About Art Therapy

(Note: This was last edited and updated on 08/14/10)

What is art therapy and what do I do as an art therapist?

 Art therapy is about healing through art. The act of creating art is expressive, restorative, and life-enhancing. It can help enhance the physical, emotional, mental, social, and spiritual well-being of people of all ages. Art therapy can reduce stress; assist in exploring, expressing, and resolving underlying feelings, problems, and conflicts; assist towards exploring and resolving trauma and abuse; help facilitate the healing of hurt, loss, and disappointment related to life; enhance mental functioning; improve problem-solving skills; improve reality orientation; improve focus and attention;  explore feelings related to substance abuse (or other addictions) and provide safe alternatives;  improve impulse control and decrease acting out or destructive behaviors; improve frustration tolerance; improve social and interpersonal skills; decrease isolation; improve self-concept; explore and resolve family conflict or anxiety or other relationship issues; increase insight and self-awareness;  increase hope, creativity, and imagination; and many more things. Art therapists work in a variety of settings, from regular hospitals, to psychiatric hospitals, in safe houses and shelters, in hospices, in outpatient settings and clinics, and even in the community providing art expression, creativity, and life-enhancement for healthy people.

An art therapist guides a person or a group of people through the process of healing through carefully selected art projects based on the person or groups particular needs and based on the art therapists knowledge of different art techniques, the responses they bring, and the indicators they observe in the artwork related to the persons well being and functioning. Whether a person has artistic talent or not, they express themselves unconsciously through their artwork and project a lot about themselves. This helps release emotions in a safe way. This is healing in and of itself, but when the process is guided by an expert in art therapy then it brings even more healing. To explain it a bit further, an art therapist will carefully select a project based on their knowledge of the art therapy process, the impact particular mediums and tasks will have on people, and the goals (such as reducing stress, facilitating insight, improving self-concept, decreasing depression) that they have for the short term or the long term, depending on how long they have to work with a  particular person. An art therapist then watches the person’s response and gradually leads the person towards their goals through the art tasks and also sometimes through discussion about the art.  The beautiful thing about art therapy is that even if a person is defended verbally or unable to communicate well, so much healing can happen through the art process alone. Also, art has a way of helping a person become comfortable and a little less defensive which can help facilitate the exploration of issues more quickly then in traditional therapy, but this could backfire if the art therapist is not well trained or prepared and allows the person to put their defenses down too quickly or become regressed when they are not in a  safe place to do so. It’s a delicate process to push a person past their defenses so they can grow and gain insight, but not so fast that they decompensate. That’s why it is imperative that only a trained art therapist attempt to provide art therapy. An art therapist is well trained both in psychology as well as in art processes and materials. In order to become an art therapist there must be a solid training in both psychology and art which is formed both in undergraduate levels and then in graduate school through a master’s level program in art therapy.  I had a Bachelor’s in Psychology from Charleston Southern University, but went on to get an extra 15 hours in art (drawing, painting, sculpting) at the College of Charleston. I went to Eastern Virginia Medical School (EVMS) for art therapy.

I am going to write about what I do as an art therapist.

I am an art therapist working in a psychiatric hospital with teenagers, children, and adults. Our psychiatric hospital has an adolescent residential unit, an acute child adolescent unit, an adult acute unit for higher functioning adults, and an acute intensive treatment program for lower functioning adults. Currently, I work on all three of the acute units and only fill in for residential when someone needs coverage, although I’ve spent years working for residential, too. I have 10 years experience as an art therapist at this hospital all together and I had three years experience working as a Bachelor’s level clinical counselor in a residential program for sex offended and behaviorally and emotionally disturbed adolescents prior to this. I run art therapy groups, about 3-4 a day spread out on the 3 different units. Basically, what I do is have them draw a picture or engage in an art directive which I plan out to meet the therapeutic needs of the group, so it will be a different thing each group. I will base what I do on their diagnosis and presenting symptoms, considering issues of safety. Each group lasts an hour. I will come to the unit, knock on every one’s doors inviting them to the art therapy group, gather everyone up into the community room, introduce myself, introduce art therapy and why we have it, and then direct them on what to do, and tell them we will have a discussion following the art task. I’ll also explain about confidentiality and the importance of creating a safe, supportive environment for everyone in the group. We usually draw or make art for about 30-40 minutes and then spend the rest of the time in the discussion, in which case I have whoever wants to hold their drawing/artwork up to the group, and explain it and discuss it. I don’t force anyone to talk or share or to make art for that matter, but do try to encourage them and help them feel safe enough to do so. From there I will try to engage the group in a therapeutic discussion asking the group to give the presenter feedback, validate them, relate to them, etc. We will touch on any themes I see come out in the art or in the discussion. The most common themes are dealing with reality, depression, mood swings, substance abuse, trauma, feelings of loneliness, lack of support, feeling misunderstood, overwhelming situational stressors, loss, dealing with disability and health impairments, relational problems, destructive coping, poor impulse control, etc. Sometimes we don’t have a discussion and I do “art as therapy” in which case the art itself is providing the corrective experience. What I choose to do depends on the therapeutic goals. Often times I will not have a discussion (or just a very light discussion) when I am trying to warm them up to art therapy or close them up before they are discharged. I like to build up my groups since we meet three times a week on the individual units, so the first day might be a warm up task, the second day we might dive deep into the presenting issues, feelings, and problems, and the third day we will usually close back up. There is usually many new people coming in as others leave so the close up task also usually makes a good warm up task. I do take into account the coming and going of the individual patients, so I will find tasks that address everyone’s needs. If the majority have depression (one of the most common diagnosis) and a quarter have substance abuse issues along with depression, and two have psychosis I will find a task that addresses all those needs. The number of people I have in my groups varies according to the unit. On Child Adolescent Acute I can have anywhere between 1-10, and the adult higher functioning unit I typically have anywhere from 2-15, and on the Intensive Treatment Programming unit I typically have anywhere between 5-25. Psychiatric technicians are available to sit in with us if it is a very large group or if safety reasons dictate that. Safety always has to be the highest priority, and my strategy is to notice potential safety risks before they happen and take measures to defuse the situation, or send out particular people that are creating an unsafe situation if they are not able to follow directions or respond to the interventions I am providing.

Why art therapy? When people make art they project many of their underlying feelings and conflicts into their art through their approach and how they organize it, colors they choose, spacing, pressure, line quality, etc. This helps them release the feelings in a safe way and gain just enough distance to then explore those feelings, so that they can validate and honor their own feelings (an important skill that many people who land in the hospital don’t have or use.) In the group setting, they can also get emotional support from other group members. Isolation is a common problem with depression, so that is an important goal I have for the group, to get people to isolate less and discover that other people share similar problems and they are not so alone. Also, I will try to get others who now are starting to feel better or regain control over their lives to share with the newer people what is working for them and how they are getting better. I will also get them thinking about how they can manage their lives more effectively once they leave the hospital, too, maybe even come up with an action plan and talk about healthier coping skills they can use. I help people learn how to sit with their feelings (safely), how to re-frame their life (replacing distortions and negative thinking with healthier thoughts), work on accepting difficult situations and decide how best to respond, and on developing faith and hope. Although, I’m not free to just talk about God or preach to them, many of the issues people are struggling with are spiritual in nature and stem from what they believe about themselves, about life, etc. Many times such themes will come up, and God can move into a particular area even if I’m not exactly using his name. It is Truth that sets people free. I try to create a safe atmosphere where they can discover the truth. If they do mention God, and many times they do, then I can feel free to respond to that, while being careful not to push my beliefs unto anyone.

Again, the making of the art not only helps people safely express their feelings as opposed to acting them out (i.e. cutting, suicide attempts, running away, violence, using alcohol or drugs, binge eating, destructive relationships, addictions, dangerous impulsive behaviors, etc.) but can also help a person improve self-image (through success-oriented tasks), improve focus and impulse control (through particular tasks which address these skills), enhance problem solving and reality orientation, reduce anxiety, improve mood, gain insight, improve social skills, improve manual dexterity, and many other things.

Also, I provide art assessments according to the Psychiatrist’s orders. Everyone in the residential program has one when they come in, but on the acute units the psychiatrist only orders them if they need additional information to guide treatment. They may need an art assessment because they are having trouble getting the information they need verbally because the person is mute, uncooperative, too defended, or too psychotic to make sense, etc, or because there are complex presenting symptoms and they are a little unsure about the diagnosis of a particular person. I provide the Art Therapy Projective Imagery Assessment (AT-PIA) and also many times the Person Picking an Apple from a Tree (PPAT). The AT-PIA is a collection of six drawings: The Scribble Drawing, the Favorite Kind of Weather Drawing, the Human Figure Drawing, the Reason Drawing, and the Free Choice. These drawings combined tell us diagnostic information about how well a person is doing, their strengths and weaknesses, their cognitive functioning, their developmental level, their coping skills, their mood and level of anxiety, their underlying conflicts and feelings, behavior patterns, focus, attention, impulsivity, personality features, their level of insight and ability to take responsibility for their problems, their style of coping, and many other diagnostic features. EVMS designed the AT-PIA based on research of the different drawings and picked the ones when combined together tell us the most possible information about a particular person for assessment purposes. Because I work in a psychiatric hospital I do my write up based on the Diagnostic and Statistical Manual, starting with axis one disorders, and moving on down the line to axis five. Usually, I will address developmental level first, then mood and thought disorders (the most common presenting problems of those in the hospital), then anxiety disorders if present (also very common), then possible ADHD or disruptive/behavior disorders such as Oppositional Defiant Disorder and Conduct disorder, then personality issues, then family dynamics, then coping skills and defenses, then strengths. If other issues present themselves such as attachment issues, anger control problems, substance abuse, suicidal or self-harming tendencies, Aspergers or Autism, organicity, or other less common disorders or problems then I will address them, too. I will actually list the most problematic issues first and on down the line. My write ups include referral and history information, behavioral observations, findings and associations to the drawings, diagnostic impression on axis 1-5, then summary and recommendations. The art assessment will go in their chart and a copy will be given to the doctor, and the findings presented to the treatment team.

Its amazing how the art can tell us all that. I was specially trained at EVMS to do this and also 10 plus years of experience has taught me. But it’s important for people not to try to base any finding on only one drawing. We really need the whole series to be more accurate. Were not only looking at the drawings, but how the drawings relate to each other. For instance in mood disorders there is often some inconsistency in space and color throughout the drawings, but this same feature could suggest personality disorders. There’s no cookie cutter recipe. There are many overlapping features like that, which is why we examine all the drawings, look for several diagnostic indicators-the more diagnostic indicators for one particular category the more likely the person has that issue. We also then combine the drawings with the person’s history, self-report, associations, and behavioral observations. Its like putting together a puzzle. The doctor will then read the report or get a first hand presentation of the assessment, and also hear from other treatment teams members like the therapist, nurses, and psychiatric technicians and decide then a final diagnosis for the patient/resident as well as decide what types of medications and interventions that particular person needs.

The doctor/psychiatrist will also decide how long a particular person needs to stay in the hospital to be stabilized or treated. In the acute setting people are there to stabilize, which means they can return to their homes or other programs and be safe around themselves and others and be able to care for themselves or able to be safe with the help of the program they are currently in. In the acute setting this usually takes anywhere between 1 day to three weeks, the average stay being about 3 days. In the residential setting they stay between 3-months to 6 months, and sometimes up to a year, although that is less common. We also have a case manager that sets them up with services before they leave so that their treatment will not suddenly stop once they leave the hospital. We definitely use a multi-disciplinary approach. We individualize our treatment plan, coming up with targeted goals for each patient. I specify an individualized art therapy goal for each person I work with and so do all the other disciplines such as the therapists, the activity therapists, and the nurses. We then document on each persons progress towards that goal. The psychiatrist will read the progress notes and have regular treatment teams meetings to decide how well the person is progressing and when they can be safely discharged from the hospital.

We are not funded to provide individual art therapy to clients/patients/residents, although we can decide to do this if time permits. When I worked residential I would see about 1-3 clients a week, and it was very rewarding. I can see clients on the acute units as well although it is solution-focused therapy and short term and must be done around my existing groups, and again there is no funding for it. I saw a client last night just to help her calm from anxiety, stabilize her emotions, and finish a project she started. Its very important for everyone to finish and feel successful and I will usually go out of my way to make sure this happens when I see that their mood or stability will depend on it. We can also provide family art therapy assessments (Projective Imagery Family Evaluation-PIFE) although there is no funding for this either and it doesn’t get ordered very often. I have provided about 4 in 10 years not counting my internships. Basically the family makes art together, and that helps us gain insight about family dynamics which is then shared with the family in a  follow up session with recommendations.

I get many skeptics, especially adults, and many who fear that they cannot benefit because they are not artistic. Once they understand the art therapy process, however (its not about how it looks or their artistic talent) they are able to get past their fears and express themselves. I tell people, even an empty drawing expresses so much. People need permission to “just be” and “just feel” whatever they feel. I don’t force anyone into my groups. Once they get this permission and begin to feel safe they open up and begin to share their feelings and struggles. I have made a believer out of many skeptics! People tell me they were surprised to get so much out of art therapy, some so much so they want to pursue making art as a coping skill on their own. If someone declines to do art therapy, but still remains in the group, I still provide them with a piece of paper and art materials anyway and say, “Just in case you change your mind.” I’d say about 75% of the time they change their mind. They are much more likely to change their mind if they don’t have to lose any face over it by then asking me for a piece of paper. Also, sometimes when they see other people benefiting they then want to join in. Often times, its fun, but sometimes the mood can be somber as they talk about and express their deep underlying feelings and hurts. Often times people have truly sad stories and there are never any magical fixes (except God, but I cant tell them that, and even He doesn’t make the pain instantly go away; He has you work through it) but sometimes just getting validation and support and getting a little hope, can make even the most grim circumstances become bearable and better. Just them sitting with their feelings is healing in and of itself. Usually once you accept a situation you can begin to find some positive things to help and make you feel better. It’s the accepting part that can be so hard, and the not accepting that can drive so many people to act out.

As you can probably tell, I love my job, and feel it fits perfectly for my personality.