Defining art therapy

Author: Narelle Smith, 2005

What are the established definitions of art therapy, and what processes define art therapy?

There is a lot of misconception amongst the general public about the aims of art therapy and the processes involved. There is also an increasing amount of interest by people employed in the helping professions to incorporate art into their practice with clients, without much thought given to the practical and ethical dilemmas that may arise in using art with clients. Art therapy has been influenced by psychoanalysis to understand the therapeutic process of the interaction between the client’s inner world and the images the client creates. Psychoanalytical concepts and theories have influenced how art therapy is structured and organised, the therapeutic boundaries between client and art therapist, defence mechanisms, and transference and countertransference. Thus, to be effective and safe for the client, art therapy requires the practitioner to be well-informed about the principles and practices considered essential to using the creative process as a modality.

There is a distinction between ‘art as therapy’ and ‘art therapy’. Art used as therapy emphasises the healing potential of art (Edwards, 2004). “The essence of art therapy is that it must partake of both parts of its name – it must involve art and therapy. The goal of the art activity, therefore, must be therapeutic.” (Rubin, 1984, p292). Thus art therapists need to have knowledge of art and therapy. Art involves drawing, painting, modelling, or sculpting. The art therapist must understand the types and properties of art media, the language of art, and the creative process (Rubin, 1984). Knowledge of therapy includes psychodynamics, development throughout the lifespan, relationships, psychopathology, and the therapeutic relationship.

The difference between art and art therapy is the merging of the process and product in art therapy (Edwards, 2004). The finished product of the client is the expression of his or her self, and is not meant to appeal to or draw praise from others. People who are trained in the arts have a tendency to want to create work that is aesthetically pleasing, which can stunt or repress the flow of unconscious thoughts and feelings (Naumberg, 1958, cited in Dalley, 1984). Art as a medium for therapy provides the opportunity for the client to release control and allow the process to assume priority within the therapeutic frame (Birtchnell, 1984).

Margaret Naumberg, one of the pioneers of art therapy in the 1940’s, defined art therapy as (cited in Edwards, 2004):

Releasing the unconscious by means of spontaneous art expression; it has its roots in the transference relation between patient and therapist and on the encouragement of free association. It is closely allied to psychoanalytical theory… Treatment depends on the development of the transference relation and on a continuous effort to obtain the patient’s own interpretation of his symbolic designs… The images produced are a form of communication between patient and therapist; they constitute symbolic speech.

There has been little change in the definition of art therapy as the following modern definitions demonstrate. The British Association of Art Therapists (BAAT, 2005) defines art therapy as:

Art therapy is the use of art materials for self-expression and reflection in the presence of a trained art therapist. Clients who are referred to an art therapist need not have previous experience or skill in art, the art therapist is not primarily concerned with making an aesthetic or diagnostic assessment of the client’s image. The overall aim of its practitioners is to enable a client to effect change and growth on a personal level through the use of art materials in a safe and facilitating environment.

The American Art Therapy Association (AATA, 2005) defines art therapy as:

Art therapy is a human service profession which utilizes art media, images, the creative art process and patient/client responses to the created art productions as reflections of an individual’s development, abilities, personality, interests, concerns, and conflicts. Art therapy practice is based on knowledge of human developmental and psychological theories which are implemented in the full spectrum of models of assessment and treatment including educational, psychodynamic, cognitive, transpersonal, and other therapeutic means of reconciling emotional conflicts, fostering self-awareness, developing social skills, managing behavior, solving problems, reducing anxiety, aiding reality orientation, and increasing self-esteem.

Australian National Art Therapy Association (ANATA, 2005):

Art Therapy is an interdisciplinary form of psychotherapy. Generally based on psychoanalytic or psychodynamic principles, art therapists are able to utilize varied theoretical frameworks in which they feel comfortable to work. Other modes of working include Jungian, humanistic, behavioural, systemic, and integrative approaches.

Using art as the means for self-expression in therapy, allows the adult to access the child and adult developmental stages (Morter, 1997; Rhyne, 2001) by fusing the experiences of childhood with the manifestation of the adult’s presenting problems. The artwork is the transitional object that allows the client to move from one developmental stage to another and achieve personal growth in the process (Klein, cited in Waller, 1984)

As there is no need for words to mediate the thoughts and feelings expressed, there is a clearer and more direct link between the unconscious and the physical act of the images produced by the client, (Freud, cited by Naumberg, 2001). Thus, thoughts and feelings are spontaneously recorded in the artwork as they arise from the unconscious, and are not rejected, criticised, or edited, as they are likely to be in the verbal forms of therapy (Naumberg, 2001). The client is encouraged to discover for himself the meaning and significance of his art (Naumberg, 2001).

The classic model of the creative process proposed by Wallas (1926, cited in Aldous, 2005) has been applied by art therapists to explain the process the client enters when engaged in art therapy. There are four stages in this process: preparation; incubation; illumination; and verification. During the creative process the person creating the artwork oscillates between conscious (preparation and verification phases) and unconscious (incubation and illumination phases) mental activity.

The concept of containment or therapeutic boundaries in art therapy provides safety and certainty for the client (Edwards, 2004). It is essential that the context of therapy allows the client the physical and mental space to express his innermost feelings, thoughts and experiences with respect, safety and confidentiality. The therapeutic frame includes the art therapy room, how the sessions are conducted, and the professional conduct of the art therapist. The therapeutic boundaries enable the art therapist to ‘hold’ the client, allowing him to explore, take risks, regress, release ego control, make sense of his world, and form new foundations for himself in a process of emotional maturation (Winnicott, 1965, cited in Dalley, Rifkind & Terry, 1993).

Ideally, the room should be a space dedicated to the practice of art therapy, and must be clean, comfortable, and free from disruption. Materials must be clean and displayed neatly to facilitate ease of access and use. The art therapy sessions should be a stated frequency and duration, and the process and boundaries explained to the client from the outset. The therapeutic relationship must be conducted on a professional basis at all times and the art therapy associations mentioned above (BAAT, ANATA, AATA) provide art therapists with a statement of ethics and code of conduct for practice.

The personal reflections and inner world of the client are contained within the frame of the picture (Schaverien, 1987, cited in Edwards, 2004). The created image is imbued with emotion and meaning for the client enabling him to engage with his inner world (Edwards, 2004). The feelings and thoughts contained or repressed within the client are expressed in the image the client creates in the art therapy session. That image is evidence for the client that those thoughts and feelings are part of his inner experience which he is drawing upon in his interactions with the world at large, whether he was aware of them or not. The image enables the client to reflect upon the meaning by providing an element of distance – it is a part of him but is now separate.

Containment also extends to how the artworks produced by the client are stored. The art therapist retains all of the client’s artwork from the art therapy session. The client produces the artwork in response to his own need and for the purpose of therapy, for a specific audience within either an individual or group setting. The client’s privacy and confidentiality pertaining to that image must be respected at all times (Birtchnell, 1984). If the client takes the artwork away with him the therapeutic frame is broken.

There is some debate within the art therapy field as to whether the artwork mediates the effect of the transference from the client towards the therapist because the client enacts his feelings in the creation of the artwork and invests so much emotional energy in it. This is referred to as a ‘triangular relationship’ because the therapeutic relationship is between the client, therapist and artwork, and emphasis can be placed on the interaction between any two of these at any given time (Case & Schaverien, cited in Edwards, 2004).

However, in the therapists’ ‘holding’ of the client, the client may direct unconscious feelings he has about other people to the therapist (Malchiodi, 2003). As the art therapist offers a limited range of art materials to the client for particular tasks based on the psychological effect the art media has on the client (Kagin & Lusebrink, 1978), the client may perceive the therapist as the provider or nurturer, and transfer feelings of people who have been in this role for him in the past (Rubin, 1978, cited in Malchiodi, 1993). The client may also express her feelings towards the therapist in her images (Schaverien, 1989) in response to the client’s own sense of abandonment by the therapist (Betensky, 1973) especially towards the end of the therapeutic relationship, or in response to something the therapist has done or said. The therapist needs to be mindful of the occurrence of transference and also his own personal responses to avoid the damaging effects of counter-transference.

The client may employ defence mechanisms (Edwards, 2004) in response to the thoughts and feelings generated by her artwork. They may be necessary at the time to reduce her anxiety, distress, or vulnerability. These defence mechanisms may include (Prentice Hall, 2005):

  • Denial – refuses to recognise threatening thoughts or feelings;
  • Repression – removing threatening memories, thoughts and feelings from one’s awareness;
  • Regression – return to an earlier developmental stage;
  • Reaction formation – expressing the opposite of disturbing thoughts or feelings;
  • Projection – attributing one’s own unacceptable thoughts or feelings to others;
  • Displacement – redirecting one’s impulses from the source of the anxiety to a less threatening object;
  • Rationalisation – finding a rational explanation for an event;
  • Sublimation – transforming thoughts and feelings into something constructive.

The art therapist understands the need for the client to access these defence mechanisms and that the client’s thoughts and feelings will continue to be expressed in her artwork in a manner and timeframe which allows her to integrate the experience with safety

Initial reluctance by the client to engage in art therapy may reflect her perception that the therapist will interpret every mark or image she creates, and form opinions of or judge her. However, in art therapy the client uses her own language to interpret her own work, including the meaning that the client attributes to the metaphors and symbols used in the artworks. Champernowne (1971, cited in Dalley 1984) advises that it can be destructive and dangerous for the therapist to interpret the client’s work, as the translation from one language to another is likely to lose or incorrectly interpret elements of the visual communication. Interpretation can affect any future work by the client. In an example provided by Betensky (1973), if the client anticipates that the therapist will interpret a dark cloud as an expression of sadness, she may not be inclined to produce a similar image in future artwork. Winnicott (1971, cited in Dalley, 1984) warns against the therapist getting ‘too clever’, as the client is the only person who knows the answers in response to her work.

An intuitive therapist runs the risk of exposing the client before she is ready and she may feel that her thoughts and feelings are not her own (Dalley, Rifkind & Terry, 1993). A therapist must be able to feel comfortable with ‘not-knowing’ and waiting for the client to find her own sense of meaning and purpose for the artwork. The therapist explores the meaning of the image in partnership with the client through interaction, discussion, and suggestion (Dalley, 1984). However, the artwork is valid on its own, and there is no necessity for the client to discuss the work with the therapist.

The therapeutic relationship is based on warmth, empathy and genuineness (Rogers, 1976, cited in Dalley, 1984) in order to establish trust, openness, safety, and understanding. The art therapist must have extensive experience with both art media and verbal modalities to make sense of the client’s experience within art therapy and to understand where his own conflicts lie so they do not impede therapy. The art therapist’s comfort with both image and words creates an environment where both can be freely expressed and where creation and facilitation are integrated (Rubin, 1984; Dalley, Rifkind & Terry, 1993).

Although the practice of art therapy is grounded in psychoanalysis, contemporary art therapists are using other therapeutic modalities to supplement their practice of art therapy. The range of applications for art therapy extends to therapy with individuals, groups and families, and incorporated with brief solution focused therapy, cognitive behavioural therapy, gestalt therapy, or narrative therapy, in a range of settings from private practice to prisons. Whilst these developments breathe life and energy into the practice of art therapy, it is extremely important that the basic tenets of art therapy are observed. The therapist must have an understanding of the creative process and it’s interaction with the unconscious. Betensky (1973) described art therapy as utilizing a “hand-eye-thought-feeling” energy, integrating the client’s inner and outer world through mind and body. Therapeutic boundaries must be maintained to reduce the client’s vulnerability and to facilitate an open and trusting relationship in which the client can begin to resolve past hurt or trauma.


Aldous, C.R. (2005). Creativity in problem solving: Uncovering the origin of new ideas. International Education Journal, 5(5) p43.

American Art Therapists Association (AATA) (2005). Frequently asked questions: What is art therapy? Internet address: Accessed: 25 July 2005.

Australian National Art Therapy Association (ANATA) (2005). About art therapy. Internet address: Accessed: 25 July 2005.

Betensky, M. (1973). Self-discovery through self-expression: Use of art in psychotherapy with children and adolescents. Illinois: Charles C Thomas.

Birtchnell, J. (1984). Art therapy as a form of psychotherapy. In: Dalley, T. (ed.). Art as therapy: An introduction to the use of art as a therapeutic technique. London: Tavistock.

British Association of Art Therapists (BAAT) (2005). What is art therapy? Internet address: Accessed: 25 July 2005.

Dalley, T. (1984). Introduction. In: Dalley, T. (ed.). Art as therapy: An introduction to the use of art as a therapeutic technique. London: Tavistock.

Dalley, T.; Rifkind, G.; & Terry, K. (1993). Three voices of art therapy: Image, client, therapist. London: Routledge.

Edwards, D. (2004). Art therapy. London: Sage Publications.

Kagin, S.L. & Lusebrink, V.B. (1978). The expressive therapies continuum. Arts in Psychotherapy, 5, pp171-180.

Malchiodi, C. (2003). Psychoanalytical, analytic, and object relations approaches. In: Malchiodi, C. (ed.). Handbook of art therapy. NY: Guilford Press.

Naumberg, M. (2001). Spontaneous art in education and psychotherapy. American Journal of Art Therapy, Aug 2001, 40(1), p46.

Rubin, J.A. (1984). Child art therapy: Understanding and helping children grow through art. (2nd ed.). NY: Van Nostrand Reinhold.

Morter, S. (1997). Where words fail: A meeting place. In: Schaverian, J. & Killick, K. (eds.). Art psychotherapy and psychosis. London: Routledge

Prentice Hall. (2005). The world of psychology: Defence mechanisms. Internet address: Accessed: 30/7/2005.

Rhyne, J. (2001). The Gestalt approach to experience, art, and art therapy. American Journal of Art Therapy, August 2001, 40(1), p109.

Schaverien, J. (1982). Transference as an aspect of art therapy. Inscape, September 1982, pp10-16.

Waller, D. (1984). A consideration of the similarities and differences between art teaching and art therapy. In: Dalley, T. (ed.). Art as therapy: An introduction to the use of art as a therapeutic technique. London: Tavistock.


Related Articles:

An artful tale – Narelle Smith

What is art therapy? – Josh Kale


About Narelle Smith

Child & Family Worker

One Response to “Defining art therapy”

  1. Keep on writing informative and accurate blogs!

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