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By Noah Hass-Cohen, M.A., A.T.R.-B.C., L.M.F.T. (Los Angeles, 1999, 2001, 2002)
The purpose of the following article is to provide a brief introduction to Art Therapy,
a field of psychotherapy, that recognizes the essential role that art and nonverbal expression play in our lives.
Art is an ancient mode of expression that preceded the evolution of verbal language. Archaeologists often look
to the art of ancient cultures to determine and understand the environment of earlier times. Native American and
African shamans in early cultures used art in healing rituals. Psychotherapists have also utilized the process of
art making as an expression of inner meanings and conflicts. Art has been used as psychotherapy from the early days
of psychology. In Western Europe in the late 1800s, Prinzhorn (1995) a German psychiatrist, collected as many as 6000
works by psychiatric patients. Prinzhorn considered these art works individual expressions of the universal urge to
create. With the emergence of psychoanalytical theory, Freud and Jung explained how images and symbols are part of
our conscious and unconscious make up (Jung, 1972). Art therapy has developed as a therapeutic modality since 1966
and has evolved as a separate discipline that can be used as a treatment approach in itself, as an adjunct to verbal
therapy or as a diagnostic and assessment tool (Junge & Asawa, 1994).
In the United States, Naumberg (1966) and Kramer (1971) are considered the pioneering mothers of Art Therapy.
Naumberg presented a psychodynamic - psychoanalytic approach to using art in therapy. She advocated art as a gateway
to the unconscious and as a support for free association and interpretation. Kramer believed that the art process
itself and creativity are healing. She emphasized how the art product promotes sublimation as a therapeutic intervention.
Art therapy approaches have traditionally echoed psychotherapy theories to include psychoanalytic, psychodynamic, Jungian,
transpersonal, studio art, humanistic, general systems, strategic, postmodern and developmental foci (Rubin, 2001).
Without agreeing on a specific psychotherapy theory and regardless of orientation, these approaches all have in common
art in therapy as the main curative factor (Norcross and Newman 1992). Therefore most modern art therapists usually utilize
a systemic eclectic approach that is not limited by a single orientation and utilize techniques and interventions that fit the
best interests of their clients. Of recent interest are mind body approaches to art therapy, neuro-art therapy, which
facilitate an explanation of art therapy treatment effectiveness and expand the boundaries of the field to include
contemporary information from neuropsychobiology, attachment theory, trauma approaches and non linear dynamic systems
theory (Hass-Cohen, 2002). A contemporary dialogic-dialectical approach to psychotherapy (Carere-Comes 2002) may offer
art therapy the possibility to re-invent its language and resolve the tension between theory and practice that has
characterized much of its history.
The National American Art Therapy Association provides a definition of the profession that is inclusive of the
total body of knowledge regarding human development and psychology:
Various approaches and techniques are utilized in art therapy depending on the client's treatment course.
For example, the therapist may ask clients to make a free drawing. This kind of technique allows for unconscious
material to surface and enhances creative expression (Naumberg, 1966). In structured art tasks and art directives,
the clinician elicits client responses or asks clients to use materials in order to address specific clinical issues
and needs. Art Therapy suggestions and directives are an integral part of treatment. Directives are embedded in the
narrative and can be simple and general or complex and specific (Riley & Malchiodi, 1994). The language and the degree
of structure suggested by the art therapy directive is a refection of the therapist's orientation. Art therapy can be
integrated into the client's daily life in the form of spontaneous drawing or journaling that the client creates at home
and brings to the session.
The artwork and the corresponding feelings may be reviewed together with the therapist so that new meaning and
understanding are integrated. Feelings or memories that are difficult to look at or understand may be explored
both verbally and visually. The details of the art making and its relationship to the clients are important clues
to difficult issues such as depression, loss, social trauma and developmental changes that may be too painful or
overwhelming to communicate with words alone. The creation of art, with the support of a trained therapist support,
allows fearful or disturbing needs, feelings and issues to be recognized and worked through gently and respectfully.
One of the most interesting phenomena is how the art product becomes a symbol of the relationship between therapist
and client (Robbins, 1980). Most art therapy approaches advocate that using words exclusively may be too focused and
limited to express and examine the multiplicity of feelings and images. Creating our images in Art Therapy allows us
to access and know our beliefs, fantasies and alternate possible realities of change that can be instrumental in
healing from distress.
Art increases communication between people who are participating in therapy since the combination of the arts
and of psychology creates more opportunities for expression and recovery (Wadeson, 1980). Creating art in psychotherapy
is initiated and controlled by the client and as a result, supports a decrease of psychological distress and all increase
in feelings of pleasure, mastery, accomplishment, self growth and self nourishment. A recurring concept in art therapy
is art as therapy. This means that, depending on the client's personality, inch nations and life situation, the art
process itself may be sufficiently healing and does not require verbal reflection or interpretation. Through the creation
of images, marks, drawings, symbols and collages, natural resistance can be overcome and forgotten strengths and growth are
rediscovered.
The art therapist's office and space play an important part in this process. It may be a studio completely dedicated
to art making and processing which supports drawing, sculpting or otherwise symbolizing thoughts and feelings. Art
materials, appropriate work surfaces and respect for the confidential artwork, communicate to clients’ full acceptance
without judgment and support the development of expressive skills that are essential to healing.
Art therapy is used in a variety of inpatient and outpatient psychiatric facilities and private practice settings and
works well with adults as well as with children and families. It is an effective tool for people of all ages who are
interested in using and exploring art to heal themselves (Lowenfeld & Brittain 1987). Children and adolescents use art
naturally as a language, as the ability to draw is learned before the ability to speak. Children begin with scribbles
and lines to express their feelings and needs through art even before verbal language is learned (Di Leo, 1996). Linesch
(1988) recommends art therapy as a clinical treatment modality of choice for adolescents. She believes that creativity
and self-expression provide outlets for fantasy that are important aids in the difficult tasks facing the adolescent.
Art therapy is a safe way for children and adolescents to express themselves since there is no pressure to perform or
compete with others. Its natural, confidential nature provides a non-threatening way to release feelings and pent-up
emotions for which children may not have other outlets. The integration of visual and verbal expression of all feeling
supports spontaneity and acceptance, encourages the child's innate intuition and creativity and supports her feelings
of mastery and confidence. It is especially useful for children and adolescents in times of family and individual crisis
and or social change. During the 1992 Los Angeles Riots, this author has observed repeated spontaneous use of blue
crayon and blue paint by many children. The children, who were traumatized by fire, used both color and medium as a
means to cool and heal physical and emotional pain. The child's artwork is a safe and expressive bridge between the
parents, their child, the therapist and their community.
For adults, there are various emotional issues that may be encountered when using art in therapy. For example, there
might be a fear of the creative process. As part of the socialization process, we may have been taught to believe that
we have no skills or talents. While art therapy may be especially attractive to the visually and tactically inclined
client, it cannot be emphasized enough that artistic skills are not a necessary requirement. This is an opportunity to
re-grow our creative life skills. Showing and voicing feelings, conflicts and solutions is easily possible through the
simple use of abstract forms colors or cutouts.
Families can benefit from the inclusion of art in therapy since family drawing help clarify the complex dynamics between
parents and children while addressing the different perceptions that each faintly member has of the family situation.
Family art work enhances the expression of feelings in the family and may provide for alternate ways of interacting and
relating to each other in the family reality despite conflicts and difficulties. Landgarten (I98I, I987) asks the family
to draw together or to create simple three-dimensional figures that represent their family. This simple directive
facilitated by the therapist, constructs a picture for the family and a new common experience for the family. Riley
and Malchiodi (1994) conceptualize the picture as a metaphorical family representation. The family drawings - pictures
are an international language that all family members can easily to understand, explore and use to discover new alternative
endings to difficulties and challenges. Art therapy tasks help families to address communication issues, to have a
different experience together and to co construct a new picture.
Art therapy continues to have an emerging role within the medical field. Siegel (1986) asks cancer patients to create
images of their treatment in order to discover and relate to their deeply held beliefs about treatment options that
demonstrates that the belief of the patient strongly affects the outcome of traditional medical therapies. Achterberg,
Dossey and Kolkmeier (1994) describe role of imagery in health and healing and emphasize the importance of matching
types of imagery with different physiological and psychological manifestations. McNiff (1992) who embraces a studio
art therapy approach views the making of art as medicine and the art itself as medicinal.
To summarize, this article has attempted to briefly present the history and development of art therapy, the major art
therapy approaches and, most importantly, the benefits of art therapy. Creating art in therapy helps accept and fulfill
inner needs and provides us with a better understanding of ourselves in our environment. Creativity brings a sense of
joy and accomplishment even when there is pain in the reflecting process and supports the expression of needs and experiences.
We are born with the innate need to make marks, images symbols and visual dialogues that can be pointers toward relief,
healing and change. Art therapy helps us to participate deeply, effectively and safely in psychotherapy.
Noah Hass-Cohen is core faculty and Art Therapy Program Director at Phillips Graduate Institute. She maintains a private
art therapy practice at the Los Angeles Institute for Art Therapy where she provides client services, supervision and
consultation.
Achterberg J., Dossey B., & Kolkmeier L. (1994). Rituals of healing: Using imagery for health and wellness. New York: Bantam Books.
American Art Therapy Association (1996). Art therapy: Definition of the profession. Art Therapy, Journal of the American Art Therapy Association 13 (1). (No page number).
Carere-Comes T. (2002) Presentation at the SEPI Conference: A new paradigm: The dialogic-dialectical approach. San Francisco, May 2002.
Di Leo, J. H. (1996). Young children and their drawings. New York: Brunner/Mazel.
Hass-Cohen N. (2002). Presentation at the American Art Therapy Association Conference. New Mexico, November 2001.
Jung C. I. (1972). Mandala symbolism. New Jersey: Princeton University Press.
Junge M., & Asawa (1994). A history of art therapy in the United States. Illinois: American Art Therapy Association.
Kramer E. (1971). Art as therapy with children. New York: Schocken.
Landgarten H. (1981). Clinical art therapy: A comprehensive guide. New York: Brunner/Mazel.
Landgarten H. (1987). Family art psychotherapy: A clinical guide and casebook. New York: Brunner/Mazel.
Linesch D. (1988). Adolescent art therapy. New York: Brunner/Mazel.
Lowenfeld V. & Brittain W. L. (1987). Creative and mental growth. New York: Macmillan.
McNiff. S. (1992). Art as medicine: Creating a therapy of the imagination. Boston: Shambhala
Naumburg M. (1966). Dynamically oriented art therapy: Its principles and practice. New York. NY: Grune & Stratton. Reprinted in 1987. Chicago IL: Magnolia Street.
Prinzhorn H. (1995). Artistry of the mentally ill. (E. Von Brockdorff, Tran.) New York. NY: Springer Verlag. (Originally published in 1922 as Bildnerie der Geisteskranken Berlin: Verlag Julius Springer.)
Riley, S. & Malchiodi C. (1994). Integrative approaches to family art therapy. Chicago, IL: Magnolia Street Publishers.
Robbins A. (1980). Expressive therapy: A creative arts approach to depth oriented therapy. New York: Human Science Press.
Rubin, J. A. (1987). Approaches to art therapy: Theory and technique. New York: Brunner/Mazel.
Siegel S. (1986). Love, medicine and miracles. Great Britain: Rider.
Wadeson. H. (1980). Art psychotherapy. New York: John Wiley & Sons.
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