Art Therapy is an integrative, holistic, evidence-based practice that treats clients using applied psychological theory, the creative process, and active art-creation to engender a psychotherapeutic relationship. It is holistic in nature, providing projective assessments to compliment client treatment and clinical team objectives. It offers a safe space for interpersonal engagement along psychotherapeutic lines. Rooted in psychoanalytic and object relations theory, Art Therapy combines verbal and somatic modalities to explore feelings, ascertain behavioral management skills, resolve conflict, increase self-esteem and resilience, and exercise effective coping skills.
Psychodynamic art therapy embodies a somatic methodology which engages bodily senses to detect, extract, and process information. Often, distress is successfully managed through the art material which serves as an intermediary object. The art therapeutic process allows for the administration of either exploratory or directive interactions. Since Art Therapy engages the senses, an art therapist is trained to use art-materials carefully to elicit specific responses from the client which can bring out unexpected early memories and sensations. Art therapy provides a non-threatening means of addressing early attachment issues that may be inaccessible through verbal therapy alone. The art may either support any verbal dialog or appear diametrically opposed to it, adding fresh viewpoints on internal relationships. This information is then processed between client and therapist to elucidate the client narrative. Art therapy helps the client form a new story that supports action, resilience, and self-governance.
Art-based assessment instruments are used by art therapists to ascertain a client’s level of functioning; formulate treatment goals; and evaluate strengths and obstacles. From an object-relations perspective, Hinshelwood (1991) suggests considering clinical assessment material in three main categories: the current life situation; infantile object-relations; and assessor relationship (or the commencement of transference). Clinical art material produced during an art therapy assessment presents visual signatures, linked to these defenses associated with those categories, which once understood, can be re-ordered into a unified narrative. While collaboration between therapist and client is encouraged, an interpretation from a specific vantage point is not an outright explanation of image significance.
EXPANDING TREATMENT OPTIONS
Art Therapy offers treatment options in unexpected places. For example, traumatic memory is stored visually and somatically (van der Kolk, 2015). For clients with PTSD and complex repetitive childhood trauma, a client may express himself more fluidly through visual means. This allows the client to communicate where there are no words and reduces the need for lengthy narrative recounting a painful event which could result in re-traumatization. Therapeutic art-making manages complex emotions, generates feelings of mastery, supporting cognitive and emotional agility. Expressivity and creativity significantly aid the trauma-clinicians’ therapeutic objectives (Haas-Cohen, 2016). Benefits include increased relaxation and future-focused confidence and a reduction of intrusive traumatic memories (Schouten et al. 2018). I experienced these benefits first-hand during my practicum at St. Vincent’s Hospital in Harrison, New York running art therapy groups for adults suffering from PTSD, severe mental illness and addiction.
DBT AND ART THERAPY
After serving on an intensive Dialectical Behavioral Therapy Team at the Joan And Arnold Saltzman Community Services Center in Hempstead, New York, I conducted an empirical research study/thesis examined the effects of art therapy and brief DBT on emotional regulation and perceived stress. Combining the two resulted in a statistically significant reduction on the DERS (Dysregulation Emotional Regulation Scale) sub-scale: difficulty engaging in goal-directed behavior.
Art Therapy's national, governing, ethical body is the American Art Therapy Association (AATA). Most states have their own organization that is closely tied to AATA. Ours is the Connecticut Art Therapy Association (CATA). On October 1, 2019, HB-5444 An Act Requiring the Licensure of Art Therapists for the state of Connecticut will go into effect. As President-elect for the Connecticut Art Therapy Association, I testified before the Joint Public Health Committee earlier this year to endorse this legislation and am an active participant in the evolution of the bill. Licensure ensures that you employ only master’s level clinicians, who are actively working toward or have already completed a minimum number of client-facing hours, expert supervision and a rigorous board examination. Licensure also protects the integrity of the Art Therapy profession.
As of October 1, 2019, to represent oneself as an art therapist in the state of Connecticut, one must:
A. Ascertain credentialing through the Art Therapy Credentials Board (ATCB) minimally as a Registered Art Therapist (ATR) or
B. Be a recent graduate from an accredited art therapy graduate program, working under the supervision of a Board-Certified Registered Art Therapist (ATR-BC) and
C. Finally, apply for the Licensed Creative Art Therapist (CLAT) which requires 1000-hours of direct client-facing work, 100 hours of supervision, and board exam (ultimately resulting in the ATR-BC designation)
Therapeutic art-making provides distance, personal reflection, participant motivation through action, encourages feedback and self-examination, and creates a safe space to cultivate the psychotherapeutic relationship. It is an integrative, holistic, evidence-based approach for individuals and groups, and supports the clinical team through expansion of treatment options and projective assessments.
Hass-Cohen, N. (2016) Secure Resiliency: Art Therapy Relational Neuroscience Trauma Treatment Principles and Guidelines. In J. King (Ed.), Art therapy, trauma, and neuroscience: Theoretical and practical perspectives. Routledge.
Hinshelwood, R. (1991). Psychodynamic formulation in assessment for psychotherapy. British Journal of Psychotherapy, 8(2), 166-174.
Schouten, K., van Hooren, S., Knipscheer, J., Kleber, R., & Hutschemaekers, G. (2019). Trauma-focused art therapy in the treatment of posttraumatic stress disorder: A pilot study. Journal of Trauma & Dissociation, 20(1), 114-130.
Van der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.