Art therapy
Diane Waller
The fundamental principles of art therapy/art psychotherapy
Definitions
Descriptions of art therapy from two of the oldest and largest professional associations, the British Association of Art Therapists and the American Art Therapy Association refer to: the use of art materials for self-expression and reflection in the presence of a trained art therapist. Art therapy uses the flexible, creative problem-solving potential of art-making to improve and enhance the physical, mental, and emotional well-being of individuals of all ages. The relationship between the therapist, client, and their artwork is of central importance. Art therapy can be used on a one-to-one and group basis.
Art therapy (or art psychotherapy, both titles are protected by law) in the United Kingdom is firmly rooted in psychodynamic and humanistic concepts and practices appropriate to public sector settings, and adapted to the social and mental health of the client. It is a broad-based discipline, involving substantial knowledge of the visual arts, individual and group psychotherapy, social and communication sciences, and the impact of culture on health.(1)
Main premises
That visual image-making is an important aspect of the human learning process;
That art made in the presence of an art therapist may enable a person to get in touch with feelings that cannot easily be expressed in words;
That the creative process helps people to resolve conflicts and problems;
That art can act as a ‘container’ for powerful emotions and be a means of communication between client(s) and therapist;
That the image can serve to illuminate the transference in the case of a psychodynamic approach.
Engagement in image-making is of central importance although clients do not need any prior experience of or skill in art, as the aim is not to produce a ‘good’ piece of art that can be exhibited. The images made in art therapy may embody thoughts and feelings, be a bridge between the ‘inner world’ and outer reality, be a mediator between unconscious and conscious, hold and symbolize past, present, and future aspects of a client’s life. Ambivalence and conflict can be stated and contained within an image. In art therapy the client tries to give form to what seem to be inexpressible or unspeakable feelings, which they can then share with the art therapist.
The focus of the transference (bringing feelings from the past into the present), can be onto the art object rather than to the therapist directly, adding a ‘third dimension’ to the therapeutic process.(2,3,4)
An important aim, as with all psychotherapy, is to bring about change. Positive change may occur when a client can direct their strong feelings into making art and when the therapist helps the client to tell their story through the art. How, when, and if change occurs obviously depends on their capacity to engage with this process and needs much time and patience while the client builds confidence. For verbally inarticulate clients, or those who use words defensively, engagement with the art materials gives the opportunity to understand self and environment, communicate emotions to the therapist, receive feedback, and encouragement.
The historical development of art therapy in the United Kingdom, United States, and Europe
There are parallels in the development of art therapy in the United Kingdom and United States, early history being shared with that of group analytic psychotherapy as a phenomenon of the Second World War rehabilitation movement.(5,6,7) In the 1940s and 1950s art therapists were simply artists working in hospitals who emphasized the healing role of art. In 1963, the British Association of Art Therapists was formed from this small group of artists and art educators, who set themselves the task of defining and extending the activity, preparing standards for training in the higher education sector, informing the public and other professionals of the potential of art therapy, and working towards a career and salary structure in the National Health Service (NHS). The first postgraduate trainings began in the late 1960s. The positive response of the NHS and other organizations to art therapy’s beneficial impact led to a petition being made for statutory regulation under the old Council for Professions Supplementary to Medicine in 1991, approved in 1997, after which art therapists, along with music and dramatherapists had their own federal Board at the Council. They were transferred to the Health Professions Council in 2001. Training in the United Kingdom is now at Master’s level, in four universities in England, one in Scotland, one in Northern Ireland, and usually follows a degree in art and design. Study of psychotherapeutic principles, visual art, and practical placement are important elements in the training. Elsewhere in Europe the picture is very different with some countries sharing the UK standards, others having no training or a great variety of trainings in both the public and private sector. The United States, Australia, and New Zealand have the same requirements of a Master’s level qualification in order to practice. (See website references for more information.)
The development of art therapy with specific client groups
One of art therapy’s main advantages as a treatment is its flexibility. It can be used with many different client groups and some of these are discussed as follows:
Children
Many founder art therapists in the United Kingdom and United States were art teachers and were influenced by the ‘child-centred’ approach to art education that developed in the 1930s. American pioneer Kramer considered that it was art activity itself that had inherent healing properties; and that within a secure relationship with the therapist, a child could sublimate their destructive and aggressive feelings by producing an object, which would symbolize those feelings, prevent them being acted out and lead to more insight and control. This often led to change in behaviour.(8)
Others pioneers from the United States gave examples of how group work could enable angry and shameful feelings to be shared among the group members as well as the therapist, to the relief of the child as well as his peers.(9) Many art therapists specializing in work with children attest to the importance of play and to the role of art materials in allowing regression in the form of mess-making. This seems to be particularly beneficial for children who have suffered sexual abuse(10,11,12) due to the loosening of control that happens when a child becomes deeply immersed in the physical process of painting and is able to lower defences as a result. Materials may be smeared, spilled, and wasted and it is important that the therapist maintains control of the boundaries and is able to tolerate a high level of anxiety as the child attacks the therapeutic space.(13)
Art therapy is helpful for children suffering from chronic constipation, faecal overflow soiling, and also ‘antisocial behaviour’ and Aldridge(14) pointed out the relationship she observed between food, painting, and faeces while working with neglected and abused children in the context of a social services Unit and how mess-making was important in their creative development. Ambridge(15) discussed how images may be used to reflect mother– child relationships with children who have been sexually abused and are often so traumatized that they cannot speak about their experiences.
The physical involvement in the art materials in enabling regression and essentially in receiving containment and acceptance from the therapist is very important to all the children mentioned above.
Dubowski(16,17) used a Developmental Art Therapy approach in research with children with learning difficulties, aiming to help the child to achieve his or her maximum potential. Understanding creativity and mark-making in early childhood is as important in this model as understanding psychodynamics. Studies made by Kellog(18) of over 100 000 children’s scribbles inform our understanding of the developmental process leading to production of meaningful marks. Visual problem-solving through picturemaking is developed between the age of about 18 months (when hand-eye co-ordination has developed to the extent that they can grasp an implement and direct it to a picture surface while attending to the activity) and 4 years, by which time most have developed the capacity to make recognizable pictures endowed with symbolic meaning.(19) This model draws on insights from art educationists, most recently Matthews.(20,21) Art therapists have also contributed to the emotional and educational development of children with Autism.(22,23)
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