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{{Short description|Creation of art to improve mental health}}
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'''Art therapy''' is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a ] profession, originated in the fields of art and ] and may vary in definition. Art therapy encourages creative expression through painting, drawing, or modelling. It may work by providing a person with a safe space to express their feelings and allow them to feel more in control over their life.<ref>{{cite web |last1=Dresden |first1=Danielle |title=What is art therapy? A guide for professionals and clients |url=https://www.medicalnewstoday.com/articles/art-therapy |website=Medical News Today |date=29 September 2020 }}</ref>
Image = Correctional Activities at Central Jail Faisalabad, Pakistan in 2010 - Convict artists busy in drawing designs of carpets on graph papers.JPG |
Caption = Two convict artists busy in drawing designs of carpets on graph papers at Industrial Workshops of ], ], ] in 2010 |
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Because of its dual origins in art and psychotherapy, art therapy definitions vary. It can either focus on dealing with the art-making process as therapeutic in and of itself ("art as therapy"), or on the psychotherapeutic 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.”<ref name="Edwards">Edwards, D. (2004). Art therapy. London, England: SAGE Publications, Ltd., p.1</ref>


There are three main ways that art therapy is employed. The first one is called analytic art therapy. Analytic art therapy is based on the theories that come from ], and in more cases, ].<ref name=":4">{{Cite book|last=Hogan|first=Susan |title=Healing Arts: The History of Art Therapy|publisher=Jessica Kingsley Publishers London and Philadelphia|year=2001|isbn=1-85302-799-5|location=United Kingdom|pages=21, 22}}</ref> Analytic art therapy focuses on the client, the therapist, and the ideas that are transferred between both of them through art.<ref name=":4" /> Another way that art therapy is utilized is art psychotherapy. This approach focuses more on the psychotherapists and their analyses of their clients' artwork verbally.<ref name=":4" /> The last way art therapy is looked at is through the lens of art as therapy. Some art therapists practicing art as therapy believe that analyzing the client's artwork verbally is not essential, therefore they stress the creation process of the art instead.<ref name=":4" /> In all approaches to art therapy, the art therapist's client utilizes paint, paper and pen, clay, sand, fabric, or other media to understand and express their emotions.<ref name=":4" />
==Definitions==
According to the ''''What is Art Therapy?'''' brochure from the website of ( - British Association of Art Therapists),


Art therapy can be used to help people improve cognitive and sensory motor function, self-esteem, self-awareness, and emotional resilience.<ref name=":6">{{Cite web|url=https://arttherapy.org/about-art-therapy/|title=About Art Therapy|website=American Art Therapy Association|language=en-US|access-date=2020-04-12}}</ref> It may also aide in resolving conflicts and reduce distress.
<blockquote>“Art therapy is a form of psychotherapy that uses art media as its primary mode of communication. It is practised by qualified, registered Art Therapists who work with children, young people, adults and the elderly.<ref>http://baat.org/What_is_Art_Therapy.pdf, p.1</ref> Clients who can use art therapy may have a wide range of difficulties, disabilities or diagnoses. These include, for example, emotional, behavioral or mental health problems, learning or physical disabilities, life-limiting conditions, brain-injury or neurological conditions and physical illness. Art therapy may be provided for groups, or for individuals, depending on clients’ needs. It is not a recreational activity or an art lesson, although the sessions can be enjoyable. Clients do not need to have any previous experience or expertise in art.”</blockquote>


Current art therapy includes a vast number of other approaches such as ], ], ], ], ], ], and ]. The tenets of art therapy involve ], creativity, reconciling emotional conflicts, fostering self-awareness, and personal growth.<ref name=":3">Wadeson, H., Durkin, J., & Perach, D. (1989). Advances in art therapy. New York: John Wiley & Sons.</ref>
The American Art Therapy Association describes it this way:


== History ==
<blockquote>"(a)rt therapy is the therapeutic use of art making, within a professional relationship, by people who experience illness, trauma or challenges in living, and by people who seek personal development. Through creating art and reflecting on the art products and processes, people can increase awareness of self and others cope with symptoms, stress and traumatic experiences; enhance cognitive abilities; and enjoy the life-affirming pleasures of making art."<ref name="americanarttherapyassociation">http://www.americanarttherapyassociation.org/aata-aboutarttherapy.html</ref> </blockquote>
In the history of mental health treatment, art therapy (combining studies of psychology and art) is still a relatively new field. This type of unconventional therapy is used to cultivate ] and awareness, improve cognitive and motor abilities, resolve conflicts or stress, and inspire resilience in patients.<ref name=":6" /> It invites sensory, ], perceptual, and sensory symbolization to address issues that verbal psychotherapy cannot reach.<ref name=":6" /> Although art therapy is a relatively young therapeutic discipline, its roots lie in the use of the arts in the ']' of psychiatric patients in the late 18th century.<ref name=":5">{{Cite web|title=Art Therapy|url=https://insessionguide.com/art-therapy/|date=2017-04-16|website=Therapist Directory|language=en-US|access-date=2020-04-30}}</ref>


Art therapy as a profession began in the mid-20th century, arising independently in English-speaking and European countries. Art had been used at the time for various reasons: communication, inducing creativity in children, and in religious contexts.<ref name=":4" /> 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.<ref name=":5" />
<blockquote>"Art therapy is a mental health profession that uses the creative process of art making to improve and enhance the physical, mental and emotional well-being of individuals of all ages. It is based on the belief that the creative process involved in artistic self-expression helps people to resolve conflicts and problems, develop interpersonal skills, manage behaviour, reduce stress, increase self-esteem and self-awareness, and achieve insight.
Art therapy integrates the fields of human development, visual art (drawing, painting, sculpture, and other art forms), and the creative process with models of counseling and psychotherapy."<ref name="americanarttherapyassociation" /> </blockquote>


The British artist ] coined the term ''art therapy'' in 1942.<ref>Hogan, S. (2001). Healing arts: The history of art therapy. London: Jessica Kingsley. p. 135.</ref> 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''.<ref>Hill, A. (1945). Art versus illness: A story of art therapy. London: George Allen and Unwin.</ref>
==History==


], "the father of art therapy in Britain"<ref>Walker, J. (1992). Glossary of Art, Architecture & Design since 1945, 3rd. ed. London, Library Association Publishing</ref>]]
Art therapy is a relatively young therapeutic discipline. It first began around the mid-20th Century, arising independently in English-speaking and European areas. In England, as in the U.S., the roots of art therapy lay mainly in art education, the practice of art, and developmental psychology.


The artist ], demobilized after ], joined Adrian Hill to extend Hill's work to the British long stay mental hospitals. Adamson studied connections between one's artistic expression and their release of emotions. One way in which Adamson practiced Art Therapy was through the depiction of patients' emotions in the art they created. In order to gain a deeper understanding of how the mind is affected by mental illness, Adamson's Collection started as a way to create an environment where patients felt comfortable expressing themselves through art. This art would then be analyzed by mental health professionals.<ref>{{Cite journal |last=Ostrowska |first=Anna |date=2015-10-02 |title=The Adamson Collection: illustrations of mental illness or a testament to spontaneous artistic expression? |journal=Journal of Visual Communication in Medicine |language=en |volume=38 |issue=3–4 |pages=196–202 |doi=10.3109/17453054.2015.1108297 |pmid=26828548 |issn=1745-3054|pmc=4898145 }}</ref> Other early proponents of art therapy in Britain include E. M. Lyddiatt, ], Diana Raphael-Halliday and Rita Simons. The British Association of Art Therapists was founded in 1964.<ref>Waller, D. (1991). ''Becoming a profession: A history of art therapy 1940–82''. London: Routledge.</ref>
According to David Edwards, an art therapist in Britain, “(n)umerous and often conflicting definitions of art therapy have been advanced since the term, and later the profession, first emerged in the late 1940s (Waller and Gilroy, 1978).”<ref name="Edwards" /> Edwards states, “in the UK, the artist ] is generally acknowledged to have been the first person to use the term ‘art therapy’ to describe the therapeutic application of image making. For Hill, who had discovered the therapeutic benefits of drawing and painting while recovering from tuberculosis, 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’ (Hill, 1948: 101–102). This, Hill suggested, enabled the patient to ‘build up a strong defence against his misfortunes’ (Hill, 1948: 103).” So, the birth of art therapy goes back to the painter, Adrian Hill, who suggested artistic work to his fellow inpatients, while he was treated in a tuberculosis (T.B.) sanatorium. That began his artistic work with patients, which was documented in 1945 in his book, Art Versus Illness.<ref>Hill, A. , Art Versus Illness, in: Dannecker, K. (2003). Internationale Perspektiven der Kunsttherapie. Graz, Austria: Nausner & Nausner.(translation: International Perspectives of Art Therapy)</ref>


U.S. art therapy pioneers ] and ] 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&nbsp;... leads to an increase in verbalization in the course of therapy."<ref>Naumburg, M. (1953). ''Psychoneurotic art: Its function in psychotherapy''. New York: Grune & Stratton, p. 3.</ref> 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&nbsp;... anger, anxiety, or pain."<ref>Kramer, E. (1971). ''Art as therapy with children''. New York: Schocken Books, p. 219.</ref> Other early proponents of art therapy in the United States include Elinor Ulman, ], and ]. The ] was founded in 1969.<ref>Junge, M. (2010). ''The modern history of art therapy in the United States''. Springfield, IL: Charles C. Thomas. {{ISBN|978-0-398-07940-6}}</ref>
]


National professional associations of art therapy exist in many countries, including Brazil, Canada, Finland, Lebanon, Israel, Japan, the Netherlands, Romania, South Korea, Sweden, and Egypt.<ref name=":10">{{Cite journal |last1=Hebi |first1=Maimounah |last2=Czamanski-Cohen |first2=Johanna |last3=Azaiza |first3=Faisal |date=November 2022 |title=Art Therapy in The Arab World |url=https://linkinghub.elsevier.com/retrieve/pii/S0197455622000909 |journal=The Arts in Psychotherapy |language=en |volume=81 |pages=101969 |doi=10.1016/j.aip.2022.101969}}</ref> International networking contributes to the establishment of standards for education and practice.<ref>Coulter-Smith, A. (August, 1990). International Networking Group of Art Therapists, Newsletter No. 1.</ref>
The artist ] (1911-1996), recently demobilised after WW2, joined Adrian Hill to extend Hill’s work to the British long stay mental hospitals. Adamson started at ] in Surrey in 1946, and continued until his retirement in 1981. Adamson established a open art studio, allowing people to come and paint: a radical act when those detained in the 'asylums' were living in bleak conditions, profoundly excluded from society, with minimum dignity, autonomy or even personal possessions. He continued, working alone with hundreds of people, for 35 years. He and his life partner and collaborator, John Timlin (b 1930), published ‘Art as Healing’, their book on his work and the Adamson Collection, in 1984 <ref>Adamson, E. (1984). Art as Healing. London, Coventure</ref>. His importance in the complex history of British Art Therapy <ref name="Hogan">], S. (2001). Healing Arts: the history of art therapy. London, Jessica Kingsley Publishers.</ref> is widely accepted, though by the end of his career his point of view was seen as at odds with the evolving psycho-dynamic era in Art Therapy; and his practice, as personal to him. Adamson saw that people recovered - ‘healed’, in his terms- through the act of expressing themselves through art. The act of creating was all that mattered – how not to influence, distort or impinge on self expression, the artist’s or therapist’s primary concern. He saw the space where he worked as an art studio, and himself an artist, “somewhere in between” the clinical staff and the patients .<ref>Adamson E. (1970). Art for Health in The Social Context of Art. Jean Creddy. Tavistock, London</ref>. He encouraged 'free expression' by letting people come to paint or sculpt without comment or judgment by him. He abhorred psychological interpretation, which he dismissed as ‘the therapist’s own projections’ onto the work. Such views did not endear him to the emerging Art Therapy profession. His working style has been termed 'non-interventionist' by Hogan <ref name="Hogan" />, and is not a practice that would probably be recognised as that of contemporary Art Therapy. Adamson, by keeping all the work done in his daily, progressive art studios over 35 years, collected an estimated 100,000 works - of which 6000 by over a hundred people survive as the Adamson Collection (at ] in South London, since 1996). He exhibited work from the Collection from 1947 on, and internationally until his death in 1996. Adamson believed the exhibiting of the Collection educated the public about the creativity and humanity of those with mental illness: "Adamson was an educator, who saw the socio-cultural intervention of showing these people’s works to the public who had excluded them - and showing it as an important contribution to their culture - as a way to change public opinion” <ref>O'Flynn, D. (2011). Art as Healing: Edward Adamson. Raw Vision, 72, Spring 2011, p46-53.</ref>. There is debate about whether work should be shown: questions about the creator's consent, confidentiality, capacity, and intention; and whether these works are always clinical records or can be ].


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.<ref>{{cite journal|last=Potash, J. S.|author2=Ramirez, W. A.|title=Broadening history, expanding possibilities: Contributions of Wayne Ramirez to art therapy.|journal=Art Therapy|year=2013|volume=30|issue=4|pages=169–176|doi=10.1080/07421656.2014.847084|s2cid=145761884}}</ref><ref>{{cite journal|last=Kalmanowitz, D.|author2=Lloyd, B.|title=Fragments of art at work: Art therapy in the former Yugoslavia|journal=The Arts in Psychotherapy|year=1999|volume=26|issue=1|pages=15–25|doi=10.1016/s0197-4556(98)00027-6}}</ref><ref>{{cite journal | author = Boston C. G. | year = 2005 | title = Life story of an art therapist of color | journal = Art Therapy | volume = 22 | issue = 4| pages = 189–192 | doi=10.1080/07421656.2005.10129519| s2cid = 145467423 }}</ref>
Around the same time as Hill and Adamson, Margaret Naumberg, a psychologist in the U.S.A., also began to use the term “art therapy” to describe her work. Naumberg’s model of art therapy based its methods on:


== Definitions ==
“Releasing the unconscious by means of spontaneous art expression; it has its roots in the transference relation between patient and therapist and on the encouragement of free association. It is closely allied to psychoanalytic theory … Treatment depends on the development of the transference relation and on a continuous effort to obtain the patient’s own interpretation of his symbolic designs … The images produced are a form of communication between patient and therapist; they constitute symbolic speech.”<ref>Naumberg, M., quoted in Ulman, 2001: 17)” [Edwards, D. (2004). Art therapy. London, England: SAGE Publications, Ltd., p. 1</ref>
There are various definitions of the term ''art therapy''.<ref name="Edwards2004">{{cite book|last1=Edwards|first1=David|title=Art therapy|date=2004|publisher=SAGE|location=London|isbn=978-0761947509}}</ref>


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 communication." They also add that "clients who are referred to an art therapist need not have previous experience in art, the art therapist is not primarily concerned with making an aesthetic or diagnostic assessment of the client's image."<ref>{{cite web|title=About Art Therapy|url=http://www.baat.org/About-Art-Therapy|publisher=British Association of Art Therapists|access-date=3 January 2018}}</ref><ref>{{cite book |last1=Edwards |first1=David |title=Art Therapy |date=1 January 2014 |publisher=SAGE |isbn=978-1-4462-9748-3 |url=https://books.google.com/books?id=CauHAwAAQBAJ&pg=PP1 |language=en}}</ref>
U.S. pioneers, Margaret Naumburg and Dr. Edith Kramer, started their art therapy at around the same time as Hill. In the late 1940s, Margaret Naumburg created “psychodynamic art therapy.”<ref>Naumburg, M. (1996). Dynamically oriented art therapy. New York: Grune & Stratton, Inc.</ref>, whereas, Edith Kramer derived art therapy out of artistic practice.<ref>Dalley, T. (2004). Art as therapy. London/New York: Brunner-Rontledge.</ref>


The ] 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,<ref>{{Cite web|title=Google Books|url=https://books.google.com/|access-date=2022-02-04|website=books.google.com}}</ref> applied psychological theory, and human experience within a psychotherapeutic relationship."<ref name="AATA">{{cite web |last=Feeny |first=Ann |date=28 March 2024 |title=What Is Art Therapy? |url=https://www.psychology.org/resources/what-is-art-therapy/ |access-date=29 October 2024 |publisher=Psychology.org}}</ref>
According to New York University’s website, “Margaret Naumburg, an eminent pioneer in the field, offered courses and training seminars on the graduate level in New York University’s Department of Art and Art Professions. This tradition was continued when Edith Kramer came to the University in 1973 to develop a master’s program in Art Therapy. By 1976, the Master of Arts in Art Therapy program had obtained approval from the New York State Education Department, and in 1979, New York University’s Graduate Art Therapy program was one of the first of five programs to receive approval from the American Art Therapy Association.”<ref>New York University’s website http://steinhardt.nyu.edu/art/therapy</ref>


The website Psychology.org defines art therapy as: "a tool therapists use to help patients interpret, express, and resolve their emotions and thoughts. Patients work with an art therapist to explore their emotions, understand conflicts or feelings that are causing them distress, and use art to help them find resolutions to those issues."<ref>{{Cite web |date=2022-02-15 |title=What Is Art Therapy? {{!}} Psychology.org |url=https://www.psychology.org/resources/what-is-art-therapy/ |access-date=2024-10-29 |website=www.psychology.org |language=en-US}}</ref>
Dr. Edith Kramer, ATR-BC, HLM, was born in Vienna, Austria, where she studied art, drawing, sculpture and painting, during the Bauhaus movement. After arriving in the United States in 1938 as a refugee, she became a U.S. citizen in 1944 and continued to pursue the practice of art. Dr. Kramer was founder of the graduate program at New York University and Adjunct Professor of Art Therapy in the Graduate Art Therapy Program from 1973-2005. During that time, she was also Assistant Professor of the Graduate Art Therapy Program at George Washington University in Washington, D.C., from 1972 – 2000.<ref>Dr. Edith Kramer: Background http://www.edithkramer.com/Edith_Kramer_Background.html</ref>


== Uses ==
Edith Kramer received an honorary doctorate in 1996 from Norwich University in Northfield, VT. Currently, Dr. Kramer is Adjunct Associate Professor George Washington University where she teaches a Psychodynamic Processes course. She maintains a studio where she paints, etches, and sculpts and specializes in art therapy with children and adolescents. The American Art Therapy Association gave Dr. Kramer the award of "Honorary Life Member,” a mark of highest esteem.<ref> George Washington University website http://www.gwu.edu/~artx/faculty/emeritus.cfm</ref>
]
As a regulated ] 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, such as in art studios and creativity development workshops. Licensing for art therapists can vary from state to state with some recognizing art therapy as a separate license and some licensing under a related field such a professional counseling or mental health counseling.<ref>{{Cite web|title=State Advocacy|url=https://arttherapy.org/state-advocacy/|website=American Art Therapy Association|language=en-US|access-date=2020-04-30}}</ref> Art therapists must have a master's degree that includes training in the creative process, psychological development, and group therapy, and they must complete a clinical internship.<ref>{{Cite web|title=Becoming an Art Therapist|url=https://arttherapy.org/becoming-art-therapist/|website=American Art Therapy Association|language=en-US|access-date=2020-04-30}}</ref> 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.<ref>{{Cite web|title=Becoming an Art Therapist|url=https://arttherapy.org/becoming-art-therapist/|access-date=2021-03-31|website=American Art Therapy Association|language=en-US}}</ref> Other professionals, such as ], social workers, psychologists, and play therapists, optionally combine artmaking with basic psychotherapeutic modalities in their treatment. Therapists may better understand a client's absorption of information after assessing elements of their artwork.<ref name="Lusebrink2010">{{cite journal|last1=Lusebrink|first1=Vija B.|title=Assessment and Therapeutic Application of the Expressive Therapies Continuum: Implications for Brain Structures and Functions|journal=Art Therapy: Journal of the American Art Therapy Association|date=2010|volume=27|issue=4|pages=168–177|url=https://files.eric.ed.gov/fulltext/EJ906442.pdf|doi=10.1080/07421656.2010.10129380|s2cid=6758378}}</ref>


While there is still little consistent research about art therapy, preliminary surveys and studies have suggested its efficacy in relieving symptoms and improving quality of life.<ref name=":7">{{Cite journal |last1=Regev |first1=Dafna |last2=Cohen-Yatziv |first2=Liat |date=2018-08-29 |title=Effectiveness of Art Therapy With Adult Clients in 2018—What Progress Has Been Made? |journal=Frontiers in Psychology |volume=9 |pages=1531 |doi=10.3389/fpsyg.2018.01531 |issn=1664-1078 |pmc=6124538 |pmid=30210388 |doi-access=free}}</ref>
Dr. Edith Kramer has authored seminal papers and books, and is renowned as a social realist painter, sculptor, print-maker and mosaicist. Edith Kramer’s starting point was art therapy work with children, which was documented among other groundbreaking literature, in the book, “Art as Therapy with Children.”<ref>Kramer, E. (1971). Art as therapy with children. New York: Schocken Books; German version: Kramer, E. (1978). Kunst als Therapie mit Kindern. München/Basel: Ernst Reihnhardt Verlag.</ref> She also wrote Art Therapy in a Children's Community.<ref>Kramer, E. (1977). Art therapy in a children's community. New York: Schocken Books.</ref>


=== Acute illness ===
In more recent history, Judith Aron Rubin, Ph.D., ATR-BC, has been a groundbreaking author and film maker in the field of art therapy for decades. She is a licensed clinical psychologist, board certified Art Therapist, Assistant Professor in the Department of Psychiatry, University of Pittsburgh, and a faculty member of the Pittsburgh Psychoanalytic Institute. Dr. Rubin received a B.A. in art from Wellesley, an M.Ed. from Harvard, and a Ph.D. in Counseling Psychology from the University of Pittsburgh. Dr. Rubin stands out through her work, which is in the tradition of Helen Landgarten, who also set forth the concept of clinical art therapy.<ref>Landgarten, H. B. (1989). Klinische Kunsttherapie – ein umfassender Leitfaden. Karlsruhe, Germany: Geradi Verlag für Kunsttherapie.</ref> Dr. Rubin’s work includes books, book chapters, films and journal articles on art therapy.
A review of the literature has shown the influence of art therapy on patient care and found that participants in art therapy programs have less difficulty sleeping, among other benefits.<ref>{{Cite journal |last1=Le Vu |first1=Minh Ngoc |last2=Do |first2=Anh Linh |last3=Boyer |first3=Laurent |last4=Tran |first4=Quy Chi |last5=Kohler |first5=Stefan |last6=Ahmed |first6=Syed Ishtiaque |last7=Molnar |first7=Andreea |last8=Vu |first8=Tung Son |last9=Vo |first9=Nhan Trong Huynh |last10=Nguyen |first10=Linh Mai Vu |last11=Vu |first11=Linh Gia |last12=Dam |first12=Vu Anh Trong |last13=Duong |first13=Thomy |last14=Do |first14=Dan Linh Nguyen |last15=Do |first15=Ngoc Minh |date=2022-09-15 |title=A Review of the Effectiveness, Feasibility, and Acceptability of Art Therapy for Children and Adolescents during the COVID-19 Pandemic |journal=International Journal of Environmental Research and Public Health |volume=19 |issue=18 |pages=11612 |doi=10.3390/ijerph191811612 |doi-access=free |issn=1660-4601 |pmc=9517402 |pmid=36141885}}</ref> Studies have found that merely observing a landscape photograph in a hospital room had reduced need for narcotic pain killers and less time in recovery at the hospital.<ref name="Stuckey2010" /> In addition, either looking at or creating art in hospitals helped stabilize vital signs, speed up the healing process, and increase optimism in patients.


=== Cancer ===
At Lesley University in Cambridge, Massachusetts, the “(e)xpressive Therapies Program was established more than 30 years ago as one of the first graduate schools in the United States to train professionals in this emerging field,” according to the University’s website, Shaun McNiff, Norma Canner and Paolo J. Knill were involved in this program’s creation.<ref>Lesley University website http://www.lesley.edu/gsass/56etp.html</ref>
Many studies have been conducted on the benefits of art therapy on cancer patients. Art therapy has been found useful for supporting patients during the stress of surgery, radiation, and chemotherapy treatment.<ref>{{Cite journal|last1=Forzoni|first1=Silvia|last2=Perez|first2=Michela|last3=Martignetti|first3=Angelo|last4=Crispino|first4=Sergio|date=March 2010|title=Art therapy with cancer patients during chemotherapy sessions: an analysis of the patients' perception of helpfulness|journal=Palliative & Supportive Care|volume=8|issue=1|pages=41–48|doi=10.1017/S1478951509990691|issn=1478-9523|pmid=20163759|s2cid=32428984}}</ref>


In a study involving women facing cancer-related difficulties such as fear, pain, and altered social relationships, it was found that: {{blockquote|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.<ref name="Stuckey2010">{{cite journal|last1=Stuckey|first1=HL|last2=Nobel|first2=J|title=The connection between art, healing, and public health: a review of current literature.|journal=American Journal of Public Health|date=February 2010|volume=100|issue=2|pages=254–63|doi=10.2105/AJPH.2008.156497|pmid=20019311|pmc=2804629}}</ref>}}Another study showed those who participated in these types of activities were discharged earlier than those who did not participate.<ref name="Stuckey2010" /> Even relatively short-term art therapy interventions may significantly patients' emotional states and symptoms.<ref name=":7" />
Dr. Shaun McNiff is an author and professor at Lesley University in Cambridge, Massachusetts. He left law school in 1969 to pursue painting and sculpture, then worked as the art therapist at Danvers State Hospital (a.k.a., the “State Lunatic Hospital at Danvers”), a residential treatment and care facility for the mentally ill, in Danvers, Massachusetts. In 1973-1974, he established the first graduate program there (then Lesley College) to integrate all of the arts in both therapy and education. The international profession of Expressive Arts Therapy grew from that work. Prof. McNiff recruited Norma Canner to work with him; she was known as a pioneer in dance therapy and for her work with children and youth with disabilities. Canner left Tufts University to work with McNiff at Lesley. McNiff also recruited the musician Paolo Knill from Switzerland, who had trained in physics and engineering. Prof. McNiff received a doctoral degree from the Union Institute and established a program in Advanced Graduate Studies in Creativity, Imagination, and Leadership at Lesley. He is a past president and Honorary Life Member of the American Art Therapy Association and is also on the faculty of the European Graduate School, Arts, Health and Society Division.<ref>Lesley University website: Biographies http://ada.lesley.edu/faculty/ftmcnifj/Bio.html</ref>


A review of twelve studies investigated the use of art therapy in cancer patients by investigating the symptoms of emotional, social, physical, and spiritual concerns 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.<ref name=":9" /> It was suggested that art therapy can provide a sense of "]" through 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, ability to discuss emotional and physical health, general well-being, and increased quality of life in cancer patients.<ref name=":9">{{cite journal |author1=Wood M. J. |author2=Molassiotis A. |author3=Payne S. | year = 2011 | title = What research evidence is there for the use of art therapy in the management of symptoms in adults with cancer? A systematic review | journal = Psycho-Oncology | volume = 20 | issue = 2| pages = 135–145 | doi=10.1002/pon.1722|pmid=20878827|s2cid=18675899 }}</ref>
Paolo J. Knill, Ph.D., Dr. h.c., is Provost of the European Graduate School and Professor Emeritus at Lesley University in Cambridge, MA. Dr. Knill was born on July 11, 1932, in Switzerland and is a scientist, artist, therapist, educator and musician.<ref>Lesley University website: http://www.egs.edu/faculty/paolo-knill/biography/</ref> Dr. Knill holds Master’s of Science in Aerodynamics and Structural Mechanics with a minor in Humanities and Applied Psychology from the Swiss Institute for Technology ETH Zurich. He studied Organizational Consulting and Management Consulting at the Massachusetts Institute of Technology (MIT), during which time, he was also a Research Fellow at the Aerospace Lab and an Adjunct Faculty for Music. He completed his certificate for Youth and Family Counseling in 1970, then completed his Ph.D. in Psychology at the Union Graduate School in Ohio in 1976.<ref>Knill, P. (2005). Principles and practice of expressive arts therapy – toward a therapeutic aestetics. London: Jessica Kingsley Publishers</ref>


=== Dementia ===
According to the website of Mount Mary College in Milwaukee, Wisconsin, “Mount Mary College has expanded its art therapy program to include a professional doctorate degree, announced President Eileen Schwalbach, Ph.D. Approval for the doctorate in art therapy was received April 25, 2011, from the North Central region's Higher Learning Commission (HLC). With an emphasis on professional competencies, the advanced degree program incorporates more than a traditional research degree and is the first of its kind in the U.S. It is also Mount Mary's first doctorate program.”<ref>Mount Mary College website http://www.mtmary.edu/</ref> The Doctorate of Art Therapy is a practitioner-oriented advanced degree that prepares already credentialed art therapists with competencies over and above those of master's level professionals.
Art therapy has been observed to have positive effects on patients with dementia,<ref>{{Cite journal |last=Emblad |first=Shayla |date=May 2021 |title=Creative Art Therapy as a Non-Pharmacological Intervention for Dementia: A Systematic Review |journal=Journal of Alzheimer's Disease Reports|volume=5 |issue=1 |pages=353–364 |doi=10.3233/ADR-201002 |pmid=34189407 |pmc=8203286 }}</ref> with tentative evidence supports benefits with respect to quality of life.<ref>{{cite journal |last1=Chancellor |first1=B |last2=Duncan |first2=A |last3=Chatterjee |first3=A |date=2014 |title=Art therapy for Alzheimer's disease and other dementias. |journal=Journal of Alzheimer's Disease |volume=39 |issue=1 |pages=1–11 |doi=10.3233/JAD-131295 |pmid=24121964}}</ref> Although art therapy helps with behavioral issues, it does not appear to reverse degenerating mental faculties.<ref>{{Cite journal|last1=Cowl|first1=Andrielle L.|last2=Gaugler|first2=Joseph E.|date=2014-10-02|title=Efficacy of Creative Arts Therapy in Treatment of Alzheimer's Disease and Dementia: A Systematic Literature Review|journal=Activities, Adaptation & Aging|volume=38|issue=4|pages=281–330|doi=10.1080/01924788.2014.966547|s2cid=144965747|issn=0192-4788}}</ref> It is important that the art tools are easy to use and relatively simple to understand.<ref>{{Cite journal |last1=Wang |first1=Qiu-Yue |last2=Li |first2=Dong-Mei |date=2016-09-01 |title=Advances in art therapy for patients with dementia |journal=Chinese Nursing Research |language=en |volume=3 |issue=3 |pages=105–108 |doi=10.1016/j.cnre.2016.06.011 |issn=2095-7718 |doi-access=free}}</ref> Art therapy had no clear results on affecting memory or emotional well-being scales.<ref>{{Cite journal|last1=Deshmukh|first1=Sunita R.|last2=Holmes|first2=John|last3=Cardno|first3=Alastair|date= 13 September 2018|title=Art therapy for people with dementia|journal=The Cochrane Database of Systematic Reviews|volume=2018|issue=9|pages=CD011073|doi=10.1002/14651858.CD011073.pub2|issn=1469-493X|pmc=6513479|pmid=30215847}}</ref> However, Alzheimer's Association states that art and music can enrich people's lives and allow for self-expression.<ref>{{cite web|title=Art and Music|url=https://www.alz.org/help-support/caregiving/daily-care/art-music|last=Alzheimer's Association|date=2020|website=Alzheimer's Association|access-date=30 April 2020}}</ref> D.W. Zaidel, a researcher and therapist at ], claims that engagement with art can stimulate specific areas of the brain involved in language processing and visuo-spatial perception, two cognitive functions which decline significantly in dementia patients.<ref>{{Cite book |last=Zaidel |first=Dahlia W. |url=https://www.taylorfrancis.com/books/mono/10.4324/9781315719931/neuropsychology-art-dahlia-zaidel |title=Neuropsychology of Art: Neurological, Cognitive, and Evolutionary Perspectives |year=2015 |doi=10.4324/9781315719931|isbn=9781317517450 }}</ref>]


===Autism===
==Art Therapy and Outsider Art==
Art therapy is increasingly recognized to help address challenges of people with autism.<ref name=":3" /> Art therapy may address core symptoms of ] by promoting sensory regulation, supporting psychomotor development, and facilitating communication.<ref>{{Cite journal|last=Durrani|first=Huma|date=2019-04-03|title=A Case for Art Therapy as a Treatment for Autism Spectrum Disorder|journal=Art Therapy|volume=36|issue=2|pages=103–106|doi=10.1080/07421656.2019.1609326|s2cid=181370829|issn=0742-1656}}</ref> Art therapy is also thought to promote emotional and mental growth by allowing self-expression, visual communication, and creativity.<ref>{{Cite web|title=The Impact of Art on Autism|url=https://www.act-today.org/the-impact-of-art-on-autism/|date=2017-10-22|website=Autism Care Today|language=en-US|access-date=2020-04-30}}</ref> Most importantly, studies have found that painting, drawing, or music therapies may allow people with autism to communicate in a manner more comfortable for them than speech.<ref>{{Cite journal |last=Jalambadani |first=Zeinab |date=2020 |title=Art therapy based on painting therapy on the improvement of autistic children's social interactions in Iran |journal=Indian Journal of Psychiatry |volume=62 |issue=2 |pages=218–219 |doi=10.4103/psychiatry.IndianJPsychiatry_215_18 |issn=0019-5545 |pmc=7197842 |pmid=32382187 |doi-access=free }}</ref> In Egypt, the Egyptian Autism Society implemented Art Therapy as a way to grow self esteem and quality of life in children. They incorporated basket weaving, a common cultural art activity, in art therapy programs. These art therapy activities were part of studies that focused on self esteem and proved that art therapy significantly, "...increased inner strength and daily living skills and reduced symptoms of emotional disorders...".<ref name=":10" /> Other forms of therapy that tend to help individuals with autism include ] and ].<ref>{{Citation |last1=Gharbieh |first1=Chafica Mansour |title=Applied behavior analysis and verbal behavior interventions in children with autism spectrum disorder and associated learning difficulties |date=2021 |url=http://dx.doi.org/10.1016/b978-0-323-85031-5.00032-3 |work=Emerging Programs for Autism Spectrum Disorder |pages=191–210 |access-date=2023-07-30 |publisher=Elsevier |last2=Gharbieh Isabella |first2=Sammy|doi=10.1016/b978-0-323-85031-5.00032-3 |isbn=9780323850315 |s2cid=236650775 }}</ref> In India, a study was done to show the effectiveness of art therapy by using both a controlled and experimental group on nine individuals with autism.<ref name=":8">{{Cite journal |last1=Koo |first1=Jongsoon |last2=Thomas |first2=Elizabeth |date=2019-10-02 |title=Art Therapy for Children With Autism Spectrum Disorder in India |url=https://www.tandfonline.com/doi/full/10.1080/07421656.2019.1644755 |journal=Art Therapy |language=en |volume=36 |issue=4 |pages=209–214 |doi=10.1080/07421656.2019.1644755 |issn=0742-1656 |s2cid=201973444}}</ref> One of the researchers, Koo, stated, "The positive changes were notable in the participants' cognitive, social, and motor skills".<ref name=":8" />
The relation between the terms ] and ] has been debated in many academic discussions, especially in regard to the practical application of both professions. 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 ] has been first used by art critic Roger Cardinal in 1972<ref>^ Cardinal, R. (1972), ''Outsider Art'', London</ref><ref> Tosatti, B. (2007)''Les Fascicules de l'Art brut, un saggio sull'artista Antonio dalla Valle'' (''Paragraphs on Outsider Art. An essay on artist Antonio dalla Valle'')</ref>.


===Schizophrenia===
Both terms have been criticized because of their social and personal impact on both patients and artists.
A 2005 systematic review of art therapy as supplemental treatment for ] found unclear effects.<ref name="Llo2005">{{cite journal|last1=Lloyd| first1=J| last2=Ruddy|first2=R| first3=D| last3=Milnes|title=Art therapy for schizophrenia or schizophrenia-like illnesses|journal=Cochrane Database of Systematic Reviews|date=2005|volume=4| issue=4|url=http://www.cochrane.org/CD003728/SCHIZ_art-therapy-for-schizophrenia-or-schizophrenia-like-illnesses|pages=CD003728.pub2 |doi=10.1002/14651858.CD003728.pub2| pmid=16235338}}</ref> Group art therapy has been shown to improve some symptoms of schizophrenia. While studies concluded that art therapy did not improve Clinical Global Impression or Global Assessment of Functioning, they showed that the use of haptic art materials to express one's emotions, cognitions, and perceptions in a group setting lowered depressing themes and may improve ], enforce creativity, and facilitate the integrative therapeutic process for people with schizophrenia.<ref>{{cite journal |last1=GM |first1=Gajić |title=Group art therapy as adjunct therapy for the treatment of schizophrenic patients in day hospital |journal=Vojnosanitetski Pregled |year=2013 |volume=70 |issue=11 |pages=1065–1069 |doi=10.2298/vsp1311065m |pmid=24397206 |doi-access=free }}</ref>
Art Therapy has been accused of not putting enough emphasis on the artistic value and meaning of the art productions of the artist, 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<ref>Baumann, Daniel (2001), ''Art Brut? Outsider art? Denkfigur und Behauptung'' (''Art Brut? Outsider Art? Meanings and Shapes of thought''), Kunst-Bulletin, Geneva</ref><ref>Navratil, Leo (1996) ''Art Brut & Psychiatry'', Raw Vision, Geneva</ref>. 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<ref>Bedoni, Giorgio; Tosatti, Bianca (2000),''Arte e psichiatria. Uno sguardo sottile'' (''Art and psychiatry. A thin look''), Mazzotta, Milano</ref><ref>Rexer, Lyle (2005), ''How to Look at Outsider Art'', New York:Abrams</ref>.


=== Post-traumatic stress disorder ===
==Application==
Art therapy may alleviate trauma-induced ]s, such as shame and anger.<ref name=":0">{{Cite journal|last=Pifalo|first=Terry|date=January 2007|title=Jogging the Cogs: Trauma-Focused Art Therapy and Cognitive Behavioral Therapy with Sexually Abused Children|journal=Art Therapy|language=en|volume=24|issue=4|pages=170–175|doi=10.1080/07421656.2007.10129471|s2cid=42145148|issn=0742-1656}}</ref> It is also likely to increase trauma survivors' sense of empowerment <ref name=":1">{{Cite journal|last=Brooke|first=Stephanie L.|date=January 1995|title=Art therapy: An approach to working with sexual abuse survivors|journal=The Arts in Psychotherapy|volume=22|issue=5|pages=447–466|doi=10.1016/0197-4556(95)00036-4|issn=0197-4556}}</ref> and control by encouraging children to make choices in their artwork.<ref name=":0" /> Art therapy in addition to psychotherapy offered more reduction in trauma symptoms than just psychotherapy alone.<ref>{{Cite journal|last1=Schouten|first1=Karin Alice|last2=de Niet|first2=Gerrit J.|last3=Knipscheer|first3=Jeroen W.|last4=Kleber|first4=Rolf J.|last5=Hutschemaekers|first5=Giel J. M.|date=April 2015|title=The Effectiveness of Art Therapy in the Treatment of Traumatized Adults: A Systematic Review on Art Therapy and Trauma|journal=Trauma, Violence, & Abuse|language=en|volume=16|issue=2|pages=220–228|doi=10.1177/1524838014555032|pmid=25403446|s2cid=19653241|issn=1524-8380|hdl=2066/142235|hdl-access=free}}</ref>
]
As a ] profession, art therapy is employed in many clinical and other settings with diverse populations. Art therapy can be found in non-clinical settings, as well as in art studios and in creativity development workshops. Closely related in practice to ]s 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, rehabilitation therapists or others. Art therapists may have received advanced degrees in art therapy or in a related field, such as psychology, in which case they then obtain post-master or post-doctorate certification as an art therapist. Art therapists who meet credentialing requirements set by the national credentialing body, the Art Therapy Credentials Board (ATCB), initially become Registered (ATR), then Board-certified (ATR-BC), after which they may go on to earn the supervisory credential, Art Therapy Certified Supervisor (ATCS). 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.


Art therapy may be an effective way to access and process traumatic memories that were encoded visually in clients.<ref>{{Cite web|url=https://www.pressherald.com/2017/11/19/a-young-survivor-finds-a-refuge-in-maine/|title=A young survivor finds a refuge in Maine|last=Writer|first=Mary PolsStaff|date=2017-11-19|website=Press Herald|access-date=2020-02-01}}</ref><ref>{{Cite web|url=https://www.chicagotribune.com/visuals/94376970-132.html|title=Pit bull attacked eight-year-old boy, now 18|website=chicagotribune.com|date=25 August 2017 |access-date=2020-02-01}}</ref> Through art therapy, individuals may be able to make more sense of their ] and form accurate trauma narratives. Gradual exposure to these narratives may reduce trauma-induced symptoms, such as ] and ]s.<ref name=":0" /> Repetition of directives reduces anxiety, and visually creating narratives helps clients build coping skills and balanced nervous system responses.<ref>{{Cite journal|last1=Hass-Cohen|first1=Noah|last2=Findlay|first2=Joanna Clyde|last3=Carr|first3=Richard|last4=Vanderlan|first4=Jessica|date=2014-04-03|title="Check, Change What You Need To Change and/or Keep What You Want": An Art Therapy Neurobiological-Based Trauma Protocol|journal=Art Therapy|volume=31|issue=2|pages=69–78|doi=10.1080/07421656.2014.903825|s2cid=144163177|issn=0742-1656}}</ref> This has been proven effective only in long-term art therapy interventions.<ref name=":7" />
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 ] experiences, increase cognitive, memory and neurosensory abilities, improve interpersonal relationships and achieve greater self-fulfillment. Many art therapists draw upon images from resources such as ] (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 ] trained in both ] 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.Assessing elements in artwork can help therapists understand how well a client is in-taking information.<ref>Lusebrink, Vija B. "Assessment and Therapeutic Application of the Expressive Therapies Continuum: Implications for Brain Structures and Functions." Art Therapy: Journal of the American Art Therapy Association 27.4 (2010): 168. Educators Reference Complete. Web. 30 Nov. 2011.</ref>


=== Depression ===
==Purpose of Art Therapy==
"Depression is considered a mood disorder characterized by distorted or inconsistent emotional states that interfere with an individual’s ability to function".<ref>{{Cite web |last=Publishing |first=Addiction Recovery |date=2022-03-15 |title=How Art Therapy Can Help With Depression |url=https://bellamonterecovery.com/how-art-therapy-can-help-with-depression/ |access-date=2024-10-31 |website=Bella Monte Recovery Center: Residential Treatment for Alcohol / Drug Addiction |language=en-US}}</ref> Since art therapy was originated in the psychotherapy field, just like the other mental-health related issues art therapy has been a new technique used to help individuals with depression and anxiety. Art therapy is not solely just using the basic traditional mediums of art, it can range from painting, dancing, writing, knitting, etc <ref>{{Cite web |date=2023-09-21 |title=Art Therapy for Depression: A Proven Treatment Method |url=https://www.find-a-therapist.com/art-therapy-for-depression/ |access-date=2024-10-31 |language=en-US}}</ref>
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, and photography. Art therapy stands in contrast with other kinds of creative or expressive arts therapies that use dance, music or drama. Studies have demonstrated the efficacy of art therapy, as applied to clients with memory loss due to Alzheimer’s and other diseases; stroke residuals;<ref>Kim, S-K., Kim, M.-Y., Lee, J.-H., & Chun, S.-I. (2008). Art therapy outcomes in the rehabilitation treatment of a stroke patient: A case report. Art Therapy: Journal of the American Art Therapy Association, 25(3), 129-133;</ref> cognitive functioning;<ref>Noice, H., Noice, T., & Staines, G. (2004). A short-term intervention to enhance cognitive and affective functioning in older adults. Journal of Aging and Health, 16(4), 562-585</ref> traumatic brain injury; post-traumatic stress disorder (PTSD);<ref>Spinner, J. (April 15, 2007). “War's pain, softened with a brush stroke: VA's art therapy eases battle stresses.” Washington Post at http://www.washingtonpost.com</ref> depression; dealing with chronic illness;<ref>Stuckey, H. (2009). Creative expression as a way of knowing in diabetes adult health education: An action research study. Adult Education Quarterly, 60(1), 46-64</ref><ref>Bar-Sela, G., Atid, L., Danos, S., Gabay, N., & Epelbaum, R. (2007). Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy. Journal of Psycho-Oncology, 16, 980-984</ref><ref>Collie, K., Bottorff, J. L., & Long, B. C. (2006) A narrative view of art therapy and art making by women with breast cancer. Journal of Health Psychology, 11(5), 761-775</ref><ref>Deane, K., Fitch, M., & Carman, M. (2000). An innovative art therapy program for cancer patients. Canadian Oncology Nursing Journal, 10(4), 147-51, 152-157</ref> and aging.<ref>Doric-Henry, L. (1997). Pottery as art therapy with elderly nursing home residents. Art Therapy: Journal of the American Art Therapy Association, 14(3), 163-171</ref><ref>Wilkstrom, B. M., Theorell, T., & Sandstrom, S. (1993). Medical health and emotional effects of art stimulation in old age: A controlled intervention study concerning the effects of visual stimulation provided in the form of pictures.</ref>


Art can be a powerful tool for relieving depression symptoms because it can instill confidence, create room for expression, and foster creativity, which has been linked to decreases in anxiety, rigid behaviors, and even physical ailments, such as heart disease and cancer. Art allows individuals to process emotions they might not have known they were dealing with or help express emotions they weren't verbally able to communicate.<ref>{{Cite web |title=Art therapy can help reduce anxiety, symptoms of depression |url=https://www.piedmont.org/living-real-change/art-therapy-can-help-reduce-anxiety-symptoms-of-depression |access-date=2024-10-31 |website=www.piedmont.org}}</ref> Creativity and creation can both be capable of lending tremendous confidence to an individual, which can lift some of the symptoms of depression.<ref>{{Cite web |date=October 10, 2024 |title=Art Therapy for Depression: Healing Through Art |url=http://www.betterhelp.com/advice/depression/treating-depression-art-expression-and-healing. |website=BetterHelp.com}}</ref>
==What Does a Typical Art Therapy Session Look Like?==
Malchiodi (2006)<ref>Needs references please</ref> provides an example of what an art therapy session involves and how it is different from an art class. "In most art therapy sessions, the focus is on your inner experience—your feelings, perceptions, and imagination. While art therapy may involve learning skills or art techniques, the emphasis is generally first on developing and expressing images that come from inside the person, rather than those he or she sees in the outside world. And while some traditional art classes may ask you to paint or draw from your imagination, in art therapy, your inner world of images, feelings, thoughts, and ideas are always of primary importance to the experience.


==== In children ====
Therapy comes from the Greek word ''therapeia'', which means 'to be attentive to.' This meaning underscores the art therapy process in two ways. In most cases, a skilled professional attends to the individual who is making the art. This person’s guidance is key to the therapeutic process. This supportive relationship is necessary to guide the art-making experience and to help the individual find meaning through it along the way. It helps the individual trust themselves more.
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.<ref name=":1" /> Group art therapy may also be beneficial in helping children with trauma regain trust and social self-esteem.<ref name=":0" />


==== In veterans ====
The other important aspect is the attendance of the individual to his or her own personal process of making art and to giving the art product personal meaning—i.e., finding a story, description, or meaning for the art. Very few therapies depend as much on the active participation of the individual (p.&nbsp;24)." In art therapy, the art therapist facilitates the person's exploration of both materials and narratives about art products created during a session.
Art therapy has an established history of being used to treat veterans, with the American Art Therapy Association documenting its use as early as 1945.<ref>{{Cite journal|last1=Sornborger|first1=Jo|last2=Fann|first2=Alice|last3=Serpa|first3=J. Greg|last4=Ventrelle|first4=Jennifer|last5=R D N|first5=M. S.|last6=Ming Foynes|first6=Melissa|last7=Carleton|first7=Megan|last8=Sherrill|first8=Andrew M.|last9=Kao|first9=Lan K.|last10=Jakubovic|first10=Rafaella|last11=Bui|first11=Eric|date=October 2017|title=Integrative Therapy Approaches for Posttraumatic Stress Disorder: A Special Focus on Treating Veterans|journal=Focus (American Psychiatric Publishing)|volume=15|issue=4|pages=390–398|doi=10.1176/appi.focus.20170026|issn=1541-4094|pmc=6519541|pmid=31975869}}</ref> As with other sources of trauma, combat veterans may benefit from art therapy to access memories and to engage with treatment. A 2016 randomized control trial found that art therapy in conjunction with ] (CPT) was more beneficial than CPT alone.<ref>{{Cite journal|last1=Campbell|first1=Melissa|last2=Decker|first2=Kathleen P.|last3=Kruk|first3=Kerry|last4=Deaver|first4=Sarah P.|date=2016|title=Art Therapy and Cognitive Processing Therapy for Combat-Related PTSD: A Randomized Controlled Trial|journal=Art Therapy: Journal of the American Art Therapy Association|volume=33|issue=4|pages=169–177|doi=10.1080/07421656.2016.1226643|issn=0742-1656|pmc=5764181|pmid=29332989}}</ref> Walter Reed Army Medical Center, the National Intrepid Center of Excellence and other Veteran Association institutions use art therapy to help veterans with PTSD.<ref>{{Cite web|title=Art & Healing {{!}} PTSD|url=https://artandhealing.org/art-healing-ptsd/|date=2015-07-02|website=The UnLonely Project|language=en-US|access-date=2020-04-30}}</ref>


=== Bereavement ===
==Art-Based Assessments==
According to the American Art Therapy Association, art therapy is "particularly effective during times of crisis, changes in circumstance, trauma, and grief."<ref>{{Cite web |title=What is Art Therapy? |url=https://arttherapy.org/what-is-art-therapy/ |access-date=2024-04-24 |website=American Art Therapy Association |language=en-US}}</ref> Bereavement is one challenging time where clients find it difficult to verbalize their feelings of loss and shock, and so may use creative means to express their feelings.<ref>{{cite journal |first1=Trevor J. |last1=Buser |first2=Juleen K. |last2=Buser |first3=Samuel T. |last3=Gladding |date=2005 |title=Good Grief: The Part of Arts in Healing Loss and Grief |journal=Journal of Creativity in Mental Health |volume=1 |issue=3–4 |pages=173–183 |url=https://www.tandfonline.com/doi/abs/10.1300/J456v01n03_10 |doi=10.1300/J456v01n03_10}}</ref> For example, it has been used to enable children to express their feelings of loss where they may lack the maturity to verbalize their bereavement.
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)<ref>Badly needs citation...</ref>. The first drawing assessment for psychological purposes was created in 1906 by German psychiatrist Fritz Mohr (Malchiodi 1998)<ref>Badly needs citation...</ref>. In 1926, researcher Florence Goodenough created a drawing test to measure the intelligence in children called the Draw–A–Man Test (Malchiodi 1998)<ref>Badly needs citation...</ref>. 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)<ref>Badly needs citation...</ref>. Goodenough and other researchers realized the test had just as much to do with personality as it did intelligence (Malchiodi, 1998)<ref>Badly needs citation...</ref>. Several other psychiatric art assessments were created in the 1940s, and have been used ever since (Malchiodi 1998)<ref>Badly needs citation...</ref>.


=== Eating disorders ===
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:


Art therapy may help people with anorexia with associated depression and weight management.<ref>{{Cite journal|last1=Lock|first1=James|last2=Fitzpatrick|first2=Kathleen Kara|last3=Agras|first3=William S.|last4=Weinbach|first4=Noam|last5=Jo|first5=Booil|date=January 2018|title=Feasibility Study Combining Art Therapy or Cognitive Remediation Therapy with Family-based Treatment for Adolescent Anorexia Nervosa|journal=European Eating Disorders Review|volume=26|issue=1|pages=62–68|doi=10.1002/erv.2571|issn=1099-0968|pmc=5732028|pmid=29152825}}</ref> Traumatic or negative childhood experiences can result in unintentionally harmful coping mechanisms, such as ]s. Art therapy may provide an outlet for exploring these experiences and ]s.<ref name=":2">{{Cite book |last=Hinz |first=Lisa |title=Drawing from within: Using art to treat eating disorders |publisher=Jessica Kingsley Publishers |year=2006 |isbn=9781846425431}}</ref>
===The Diagnostic Drawing Series (DDS)===
The is an art therapy assessment that is correlated with the diagnosis of major psychiatric disorders (Mills, 2003). The DDS is a three drawing series that is used by mental health professionals around the world ( website, 2009). In the first part, subjects are asked to draw any picture using colored chalk pastels on an 18 x 24&nbsp;inch piece of paper. Then they are asked to draw a tree in the second part. In the last part of the art interview, subjects are asked to show how they are feeling using lines, shapes, and colors. Research regarding the pictures is generally based on the presence and absence of many elements, such as use of color, blending, and placement of the images on the paper (Cohen, Hammer, & Singer, 1988)...


Art therapy may be beneficial for clients with eating disorders because clients can create visual representations with ] of progress made, represent alterations to the body, and provide a nonthreatening method of acting out impulses.<ref name=":2" /> Individuals with eating disorders tend to rely heavily on ] to feel a sense of control; it is important that clients feel a sense of ] over their art products through freedom of expression and controllable art materials.<ref name=":2" />
===The Mandala Assessment Research Instrument (MARI)===
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 (Malchiodi 1998). The person is then asked to draw the mandala from the card they choose with an oil pastel of the color of their choice (Malchiodi 1998). The artist is then asked to explain if there were any meanings, experiences, or related information related to the mandala they drew (Malchiodi 1998). 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 (Malchiodi 1998). This test assesses and gives clues to a person's psychological progressions and their current psychological condition (Malchiodi 1998).
The mandala originates in ]; its connections with ] help us to see links with ].


=== Daily challenges ===
===House–Tree–Person (HTP)===
Healthy individuals without mental or physical illnesses are also treated with art therapy; these patients often have ongoing challenges such as high-intensity jobs, financial constraints, and other non-traumatic personal issues. Findings revealed that art therapy reduces levels of stress and burnout related to patients' professions.<ref name=":7" />
In this assessment, the patient is asked to draw three separate images; a house, a tree, and a person (Malchiodi 1998)<ref>Needs reference, as do all of these Malchiodi citations, please.</ref>. After the patient has finished the drawings, the therapist asks questions like, "How old is the person in your drawing? What is he or she doing? What is the house made of? What is the weather in this picture?" (Malchiodi 1998). This assessment is done achromatically (using lead pencil). This is a projective assessment and the house, the tree, and person in the drawing represent different aspects of the artist and the way the artist feels about him or herself (Malchiodi 1998).


===Road Drawing=== == Methods ==
Art therapists choose materials and interventions appropriate to their clients' needs and design sessions to achieve therapeutic goals. They may use the creative process to help their clients increase insight, cope with stress, work through ] experiences, increase cognitive, memory and neurosensory abilities, improve interpersonal relationships and achieve greater self-fulfillment. 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 the ] to incorporate historical art and symbols into their work with patients.
In this drawing assessment and therapeutic intervention, the patient is asked to draw a road. This is a projective assessment used to create a graphic representation of the person's "road of life." The road drawing has the potential to elicit spontaneous imagery that represents the client's origins, the history of his or her life process, experiences to date, and intent for the future - even from a single drawing (Hanes, 1995, 1997, 2008). The road's reparative features or its need for "periodic upgrade" can serve as a metaphor for the client's capacity for change and restoration (Hanes, 1995, 1997, 2008).
]
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."<ref>{{cite web|url=http://www.artschools.com|title=Directory of Art Schools & Colleges – ArtSchools.com|access-date=2017-07-09|archive-url=https://web.archive.org/web/20170705214713/http://artschools.com/|archive-date=2017-07-05|url-status=dead}}</ref>


== Art-based assessments ==
==Art Therapy Standards of Practice in the United States==
] page with a ] motif]]
===Board Certification, Registration, and Licensure===
Art therapists and other professionals use art-based assessments to evaluate emotional, cognitive, and developmental conditions. The first drawing assessment for psychological purposes was created in 1906 by German psychiatrist Fritz Mohr.<ref name="Machioldi">Machioldi, C. (1998) Understanding Children's Drawings. Guildford Publications</ref> In 1926, researcher ] created a drawing test to measure the intelligence in children called the ] test which posited the notion that a child who incorporated more detail into a drawing was more intelligent than one who did not.<ref name="Machioldi" /> Goodenough and other researchers concluded the test had just as much to do with personality as it did intelligence.<ref name="Machioldi" /> Several other psychiatric art assessments were created in the 1940s and are still used today.<ref name="Machioldi" />
In the United States, art therapists may become Registered (ATR), Board Certified (ATR-BC), and, in some states, licensed as an art therapist , creative arts therapist (LCAT; NY State only), or professional or mental health counselor (many states).<ref></ref> A Code of Professional Practice, a 17 page document summarizing the standards of practice for professional art therapists. The ATCB Code of Professional Practice is divided into five main categories; General Ethical Principles, Independent Practitioner, Eligibility for Credentials, Standards of Conduct, and Disciplinary Procedures (ATCB 2005).


However, many art therapists eschew diagnostic testing and some writers{{Who|date=January 2024}} question the validity of therapists making interpretative assumptions. Below are some examples of popular art therapy assessments:
For more information on how to become licensed, US art therapists should contact the state licensure board in the state in the US in which they wish to practice. Art therapy students who are preparing for practice in the field should consult with their academic advisers about what courses are necessary to meet board certification and/or licensure requirements. Licensure is generally needed to obtain reimbursement for services as an independent practitioner and in some states, is required by law in order to practice independently.


=== Mandala Assessment Research Instrument ===
In countries other than the US, art therapists should contact governmental or regulatory boards that oversee the practice of mental health or health care professions to identify any specific coursework or education that is needed. Because art therapy is still considered a developing field, most countries do not regulate its practice and application.
In this assessment, a person is asked to select a card from a deck with different ]s, a repetitive symbol originating in ], 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 correlation between the images, pattern and shapes in the mandalas that people draw and the personalities of the artists.<ref>{{Cite journal |last1=Kellogg |first1=Joan |last2=Mac Rae |first2=Margaret |last3=Bonny |first3=Helen L. |last4=di Leo |first4=Francesco |date=1977 |title=The use of the mandala in psychological evaluation and treatment |url=https://psycnet.apa.org/record/1979-11275-001 |journal=American Journal of Art Therapy |volume=16 |issue=4 |pages=123–134 |via=APA PsycNet}}</ref>


=== House–Tree–Person ===
===General Ethical Principles===
]]]
One topic covered in this section describes the responsibility art therapist have to their patients (ATCB 2005). According to the ATCB, art therapists must strive to advance the wellness of their clients, respect the rights of the client, and make sure they are providing a useful service (2005). They cannot discriminate against patient whatsoever, and may never desert or neglect patients receiving therapy<ref name=atcb/>. Art therapist must fully explain to their patients what their expectations of the patients will be at the outset of the professional relationship between the two. Art therapists should continue therapy with a patient only if the client is benefiting from the therapy. It's against the principles established by the ATCB for art therapist to have patients only for financial reasons<ref name=atcb/>.
Modeled after Goodenough's Draw-A-Man Test, childhood psychologist John Buck created the house-tree-person test in 1946.<ref>{{Citation |last1=Gordon |first1=Robert M. |title=House-Tree-Person Test |date=2011 |encyclopedia=Encyclopedia of Clinical Neuropsychology |pages=1266–1269 |editor-last=Kreutzer |editor-first=Jeffrey S. |url=https://doi.org/10.1007/978-0-387-79948-3_2029 |access-date=2024-01-25 |place=New York, NY |publisher=Springer |language=en |doi=10.1007/978-0-387-79948-3_2029 |isbn=978-0-387-79948-3 |last2=Rudd-Barnard |first2=Alexandra |editor2-last=DeLuca |editor2-first=John |editor3-last=Caplan |editor3-first=Bruce}}</ref> In the assessment, the client is asked to create a drawing that includes a house, a tree and a person, after which the therapist asks several questions about each. For example, with reference to the house, Buck wrote questions such as, "Is it a happy house?" and "What is the house made of?" Regarding the tree, questions include, "About how old is that tree?" and "Is the tree alive?" Concerning the person, questions include, "Is that person happy?" and "How does that person feel?"


The house–tree–person test is a projective ], a type of exam in which the test taker responds to or provides ambiguous, abstract, or unstructured stimuli (often in the form of pictures or drawings). It is designed to measure aspects of a person's personality through interpretation of drawings and responses to questions, self-perceptions and attitudes.<ref>{{Cite web|title=House-Tree-Person Test {{!}} Encyclopedia.com|url=https://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/house-tree-person-test#:~:text=The%20primary%20purpose%20of%20the,damage%20or%20overall%20neurological%20functioning.|access-date=2021-04-03|website=www.encyclopedia.com}}</ref>
Another topic of this section discuses the competency and integrity art therapists must possess (ATCB 2005). The ATCB states art therapists must be professionally proficient and must have integrity (2005). Art therapists must keep updated on new developments in art therapy. They are only supposed to treat cases in which they are qualified as established by their training, education, and experience (ATCB 2005). They are not allowed to treat patients currently seeing another therapist without the other therapist's permission (ATCB 2005). Art therapists must also observe patient confidentiality (ATCB 2005).


== Outsider art ==
Other topics covered in this section discuss other responsibilities of art therapists. This responsibilities include, “responsibility to students and supervisees, responsibility to research participants, responsibility to the profession” (ATCB 2005). This section also establishes the rules by which art therapists must follow when making financial arrangements and when they chose to advertise their service (ATCB 2005)


The relation between the fields of art therapy and ] has been widely debated{{By whom|date=January 2024}}. 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.<ref>^ Cardinal, R. (1972), ''Outsider Art'', London</ref><ref>Tosatti, B. (2007) ''Les Fascicules de l'Art brut, un saggio sull'artista Antonio dalla Valle'' (''Paragraphs on Outsider Art. An essay on artist Antonio dalla Valle'')</ref> Outsider art continues to be associated with mentally ill or developmentally disabled individuals.
===Independent Practitioner===
Independent practitioners are art therapists who are practicing independently or responsible for the service they are providing to paying clients. This section covers the credentials for independent practitioners.


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. However, critics of the outsider art movement suggest that crediting an artist's work to an impairment is reductive.<ref>Navratil, Leo (1996) ''Art Brut & Psychiatry'', Raw Vision, Geneva</ref><ref>Bedoni, Giorgio; Tosatti, Bianca (2000),''Arte e psichiatria. Uno sguardo sottile'' (''Art and psychiatry. A thin look''), Mazzotta, Milano</ref>
Independent practitioners must provide a safe and functional environment to conduct art therapy sessions (ATCB 2005). According to ATCB, "this includes but is not limited to: proper ventilation, adequate lighting, access to water supply, knowledge of hazards or toxicity of art materials and the effort need to safeguard the health of clients, storage space for art projects and secured areas for any hazardous materials, monitored use of sharp objects, allowance for privacy and confidentiality, and compliance with any other health and safety requirements according to state and federal agencies which regulate comparable businesses" (2005).

This section also establishes the standards for independent practitioners to follow when dealing with financial arrangements.. Basically it states that the art therapist must provide a straight forward contract to the payer of the therapy sessions<ref name=atcb/>. It also states that the art therapist must not deceive the payers or exploit clients financially<ref name=atcb/>.

The last topics this section sets standards for address treatment planning and documentation (ATCB 2005). Art therapists must provide a treatment plan that assists the patients to reach or maintain the highest level of quality of life and functioning<ref name=atcb/>. This involves using the clients’ strengths to help them reach their goals and address their needs. Art therapists are also required to record and take notes that reflect the proceedings of the events of therapy sessions<ref name=atcb/>. According to ATCB, the following is the minimum of which must be documented: “the current goals of any treatment plan, verbal content of art therapy sessions relevant to client behavior and goals, artistic expression relevant to client behavior and goals, changes (or lack of change) in affect, thought process, and behavior, suicidal or homicidal intent or ideation” (2005) and a summary of the "clients response to treatment and future treatment recommendations" (2005).

===Eligibility for Credentials===
This section of the ATCB Code of Professional Practice outlines the process by which art therapy students receive their credentials. It discusses the standards for eligibility and describes the application process. It also states that the ATCB certificates are the property of the ATCB and that any art therapist who loses their certificate and still claim to have ATCB credentials can be punished legally. It also discusses the procedure to follow when accused of wrong doing related to art therapy. Lastly, it discusses the wrong doings related to art therapy that therapists can be convicted for with a felony or another criminal conviction. These wrong doings include rape, sexual abuse, assault, battery, prostitution, or the sale of controlled substances to patients.

===Standards of Conduct===
This ''section of the ATCB Code of Professional Practice addresses in detail confidentiality, use of clients’ artwork'', professional relationships, and grounds for discipline<ref name=atcb>ATCB Code of Professional Practice, 2005</ref>.

Art therapists are not permitted to disclose information about the clients’ therapy sessions. This includes “all verbal and/or artistic expression occurring within a client-therapist relationship” (ATCB 2005). Art therapist are only allowed to release confidential information if they have explicit written consent by the patient or if the therapist has reason to believe the patient needs immediate help to address a severe danger to the patients life<ref name=atcb/>. Also, therapists are not allowed to publish or display any of the patients work without the expressed written consent of the patient<ref name=atcb/>.

The standards of a professional relationship between art therapists and clients are covered in this section. Within a professional relationship, art therapists are banned from engaging in exploitative relationships with current and former patients, students, inters trainees, supervisors, or co-workers<ref name=atcb/>. The ATCB defines an exploitative relationship as anything involving sexual intimacy, romance, or borrowing or loaning money<ref name=atcb/>. Within professional relationships, therapists are to do what they feel is best in the clients interest, shall not advance a professional relationship for their own benefit, and shall not steer their patients in the wrong direction<ref name=atcb/>.

The breaking of any of the standards established in this section is grounds for discipline<ref name=atcb/>.

===Disciplinary Procedures===
The content contained in this section of the ATCB Code of Professional Practice specifically discusses in legal and technical detail the entire disciplinary procedures for wrong doings in art therapy (2005). Main topics covered in this section cover: “submission of allegations, procedures of the Disciplinary Hearing Committees, sanctions, release of information, waivers, reconsideration of eligibility and reinstatement of credentials, deadlines, bias, prejudice, and impartiality”<ref name="atcb"/>

While the ATCB oversees disciplinary procedures for art therapists, if an art therapist is licensed, the state board through which the art therapist is licensed carries out disciplinary action for violations or unethical practice.

Effectiveness
Art Therapy has bona fide research in various venues: phenomenological, heuristic, quantitative, qualitative, etc. Numerous articles, books, NIH reports, etcetera are replete with information that attests to the efficacy of Art Therapy as evidence-based, effective treatment. However, it has been noted that Art Therapy's effectiveness is not well understood through unsubstantiated claims, uncited research, or vague generalizations.

==Broad Uses of Art Therapy==

===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 <ref name="stuckley">Stuckley, Heather L, and Jeremy Nobel. "The Connection Between Art, Healing, and Public Health: A Review of Current Literature." American Journal of Public Health (Feb2010): 254-263. Web. 9 Nov 2010.</ref>.

Hospitals have started studying the influence of arts on patient care and found that participants in art programs have better vitals and less 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. <ref name="stuckley"/>

===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.

Studies have also shown how the emotional destress 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 <ref name="stuckley"/>

===Disaster Relief===
Art therapy has been used in a variety of traumatic experiences, including disaster relief and crisis intervention <ref>Appleton, V. (2001). Avenues of hope: Art therapy and the resolution of trauma. Art Therapy: Journal of the American Art Therapy Association , 18 (1), 6-13.</ref><ref>Eaton, L. G., Doherty, K. L., & Widrick, R. M. (2007). A review of research and methods used to establish art therapy as an effective treatment method for traumatized children. The Arts in Psychotherapy , 34, 256-262.</ref><ref>Kazim, A. (2002, Fall). Traumatic events and children: How early childhood educators can help. Association for Childhood Education International.</ref><ref>Metzl, E. S. (2009). The role of creative thinking in resilience after Hurricane Katrina. Psychotherapy of Aesthetics, Creativity and the Arts , 3 (2), 112-123.</ref><ref>Orr, P. P. (2007). Art therapy with children after a disaster: A content analysis. The Arts in Psychotherapy , 34, 350-361.</ref>. 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 <ref>Davidhizar, R., & Shearer, R. (2002). Helping children cope with public disasters. The American Journal of Nursing , 102 (3), 26-33.</ref><ref>Malchiodi, C. A. (2007). The art therapy sourcebook. United States: McGraw-Hill.</ref><ref>Seligman, Z. (1995). Trauma and drama: A lesson from the concentration camps. The Arts in Psychotherapy , 22 (2), 119-132.</ref><ref>Wadeson, H. (2010). Art Psychotherapy (2nd ed.). Hoboken, NJ: John Wiley& Sons, Inc.</ref>


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* {{Cite journal|last1=Wang|first1=Qiu-Yue|last2=Li|first2=Dong-Mei|date=2016-09-01|title=Advances in art therapy for patients with dementia|journal=Chinese Nursing Research|language=en|volume=3|issue=3|pages=105–108|doi=10.1016/j.cnre.2016.06.011|issn=2095-7718|doi-access=free}}


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Latest revision as of 21:40, 31 October 2024

Creation of art to improve mental health
An art therapist watches over a person with mental illness during an art therapy workshop in Senegal.

Art 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 encourages creative expression through painting, drawing, or modelling. It may work by providing a person with a safe space to express their feelings and allow them to feel more in control over their life.

There are three main ways that art therapy is employed. The first one is called analytic art therapy. Analytic art therapy is based on the theories that come from analytical psychology, and in more cases, psychoanalysis. Analytic art therapy focuses on the client, the therapist, and the ideas that are transferred between both of them through art. Another way that art therapy is utilized is art psychotherapy. This approach focuses more on the psychotherapists and their analyses of their clients' artwork verbally. The last way art therapy is looked at is through the lens of art as therapy. Some art therapists practicing art as therapy believe that analyzing the client's artwork verbally is not essential, therefore they stress the creation process of the art instead. In all approaches to art therapy, the art therapist's client utilizes paint, paper and pen, clay, sand, fabric, or other media to understand and express their emotions.

Art therapy can be used to help people improve cognitive and sensory motor function, self-esteem, self-awareness, and 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.

History

In the history of mental health treatment, art therapy (combining studies of psychology and art) is still a relatively new field. This type of unconventional therapy is used to cultivate self-esteem and awareness, improve cognitive and motor abilities, resolve conflicts or stress, and inspire resilience in patients. It invites sensory, kinesthetic, perceptual, and sensory symbolization to address issues that verbal psychotherapy cannot reach. 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.

Art therapy as a profession began in the mid-20th century, arising independently in English-speaking and European countries. Art had been used at the time for various reasons: communication, inducing creativity in children, and in religious contexts. 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.

Edward Adamson, "the father of art therapy in Britain"

The artist Edward Adamson, demobilized after World War II, joined Adrian Hill to extend Hill's work to the British long stay mental hospitals. Adamson studied connections between one's artistic expression and their release of emotions. One way in which Adamson practiced Art Therapy was through the depiction of patients' emotions in the art they created. In order to gain a deeper understanding of how the mind is affected by mental illness, Adamson's Collection started as a way to create an environment where patients felt comfortable expressing themselves through art. This art would then be analyzed by mental health professionals. Other early proponents of art therapy in Britain include E. M. Lyddiatt, Michael Edwards, Diana Raphael-Halliday and Rita Simons. 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, Sweden, and Egypt. International networking contributes to the establishment of standards for education and practice.

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.

Definitions

There are various definitions of the term art therapy.

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 communication." They also add that "clients who are referred to an art therapist need not have previous experience in art, the art therapist is not primarily concerned with making an aesthetic or diagnostic assessment of the client's image."

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."

The website Psychology.org defines art therapy as: "a tool therapists use to help patients interpret, express, and resolve their emotions and thoughts. Patients work with an art therapist to explore their emotions, understand conflicts or feelings that are causing them distress, and use art to help them find resolutions to those issues."

Uses

Art media commonly used in art therapy.

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, such as in art studios and creativity development workshops. Licensing for art therapists can vary from state to state with some recognizing art therapy as a separate license and some licensing under a related field such a professional counseling or mental health counseling. Art therapists must have a master's degree that includes training in the creative process, psychological development, and group therapy, and they must complete a clinical internship. 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 Clinical mental health counseling, social workers, psychologists, and play therapists, optionally combine artmaking with basic psychotherapeutic modalities in their treatment. Therapists may better understand a client's absorption of information after assessing elements of their artwork.

While there is still little consistent research about art therapy, preliminary surveys and studies have suggested its efficacy in relieving symptoms and improving quality of life.

Acute illness

A review of the literature has shown the influence of art therapy on patient care and found that participants in art therapy programs have less difficulty sleeping, among other benefits. Studies have found that merely observing a landscape photograph 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 increase optimism in patients.

Cancer

Many studies have been conducted on the benefits of art therapy on cancer patients. Art therapy has been found useful for supporting patients during the stress of surgery, radiation, and chemotherapy treatment.

In a study involving women facing cancer-related difficulties such as fear, pain, and altered social relationships, 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.

Another study showed those who participated in these types of activities were discharged earlier than those who did not participate. Even relatively short-term art therapy interventions may significantly patients' emotional states and symptoms.

A review of twelve studies investigated the use of art therapy in cancer patients by investigating the symptoms of emotional, social, physical, and spiritual concerns 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 suggested that art therapy can provide a sense of "meaning-making" through 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, ability to discuss emotional and physical health, general well-being, and increased quality of life in cancer patients.

Dementia

Art therapy has been observed to have positive effects on patients with dementia, with tentative evidence supports benefits with respect to quality of life. Although art therapy helps with behavioral issues, it does not appear to reverse degenerating mental faculties. It is important that the art tools are easy to use and relatively simple to understand. Art therapy had no clear results on affecting memory or emotional well-being scales. However, Alzheimer's Association states that art and music can enrich people's lives and allow for self-expression. D.W. Zaidel, a researcher and therapist at VAGA, claims that engagement with art can stimulate specific areas of the brain involved in language processing and visuo-spatial perception, two cognitive functions which decline significantly in dementia patients.

An art therapy patient's work

Autism

Art therapy is increasingly recognized to help address challenges of people with autism. Art therapy may address core symptoms of autism spectrum disorders by promoting sensory regulation, supporting psychomotor development, and facilitating communication. Art therapy is also thought to promote emotional and mental growth by allowing self-expression, visual communication, and creativity. Most importantly, studies have found that painting, drawing, or music therapies may allow people with autism to communicate in a manner more comfortable for them than speech. In Egypt, the Egyptian Autism Society implemented Art Therapy as a way to grow self esteem and quality of life in children. They incorporated basket weaving, a common cultural art activity, in art therapy programs. These art therapy activities were part of studies that focused on self esteem and proved that art therapy significantly, "...increased inner strength and daily living skills and reduced symptoms of emotional disorders...". Other forms of therapy that tend to help individuals with autism include play therapy and ABA therapy. In India, a study was done to show the effectiveness of art therapy by using both a controlled and experimental group on nine individuals with autism. One of the researchers, Koo, stated, "The positive changes were notable in the participants' cognitive, social, and motor skills".

Schizophrenia

A 2005 systematic review of art therapy as supplemental treatment for schizophrenia found unclear effects. Group art therapy has been shown to improve some symptoms of schizophrenia. While studies concluded that art therapy did not improve Clinical Global Impression or Global Assessment of Functioning, they showed that the use of haptic art materials to express one's emotions, cognitions, and perceptions in a group setting lowered depressing themes and may improve self-esteem, enforce creativity, and facilitate the integrative therapeutic process for people with schizophrenia.

Post-traumatic stress disorder

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. Art therapy in addition to psychotherapy offered more reduction in trauma symptoms than just psychotherapy alone.

Art therapy may be an effective way to access and process traumatic memories that were encoded visually in clients. Through art therapy, individuals 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. Repetition of directives reduces anxiety, and visually creating narratives helps clients build coping skills and balanced nervous system responses. This has been proven effective only in long-term art therapy interventions.

Depression

"Depression is considered a mood disorder characterized by distorted or inconsistent emotional states that interfere with an individual’s ability to function". Since art therapy was originated in the psychotherapy field, just like the other mental-health related issues art therapy has been a new technique used to help individuals with depression and anxiety. Art therapy is not solely just using the basic traditional mediums of art, it can range from painting, dancing, writing, knitting, etc

Art can be a powerful tool for relieving depression symptoms because it can instill confidence, create room for expression, and foster creativity, which has been linked to decreases in anxiety, rigid behaviors, and even physical ailments, such as heart disease and cancer. Art allows individuals to process emotions they might not have known they were dealing with or help express emotions they weren't verbally able to communicate. Creativity and creation can both be capable of lending tremendous confidence to an individual, which can lift some of the symptoms of depression.

In children

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.

In veterans

Art therapy has an established history of being used to treat veterans, with the American Art Therapy Association documenting its use as early as 1945. As with other sources of trauma, combat veterans may benefit from art therapy to access memories and to engage with treatment. A 2016 randomized control trial found that art therapy in conjunction with cognitive processing therapy (CPT) was more beneficial than CPT alone. Walter Reed Army Medical Center, the National Intrepid Center of Excellence and other Veteran Association institutions use art therapy to help veterans with PTSD.

Bereavement

According to the American Art Therapy Association, art therapy is "particularly effective during times of crisis, changes in circumstance, trauma, and grief." Bereavement is one challenging time where clients find it difficult to verbalize their feelings of loss and shock, and so may use creative means to express their feelings. For example, it has been used to enable children to express their feelings of loss where they may lack the maturity to verbalize their bereavement.

Eating disorders

Art therapy may help people with anorexia with associated depression and weight management. Traumatic or negative childhood experiences can result in unintentionally harmful coping mechanisms, such as eating disorders. Art therapy may provide an outlet for exploring these experiences and 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.

Daily challenges

Healthy individuals without mental or physical illnesses are also treated with art therapy; these patients often have ongoing challenges such as high-intensity jobs, financial constraints, and other non-traumatic personal issues. Findings revealed that art therapy reduces levels of stress and burnout related to patients' professions.

Methods

Art therapists choose materials and interventions appropriate to their clients' needs and design sessions to achieve therapeutic goals. They may 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. 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 the Archive for Research in Archetypal Symbolism to incorporate historical art and symbols into their work with patients.

An image depicting an art therapy method used by children.

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."

Art-based assessments

A coloring book page with a mandala motif

Art therapists and other professionals use art-based assessments to evaluate emotional, cognitive, and developmental conditions. The first drawing assessment for psychological purposes was created in 1906 by German psychiatrist Fritz Mohr. In 1926, researcher Florence Goodenough created a drawing test to measure the intelligence in children called the Draw-A-Man test which posited the notion that a child who incorporated more detail into a drawing was more intelligent than one who did not. Goodenough and other researchers concluded the test had just as much to do with personality as it did intelligence. Several other psychiatric art assessments were created in the 1940s and are still used today.

However, many art therapists eschew diagnostic testing and some writers question the validity of therapists making interpretative assumptions. Below are some examples of popular art therapy assessments:

Mandala Assessment Research Instrument

In this assessment, a person is asked to select a card from a deck with different mandalas, a repetitive symbol originating in Buddhism, 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 correlation between the images, pattern and shapes in the mandalas that people draw and the personalities of the artists.

House–Tree–Person

Child's stick-figure drawing of a person.
Four-year-old's drawing of a person

Modeled after Goodenough's Draw-A-Man Test, childhood psychologist John Buck created the house-tree-person test in 1946. In the assessment, the client is asked to create a drawing that includes a house, a tree and a person, after which the therapist asks several questions about each. For example, with reference to the house, Buck wrote questions such as, "Is it a happy house?" and "What is the house made of?" Regarding the tree, questions include, "About how old is that tree?" and "Is the tree alive?" Concerning the person, questions include, "Is that person happy?" and "How does that person feel?"

The house–tree–person test is a projective personality test, a type of exam in which the test taker responds to or provides ambiguous, abstract, or unstructured stimuli (often in the form of pictures or drawings). It is designed to measure aspects of a person's personality through interpretation of drawings and responses to questions, self-perceptions and attitudes.

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 1972. Outsider art continues to be associated with mentally ill or developmentally disabled individuals.

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. However, critics of the outsider art movement suggest that crediting an artist's work to an impairment is reductive.

See also

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