Q: I have no training in art therapy but would like to weave creative arts approaches into my clinical work. How do I start and what are some of your favorite tools and techniques?
A: As I often tell fellow therapists, many clients benefit when we integrate creative approaches into therapy. Because they don’t require verbalization, these approaches are helpful when treating trauma, and for working with clients on the spectrum, as well as those who speak different languages or are resistant to authentic self-expression.
Art therapy involves master’s-level training in art and psychology, and has its own set of standards and ethics, but integrating its tools doesn’t have to be complicated, nor does it require great artistic skill on the part of the therapist or the client. I have an LCSW, and because art therapy can be adjunctive to talking therapy or stand alone, I’ll often ask my clients to choose whether they’d like to talk, make art, or do both in sessions.
I might bring art into therapy when I notice a client using avoidance or intellectualization instead of accessing meaningful emotion. In these moments, I’ll ask them to pause their talking and drop inside their body to see what images and emotions come up.
When we do explore feelings through art, I remind them not to judge the artistic quality and to notice instead the way the experience feels and what evolves from it. Once a picture is made, we look at it together and draw conclusions led by the client, not me.
A Powerful Tool
Art is a powerful tool for self-expression, but it’s important to note that asking clients to create spontaneously in a session can be dysregulating or even traumatic for them.
Art therapists are trained to work with dysregulation; however, dealing with trauma responses can be challenging. For example, Susan, a dissociative client of mine, had been triggered before a recent session by an uncomfortable encounter with a family member. As she talked about that event in my office, her face flushed. I asked her to pause and, with crayons and a drawing pad, create a picture that represented her current state. The resulting graphic image expressed a frightening scene that was connected to her early sexual trauma. I could see she was visibly shaken as we viewed the picture together.
As a trauma-informed art therapist, I was able to help Susan manage this traumatic memory and work with the now-present child part, called Susie, to find a way to de-escalate the situation. I invited her to create a second drawing and, in the style of an eight-year-old, Susie drew an image of a large purple unicorn. This clever response allowed us to put aside the initial disturbing drawing, knowing we could return to it later, when she was more resourced to do so.
Often, I’ll ask clients to try to create small “emotion doodles” using varied colors and lines that might represent anger, sadness, confusion, joy, and so forth. Each doodle should take about one to two minutes to make and capture the essence of an emotion using lines, shapes, and colors. Anger might be a red, heavily drawn scribble, sadness a single, light-colored line. There’s no right or wrong way to make the doodles, but it’s always interesting to talk about how one looks next to the other, and what contributes to something like sadness feeling gray.
This works beautifully in a group setting, where many people scribbling their anger can compare how it looks and feels, and thus gain proficiency in developing a visual language that connects to personal emotions. It’s important to remember that there’s no art therapy rulebook that says red equals anger, and that we must take culture and individual differences into consideration when looking at these quick sketches.
Create Like a Child
Jack was referred to me by his wife and their couples therapist because he seemed cut off from his feelings. He didn’t want to engage in individual therapy, nor did he initially appreciate how art therapy might be helpful. But he was affable in session and told me sarcastic stories about his life and family history. In our second session, when I put a large sheet of drawing paper on the table between us and invited him to experiment, he looked skeptically at it and pushed his chair back. “I’m not an artist,” he said.
“Okay, so let’s start with you making any kind of mark you want on this paper with one of these pastel crayons.” After a few moments of hesitation, Jack grabbed the red and made a long, sweeping mark from the top left to the bottom right of the page.
“There’s your mark,” he said, smiling provocatively. “How’s that?”
Without skipping a beat, I held the paper at an angle so we could look at it together to see if any feelings or thoughts came up. After a few moments in shared silence, Jack sighed deeply, then said softly: “That’s the slope of my mother’s lap. I was never held, nor did I ever feel safe with her.”
Jack stayed with me for nearly a year and progressed to making images related to loss and attachment trauma. He eventually enrolled in a series of watercolor classes—a new creative outlet that further developed his self-expression and self-compassion.
Downplay the Outcome
When you introduce creative approaches to your clients, be mindful that many have had only basic art education, and some will carry childhood memories of being told they lacked talent, or of being admonished for not following directions or staying within the lines. These early experiences can plant seeds of self-doubt and feelings of inadequacy around any art experience.
When a client says, “I’m not an artist,” I tell them it’s great that they have no training and no agenda to become an artist because this will make our work easier. It’s often more difficult working with visual artists, as they may need to unlearn years of technique-based schooling to engage therapeutically with the materials!
You can explain to your clients that therapeutic art processes may feel childlike—meaning, we work with intuitive expression that’s not stifled by technique or critique. It’s the process of creating the imagery or sculpture that’ll be therapeutic for them.
Once you’re engaged in session, downplay the end product as you work. You might say, “When we trust the process, the sculpture emerges, and the picture paints itself.” I tell my clients this act of letting go is how, in a fundamental sense, therapy itself is healing. As Picasso said, “It took me four years to paint like Raphael, but a lifetime to paint like a child.”
As the client enters the room or the Zoom meeting, I acknowledge the importance of grounding. A simple way to do this is to invite them to do “breath tracing”: making random marks and lines on a large sheet of paper while paying attention to the breath. It’s a mindfulness exercise that helps us become aware of the rhythm of our breath as we transpose each moment into marks.
First, I instruct them to hold the pen gently and close their eyes or focus them on a neutral spot away from the page. Then I might say, “During this mindful practice, we’ll be making contact with the paper with each part of the breath. Try to keep your pen on the page as we breathe together. Inhaling and exhaling may produce a variety of lines. There may be a rhythm or flow to the marks of some, or they might seem static. Whatever happens, don’t judge or analyze what you’re doing. This is an experience in focusing.”
After several minutes, the client and I examine the rendered lines. The marks aren’t expected to look like anything, but we might notice that changes in size occurred in response to the breath. Some might be loopy and free, others constricted. The final picture may be pleasing to look at, or not. If we repeat the activity, perhaps with the nondominant hand, we’ll often notice different variations and another opportunity to be curious about the practice and the breath.
Not only does this bring a mindful focus to the session: it builds a vocabulary to talk about information we find on the page.
Tina, with a history of interpersonal trauma and social anxiety, was quite hesitant to try breath tracing the first time. I invited her to avert her eyes while she let the pen move on the paper with each inhale and exhale. The result was a tiny, constricted scribble of intersecting lines. I invited Tina to be curious about her “tight” lines, which she acknowledged connected with a feeling in her chest and a fear of being “too much.” I invited her to repeat the tracing to see if she might challenge herself with a new breathing pattern. With a larger piece of paper and markers, she eventually deepened her breath, the lines became bolder and less constricted, and her physical presence was freer. We continued using this activity as a warm-up for our sessions to cue the possibility of being seen and taking up space.
On to Scribbles!
Clients may find it freeing to tap into their inner two-year-old and scribble circles, loops, and lines on a large sheet of paper. To get some activation in the body, it’s best to use drawing paper that’s at least 11 by 14 inches.
This scribble technique is projective, and things of personal consequence often emerge on the page. I’ve been told it’s like a do-it-yourself Rorschach inkblot.
Years ago, I invited a graduate social work class to create scribbles and to develop them into pictures of whatever they see in the intersecting lines. One young woman said her image had “no personal meaning” before discovering a giant pink pig in her scribble. When she reflected further, tears filled her eyes as she explained that she’d recently moved out of her childhood home. Motivated by her packing, her family had let go of her childhood things. At the last minute, she’d grabbed an old copy of Charlotte’s Web, featuring Wilbur the pig on the cover.
When we invite clients to stay with an image, personal significance and meaning often eventually surface. That’s because the unconscious is embedded in the practice of making art this way.
Another easy technique to integrate into therapy practice is collage making. Creating art out of cut-out pieces of paper, printed images, or fabric is helpful for clients who have trouble drawing what they picture in their minds.
I keep a container of pre-cut images for clients to look through. The images you cut out can be comforting, benign, or evocative—even triggering. I provide a range so as not to limit my clients’ experiences. I will, however, remind them they can discard any overly disturbing image.
Noticing what comes up for clients as they review image options is another advantage of working experientially. And sorting can provide clients with a refreshing amount of control.
I recently had a dramatic session with Mary, a trauma survivor with severe depression and anxiety. She arrived in my office in a fragile state. Shaking as she sat down, she told me she’d just discovered her husband was having an affair. She started to weep uncontrollably and couldn’t stop. Even when I gently asked her if she wanted to share more of what had happened, she couldn’t verbalize her experience. I suggested she sit with me at the art table and sort through my box of images, to see if any of them would speak for her.
With her tears falling, she silently pondered each image for a moment before turning it face down and moving on to the next. Finally, after about 30 minutes, she found a photo of a peasant woman, taken somewhere in the Andes, who was bent over and carrying a huge bundle of sticks on her back.
Gluing the image to a sheet of blank paper, she said, “this feels like my journey. This violation of my marriage, this terrible truth about the life I thought I knew, is my burden now, and I don’t know how I’m going to manage.”
As we began turning the remaining pictures back over and putting them into the box, another image, this one a beautiful tropical bird, caught her eye. She paused, focusing on the colorful bird, and then with an impulsive burst of energy, she glued it atop the bundle of sticks. The transformed image seemed to say that despite the heaviness of her burden, the bird would be a resource, and she’d be taking it with her.
Later that day, she called me to report she’d seen a beautiful bird at her bird feeder. She was certain it was a message from the universe that she was going to be okay. I wondered aloud if she felt more hopeful seeing the bird. “Yes,” she said, “there’s hope despite my pain.”
Practice What You Preach
Art making is a wonderful therapy tool, but it can be challenging. Before you add art to sessions, experiment with materials and techniques and your own creative expression. See how it feels to work in these ways, familiarize yourself with different art forms, and practice applying materials. Experienced art therapists know that if our paper is too thin, the marker bleeds through, dried clay breaks apart, and mixing certain colors of paint results in hues that are muddy and dull. Know this before you hand these materials to a client, or they may become frustrated or overwhelmed by working with them.
Art has the power to help clients deepen their healing through expression that’s both creative and cathartic. Clients who never thought to turn to art can discover that working through pain creatively increases positive emotions, reduces stress and anxiety, and provides them with a tool they can use to process myriad complex feelings—a resource for solace that’ll stay with them long after your work is done.
PHOTO © iStock/hsyncoban
CategoriesProfessional Development In the Therapy Room Clinical Practice & Guidance Anxiety & Depression Clinical Skills & Experience Professional Development Trauma
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