Art Therapy

Woman painting with varied supplies

Art therapy, a hybrid field largely influenced by the disciplines of art and psychology, uses the creative process, pieces of art created in therapy, and third-party artwork to help people in treatment develop self-awareness, explore emotions, address unresolved emotional conflicts, improve social skills, and raise self-esteemArt therapy primarily aims to help individuals experiencing emotional and psychological challenges achieve personal well-being and improved levels of function.
 
Neither previous artistic experience nor natural artistic ability is necessary for successful treatment, and any individuals seeking the help of a mental health professional may find benefit from art therapy. 

History and Development of Art Therapy

Art has been used as a means of communication, self-expression, group interaction, diagnosis, and conflict resolution throughout history. For thousands of years, cultures and religions around the world have incorporated the use of carved idols and charms, as well as sacred paintings and symbols, in the healing process. The establishment of art therapy as a unique and publicly accepted therapeutic approach only took place recently, in the mid-20th century. The emergence of art therapy as a profession arose independently and simultaneously in the United States and Europe. 

The term “art therapy” was coined in 1942 by British artist Adrian Hill, who discovered the healthful benefits of painting and drawing while recovering from tuberculosis. In the 1940s, several writers in the mental health field began to describe their work with people in treatment as “art therapy.” As there were no formal art therapy courses or training programs available at that time, these care providers were often educated in other disciplines and supervised by psychiatrists, psychologists, or other mental health care professionals.

Contributors to the Field

Margaret Naumburg, Hanna Kwaitkowska, Florence Cane, Edith Kramer, and Elinor Ulman were five influential writers of the 1940s who made significant contributions toward the development of art therapy as a recognized field. 

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Margaret Naumburg, often described as the “mother of art therapy,” established the Walden School in her home city of New York in 1915. She is widely viewed as the primary founder of the American art therapy movement. Naumburg believed children who were allowed to express themselves creatively and pursue subjects of interest to them would experience healthier development. Influenced by the psychoanalytic movement prevalent at the time, Naumburg began to view the creative process as a methodology similar to verbal expression—a means of unearthing repressed, unconscious thoughts and emotions. She believed once the symbolic expression of a person’s state of mind was combined with the cognitive and verbal aspects of experience, healing could take place. Both this expression and healing were believed to be able to occur in an art therapy session. She wrote several influential books on art therapy, including Studies of the "Free" Expression of Behavior Problem Children as a Means of Diagnosis and Therapy (1947), Schizophrenic Art: Its Meaning in Psychotherapy (1950), and Dynamically Oriented Art Therapy: Its Principles and Practice (1966). These and other publications by leading contributors in the field are still used and referenced today as original sources in art therapy literature. Paintbrushes and colorful splashes of paint

Hanna Kwiatkowski, another major contributor, was born in Poland and educated throughout eastern Europe. A talented sculptor and artist, Kwiatkowski eventually moved to the United States and began working at the National Institutes of Mental Health, where she bridged the gap between her passion and her profession by introducing art into the therapy sessions she conducted with families.

As a result of these sessions, Kwiatkowska found the creative expression of drawing to allow family members to better identify their roles and status within the family. She also saw the significant therapeutic benefits of the drawing process. Although she had originally hoped to use her art therapy to help treat individuals facing intellectual challenges, Kwiatkowska discovered her technique also provided relief to families and individuals who who faced moderate psychological issues and dysfunctions.

Other contributors include Florence Cane, an art educator who utilized teaching methods emphasizing the importance of free artistic expression and encouraging emotional creativity, and Edith Kramer, who proposed the more process-oriented art-as-therapy approach that defined goals of supporting the ego, helping the development of identity, and fostering growth. Finally, Elnor Ulman established the first art therapy journal in the United States and initiated one of the earliest training programs in the field.

Health Issues Treated by Art Therapy

Art therapy has been shown to benefit people of all ages. Research indicates art therapy can improve communication and concentration and can help reduce feelings of isolation. This type of therapy has also been shown to lead to increases in self-esteem, confidence, and self-awareness. 

Positive results in art therapy may often be achieved by those facing issues such as:

Because art therapy allows people to express feelings on any subject through creative work rather than with speech, it is believed to be particularly helpful for those who feel out of touch with their emotions or feelings. Individuals experiencing difficulty discussing or remembering painful experiences may also find art therapy especially beneficial. 

Recent research suggests art therapy may help individuals diagnosed with schizophrenia see improvement of some of their symptoms, although trials are still being conducted. 

The memoir, Sybil, and two movies of the same name, describe a woman diagnosed with dissociative identity disorder who, through the use of art, appeared to gain greater insight about her alters and trauma she had experienced in childhood. Painting both provided an outlet for Sybil and her alters to express feelings and rediscover memories of the trauma, which could then be discussed in therapy.

Melinda, the main character of the 1999 young adult novel, Speak, uses art to cope with traumatic mutism—her inability to speak following a traumatic event—and isolation. 

Art Therapy Techniques and Exercises

Certified art therapists will typically have a comprehensive understanding of the powerful effect that the creative process can have on those in therapy. Art therapists often use psychological, spiritual, and artistic theories in conjunction with clinical techniques to achieve the desired therapeutic outcome. The approach has proven to be beneficial even for non-verbal individuals and professional artists. Common techniques used in therapy include:

  • Painting
  • Finger painting
  • Doodling
  • Scribbling
  • Sculpting
  • Drawing
  • Using molding clay
  • Carving
  • Making pottery
  • Making cards
  • Using textiles
  • Making collages

Art therapy can help people express those thoughts, emotions, and experiences that may be difficult to speak about. In a 2004 study, thirty-two women with heart disease were first interviewed and then asked to individually illustrate the illness. The resultant drawings were grouped into three categories: (1) the heart at the center, (2) the heart in the lived body, and (3) heart disease as a social illness. The use of color, spatial arrangement, and composition were analyzed, and the drawings ultimately helped health care professionals better appreciate how each woman understood her condition and provided insight on how to best to approach each case.

A young girl makes a collage with paint and other toolsIllness is often closely associated with intense emotions, and tactile techniques, such as working with molding clay, may provide a refuge from these feelings. These activities have also been shown to be effective in revealing unconscious material, providing cathartic release, and promoting verbal expression.

A study in which women with cancer were encouraged to engage in various visual arts exercises and techniques found that the participants benefited in four key ways. While the women initially experienced a number of illness-related challenges such as loss of confidence, loss of sleep, and altered social relationships, after the study they reported an increased focus on positive life experiences, increased self-worth, maintenance of social identity (as opposed to being defined by cancer), and an increased ability to express their feelings in a symbolic manner.

Numerous other clinical reports have supported the therapeutic benefits of art therapy. Chronically ill individuals have reported better health and well-being, and people with breast cancer have reported a decrease in negative emotions and an increase in positive emotions. Further, individuals undergoing hemodialysis treatment reported reduced depression, and people adversely affected by trauma have reported lower levels of stress, less compassion fatigue, and an increased sense of purpose.

Art therapists work to help individuals, families, groups, and communities become more in touch with their emotions. Art therapy has become an integral part of many rehabilitation centers, mental health facilities, crisis centers, private practices, schools, and various other social and community institutions that strive to promote health, wellness, and growth.

Art Therapy vs Expressive Arts Therapy

Distinguishing between art therapy and expressive arts therapy may be somewhat difficult, as both approaches utilize a wide variety of therapeutic techniques to provide mental and emotional relief.

Art therapy often incorporates techniques such as painting, finger painting, drawing, sculpting, and carving. Art therapy has become an integral part of many rehabilitation centers, mental health facilities, crisis centers, private practices, schools, and various other social and community institutions that strive to promote health, wellness, and growth. Since art therapy focuses primarily on the visual arts, it is considered a single modality therapy. Expressive arts therapy is considered a multi-modal approach because it integrates techniques from many different artistic modalities. To illustrate, an expressive arts therapist may integrate therapeutic principles and tools from poetry therapy, dance and movement therapy, music therapy, and even art therapy in one therapeutic session.

Another noteworthy difference between the two approaches is the final product: At the end of an art therapy session there is likely to be a tangible product (such as a painting, drawing, or sculpture). Expressive arts therapy is not limited to the visual arts and so the primary means of expression may be visual, tactile, or auditory. The created product may be tangible or intangible, depending on the technique used. 

Art Therapist Training and Accreditation

Art therapy practice requires a knowledge of the visual forms—drawing, painting, sculpture, and so on— as well as the creative process, human development and psychology, and counseling theories and methodology.

Those who practice art therapy, even at the entry level, must have earned at least a master’s degree from an accredited institution. The Educational Program Approval Board (EPAB) uses academic standards set by the American Art Therapy Association (AATA) to evaluate the compliance of art therapy programs with the recommended requirements. Additionally, the body providing accreditation to the tertiary-level institution must be approved by the Council for Higher Education Accreditation (CHEA).

The Art Therapy Credentials Board (ATCB) was established in 1993. The primary goal of the ATCB is to safeguard the interests of the public by ensuring that practicing art therapists meet and maintain required ethical and quality standards. The ATCB does this by offering three professional credentials to individuals desiring to be art therapists:

  • Registered Art Therapist (ATR): This confirms the therapist has taken and satisfactorily completed graduate-level courses in art therapy and gained post-graduate clinical experience under the supervision of a qualified mentor.
  • Board Certified Art Therapist (ATR-BC): This is the highest credential an art therapist can earn. Applicants are required to successfully complete a national exam to highlight their complete understanding of the clinical skills and theories associated with art therapy.
  • Art Therapy Certified Supervisor (ATCS): This advanced supervisory credential may be earned by experienced Board Certified Art Therapists.

Art therapists who have earned their credentials at the ATCB are required to adhere to the institution’s code of professional practice. At present, the ATCB database contains over 5000 credentialed art therapists.

Limitations and Concerns of Art Therapy

One of the major concerns of art therapy is the effectiveness of the approach. Though many support its efficacy, others are skeptical. Adults in particular may not be inclined to cooperate fully and openly with the treatment process or may refuse this type of treatment entirely. Additionally, some individuals may believe they are not creative or artistic enough for the treatment to be successful, although the goal of treatment is to express one's thoughts and emotions, not produce artistic masterpieces. The effectiveness of art therapy may also be criticized, due to a lack of supporting empirical evidence.

Those who do proceed with art therapy treatment may find they have to commit to a series of sessions before they begin to experience the therapeutic benefits of the approach. Other concerns include the costs associated with the purchase of needed tools, media, and other materials. Obtaining a suitable setting for therapy to take place (especially if fluid media, special lighting, or other specialized equipment is used) may also prove challenging. 

References:

  1. American Art Therapy Association. (n.d.). History and background. Retrieved from http://www.americanarttherapyassociation.org/aata-history-background.html
  2. American Art Therapy Association. (2013). What is art therapy? Retrieved from http://www.arttherapy.org/upload/whatisarttherapy.pdf
  3. Art Therapy Credentials Board. (n.d.). About the credentials. Retrieved from http://www.atcb.org/Public/AboutTheCredentials
  4. Center for Health and Healing. (2011). Art therapy – history and philosophy. Retrieved from http://www.healthandhealingny.org/complement/art_history.asp
  5. Arts therapies. (2014, September 27). Retrieved from http://www.mentalhealthcare.org.uk/arts_therapies 
  6. Child Art and Psychological Perspectives. (n.d.). Retrieved from http://uir.unisa.ac.za/bitstream/handle/10500/1919/04chapter3.pdf
  7. Rubin, J. A. (1999). Art therapy: An introduction. Philadelphia: Taylor & Francis.
  8. Stuckey, H. L. & Nobel, J. (2010). The connection between art, healing and public health: A review of current literature. American Journal of Public Health, 100(2), 254-263.
  9. Thompson, G. (n.d.). The Hidden Paintings of Shirley A. Mason ... Sybil. Retrieved from http://www.hiddenpaintings.com
  10. Trevisani, F., Casadio, R., Romagnoli, F., Zamagni, M. P., Francesconi, C., Tromellini, A., Di Micoli, A., Frigerio, M., Farinelli, G. and Bernardi, M. (2010). Art in the hospital: Its impact on the feelings and emotional state of patients admitted to an internal medicine unit. The Journal of Alternative and Complementary Medicine, 16(8), 853-859.
  11. Vick, R. M. (n.d.). A brief history of art therapy. Retrieved from http://areas.fba.ul.pt/jpeneda/Briefhistoryat.pdf

 

Last updated: 04-18-2016

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