Art therapy (not to be confused with arts therapy which includes other creative therapies such as drama therapy and music therapy) is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition.
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 Analysis of transference is no longer always a component.
Art therapy can be used to help people improve cognitive and sensory motor function, self-esteem, self awareness, emotional resilience. It may also aide in resolving conflicts and reduce distress.
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.
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."
As a regulated mental health profession, art therapy is employed in many clinical and other settings with diverse populations. It is increasingly recognized as a valid form of therapy. 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. Art therapists may 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 optionally combine art-making with basic psychotherapeutic modalities in their treatment. Therapists may better understand a client's absorption of information after assessing elements of their artwork.
Art-making is a common activity used by many people to cope with illness. Art and the creative process can alleviate many illnesses (cancer, heart disease, influenza, etc.). This form of therapy helps benefit those who suffer from mental illnesses as well (chronic depression, anxiety disorders, bipolar disorders, etc.). People can escape the emotional effects of illness through art making and many creative methods. 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". 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. In addition, either looking at or creating art in hospitals helped stabilize vital signs, speed up the healing process, and in general, bring a sense of hope and soul to the patient. Family, care workers, doctors and nurses were equally positively effected.
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 chemotherapy.
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.
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.
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 stability.:137ff:120ff
Art therapy is increasingly recognized to help address challenges of people with autism, as evidenced through these sources.
Trauma and children
Art therapy may alleviate trauma-induced emotions, such as shame and anger. It is also likely to increase trauma survivors’ sense of empowerment and control by encouraging children to make choices in their artwork.
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.
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. Group art therapy may also be beneficial in helping children with trauma regain trust and social self-esteem. Usually, participants who under go art therapy through group interventions have positive experiences and allow their internal feelings have validation
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. 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 emotions.
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. 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. 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 themes.
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. 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. 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.
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.
A typical session
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." 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 time.
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. 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.
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). The first drawing assessment for psychological purposes was created in 1906 by German psychiatrist Fritz Mohr (Malchiodi 1998). In 1926, researcher Florence Goodenough created a drawing test to measure the intelligence in children called the Draw-A-Man Test (Malchiodi 1998). 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). Goodenough and other researchers realized the test had just as much to do with personality as it did intelligence (Malchiodi, 1998). Several other psychiatric art assessments were created in the 1940s, and have been used ever since (Malchiodi 1998).
Notwithstanding, many art therapists eschew diagnostic testing and indeed some writers (Hogan 1997) question the validity of therapists making interpretative assumptions. More recent literature, however, highlights the utility of standardized approaches to treatment planning and clinical decision-making, such as is evidenced through this source. Below are some examples of art therapy assessments:
Mandala Assessment Research Instrument
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.
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", and in a re-evaluation of the art of non-western art and of the art of untrained artists and of the insane.
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. 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.
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.
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." 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." 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 1969.
National professional associations of art therapy exist in many countries, including Brazil, Canada, Finland, Lebanon, Israel, Japan, the Netherlands, Romania, South Korea, and Sweden. International networking contributes to the establishment of standards for education and practice.
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 1972.
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. 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.
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