequent, individuals with VI also expressed concerns related to sustaining injury either by self or others.
Latham et al. (2015) questioned which mental health tasks were most difficult for individuals with VI to manage independently. The findings suggested that dealing with feelings
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 20 of anxiety, stress, frustration, and having to explain their visual impairment, were among the more challenging mental health tasks that individuals with VI cope with (Latham et al., 2015).
ADHD link. Individuals with VI reportedly had an increased risk of having Attention-
Deficit/Hyperactivity Disorder (ADHD). Visually impaired children had an 15.6% prevalence of comorbid ADHD compared to an 8.3% prevalence in normally sighted children (Pope, 2016).
Bathelt et al. (2018) evidenced the higher presence of executive dysfunction and behavioral difficulties of visually impaired individuals in comparison to sighted individuals. Maćešić-
Petrović, Žigić, Kovačević, and Jačova (2016) called for complex treatment approaches for individuals with VI who also had ADHD. Howell (2012) warned that ADHD and other behavioral medications may have adverse effects on vision. Additionally, Mokobane, Pillay and
Meyer (2019) stated that ADHD can lead to a deficit in fine motor functioning, compounding the issues individuals with VI have with motor functioning.
Current Treatment Methods
A review of the literature suggested that there had been a shift within the research regarding individuals with VI from a creative and holistic perspective toward one that was more clinical and utilitarian in nature (McEwen, 2018). Current research emphasized cognitive and motor development (Heyl & Hintermair, 2015; Morash & McKerracher, 2017; Reimer et al.,
2015) as well as the use of tactile aids and tool utility (Gual, Cazorla, & Lloveras-Macia, 2013;
Jo et al., 2016). While this could be instrumental in understanding how to improve accessibility for individuals with VI and brought awareness to the motor and developmental impacts of VI, this research often did not address the emotional impact of VI and could pathologize individuals within the population (Matsugma, Kawashima, Sano, & Tsubota, 2019).
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Cognitive development. Observations of the cognitive skills of visually impaired individuals conducted in Ek, Jacobson, Ygge, Fellenius, and Flodmark (2000) recalled a visually impaired child’s difficulties with memory tasks and attention. Ek et al. presented examples of challenges with mathematical processing. Schubert, Cruickshanks, Fischer, Chen, Klien, Klien, and Pinto (2017) revealed that middle-aged individuals with sensory impairments had poorer cognitive functioning performance than those who did not have sensory impairment. Some research states that older individuals with VI, particularly late onset age related macular degeneration, had a higher prevalence of cognitive impairment than individuals without VI
(Pham, Kifley, Mitchell, & Wang, 2006). On the other hand, another study of older individuals with VI suggested that there was no significant difference in cognitive functioning between individuals with VI and sighted individuals of the same age and gender (Bazzazi et al., 2019).
Even when testing the impact on blurred vision on non-verbal testing using simulated blurred vision with sighted individuals, blurred sight negatively impacted testing results. However, it was noted that visually impaired individuals likely displayed more compensating factors and coping strategies (Bertone, Bettinelli, & Faubert, 2007). According to Ek et al. (2000) determinates of compensating strategies among children were intelligence and overall motor function.
Motor development. Prior research was in agreement that individuals with VI had a steeper learning curve when it came to motor skills (Reimer et al, 2015; Sretenović & Nedovic,
2019). Generally speaking, it took individuals with VI a longer time to develop motor skills.
Compared to sighted individuals, individuals with VI were below average in terms of motor development (Reimer et al, 2015; Sretenović & Nedovic, 2019). According to Reimer et al.
(2015) children with VI also took a longer time to complete individual tasks requiring fine motor
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 22 skills. Additionally, it was suggested that the time it takes to develop adaptive strategies played a role in the rate of fine-motor skills acquisition among visually impaired individuals (Reimer et al., 2015).
Tactile aids and tool utility. Several studies on the topic of visual impairment discussed the processes of creating new tactile aid, how certain sensory aids were utilized, and improvements that should be made or were being made to existing technologies and tactile aids.
Periša, Peraković, & Vaculík, 2015) presented changes to the traffic alert system that may be beneficial to individuals with VI. Periša et al. indicated that the availability of more information at traffic stops such as intersection size and street names could make intersections safer for individuals with VI. Taylor, Bambrick, Brand, Bray, Dutton, Harper, Hoare, Ryan,
Edwards, Waterman, and Dickinson (2017) examined the effectiveness of digital magnifiers with the visually impaired population, it was suggested that some tools rely on precise factors which deemed them less effective. The usability of visual tools also depended on the comfort of the user (Taylor et al., 2017). Other research and news discussed the process of translating color, art, and visual aids into three-dimentional models (Jo et al., 2016) tactile experiences (Juricevic,
2009), or tactile aids (Ramsamy-Iranah, Maguire, Gardner, Rosunee, & Kistamah, 2016).
Consideration of Individual Strengths and Differences
One important consideration when working with visually impaired individuals was the varying degrees of visual impairment, that in combination with environmental factors affected each individual differently. Cohen (1987) stated that no one definition of blindness or visual impairment could fit everyone, adding that “functional as well as adaptive criteria should be considered when affixing a diagnosis.” (p. 15). Lowenfeld (1952) regarded people with VI as creative individuals, however, he also acknowledged the presence of two creative types. These
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 23 two types were identified as the visual type and the haptic type. Visual types continued to use their eyes to connect with the environment despite low vision, whereas haptic types connected with the environment through their sense of touch. According to Cohen (1987) it was important not to underestimate blind or visually impaired individuals or make assumptions about how familiar they might have been with certain materials.
Visual type. While there was limited research on the visual type of perception among individuals with visual impairment, Lowenfeld (1952) stated that individuals within the visual type processed information through observation of visual details in their surrounding environment. According to Jansson (2008) visual perception was beneficial in gaining awareness of an overall picture of experience and was often utilized to sense and process distant stimuli.
Individuals with difficulties in visual processing often used gestalt perception in order to fill in the blanks that their eyes were unable to (Van der Zee, Kooiker, Ojeda, & Pel, 2019). Van der
Zee et al. (2019) stated that individuals with VI who also had cerebral visual impairment or brain damage, tended to fare poorer in gestalt performance than individuals with ocular visual impairment. Malinovská (2014) documented the challenges visually impaired individuals had regarding spatial awareness in the classroom setting. Additionally, this required individuals with
VI to expend a substantial amount of energy on concentration and memorization of environmental factors (Malinovská, 2014).
Haptic type. Haptics was also known as active touch (Jansson, 2008; Lowenfeld, 1952).
In comparing haptic perception with visual perception Jansson (2008) described the strengths and weaknesses of each. Both visual and haptic perception allowed individuals to perceive size, shape, form, texture, and location of nearby objects (Jansson, 2008). Haptic perception had the advantage of sensing the weight, hardness, and temperature of surfaces (Jansson, 2008). Petrini,
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Remark, Smith, and Nardini (2014) suggested that integration of auditory and haptic data improved with time, therefore it was more beneficial for adults with VI than for children.
McLinden (2012) reported that haptic exploratory procedures included lateral motion, pressure, static contact, enclosure, unsupported holding and contour following. According to Norman,
Cheeseman, Adkins, Cox, Rodgers, and Reyes (2015) haptic recognition was typically as effective in the identification of manmade objects. However, they stated that haptic perception preformed less effectively to learn and recognize unfamiliar objects (Norman et al., 2015).
Media Properties and Use within Art Therapy
A foundational model surrounding the material properties and material use within the field of art therapy was the Expressive Therapies Continuum (ETC; Hinz, 2009; Kagin &
Lusebrink, 1978). This framework served as a means of classifying interactions with art materials, information processing, and image formation. Many material properties evoked certain reactions that were classified within the hierarchical structure. Material types and properties were most often separated into fluid and resistive media types; fluid was associated with affective response whereas resistive media was associated with cognitive response (Hinz, 2009). However, some materials rested closer to the middle of this spectrum. Materials that were considered fluid flowed easily and had minimal inherent structure. Fluid materials included chalk pastels, watercolor paint, and other paint types. Resistive materials had inherent structure and required the use of pressure to create marks. Resistive media included wood or stone sculpture, plasticine clay, pencils/colored pencils, and collage (Hinz, 2009). Mid-spectrum media was neither completely fluid or resistive; it had some structure, required pressure to utilize, and could be manipulated. Past research demonstrated how the differences between material types elicited various thoughts and emotional responses (Camic, Brooker & Neal, 2011; Moon, 2010; Pesso-
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Aviv, Regev & Guttman, 2014; Rubin, 1975; Snir & Regev, 2013; Tulák-Krčmáriková &
Lessner-Lištiaková, 2018).
Snir and Regev (2013) reported that fluid materials, finger painting and gouache paint in particular, resulted in a variety of responses. They stated that individuals utilizing gouache reported themes of excitement and worry, and themes of hesitation were present among individuals working with finger paint. In response to both of these materials individuals expressed hesitation with the loss of control and messiness, however during creative art sessions most individuals allowed themselves freedom of expression with the materials (Snir & Regev,
2013). Rubin (1975) expressed that working with fluid media may have been a source of anxiety for individuals with VI unless utilizing boundaries and barriers. Pesso-Aviv et al. (2014) evidenced that children between the ages of seven and nine years old experienced a decrease in self-control while working with gouache.
Mid-spectrum media seemed most familiar to individuals. Snir and Regev (2013) stated that individuals were disappointed by the use of felt-tip markers, feelings of limited creative possibilities emerged. Whereas clay evoked both freedom of expression, and concern regarding the end product and the high expectations held by participants (Snir & Regey, 2013). Tulák-
Krčmáriková and Lessner-Lištiaková (2018) described clay as a multisensory art material that acted to ground the tactile senses of individuals during a time where senses such as sight and sound may have been overloaded. They stated that clay was an ever-changing material that simultaneously shaped the artist and was shaped by the artist. Additionally, they suggested that clay often reflected the emotions and energy of the creator (Tulák-Krčmáriková & Lessner-
Lištiaková, 2018). Pesso-Aviv et al. (2014) reported that self-control increased in children while working with oil pastels. Additionally, Sinr and Regey (2013) stated that creators working with
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 26 oil pastels expressed feelings of joy. Individuals working with oil pastel enjoyed the creative possibilities of the material and did not exhibit the fear of losing control.
Pesso-Aviv et al. (2014) stated that children working with resistive material, colored pencils in particular, displayed an increase of self-control. Found object collage and natural object collage had been shown as materials that allowed creators to connect with personal symbols and meaning (Camic et al., 2011; Chang & Netzer, 2019).
Art Therapy and Visual Impairment
In contrast, since the infancy of the art therapy profession, pioneers within the field such as Kramer (2000) and Rubin (1975) had worked with blind and visually impaired individuals to address emotional conflicts, grief, identity development, issues of control and freedom, and social engagement. Rubin (1975) recorded observations of how visually impaired individuals engaged during art therapy sessions and documented common themes that emerged regarding the needs of individuals within the population. Additionally, Rubin (2005) discussed how individuals with VI, alongside other disabilities interacted with tactile materials. Research regarding the use of expressive arts therapies with visually impaired individuals suggested that art therapy may have been an effective treatment approach for individuals who had visual impairments.
Greif/emotional conflicts. Individuals with VI, particularly those whose visual impairment was acquired, endured a process of adaptation and grief for their lost sight.
According to Papadopoulos, Papakonstantinou, Montgomery, and Solomou (2014), individuals whose VI developed in adolescence and adulthood had lower self-esteem compared to individuals whose VI was present and identified in early childhood. However, emotional conflicts arose whether an individual was born blind or acquired their visual impairment. Rubin
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(1975) identified anxiety, vulnerability, helplessness, and anger as feelings that blind and visually impaired children frequently experienced. She stated that manipulation of art materials and creative expression aided children who were blind to express and communicate these feelings (Rubin, 1975). Bergeron and Wanet-Defalque (2012) revealed that individuals with VI expressed lower acceptance and higher denial when vision loss was more recent versus those who lived with VI for a longer period of time.
Identity/self-image. Kramer (2000) stated that because blind children depended on having faith in outside information which they could not see themselves, it posed the risk of individuals with IV becoming overly compliant and losing their sense of self. It was suggested that through free expression and gained autonomy via the manipulation of artistic media self- awareness was increased and loss of identity among individuals with VI was prevented
(Herrmann, 1995; Kramer, 2000). Previous research examined art therapy and art interaction as a way of increasing self-awareness and self-esteem (Heenan, 2006; Muri, 2007). Muri (2007) discussed how artists of the past such as Frida Kahlo utilized art, self-portraiture in particular, as a way of combining the perceptions of inner and outer self in order to cope with physical disability. Matsugma et at. (2019) stated that the acknowledgement of personal strengths among individuals with VI was a primary indicator of self-confidence. Additionally, Cohen (1987) suggested that the art therapy environment may provide a non-judgmental setting in which individuals with VI could explore personal strengths and develop advantageous personal concepts.
Control/freedom. According to Papadopoulous et al. (2014), individuals with VI who were able to support themselves had fewer depressive symptoms than those who required support in daily living. One possible cause of co-occurring anxiety with VI was feeling a loss of
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 28 control. According to Rubin (1975) the use of fluid media, such as paint or very wet clay, may have exacerbated these feelings. However, structured boundaries such as frames may be used to help clients with VI to regain a sense of autonomy and control. Thurston, Mcleod, and Thurston
(2012) reported that individuals with VI experienced feelings associated with the lack of and loss of control. Additionally, Rubin (1975) noted the importance of utilizing play, fantasy, and drama therapy as a way of encouraging individuals with VI to take on an active role. She stated that the use of play and drama therapy could also act as a means of reworking traumatic situations
(Rubin, 1975). In addition to self-awareness, providing freedom to manipulate artistic media could also help individuals with VI regain a sense of freedom and personal control. On the other hand, Abbing, Sonneville, Baars, Bourne, and Swaab (2019) implied that art therapy had no direct connection with anxiety reduction specifically.
Social engagement. According to Papadopoulous et al. (2014), individuals with VI who had high levels of social support exhibited fewer depressive symptoms compared to individuals with low levels of social support. Due to transportation limits, it may have been hard for individuals with VI to become involved in social engagement and build a community of support.
However, Ueda and Tsuda (2013) indicated that group therapy was an ineffective treatment approach with blind and visually impaired individuals. They stated that clients with VI in group therapy were less motivated to share their experiences than in individual therapy. In contrast,
Cohen (1987) discussed the creation and implementation of a creative group experience with blind and visually impaired individuals. One objective of the experience was to help individuals with VI build social engagement and trust in their peers. Cohen concluded each creative experience by encouraging the members to discuss their feelings and concerns, over time the members became more open to discussing the personal meaning behind their art. In this example,
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Cohen was able to utilize art to encourage expression and social engagement. Lastly, Levens
(1986) suggested that individuals with VI often internalize feelings and experiences as a result of limited contact with external stimuli.
Media preferences. Much of the previous research and clinical observations regarding art therapy with VI discussed the use of clay with this population (Cohen;1987; Herrmann,1995;
Lowenfeld, 1952; Rubin, 1975). While Rubin (1975) discussed observations of clients using paint. She stated that fluid media and the associated loss of control could contribute to anxiety in individuals with VI as they engaged in creative exploration. Therefore, it was predicted that participants would prefer artistic media that fell somewhere in the middle of the spectrum between fluid and resistive. Materials within this area of the spectrum include oil pastels, chalk pastels, water-based or modeling clay, markers, and crayons.
Summary
Many individuals around the world faced having visual impairment from a variety of different causes. Visual impairment was linked with a variety of physical, developmental, psychological, social, and socioeconomic challenges. However, it remained important that individuals with VI were regarded as more than just their impairment, but rather as capable human beings. Previous research in the field of art therapy suggested that art therapy may be beneficial in mitigating the negative symptomology experienced by those who have VI.
Unfortunately, limited research had been conducted in recent years regarding the use of art therapy with visually impaired individuals.
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CHAPTER III
Methodology
This was a heuristic study that investigated media preferences, experiences with each spectrum of media, and the impact of art interaction on the participant’s feelings of self-worth.
Art interaction, written responses, and self-worth measurements were utilized to collect data.
Data was analyzed through charting of quantitative data and thematic analysis of written responses.
Participants
The researcher and participant in this study was a 27-year-old Caucasian female, who was a graduate student in an art therapy program. Diagnosis was a degenerative eye condition called Keratoconus (KC) since around 16 years of age. The researcher had received a corneal transplant in one eye, along with a preventative procedure in the other. Additionally, she had an
ADHD diagnosis which had been present since the age of 14. The researcher was a viable participant in this study because of acquired VI and presentation of associated mental health and developmental symptomology.
Research Design
This was a heuristic research design in which the visually impaired researcher assessed artistic media preferences and associated feelings via survey responses and thematic analysis following art engagement. The procedure consisted of art interaction, survey responses, and a feelings of self-worth measurement. The study required the participant to interact with art materials that corresponded with the three different spectrums of artistic media, complete an eight-question survey about her experience after each art interaction, and complete the feelings of self-worth measurement prior to- and following each interaction. The process was completed
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 31 for each spectrum of media a total of two times. Each interaction with art materials corresponded with different levels of fluidity and resistiveness of the materials being used. The different art interaction types were fluid media, mid-spectrum media, and resistive media. The participant also recorded their art process during the first set of art interactions (Appendix D).
Research Instruments
Art directives. The participant engaged with art interactions in order to observe and record thoughts and feeling of working with each type of material. Therefore, interpretation of the artwork was not considered a primary factor in this research. The participant interacted with three different art directives for each type of media. While working with fluid media the researcher made a fluid acrylic and oil pastel resist, a finger painting, and a colored pencil and gouache resist. During interaction with mid-spectrum media, the participant created a watercolor pencil drawing, a marker mandala, and a charcoal drawing. Lastly, the participant created a collage, a polymer clay rose, and a colored pencil drawing. Moon (2003) stated that assessment utilizing art can be beneficial in understanding and clarifying clinical impressions and designing appropriate treatment plans.
Art interaction survey. The review of the literature assisted the researcher in creating an art interaction survey as a way of gathering information regarding the thoughts, feelings, likes, and dislikes on the three types of art materials used in this study. The survey consisted of three sections: fluid, mid-spectrum between fluid and resistive, and resistive. Each section was made up of seven questions. Five of the questions were short answer, two were scales, and one was asked at the end of the study regarding the overall experience. Survey questions included the following:
• What materials were used?
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• How did you feel while working with this art material?
• What did you enjoy about working with this type of art material?
• What did you dislike about working with this type of art material?
• How familiar were you with this type of art material prior to this activity?
• How likely are you to use this type of art material again?
• What, if any, insights were gained through this experience.
• What was this overall experience like for you?
This survey design utilized content validity which indicated that the questions within the survey were measuring the intended subject of measurement (Creswell & Creswell, 2018).
As the content of this survey had not been previously tested for reliability, the researcher provided the survey contents to allow for reader access and accessibility of further use and testing (Creswell & Creswell, 2018).
Feelings of self-worth measure. The feelings of self-worth measurement was an adaptation of Critcher and Dunning (2015) Feelings of Self-Worth Measure. This assessment was adapted from the Rosenberg Self-Esteem Scale (RSES; Rosenburg, 1979). Modifications were made by the researcher to minimize redundancy within the measure and to add attention checks by randomizing the order between positive and negative feelings of self-worth (Appendix F).
The measure is a nine-point Likert scale that asked respondents to rate agreement towards statements about self-worth on a scale from 1(not at all) to 9 (extremely). Likert scale self- esteem measures similar to the feelings of self-worth measurement, such as the RSES and modified versions, have been evidenced through existing research to be reliable (Bae, Choi, Yu,
Lee, & Choi, 2014; Rosenberg, 1979; Tinakon & Nahthai, 2012).
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Data Collection
Research data was recorded and stored as digital word documents on a password protected computer. Pre-test and post-test measures and survey responses were categorized by media type. The research data was organized into folders that corresponded with the research instrument used.
Data Analysis
The researcher analyzed the impact of different types of art materials on self-worth through the use of pretest-posttest measurements of self-worth on the nine-point Likert scale.
Data from pre-test and post-test measures on the feelings of self-worth scale were plotted on graphs that presented differences between baseline and post-art interaction feelings of self-worth.
Each graph corresponded with a spectrum type of art material and a graph was created for each interaction (Appendix G). Qualitative data such as survey responses regarding the researcher’s thoughts, feelings, experiences, and preferences of working with each type of material was assessed through thematic analysis. Braun and Clark (2006) outlined the six steps of thematic analysis as presented in the sections below. Each step was explained and detailed along with benefits and pitfalls to utilizing thematic analysis in psychology. They stated that thematic analysis was beneficial to use in psychological research because it was flexible, clearly understood and easily learned, accessible, useful in summarizing information from large data sets, can generate new insights, could lend itself to interpretation, and aided in developing policy
(Braun & Clark, 2006).
Phase 1, familiarization with the data. The researcher first familiarized herself with the data that was recorded in the post-art interaction survey. This was achieved by reading through
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 34 the survey data and making notes of initial impressions. Additionally, the researcher reviewed the videos that were recorded in order to gain insight on how the materials were engaged with.
Phase 2, generating initial codes. Quotes from survey responses that provided an overview of what the participant was trying to convey were highlighted. Each of these quotes were given an initial code that summarized the response focus. Codes and associated data sets were compared across media types and entered into corresponding charts (Appendix G).
Phase 3, searching for themes. Initial codes were written out in an outline to identify possible themes. Themes were also written as an outline in order to draw connections between themes and media types. Additionally, codes were written on posted notes and organized in efforts to draw further connections.
Phase 4, review of themes and data sets. The researcher read over the themes and compared them against the previously viewed data sets. It was determined whether new themes needed to be added, if any themes could be condensed, or if there was a better fit of theme for certain data sets.
Phase 5, defining and naming themes. The researcher reviewed themes to determine names that best represented the data. Theme names were modified in order to succinctly convey the corresponding data. Themes were clarified and connections were displayed on a thematic analysis chart (Figure 1).
Phase 6, reporting the final analysis. Final themes were written in the results of this study in addition to an analysis of their context. The meaning, frequency, and data supporting themes were addressed within the results of the study.
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Figure 1. Thematic Analysis Chart.
Validity and Reliability
This study used Moustakas six phases of heuristic inquiry (Moustakas, 1990) to collect and analyze data. Lubart and Getz (1998) stated that heuristic inquiry was beneficial in studying the psychology of creativity. Additionally, heuristic research was beneficial to research and
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 36 exploration within the realm of creativity in general (Lubart & Getz, 1998). Brisola and Cury
(2015) utilized heuristic research to connect their personal experience to the greater population as outlined by Moustakas (1990), they implemented heuristic research in order to analyze the psychological impact of singing.
Ethical Implications
The participant was aware of the factors of the study that they were consenting to, in accordance with the American Art Therapy Association’s ethical guidelines. The ethical guidelines stated that participants must be informed on the procedure of the study, participants must be aware of the measures taken to protect confidentiality, and there must be written documentation of consent (Kapitan, 2010). Since the participant was also the researcher, their name was associated with this study, along with the data presented from written responses and images. While the researcher’s identity was not kept confidential, the researcher was aware of the procedure of the study, agreed to participate in conducting this heuristic study without the use of a pseudonym. Risks regarding the possibility of negative thoughts and feelings arising as a result of working closely with personal thoughts, feelings, and experiences were mitigated through the arrangement of a mental health contact during the process of this study. A mental health professional was available to the researcher if one was needed.
Researcher Bias
Although the researcher strived to remain unbiased during this study, some inherent bias may have still existed. The researcher was an art therapy graduate student and believed in the healing power of art, this may possibly have had a subconscious influence on posttest measures.
The researcher received formal training in art and had abundant exposure to art techniques and materials, thus impacting the researcher’s level of comfortability with art interaction. The
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 37 researcher had the most experience with mid-spectrum media, which may have also influenced the researcher’s comfortability with that type of media. Lastly, the researcher’s upbringing occurred in a middle-class environment, therefore the access and availability to certain art materials may have been more attainable.
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CHAPTER IV
Results
An analysis of the data indicated seven overarching themes surrounding the central theme of artist media experiences and preference. These included (a) control, (b) freedom, (c) challenges, (d) relaxation and anxiety reduction, (e) creativity and self-expression, (f) self-worth, and (g) response to art materials.
Control
Control and the ability to exert a certain level of it over artistic media was a strong theme that was woven throughout the participant’s survey responses corresponding with all three media types. The exact word “control” was used 15 times in the participant’s responses, not including subthemes that also corresponded with the overarching theme. This was displayed through coinciding themes of perfectionism, restrictions and barriers, overcompensation, and mediation.
Anxiety surrounding loss of control appeared to influence the participant’s use of each of these subthemes to cope. However, the participant also suggested that overuse of these tactics could lead to anxiety as well. She stated, “I find myself uncomfortable if I feel that a sense of control is lost.” Additionally, she related her anxiety surrounding loss of control to the control that she had lost due to VI, “Personally, due to the loss of control I have experienced as a result of my VI, I find it hard to let go of.” The material with the most written responses pertaining to loss of control was fluid media. However, the participant discussed loss of creative control and freedom in her responses related to resistive media instead of the loss of physical control. Mid-spectrum media had the most positive responses that spoke to the balance between freedom and control of the materials.
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The participant proposed the idea that some of her attention to detail, overcompensation, and perfectionism had been a way of adapting to her visual impairment. She stated, “Perhaps I am perfectionistic too, because I have had to mentally fill in the gaps of what I cannot see”.
Additionally, she suggested that flexibility had been a way of coping with visual impairment, and that this must also have been used to adapt during the creative process. The participant showed instances of both internal and external locus of control; however, she was accepting of the fact that she had more control than previously thought. The participant stated,
Perhaps in a way it is not my desire to control things, but rather than my familiarity with
the mindset that I am restricted. However, through this process I’ve come to understand
that I have more control than I realize.
Perfectionism. Perfectionism in participant responses often spoke to frustration with the lack of control of certain materials and how they impacted the final product. Participant responses regarding fluid media and some resistive media indicated that the participant felt uneasy when materials were smudged or easily left unintended marks. Participant responses suggested that her perfectionistic tendencies may have acted as a way of resisting lack of control inherent to the materials. For example, in reference to working with fluid media the participant stated that “I sometimes find it hard to bend to the will of certain art materials. No matter how I might envision something to turn out, the final results depend on factors outside of my control.”
Acceptance of imperfection was demonstrated in participant responses regarding mid- spectrum media interaction. The participant voiced her preference toward materials that produced realistic, abstract, and impressionistic results, she stated “…this type of material lends well to impressionistic designs. This is positive because an artwork then is able to capture a feeling without having to be perfect.” The participant also compared images created with mid-
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 40 spectrum media to themselves, stating “If images are canvas-mirrors as Bruce Moon states, perhaps this type of material is a good reflection of myself, perfectly imperfect.” This statement reflected acceptance of both personal flaws and imperfection within the creative process.
Restrictions and barriers. In efforts to control materials that had less inherent structure, the participant tended to rely on borders and barriers. In particular, the participant heavily relied on the use of barriers and very small borders when working with fluid media. In utilizing fluid media, the participant used both colored pencil and oil pastel resists in order to maintain a sense of control over the material. However, extensive use of these measures might produce the opposite effect. Strict reliance on overly rigid barriers and boarders presented feelings surrounding the loss of freedom as well, the participant stated, “the boundaries and barriers in my interaction may have been too extreme, I put myself into a box rather than allowing myself freedom.”
On the other hand, at times borders and barriers aided in the reduction of anxiety surrounding the need to fill a large space. The participant discussed the use of small paper to reduce the likelihood of feeling overwhelmed, stating “I enjoy using small paper while working with highly resistive art materials, especially because I tend to become intimidated when I feel like I need to fill a large area.” However, the use of such small papers may have also resulted from participant overcompensation.
Overcompensation. The participant stated, "I have a tendency of working small, whether this is more in line with the Adlerian concept of overcompensation due to organ inferiority, or it’s a result of my general low self-confidence and desire to take up minimal space."
She also used certain strategies to allow such overcompensation, such as sharpening pencils to a very fine point and leaning very close their image while working. The participant stated, “I’ve
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 41 found that through my artworks I tend to overcompensate for my eyesight by creating very structured, small, and detailed works of art.”
Mediation. The participant discussed the use of mediators, or tools, in working with mid- spectrum media. She mentioned this in relation to the addition of control, rather than as a way of gaining distance in order to aid reflection. However, participant responses implied that the use of mediators allowed for full engagement with the process, rather than focusing on the end product.
In classifying charcoal pencil, the participant wrote “I am classifying this as mid-spectrum since
I manipulate it with a tortillon for most of my process, however there is both inherent structure and flow to this material which is mediated by tools.” The participant also discussed how mediation allowed for assessment and modification prior to completion of the end product.
Freedom
The participant discussed freedom in the sense of autonomy, creative freedom, physical freedom, and freedom to express feeling and loosen their grasp on control. The participant addressed her discomfort with the loss of control fluid media created, however she also stated that it could be freeing. This suggested that allowing some control to be lost in the creative process may help manage anxiety surrounding attempts to maintain consistent control. Her responses also suggested that experimentation with different types of media may also be freeing, she stated “It was relaxing to have power in my hands but also the freedom to experiment.” The participant also suggested preference to materials allowing freedom in terms of physical and time barriers as well, stating “I enjoy the portability of the material…it allows me to break physical barriers and take it with me…to choose the environment that I work in.” Additionally, the participant also stated, “Process that are time consuming are most enjoyable to me if I have the freedom to create them outside the constructs of a certain time frame.” These statements
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 42 suggested that the participant preferred creative processes that did not require her to be controlled by environmental certain constraints.
Challenges
The participant addressed both physical and mental challenges of working with each type of art material. However, physical challenges were more frequently discussed. Some of these physical challenges included eye strain, back strain, and deficits in hand-eye coordination. The participant hypothesized that her use of small and restrictive borders may have led to some of the eye and back strain, and therefore those symptoms may be minimized by working larger, she stated “…with the amount of resistance and how small I was working, it does put a strain on my body.” She also stated “However, working larger may be better for my vision as well.” It was suggested by the participant’s responses that some of this strain, on the back especially, was a result of having to lean over their work due to their VI. She expressed that working on tasks that required a large amount of spatial awareness were frustrating and difficult due to deficits in hand eye coordination, responding “It was interesting for me to link my history of hand-eye coordination difficulties with spatial awareness challenges.” She also provided an analysis of what could be worked on in the future to address these challenges, stating “Perhaps working on my mastery of this art material will not only increase my confidence…, but help to improve my overall hand-eye coordination as well.” This response addressed both the mental and physical challenges experienced by the participant while working with resistive media in particular.
A primary mental challenge that the participant reported experiencing is anxiety over the loss of control, particularly while working with fluid media. She stated that the loss of control was anxiety producing but freeing as well. The participant also referred to their overall low-self- confidence as a possible reason for working so small. Additionally, the general sense of
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 43 frustration was discussed by the client in terms of being agitated by how certain materials were preforming, by the outcome, or due to loss of control. For example, the participant stated in regard to working with fluid media “I think it’s beneficial for seeing outside of the box I have set for myself, despite at times being frustrating.”
Relaxation and Anxiety Reduction
Post-art interaction responses suggested that a predominant root in the participant’s anxiety during the creative process surrounded perfectionistic tendencies and the loss of control.
The participant discussed the loss of control mostly in reference to fluid media. However, in pretest-posttest measurements of self-worth, fluid media presented the largest decrease in feelings of uneasiness. Additionally, the participant reported feeling relaxed despite some unease surrounding having minimal control, she stated “I felt relaxed at times, but also that control was lacking.”
Despite evidence of fluid media and anxiety reduction, the participant directly reported feelings of ease and anxiety reduction while working with mid-spectrum media. In the post art interaction survey for mid-spectrum media, she stated “I feel that being forced to slow down in the process of working with this material helps in reducing my underlying anxiety.” Responses also discussed how working on slow and methodical processes was beneficial in eliciting calm, relaxed, and focused feelings; regardless of the type of art material.
Creativity and Self Expression
Responses suggested a possible connection between creative freedom/self-expression and the mitigation of negative feelings associated with control and the anxiety surrounding the perceived loss of it. Additionally, materials with which the participant felt had the most creative freedom resulted in more positive responses. The participant discussed her perceived creative
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 44 freedom while working with mid-spectrum media stating, “I enjoy the level of creative freedom and interpretation of line, shape, and form that working with this material allows.”
Conversely, materials with less perceived creative freedom by the participant, had fewer positive responses. For example, the participant reported having more physical control over collage, but minimal creative control. The participant stated “When completing a collage, you are restricted to the images in the magazines that are available. I also feel as if I am unable to be as creative while working with this type of material.” The participant also proposed ways in which resistive materials were more pleasurable to work with, suggesting “When working with resistive media, materials that are more tactile and allow for more creative interpretation, such as sculpture, are preferable.”
The participant reported finding value in the process of creation, as well as in the space and time to create. She also discussed how she was most satisfied with creations that were made while involved in learning a certain process. In relation to process oriented work, the participant stated, “I am able to become immersed in the process without being overly consumed with the idea of the final product.”
Self-worth
Overall, pre-test and post-test Feelings of Self-Worth Measurement results for art interaction displayed an average increase of 1.2 on a 7-point Likert scale. However, negative feelings of self-worth only had an average decrease 0.55. Resistive media had the highest increase of positive feelings of self-worth with an average increase of 2.
Fluid media had the highest impact on decreasing negative feelings of self-worth, with an average decrease of 1. Results of the pretest and posttest Feelings of Self-Worth Measurement for fluid media interaction (Appendix F) displayed an increase in the participant’s positive
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 45 feelings of self-worth, except for in the area of confidence. The results of the first art interaction revealed a decrease in the participant’s negative feelings of self-worth. However, due to the minimal presence of low self-worth in the second art interaction pretest, there was neither an increase nor decrease in negative feelings.
Pretest and Posttest results of the Feelings of Self-Worth measurements for mid-spectrum media interaction presented an increase in participant positive feelings of self-worth (See
Appendix F). Additionally, the results displayed a decrease in participant negative feelings of self-worth. On average, positive participant feelings of self-worth increased by 2 on a scale between 1-7. Negative feelings of self-worth decreased by 0.5 on average.
The pretest-posttest Feelings of Self-Worth Measurement results for resistive media interaction presented a slight increase in positive feelings of self-worth (See Appendix F).
However, the results displayed little to no change regarding negative feelings of self-worth.
Positive feelings of self-worth had an average increase of 1. Negative feelings had an average decrease of 0.16. However, the participant reported feeling “mediocre” in her ability to utilize this type of material, which may suggest some negative feelings surrounding working with resistive media specifically.
Additionally, the participant discussed her experience to her past mindset surrounding their VI, stating “Just as it was my own mindset in the past that to some extent placed barriers around myself, not just my visual impairment.” The engagement with art materials placed control in the participant’s hands, which may have aided in an increased internal locus of control, thereby resulting in increased positive feelings of self-worth on posttest measurements.
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Response to Art Materials
Fluid media. Participant responses for fluid media displayed heavy themes of perfectionism and loss of control. Additionally, responses discussed the overuse of barriers and boarders as a way of exerting control over this media, which is displayed in Figure 2 and Figure
3. Themes of control and loss were presented as having a relation to control and loss due to VI.
While working with fluid acrylic and oil pastel, the participant found the process of adding color
to the paper relaxing.
Figure 2. Fluid Acrylic and Oil Pastel Resist
Figure 3. Gouache and Colored Pencil Resist
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 47
However, the participant was frustrated by how easy it was to smudge the material. She discussed in her response how it was difficult to allow the material to move freely, stating “I sometime find it hard to bend to the will of certain art materials.” In contrast, the participant expressed that while she enjoyed the end product of their interaction with gouache and colored pencil, she found that had put herself under more constraints than preferred. The participant expressed that working so small and detailed on small 3” x 5” paper, did not allow her to fully experience affective expression that fluid materials often promote. She stated “the boundaries and barriers in my interaction may have been too extreme, I put myself into a box rather than allowing myself freedom.”
Mid-spectrum media. Participant responses regarding interaction with mid-spectrum media presented, overall, the most positive language associated with the interaction.
Additionally, mid-spectrum media had the most participant response data. This may indicate that the participant had a preference for this type of media. Responses to this material displayed themes of self-awareness, acceptance of imperfection, a balance between control and freedom, creative expression, and relaxation and anxiety reduction.
The participant was focused and worked diligently while using markers to create the mandala displayed in Figure 4. She started the process by planning the drawing and the colors to be used
(See Appendix D). This potentially added a sense of control, and therefore comfort to the participant. Additionally, she did not feel under pressure to create this image at the time.
Considering the participant discussed her preference of creating art without time constraints, this may have also led to more positive outcomes in the survey response. The participant stated that a quality she liked about this material was that it could be used to “create impressionistic designs” and “capture a feeling without having to be too perfect.” Although the participant had minimal
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 48 dislikes toward utilizing this material, she stated “it is hard to capture fine detail or easily fix mistakes”. A quality of both markers and charcoal pencils that the participant discussed was how they lent well to creative freedom, while also requiring the artist to slow down and enjoy the creative process. One quality that the participant reported to be different between markers and charcoal pencils was the ease of correcting mistakes. She stated “The material more easily allows for mistakes and correction. I don’t feel like I will be penalized for making a wrong mark.” This may be beneficial in helping to minimize anxiety associated with perfectionistic tendencies and fear of making mistakes. The participant also related these tendencies to her upbringing with parents who had perfectionistic tendencies. It was important to note that the participant’s reactions to certain materials were based on a multitude of factors, not solely on her experience with VI. Another interesting point to note regarding the participant’s charcoal drawing was that it was created by first drawing the eye sockets, much like what would be done in a sculptural process seen in Figure 5.
Figure 4. Marker Mandala
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 49
Figure 5. In Progress Charcoal Rendering
Resistive media. Resistive media had the lowest amount of data in participant responses, a majority of which used more negative language. This may possibly suggest participant dissatisfaction in working with this material. Themes in the responses to interaction with resistive media centered around lack of creative freedom, physical challenges such as deficits in hand-eye coordination, frustration in relation to physical deficits, and the time-consuming nature of this material. While no clear statements regarding control were present, statements regarding being constrained creatively while working with collage hint at frustration regarding lack of freedom and control. Participant responses also discussed overcompensation in regard to her choice of boarders and barriers.
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 50
For the magazine collage presented in the participant first began by gathering magazines that contained various images that were to her liking. This possibly helped to minimize feelings of being restricted to available material. Additionally, this allowed the participant to find images that she symbolically connected with. She also used a variety of cutting tools, including different sized scissors and Exacto knives. These materials were utilized as a way of adapting to the task given the participant’s deficits in hand eye-coordination.
The participant’s colored pencil drawing depicted in Figure 7 was also on small 3” x 5” paper. She discussed how this provided her mental comfort when working with resistive materials. Unlike collage, the participant expressed that colored pencil allowed for more creative freedom, stating,
I was satisfied by the amount of control I was able to have, but also the potential for
abstraction and adding my own personal style to the piece without feeling like a great
amount of mental energy had to be expended in order to break the barriers of an overly
constricting material.
However, the participant was also concerned with having to create the work within a certain timeframe, especially considering how time consuming the process is. The participant reported feeling calm and focused while working with this material. Additionally, she was able to bring it with her as she had a tire replaced, something that would ordinarily bring up feelings of inferiority due to her previous delayed driving and being an adult learner in that aspect.
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Figure 6. Magazine Collage
Figure 7. Colored Pencil Drawing
The participant in this study experienced similar feelings and behaviors to those that have been presented in previous research. In particular the participant experienced challenges with control and freedom during the art making process. Additionally, the participant presented with feelings of anxiety while working with some types of materials, predominately fluid media. The following draws connections between the participant’s responses to various art materials and experiences of visually impaired individuals documented by previous studies.
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CHAPTER IV
Discussion
This heuristic study aimed to assess artistic media preferences of the visually impaired individual, how each level of fluidity along the spectrum of art materials impacted the participant’s thoughts and feelings, and how feelings of self-worth were influenced by art interaction along this spectrum. This study was intended to expand the research body on the use of art therapy with individuals who have VI. The following overarching themes were present in the current study and included (a) control, (b) freedom, (c) challenges, (d) relaxation and anxiety reduction, (e) creativity and self-expression, (f) self-worth, and (g) response to art materials.
Control
In this study strong themes of control and freedom were present in the participant’s written responses to art interaction. In particular, the participant spoke of an overexertion of control in order to cope with the control that had been lost due to her visual impairment.
Thurston et al. (2012) reported feelings associated with the lack of and loss of control. Jessup et al. (2018) addressed the lack of control that students with VI experience at school in making the decision of doing nothing, and therefore furthering social exclusion. In the present study, the participant spent a majority of her time in school, which also minimized her control. The participant utilized art and creative freedom as a way to cope with feelings of helplessness and loss of control. This method of coping mirrored what Rubin (1975) observed while utilizing art therapy with blind children. She stated that blind children were able to find joy in the control and manipulation of art materials.
In contrast, Herrmann (1995) reported in a case study instances of low emotional control, which were physically displayed during the creative process. However, the participant in this
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 53 study had a tendency to put barriers and borders on emotional expression. The participant did not allow for kinetic engagement with the art, or very affective work. This may be a result of the participant’s reliance on control, which may also translate into the participant trying to overly control her emotions as well. Levens (1986) suggested that individuals with vision loss may lose a certain degree of contact with external reality, therefore internalization may occur as a result.
Although it had been difficult for individuals to balance expression with feelings of vulnerability, utilizing art as a way of expressing anxieties in particular was beneficial in reducing the individual’s need to rely escapism through internalization.
Freedom
Rubin (1975) stated that blind children can be given freedom in the process of art therapy by allowing them to choose what they create, and what they create with. This also was represented in the current study through the participant’s written statements that she enjoyed the creative process more when she was given the freedom to experiment with different materials and to create outside the bounds of time constraints.
Cohen (1987) also stressed the need for individuals with visual impairment to explore various materials. This allowed for autonomy in the choice of which materials to use and how to utilize them. Papadopoulous et al. (2014) also supported the need for individuals with VI to gain freedom through the ability to support themselves, reducing depressive symptoms and increasing one’s internal locus of control. The participant in the present study exercised creative freedom though the use of art material, however she became frustrated if the materials were too limiting of creative freedom. Additionally, the participant expressed the need for freedom of time limits in order to fully emotionally benefit from the creative process.
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Relaxation and Anxiety Reduction
Similar to Rubin’s (1975) account of the anxiety experienced by blind children while working with fluid media, the participant in the current study also dealt with anxiety brought on by the lack of control fluid media had. Rubin (1975) also stated that such anxiety can be minimized by the use of physical boundaries. The participant of this study attempted to combat anxiety associated with loss of control by creating barriers with oil pastel and colored pencil.
Additionally, the participant utilized the chosen paper size as a method of controlling the physical boarders of the image in order to minimize feeling intimidated and anxious from having to fill a large area.
Abbing et al. (2019) suggested that there was no connection between the implementation of art therapy and anxiety reduction in particular. However, they stated that there was some support in the hypothesis that art therapy aided in executive function. Additionally, they reported that higher levels of executive function such as organization and cognitive flexibility were associated with greater stress reduction (Abbing et al., 2019). This may support the current study’s results of participant stress reduction. In the current study the participant had a preexisting executive function diagnosis. It may be possible that the participant’s interaction with art materials was beneficial to the increase of her executive function skills, therefore aiding the reduction of associated stress.
Self-Worth
Papadopoulos et al. (2014) stated that individuals who had higher internal locus of control expressed fewer negative psychological symptoms than those with higher external locus of control. Self-esteem was also positively associated with internal locus of control.
Additionally, they stated that individuals who had VI for longer periods of time had greater
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 55 internal locus of control. Therefore, individuals who have had VI for longer periods of time tended to have higher levels of self-esteem. This may have been a result of the time an individual had to cope with VI and learn how to adapt.
Matsugma, et al. (2019) supported the use of strengths based therapeutic treatment to improve the self-esteem of individuals with VI. They stated that previous literature failed to acknowledge personal strengths of individuals with VI, and instead emphasized deficits.
Matsugma et al. also reported that acknowledgement of personal strengths was a significant predictor of self-esteem among individuals with VI. This also was significant in the present study as the participant had been trained in art, and therefore viewed it as a personal strength.
Additionally, the participant viewed personal artistic strengths as a representation of ability to overcome visual challenges through the creation of artwork. It was possible that learning to master certain art materials and techniques may have increased self-esteem among other individuals with VI as well. Herrmann (1995) suggested that the creation of art during art therapy provided a nonjudgmental environment for individuals with VI to explore their internal world, and to create their own style outside the bounds of what might be ordinarily expected of them by sighted individuals. Cohen (1987) also observed how nonjudgmental creation allowed children with VI to improve self-concept, stating “It was through exploration and action that the children discovered more completely their abilities and strengths which, in turn, contributed to their developing healthy self-concepts” (p. 24).
Challenges
The participant in this study discussed how she found greater enjoyment during the creative process if not required to complete artworks within a certain time frame. The participant expressed that she was ordinarily a “slow artist” and felt intimidated when having to meet a
VISUAL IMPAIRMENT AND ARTISTIC MEDIA PREFERNCES 56 deadline for creative engagement, especially when working alongside sighted peers. Previous research stated that it took a longer amount of time for individuals with VI to develop fine-motor skills and complete tasks that required use of fine-motor skills (Reimer et al., 2015; Sretenović &
Nedović, 2019). They also stated that more time was needed by children with VI to learn adaptive strategies to adequately complete fine-motor tasks (Reimer et al., 2015). The participant also discussed how she needed to utilize adaptive strategies with highly resistive tasks, collage in particular. Lastly, the participant also had a longstanding history of fine-motor skill challenges dating back to childhood, this could be linked to both her experience with VI and her ADHD diagnosis. Mokobane, Pillay and Meyer (2019) suggested that children with ADHD showed impairments in fine-motor functioning.
Response to Art Materials
The participant’s responses were consistent with the use of materials in previous research
(Rubin, 1975), for example, she expressed anxiety surrounding the loss of control while working with fluid media without boundaries or barriers. Additionally, previous research often utilized water-based clay as the primary material when working with visually impaired individuals
(Cohen;1987; Herrmann,1995; Lowenfeld, 1952; Rubin, 1975), which fell under mid-spectrum material. The participant also presented a preference toward mid-spectrum media, however her preference to this part of the material spectrum applied to more than just clay. However, Cohen
(1987) stated that it was imperative that practitioners avoided underestimating individuals with
VI, and that individuals with VI should be given the freedom to explore a variety of materials and media. This was displayed to be accurate through the participant’s interactions with various materials during the course of this study.
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Limitations
Due to the lack of responses to the study survey for artistic media preferences of individuals with VI, the present study was limited to heuristic research methodology. Further research should be conducted in order to determine the average media preferences for a larger sample of individuals with acquired VI. Additionally, while video instructions were provided for potential participants to follow, an online study may have presented challenges in accessibility for individuals with visual deficits. Previous research on visual impairment often was conducted with children or older adults. Specifically, much of the research conducted with acquired vision loss or impairment was conducted with an older population. Lastly, a majority of research related to the use of art therapy was not current. Further research is required to assess the use of art therapy with visually impaired individuals within the social context of present times.
Recommendations
Future research is necessary to assess the connection between fluid media use and anxiety among the visually impaired population. Additionally, avoidance of affective artistic expression among individuals with VI is a topic for future study. Deficits in motor skills in relation to the completion of art therapy interventions and associated feelings should also be considered for further study. Further research of acquired visual impairment, especially with adolescents and adults, is required in order to assess the unique experiences and feelings of grief and loss within the population. This is necessary to design current therapeutic groups, services, and art therapy directives that address the specific needs of the population. In-person research environments may increase participation rates, however transportation limitations and associated stress among the population should be considered.
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Conclusion
In the present study it was suggested that the participant had a preference toward mid- spectrum media. Mid-spectrum media presented the highest amount of positive written responses from the participant, as well as the highest average increase of positive feelings of self-worth on the feelings of self-worth scale. The participant expressed the highest degree of anxiety surrounding loss of control while working with fluid media. However, fluid media interaction displayed the greatest average decrease of negative feelings of self-worth. Lastly, resistive tasks allowed the participant the largest amount of physical control over the media, but at times was perceived as creatively restricting. Media preferences vary between individuals; however, the current study revealed that the participant’s media interactions and preferences were in line with previous research regarding individuals with VI, the challenges faced, and media use in the realm of art therapy. Further research is needed in order to assess the media preferences of a larger population of individuals with acquired VI. More research is also necessary in order to develop specialized art therapy services for individuals with VI with consideration and implementation of current research.
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APPENDIX A Prevalence of VI Between Ages
Prevalence of VI Between Age Groups Statistics taken from disabilitystatistics.org
10.00% 9.00% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% Under 4 5-15 16-20 21-65 65+ 75+
Prevalence
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APPENDIX B Causes of Visual Impairment
Causes of Visual Impairment Statistics taken from the American Academy of Ophthalmology 60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00% Cateracts Other Age-Related Diabetic Glaucoma Macular Retinopathy Degeneration
White Black/African American Hispanic
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APPENDIX C Educational Attainment of Individuals with VI
Educational Attainment Statistics taken from disabilitystatistics.org 35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00% < High School High School Diploma Some College/Associate's Bachelor's Degree or Higher
Percentage
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APPENDIX D Art Process and Interaction Videos
Fluid Media: https://youtu.be/V9stYPe76sw
Mid-spectrum Media: https://youtu.be/BXRPHyesF0A
Resistive Media: https://youtu.be/s-RXFsB2hIY
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APPENDIX E Feelings of Self-Worth Measure
1. I feel confident right now
1 (not at all) 9 (Extremely)
1 2 3 4 5 6 7 8 9
2. I feel inferior
1 (not at all) 9 (Extremely)
1 2 3 4 5 6 7 8 9
3. I feel successful
1 (not at all) 9 (Extremely)
1 2 3 4 5 6 7 8 9
4. I feel positively toward myself right now
1 (not at all) 9 (Extremely)
1 2 3 4 5 6 7 8 9
5. I feel uneasy
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1 (not at all) 9 (Extremely)
1 2 3 4 5 6 7 8 9
6. I feel humiliated
1 (not at all) 9 (Extremely)
1 2 3 4 5 6 7 8 9
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APPENDIX F Feelings of Self-Worth Data Charts
Fluid Media Feelings of Self-Worth: Watercolor Resist & Finger Painting 7 5 3 1 -1 Question 1: I feel Question 2: I feel Question 3: I feel Question 4: I feel Question 5: I feel Question 6: I feel confident right successful positively toward inferior uneasy humiliated now myself right now
Pretest Posttest
Fluid Media Feelings of Self-Worth: Colored Pencil Resist with Gouache
7 6 5 4 3 2 1 0 Question 1: I feel Question 2: I feel Question 3: I feel Question 4: I feel Question 5: I feel Question 6: I feel confident right successful positively toward inferior uneasy humiliated now myself right now Pretest Postest
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Mid-Spectrum Feelings of Self-Worth: Charcoal Pencil Drawing 7 6 5 4 3 2 1 0 Question 1: I feel Question 2: I feel Question 3: I feel Question 4: I feel Question 5: I feel Question 6: I feel confident right successful positively toward inferior uneasy humiliated now myself right now
Pretest Posttest
Mid-Spectrum Feelings of Self-Worth: Watercolor Pencil Drawing & Marker Mandala
7 6 5 4 3 2 1 0 Question 1: I feel Question 2: I feel Question 3: I feel Question 4: I feel Question 5: I feel Question 6: I feel confident right now successful positively toward inferior uneasy humiliated myself right now Pretest Posttest
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Resistive Media Feelings of Self-Worth: Collage & Clay Modeling 7 6 5 4 3 2 1 0 Question 1: I feel Question 2: I feel Question 3: I feel Question 4: I feel Question 5: I feel Question 6: I feel confident right successful positively toward inferior uneasy humiliated now myself right now
Pretest Posttest
Resistive Media Feelings of Self-Worth Measurement: Colored Pencil Drawing
7 6 5 4 3 2 1 0 Question 1: I Question 2: I Question 3: I Question 4: I Question 5: I Question 6: I feel confident feel successful feel positively feel inferior feel uneasy feel humiliated right now toward myself right now
Pretest Postest
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APPENDIX G Thematic Analysis Charts
Theme Fluid Media Responses "At times I find myself uncomfortable if I feel that a sense of control is lost." 1. Control … "personally, due to the loss of control I have experienced as a result of my VI, I find it hard to let go of."
"I sometimes find it hard to bend to the will of certain art materials. No 1.1a Perfectionism matter how I might envision something to turn out, the final results depend on factors outside of my own control."
" I believe it important that individuals with VI such as myself not grasp too 1.1b Acceptance of Imperfection tightly to the idea of control either."
"the boundaries and barriers in my interaction my have been too extreme, I 1.2 Restrictions and Barriers put myself into a box rather than allowing myself freedom."
"I have found that through my artworks I tend to overcompensate for my 1.3 Overcompensation eyesight by creating very structured, small, and detailed works of art."
1.4 Mediation 2. Freedom "… but it can also be very freeing." 3. Challenges 3.1 Physical Challenges "It was at times anxiety producing because it is so easy to accidentally bump 3.2 Mental Challenges into the image and make a mistake or ruin it."
4. Relaxation and Anxiety Reduction "I felt relaxed at times, but also that control was lacking."
5. Creativity and Self-Expression "I think it Is beneficial for seeing outside the box."
5.1 Process Orientated
"Perhaps I am perfectionistic too because I have had to mentally fill in the 6. Adaptation and Coping Strategies blanks of what I was unable to see."
"I sometimes try to paint the world, quite literally, through the lens of 7. Perspective someone with normal vision instead of through my own personal lens."
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Theme Mid-Spectrum Media Responses 1. Control "It is good for expression whilst maintaining control."
"I am not fond of how easy it is to leave smudge marks on the image where 1.1a Perfectionism unintended. This is probably a result of some perfectionistic qualities that I have."
"If images are canvas-mirrors as Bruce Moon states, perhaps this type of 1.1b Acceptance of Imperfection material is a good reflection of myself. Perfectly imperfect."
"I enjoy that the barriers and structure of this material allows some control 1.2 Restrictions and Barriers without being too constricting."
In reference to attempting to sharpen charcoal pencils, but they often ended 1.3 Overcompensation up breaking: "perhaps by sharpening the pencils to a fine point, I am overcompensating for the deficits in my visual acuity." "I liked that while there is some ability to manipulate this material, and 1.4 Mediation therefore possible loss of control, there Is more mediation through the use of tools." "it was relaxing to have power in my hands, as well as the freedom to 2. Freedom experiment." 3. Challenges "with my VI I find that sometimes processes involving such detail can be 3.1 Physical Challenges straining on my back and eyes" "I could however find some of the processing frustrating depending on my 3.2 Mental Challenges mood."
"I feel that being forced to slow down in the process of working with this 4. Relaxation and Anxiety Reduction material helps in reducing my underlying anxiety."
"I enjoy the level of creative freedom and interpretation of line, shape, and 5. Creativity and Self-Expression form, that working with this material allows." "I am able to become immersed in the process without being overly consumed 5.1 Process Orientated by the idea of the final product…"
"similarly to the qualities of this material; I like control, but I can also be very 6. Adaptation and Coping Strategies flexible. When dealing with my VI I have had to be.
My visual impairment has made things challenging, but it has also allowed me 7. Perspective to understand things from a different perspective.
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Theme Resistive Media Responses
1. Control
1.1a Perfectionism
1.1b Acceptance of Imperfection
1.2 Restrictions and Barriers "when completing a collage you are restricted to the images in the magazines you have available." "I enjoy using small paper when working with highly resistive art materials, 1.3 Overcompensation especially because I tend to become intimidated when I feel I need to fill a large area."…"I believe that is another area where I overcompensate." 1.4 Mediation "Processes that are time consuming [such as when working with resistive 2. Freedom material] are most enjoyable to me only if I have the freedom to engage with them outside the constructs of a time restraint." 3. Challenges 3.1 Physical Challenges "it does put a strain on my body from having to lean closer to it."
"It was somewhat frustrating having been restricted to a more repetitive task that I tend to struggle with due to deficits in hand eye coordination." 3.2 Mental Challenges "Overall I felt ok, but mediocre in my ability to use this material. It generally takes me a decent amount of time to preform spatial awareness tasks."
"colored pencil in an altered book…I felt at ease when applying the pencil on that type of paper because it was smooth and not overly resistant." "I 4. Relaxation and Anxiety Reduction changed to watercolor pencil… While working with colored pencil on this paper I felt fairly calm and focused."
"When completing a collage…I feel like I am not able to be as creative when working with this material." "When working with resistive materials I prefer 5. Creativity and Self-Expression materials that are more tactile, such as sculpture, or allow for more creative interpretation."
" I believe I would enjoy this material more if I allowed myself more time to 5.1 Process Orientated fully experience the creative process." "I feel that I end up using more adaptive strategies while working with collage 6. Adaptation and Coping Strategies in particular."
"I have a tendency of working small, whether this is more in line with the 7. Perspective Adlerian concept of overcompensation due to organ inferiority, or it’s a result of my general low self-confidence and desire to take up minimal space."