Art therapy: methods, applications, and therapeutic outcomes

Art Therapy: Origins, Applications, And Potential Limitations

Art Therapy is form of therapy dating back to early 19th century Scotland, where mental asylum residents were given art materials and encouraged to paint and draw. After observing the therapeutic affects of making art in mental patients, asylum director Cesare Lombroso theorized that artistic ability and pathology are connected, and later published a collection of the works of his patients, entitled Art and the Insane (1880). Similarly, biological psychiatrist Emil Kraepelin observed and collected the art produced by his patients at the hospital of the University of Heidelberg, Germany; a collection that Hans Prinzhorn later expanded and published in Artistry of the Mentally Ill (1922). In addition to the development of Art Therapy, these early publications led to recognition of "Outsider Art" -- art created by persons not actively involved in the artistic community -- as potentially possessing of artistic value (Rustin 5).

Art Therapy as a therapeutic institution continued to evolve over the next century, largely due to the pioneering works of Carl Rodgers and his daughter, Natalie Rodgers. While Carl Rodgers is considered the father of person-centered theory and therapy -- in which patient acts as the prime mover of therapeutic progression -- his daughter, Natalie, applied Rogers' early techniques to the development of Person-Centered Expressive Art Therapy, incorporating painting, drawing, drama and movement, in a sort of "play therapy" for adults (Sommers-Flanagan 4). Theorizing that pathology is caused by the failure to learn from experiences, and also that people learn in different ways, Natalie Rogers' comprehensive approach to art therapy sought to encourage the "inherent impulse toward growth in every individual." As Rogers said in 1993, after more than two decades of practicing expressive art therapy, "I base my approach to expressive arts therapy on this very deep faith in the innate capacity of each person to reach toward her [or his] full potential" (Sommers-Flanagan 5).

While art therapy began as a treatment for the mentally ill, it has since been applied to a host of pathological disorders, to include addiction, trauma-induced depression, and Pervasive Development Disorders (PDD) such as Autism, Rett Syndrome, Childhood Disintegrative Disorder, Asperger's Syndrome, and mild learning disorders. Art therapy is particularly effective in treating PDD, as PDD sufferers are typically visual, concrete thinkers who often have trouble expressing themselves in words. Complex emotions in particular -- such as fear, shame, rage and guilt -- are often more easily expressed in images for PDD patients, while the very act of creating images can aid in the brain's development of communication and social skills.

In Isobel's Images -- one woman's experience of art therapy, art therapist Stephanie Bull and psychologist Mary Beavis interview Isobel White (pseudonym) about her four-year experience with expressive art therapy. Isobel White has a mild learning disorder and a history of parental neglect, due in part to a severely handicapped younger brother. For this reason, the development of the therapist-patient relationship was every bit as important -- if not more so -- than the expressive therapy itself.

Isobel and Stephanie began with an initial meeting, the purpose of which was to determine if Isobel was sufficiently prepared to embark on the therapeutic process, and also the potential for therapist-patient compatibility. "I tried to explain to you what art therapy might be like and I think we decided to just do six sessions to start with, to test it out, to if you and I could work together. I remember that I thought you seemed very motivated," Stephanie recounts that first meeting (Beavis, Bull 104). After establishing Isobel's motivation and degree of preparedness for art therapy, Stephanie then worked to create a "safe" and predictable environment for therapy take place in. For example, the configuration of the therapy room was the same every time -- same furniture and provided materials -- as was the day and time of each weekly session. In regards to the materials provided, Isobel had the choice of using the same "safe" materials -- such as paint and crayons -- or exploring with new materials, such as clay and magazine clippings. In this way, Isobel was encouraged to explore various ways of expressing herself without being forced to leave her established comfort zone -- a popular technique of Rogers' person-centered therapy.

That Isobel found it easier to express complex emotions in images is apparent in one of the first pictures she painted for Stephanie. In the picture, she portrays stick-figure Stephanie in light, bright colors such as orange and yellow, while she herself is portrayed in all black. When Stephanie asked her to expound on this early painting, Isobel said, "That's me feeling evil," (pointing to the black picture). "Yes -- I was feeling fed up with things I think. Only that day -- feeling annoyed with something" (Beavis, Bull 105). That Isobel was able to explain this in words at the time of the interview -- when she was unable to explain it at the time of the painting -- is merely one example of communicative strides she made with art therapy.

While the majority of art therapists play a passive, supporting role, in which their primary objective is to provide encouragement, therapist and nursing professor, Terry a. Rustin demonstrated that assuming an active, transference-utilizing role be just as effective. In her published article, entitled Using artwork to understand the experience of mental illness: Mainstream artists and Outside artists, Rustin describes her technique of painting pictures that correspond with her patient's experiences as a way of further understanding and instigating discussion of those experiences. For example, for her patient Olivia, Rustin painted a chaotic abstract entitled, Olivia: I feel running away, but there's no place to run to. Later, when Olivia was presented the painting, she said, "It keeps reminding me that I can never run away from I feel. it's either learn to deal with it, or still suffer from it." Says Rustin of Olivia's reaction to the painting, "Being confronted with a depiction of her fear-based behavior during each session has encouraged Olivia to confront her fears and take action to improve her life" (Rustin 9).

The widespread effectiveness of art therapy for pathology has to do with its utilization of images as a language of communication as opposed to words. For people who think in visual, literal terms, the images created in art therapy provide them with a way of confronting and finally understanding concepts and emotional complexities they were previously unable to understand. For example, feelings of guilt and fear produced from child molestation, or feelings of unworthiness produced by child neglect are often addressed through art therapy. Similarly, feelings of social inferiority due to race or cultural differences can be confronted in a safe, unthreatening environment through expressive art therapy. For example, in Eileen P. McGann's article, Color Me Beautiful:Racism, Identity Formation, and Art Therapy, she speaks of her struggle to encourage Lekandra, a young black girl, to draw herself as she really was -- with brown hair, brown eyes and skin -- as opposed blue eyes, blond hair and pale skin. This struggle was later replicated with Kayla, another young black woman, who worked for months molding a clay self-portrait, but experienced serious trouble choosing an appropriate color for the portrait's face. While Lekandra "remained steadfast in her desire to have blue eyes instead of the brown eyes she was born with," McGann eventually succeeded in encouraging Kayla to choose a color true to her natural skin tone (McGann 208, 211).