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Art therapy

Art therapy (also known as arts therapy) is

a creative method of expression used as a
therapeutic technique. Art therapy, as a
creative arts therapy modality, originated
in the fields of art and psychotherapy and
may vary in definition.
Art therapy

Two convict artists draw designs of carpets on

graph paper at Industrial Workshops of Central
Jail Faisalabad, Faisalabad, Pakistan, in 2010

MeSH D001155

[edit on Wikidata]

Art therapy may focus on the creative art-

making process itself, as therapy, or on the
analysis of expression gained through an
exchange of patient and therapist
interaction. The psychoanalytic approach
was one of the earliest forms of art
psychotherapy. This approach employs the
transference process between the
therapist and the client who makes art.
The therapist interprets the client's
symbolic self-expression as
communicated in the art and elicits
interpretations from the client.[1]:1 Analysis
of transference is no longer always a

Current art therapy includes a vast number

of other approaches such as person-
centered, cognitive, behavior, Gestalt,
narrative, Adlerian, and family. The tenets
of art therapy involve humanism, creativity,
reconciling emotional conflicts, fostering
self-awareness, and personal growth.[2]


An art therapist watches over a person with mental

health problems during an art therapy workshop in
Various definitions of the term "art
therapy" exist.[1]:1

The British Association of Art Therapists

defines art therapy as "a form of
psychotherapy that uses art media as its
primary mode of expression and

The American Art Therapy Association

defines art therapy as: "an integrative
mental health and human services
profession that enriches the lives of
individuals, families, and communities
through active art-making, creative
process, applied psychological theory, and
human experience within a
psychotherapeutic relationship."[4]

As a mental health profession, art therapy
is employed in many clinical and other
settings with diverse populations. Art
therapy can also be found in non-clinical
settings, as well as in art studios and in
creativity development workshops. Closely
related in practice to marriage and family
therapists and mental health counselors,
U.S. art therapists are licensed under
various titles, depending upon their
individual qualifications and the type of
licenses available in a given state. Art
therapists may hold licenses as art
therapists, creative arts therapists,
marriage and family therapists, counselors
of various types, psychologists, nurse
practitioners, social workers, occupational
therapists, or rehabilitation therapists. Art
therapists may have received advanced
degrees in art therapy or in a related field
such as psychology in which case they
would have to obtain post-master's or
post-doctorate certification as an art
therapist. Art therapists work with
populations of all ages and with a wide
variety of disorders and diseases. Art
therapists provide services to children,
adolescents, and adults, whether as
individuals, couples, families, or groups.

Using their evaluative and psychotherapy

skills, art therapists choose materials and
interventions appropriate to their clients'
needs and design sessions to achieve
therapeutic goals and objectives. They use
the creative process to help their clients
increase insight, cope with stress, work
through traumatic experiences, increase
cognitive, memory and neurosensory
abilities, improve interpersonal
relationships and achieve greater self-
fulfillment. The activities an art therapist
chooses to do with clients depend on a
variety of factors such as their mental
state or age. Many art therapists draw
upon images from resources such as
ARAS (Archive for Research in Archetypal
Symbolism) to incorporate historical art
and symbols into their work with patients.
Depending on the state, province, or
country, the term "art therapist" may be
reserved for those who are professionals
trained in both art and therapy and hold a
master or doctoral degree in art therapy or
certification in art therapy obtained after a
graduate degree in a related field. Other
professionals, such as mental health
counselors, social workers, psychologists,
and play therapists combine art therapy
methods with basic psychotherapeutic
modalities in their treatment. Therapists
may better understand a client's
absorption of information after assessing
elements of their artwork.[5]

General illness

People always search for some escape

from illness and it has been found that art
is one of the more common methods. Art
and the creative process can aid many
illnesses (cancer, heart disease, influenza,
etc.). People can escape the emotional
effects of illness through art making and
many creative methods.[6] Sometimes
people cannot express the way they feel,
as it can be difficult to put into words, and
art can help people express their
experiences. "During art therapy, people
can explore past, present and future
experiences using art as a form of
coping".[6] Art can be a refuge for the
intense emotions associated with illness;
there are no limits to the imagination in
finding creative ways to express emotions.

Hospitals have started studying the

influence of arts on patient care and found
that participants in art programs have
better vitals and fewer complications
sleeping. Artistic influence doesn't need to
be participation in a program, but studies
have found that a landscape picture in a
hospital room had reduced need for
narcotic pain killers and less time in
recovery at the hospital.[6]

Cancer diagnosis

Art therapists have conducted studies to

understand why some cancer patients
turned to art making as a coping
mechanism and a tool to creating a
positive identity outside of being a cancer
patient. Women in the study participated in
different art programs ranging from
pottery and card making to drawing and
painting. The programs helped them
regain an identity outside of having cancer,
lessened emotional pain of their on-going
fight with cancer, and also giving them
hope for the future.

In a study involving women facing cancer-

related difficulties such as fear, pain,
altered social relationships, etc., it was
found that:

Engaging in different types of

visual art (textiles, card making,
collage, pottery, watercolor,
acrylics) helped these women in
4 major ways. First, it helped
them focus on positive life
experiences, relieving their
ongoing preoccupation with
cancer. Second, it enhanced
their self-worth and identity by
providing them with
opportunities to demonstrate
continuity, challenge, and
achievement. Third, it enabled
them to maintain a social
identity that resisted being
defined by cancer. Finally, it
allowed them to express their
feelings in a symbolic manner,
especially during

Another study showed those who

participated in these types of activities
were discharged earlier than those who
did not participate.[6]

Studies have also shown how the

emotional distress of cancer patients has
been reduced when utilizing the creative
process. The women made drawings of
themselves throughout the treatment
process while also doing yoga and
meditating; these actions combined
helped to alleviate some symptoms.[6]

A review of 12 studies investigating the

use of art therapy in cancer patients by
Wood, Molassiotis, and Payne (2010)
investigated the symptoms of emotional,
social, physical, global functioning, and
spiritual controls of cancer patients. They
found that art therapy can improve the
process of psychological readjustment to
the change, loss, and uncertainty
associated with surviving cancer. It was
also suggested that art therapy can
provide a sense of "meaning-making"
because of the physical act of creating the
art. When given five individual sessions of
art therapy once per week, art therapy was
shown to be useful for personal
empowerment by helping the cancer
patients understand their own boundaries
in relation to the needs of other people. In
turn, those who had art therapy treatment
felt more connected to others and found
social interaction more enjoyable than
individuals who did not receive art therapy
treatment. Furthermore, art therapy
improved motivation levels, abilities to
discuss emotional and physical health,
general well-being, and increased global
quality of life in cancer patients.[7]
Disaster relief

Art therapy has been used in a variety of

traumatic experiences, including disaster
relief and crisis intervention. Art therapists
have worked with children, adolescents
and adults after natural and manmade
disasters, encouraging them to make art in
response to their experiences. Some
suggested strategies for working with
victims of disaster include: assessing for
distress or post traumatic stress disorder
(PTSD), normalizing feelings, modeling
coping skills, promoting relaxation skills,
establishing a social support network, and
increasing a sense of security and


While art therapy helps with behavioral

issues it does not appear to affect
worsening mental abilities.[10] Tentative
evidence supports benefits with respect to
quality of life.[11]


Art therapy has not been studied much in

autism as of 2011.[12]

A 2005 systematic review of art therapy as
an add on treatment for schizophrenia
found unclear effects.[13]

Trauma and children

Art therapy may alleviate trauma-induced

emotions, such as shame and anger.[14] It
is also likely to increase trauma survivors’
sense of empowerment [15] and control by
encouraging children to make choices in
their artwork.[14]

Because traumatic memories are encoded

visually, creating art may be the most
effective way to access them. Through art
therapy, children may be able to make
more sense of their traumatic experiences
and form accurate trauma narratives.
Gradual exposure to these narratives may
reduce trauma-induced symptoms, such
as flashbacks and nightmares.[14]

Children who have experienced trauma

may benefit from group art therapy. The
group format is effective in helping
survivors develop relationships with others
who have experienced similar
situations.[15] Group art therapy may also
be beneficial in helping children with
trauma regain trust and social self-

Eating Disorders

Traumatic or negative childhood

experiences can result in unintentionally
harmful coping mechanisms, such as
eating disorders. As a result, clients may
be cut off from their emotions, self-
rejecting, and detached from their
strengths.[16] Art therapy may provide an
outlet for exploring these inaccessible
strengths and emotions; this is important
because persons with eating disorders
may not know how to vocalize their

Art therapy may be beneficial for clients

with eating disorders because clients can
create visual representations with art
material of progress made, represent
alterations to the body, and provide a
nonthreatening method of acting out
impulses.[16] Individuals with eating
disorders tend to rely heavily on defense
mechanisms to feel a sense of control; it is
important that clients feel a sense of
authority over their art products through
freedom of expression and controllable art
materials.[16] Through controllable media,
such as pencils, markers, and colored
pencils, along with freedom of choice with
the media, clients with eating disorders
can create boundaries around unsettling


The term containment, within art therapy

and other therapeutic settings, has been
used to describe what the client can
experience within the safety and privacy of
a trusting relationship between client and
counselor.[18][19] This term has also been
equated, within art therapy research, with
the holding or confining of an issue within
the boundaries of visual expression, like a
border or the circumference of a
mandala.[20] The creation of mandalas for
symptom regulation is not a new approach
within the field of art therapy, and
numerous studies have been conducted in
order to assess their efficacy.[21][22]


Art media commonly used in art therapy

The purpose of art therapy is essentially
one of healing. Art therapy can be
successfully applied to clients with
physical, mental or emotional problems,
diseases and disorders. Any type of visual
art and art medium can be employed
within the therapeutic process, including
painting, drawing, sculpting, photography,
and digital art.[23]

One proposed learning mechanism is

through the increased excitation, and as a
consequence, strengthening of neuronal

A typical session
A man draws in response to an art therapy directive

Art therapy can take place in a variety of

different settings. Art therapists may vary
the goals of art therapy and the way they
provide art therapy, depending upon the
institution's or client's needs. After an
assessment of the client's strengths and
needs, art therapy may be offered in either
an individual or group format, according to
which is better suited to the person. Art
therapist Dr. Ellen G. Horovitz wrote, "My
responsibilities vary from job to job. It is
wholly different when one works as a
consultant or in an agency as opposed to
private practice. In private practice, it
becomes more complex and far reaching.
If you are the primary therapist then your
responsibilities can swing from the
spectrum of social work to the primary
care of the patient. This includes
dovetailing with physicians, judges, family
members, and sometimes even
community members that might be
important in the caretaking of the
individual."[25] Like other psychotherapists
in private practice, some art therapists find
it important to ensure, for the therapeutic
relationship, that the sessions occur each
week in the same space and at the same

Art therapy is often offered in schools as a

form of therapy for children because of
their creativity and interest in art as a
means of expression. Art therapy can
benefit children with a variety of issues,
such as learning disabilities, speech and
language disorders, behavioral disorders,
and other emotional disturbances that
might be hindering a child's learning .[26]
Similar to other psychologists that work in
schools, art therapists should be able to
diagnose the problems facing their
student clients, and individualize treatment
and interventions. Art therapists work
closely with teachers and parents in order
to implement their therapy strategies.[26]

Art-based assessments
Art therapists and other professionals use
art-based assessments to evaluate
emotional, cognitive, and developmental
conditions. There are also many
psychological assessments that utilize
artmaking to analyze various types of
mental functioning (Betts, 2005). Art
therapists and other professionals are
educated to administer and interpret these
assessments, most of which rely on
simple directives and a standardized array
of art materials (Malchiodi 1998, 2003;
Betts, 2005).[27] The first drawing
assessment for psychological purposes
was created in 1906 by German
psychiatrist Fritz Mohr (Malchiodi
1998).[27] In 1926, researcher Florence
Goodenough created a drawing test to
measure the intelligence in children called
the Draw-A-Man Test (Malchiodi 1998).[27]
The key to interpreting the Draw-A-Man
Test was that the more details a child
incorporated into the drawing, the MORE
intelligent they were (Malchiodi, 1998).[27]
Goodenough and other researchers
realized the test had just as much to do
with personality as it did intelligence
(Malchiodi, 1998).[27] Several other
psychiatric art assessments were created
in the 1940s, and have been used ever
since (Malchiodi 1998).[27]

Notwithstanding, many art therapists

eschew diagnostic testing and indeed
some writers (Hogan 1997) question the
validity of therapists making interpretative
assumptions. Below are some examples
of art therapy assessments:

Mandala Assessment Research

In this assessment, a person is asked to
select a card from a deck with different
mandalas (designs enclosed in a
geometric shape) and then must choose a
color from a set of colored cards. The
person is then asked to draw the mandala
from the card they choose with an oil
pastel of the color of their choice. The
artist is then asked to explain if there were
any meanings, experiences, or related
information related to the mandala they
drew. This test is based on the beliefs of
Joan Kellogg, who sees a recurring
correlation between the images, pattern
and shapes in the mandalas that people
draw and the personalities of the artists.
This test assesses and gives clues to a
person's psychological progressions and
their current psychological condition
(Malchiodi 1998). The mandala originates
in Buddhism; its connections with
spirituality help us to see links with
transpersonal art.


4-year-old's drawing of a person

In the house-tree-person test, the client is
asked to first draw a house, then a tree,
then a person, and is asked several
questions about each. As of 2014, this test
had not been well-validated.[28]

Although art therapy is a relatively young
therapeutic discipline, its roots lie in the
use of the arts in the 'moral treatment' of
psychiatric patients in the late 18th
century, this moral treatment, Susan
Hogan argues, "arose out of utilitarian
philosophy and also from a non-
conformist religious tradition",[29] and in a
re-evaluation of the art of non-western art
and of the art of untrained artists and of
the insane.[30]

Art therapy as a profession began in the

mid-20th century, arising independently in
English-speaking and European countries.
The early art therapists who published
accounts of their work acknowledged the
influence of aesthetics, psychiatry,
psychoanalysis, rehabilitation, early
childhood education, and art education, to
varying degrees, on their practices.

The British artist Adrian Hill coined the

term art therapy in 1942.[31] Hill, recovering
from tuberculosis in a sanatorium,
discovered the therapeutic benefits of
drawing and painting while convalescing.
He wrote that the value of art therapy lay in
"completely engrossing the mind (as well
as the fingers)…releasing the creative
energy of the frequently inhibited patient",
which enabled the patient to "build up a
strong defence against his misfortunes".
He suggested artistic work to his fellow
patients. That began his art therapy work,
which was documented in 1945 in his
book, Art Versus Illness.[32]
Edward Adamson, "the father of art therapy in

The artist Edward Adamson, demobilised

after WW2, joined Adrian Hill to extend
Hill's work to the British long stay mental
hospitals. Other early proponents of art
therapy in Britain include E. M. Lyddiatt,
Michael Edwards, Diana Raphael-Halliday
and Rita Simon. The British Association of
Art Therapists was founded in 1964.[34]
U.S. art therapy pioneers Margaret
Naumburg and Edith Kramer began
practicing at around the same time as Hill.
Naumburg, an educator, asserted that "art
therapy is psychoanalytically oriented" and
that free art expression "becomes a form
of symbolic speech which…leads to an
increase in verbalization in the course of
therapy."[35] Edith Kramer, an artist, pointed
out the importance of the creative process,
psychological defenses, and artistic
quality, writing that "sublimation is attained
when forms are created that successfully
contain…anger, anxiety, or pain."[36] Other
early proponents of art therapy in the
United States include Elinor Ulman, Robert
"Bob" Ault, and Judith Rubin. The American
Art Therapy Association was founded in

National professional associations of art

therapy exist in many countries, including
Brazil, Canada, Finland, Israel, Japan, the
Netherlands, Romania, South Korea, and
Sweden. International networking
contributes to the establishment of
standards for education and practice.[38]

Art Therapist process work

Diverse perspectives exist on history of art
therapy, which complement those that
focus on the institutionalization of art
therapy as a profession in Britain and the
United States.[39][40][41]

Outsider art

The relation between the fields of art

therapy and outsider art has been widely
debated. The term 'art brut' was first
coined by French artist Jean Dubuffet to
describe art created outside the
boundaries of official culture. Dubuffet
used the term 'art brut' to focus on artistic
practice by insane-asylum patients. The
English translation "outsider art" was first
used by art critic Roger Cardinal in

Both terms have been criticized because

of their social and personal impact on both
patients and artists. Art therapy
professionals have been accused of not
putting enough emphasis on the artistic
value and meaning of the artist's works,
considering them only from a medical
perspective. This led to the misconception
of the whole outsider art practice, while
addressing therapeutical issues within the
field of aesthetical discussion. Outsider
Art, on the contrary, has been negatively
judged because of the labeling of the
artists' work, i.e. the equation artist =
genius = insane. Moreover, the business-
related issues on the term outsider art
carry some misunderstandings.[44][45]
While the outsider artist is part of a
specific art system, which can add a
positive value to both the artist's work as
well as his personal development, it can
also imprison him within the boundaries of
the system itself.[46][47]

See also
Comic book therapy
Expressive therapy
List of psychotherapies
List of therapies

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