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In clinical practice, formal elements of art products are regularly used in art therapy observation to obtain insight into clients’ mental health and provide directions for further treatment. Due to the diversity of formal elements used in existing studies and the inconsistency in the interpretation, it is unclear which formal elements contribute to insight into clients’ mental health. In this qualitative study using Constructivist Grounded Theory, eight art therapists were interviewed in-depth to identify which formal elements they observe, how they describe mental health and how they associate formal elements with mental health. Findings of this study show that art therapists in this study observe the combination of movement, dynamic, contour and repetition (i.e., primary formal elements) with mixture of color, figuration and color saturation (i.e., secondary formal elements). Primary and secondary elements interacting together construct the structure and variation of the art product. Art therapists rarely interpret these formal elements in terms of symptoms or diagnosis. Instead, they use concepts such as balance and adaptability (i.e., self-management, openness, flexibility, and creativity). They associate balance, specifically being out of balance, with the severity of the clients’ problem and adaptability with clients’ strengths and resources. In the conclusion of the article we discuss the findings’ implications for practice and further research.

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This piece of writing has focused on the first stage of creating a co-production arts wing of the Recovery College and is written with the intention of demonstrating the practical value of a dramatherapy and ‘experts by experience’ collaboration. It includes an introduction to ‘recovery’ and the contemporary NHS guidelines for a Recovery College. The first four classes of co-production in action with a dramatherapist are described with feedback from students. Followed by a sharing of the evolution of this process into three new courses leading to a workshop, performance and exhibition on World Mental Health Day. It also includes a BASIC Ph evaluation analysis of group work through the three courses run in collaboration with a dramatherapist at the Recovery College. The following questions are addressed by the evaluation – Can dramatherapy effectively support the co-production process? Can these co-production situations be creatively defined and described by their participants? The conclusions are that dramatherapy lends itself to collaborative work. Service users share languages of resilience and, through forming social networks, improve in confidence and self-esteem.

Over the last decade the question of arts therapies research has provided much material for discussion. How does research further the knowledge of our field? Do we do research to prove our effectiveness as a treatment modality? Hostility towards 'scientific' models and a view of research as very separate from practice and personal experience, was addressed through new paradigm research. In the following article I want to tell the (hi)story of my research in intercultural dramatherapy practice, from personal experience to practice, to research question and methodology and back again in an ongoing spiralling journey. In doing so I hope to show that the three are intimately related and mutually influence each other. BackgroundOver the past ten years I have been researching the effectiveness of dramatherapy across cultural and ethnic borders. Although I say ten years, that only indicates the formal period of time, from taking my masters in social anthropology and writing my thesis on the cultural contradictions across Europe (Dokter 1993) to my PhD research. However, the research started ten years before that, when I migrated to Britain to study Dramatherapy. I came from an understanding of drama as expression through word and movement. I had done some work within the deaf community in the Netherlands and was interested in exploring this possibility of drama. For someone of my Calvinist working-class background theatre it was rather alien territory and I had not linked it with drama. The encounter with Shakespeare and Stanislavski during my training was an eye opener and very beneficial for my personal development, although an enormous struggle for someone whose English is a second language and whose literary background is not extensive. As a consequence, I have always had a sneaking sympathy for those of my clients, who say they feel alienated from this very literate and middle class form of our medium. I struggled to maintain my notion of what drama could also be, trying not to see it as inferior, naive and simple.It was not until the end of theeighties, when I facilitated a week long workshop on therapeutic laughter as part of a theatre festival in Grenoble, France, that I realised afresh that my appreciationof theatreanddrama was very culturally determined. The pulpit thumpers and Dutch cabaretiers with their strong political comment had left their mark. My Grenoble workshops took place in the mornings. In the

Formal elements are often used in art therapy assessment. The assumption is that formal elements are observable aspects of the art product that allow reliable and valid assessment of clients' mental health. Most of the existing art therapy assessment instruments are based on clinical expertise. Therefore, it is not clear to what degree these instruments are restricted to formal elements. Other aspects might also be included, such as clinical expertise of the therapist. This raises the question of whether and how formal elements as observable aspects of the art product are related to clients' mental health. To answer this question, four studies are presented that look at: (1) a meta-theoretical description of formal elements; (2) operationalization of these formal elements so they can be analyzed reliably in clients' art products; (3) establishment of reliable and clinically relevant formal elements; (4) the relationship between formal elements and adult clients' mental health. Results show that the combination of the formal elements "movement," "dynamic," and "contour" are significantly interrelated and related to clients' mental health, i.e., psychopathology, psychological flexibility, experiential avoidance, and adaptability. These findings give insight in the diagnostic value of art products and how they may add to clients' verbal expression and indicate their potential to benefit from therapy.

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